Biomedical subjects
A E Young
Publications and source records attributed to A E Young.
Grip strength before and after carpal tunnel decompression.
We prospectively studied preoperative and postoperative grip and pinch strength in 21 patients having 30 consecutive median nerve decompressions for carpal tunnel syndrome. All procedures were done by one surgeon. Each hand operated on served as its own control and was studied by the same therapist preoperatively and at monthly intervals for 6 months after the procedure. An initial decline in both grip and pinch strength was noted in most hands during the first postoperative month. Eighty percent or more grip strength was regained in 65% of the hands at 2 months and in 81% at 3 or more months. In those hands (65%) that regained at least 100% of their preoperative grip strength at 3 or more months, there was an average increase in maximal grip of 56%, as compared with an average decrease of 20% in the remaining hands (35%).
Diagnosis and management of ulnar nerve entrapment.
Ulnar nerve entrapment can be divided into compression at the elbow and the wrist. Etiologies range from direct trauma to metabolic derangements. Guidelines for diagnosis at each site have been presented. Surgical release at the elbow begin at the mid arm where the nerve passes from the anterior to the posterior compartment through the intermuscular septum and extends into the proximal forearm, where it dives down under the heads of the flexor carpi ulnaris. Surgical release at the wrist involves deroofing the canal of Guyon. The authors' preferred methods of release at each site are given along with a description of positive care.
Reporting of fine needle aspiration.
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Quadrantectomy for early breast cancer.
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Preoperative localization of parathyroid tumours does not reduce operating time.
Accurate preoperative localization of abnormal parathyroid glands might be expected to result in a reduction in operating time. To test this hypothesis the duration of surgery was recorded in a consecutive series of 50 patients who underwent neck exploration after preoperative localization by thallium-201 and technetium-99m subtraction scanning and were found to have parathyroid tumours. A total of 34 patients had accurate localization by the scan, and these patients had a median operating time of 90 min. When the tumour had not been localized before operation, the median operating time was not significantly different (80 min). Accurate preoperative localization of parathyroid tumours does not reduce operating time.
Role of splenectomy as a salvage procedure in thrombotic thrombocytopenic purpura.
Thrombotic thrombocytopenic purpura is a rare but serious haematological disease for which first-line therapy is medical, but not always successful. The role of splenectomy in the management of such patients is unclear. This paper reports three patients with the condition who went into remission following splenectomy after other forms of therapy had failed. Because thrombotic thrombocytopenic purpura is nearly always fatal if a remission is not obtained, splenectomy should be considered in patients who prove to be resistant to medical therapy.
Metastatic renal clear cell carcinoma in the thyroid gland diagnosed by fine needle aspiration cytology.
An 81-year-old woman presented with a mass in the right lobe of the thyroid. Fine needle aspiration of this lesion showed metastatic clear cell carcinoma. This was subsequently confirmed histologically. In patients with metastatic carcinoma, tumour deposits are frequently found in the thyroid. The most common metastatic tumour to masquerade as a primary thyroid tumour is a renal cell carcinoma. In patients with this tumour the possibility that a thyroid mass may be a metastatic deposit should always be considered.
Non-recurrent laryngeal nerves. The role of digital subtraction angiography to identify subjects.
Three cases of non-recurrence of the right recurrent laryngeal nerve are reported. In one, the predicted anomaly of dorsal origin of the right subclavian artery was confirmed by intravenous digital subtraction angiography (IVDSA). The surgical anatomy and embryology of this rare condition are discussed. Non-recurrent laryngeal nerves are at increased risk of injury, especially during re-operative thyroid surgery. It is, therefore, suggested that an IVDSA be performed in that small subset of patients in whom re-operative thyroid surgery is contemplated on the right, and in whom the nerve was not found at the previous operation.
Thyroid hormone concentrations in Nepal: a study of potential Gurkha army recruits. The effect of changes in diet.
A group of non goitrous, potential Gurkha army recruits were tested in Nepal for serum free triiodothyronine (fT3), free thyroxine (fT4) and thyrotropin (TSH) concentrations. Twenty-five percent of the men were recruited into the army and urine samples taken for analysis of iodine and creatinine. Twenty per cent of the recruits underwent thyrotropin releasing hormone (TRH) stimulation tests. After ten months basic training on a diet considered to be iodine sufficient, the tests were repeated on the same men. The results were also compared to army recruits in the UK. All the potential Gurkha recruits had higher serum levels of thyroid hormones than the UK recruits. Some regional differences were found with those men from the Western recruiting depot having lower fT4 and higher TSH concentrations. Urinary iodine and creatinine concentrations showed evidence of slight relative malnutrition and iodine deficiency which was more pronounced in the Western depot. TRH stimulation tests showed no evidence of thyroid dysfunction but highlighted the differences between the Eastern and Western groups. After ten months on an iodine sufficient diet the serum thyroid hormone concentrations became closer to those of the UK recruits, showing any differences to be reversible. The results from the two Gurkha groups became similar which was reflected in the urine analysis results.
Misinterpretation of the upper parathyroid adenoma on thallium-201/technetium-99m subtraction scintigraphy.
Pre-operative thallium-technetium subtraction scintigraphy of 50 patients with primary hyperparathyroidism, which was subsequently proven on histology to be due to an adenoma, was compared with operative findings. Six scans were negative and seven uninterpretable. Of the remaining 37 patients, 34 had correct scan prediction of the anatomical locations of the adenomas. On examination of the origins of the adenomas, all six scintigraphic predictions of upper adenomas corresponded to tumours arising from the upper gland found at operation. Of the 25 lower predictions, there was one false positive and 16 were correct, i.e. of lower gland origin, but eight were found to originate from the upper gland. This misinterpretation is though to be due to the prolapse of an adenoma arising from the upper gland towards the lower pole of the thyroid, thereby mimicking a lower lesion on the scan.
Gynecomastia.
Gynecomastia is a serious cosmetic concern for many adolescent and adult males. In the majority of cases no pathologic cause for the problem can be found. The authors discuss the types of surgical treatment of gynecomastia.
An efficacy trial of the rhesus rotavirus vaccine in Maryland. The Clinical Study Group.
A double-blind, placebo-controlled trial of oral rhesus rotavirus vaccine at a dose of 10(4) plaque-forming units was performed in 114 young infants in Maryland. Significantly more vaccinees than controls had fever and vomiting during the week after vaccination, but these reactions were mild. Of the vaccinees, 83% had a fourfold or greater rise in neutralizing antibody to rhesus rotavirus vaccine and 69% shed vaccine virus. Seventeen percent of the vaccinees and 24% of controls had rotavirus-positive diarrhea during the 2 years of surveillance. Vaccine efficacy was therefore 29% (95% confidence limits, -31% to +66%). Stools from 12 of 13 episodes containing sufficient antigen to type were serotype 1. We conclude that rhesus rotavirus vaccine was infective, immunogenic, and probably acceptably attenuated but that this serotype 3 vaccine provided little heterotypic protection during serotype 1 outbreaks in the community.
Role of thallium-201/technetium-99m subtraction scanning in persistent or recurrent hypercalcaemia following parathyroidectomy.
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Parathyroid autotransplantation.
This paper reviews the technique, indications and results of parathyroid autotransplantation. Autotransplantation is most commonly indicated following parathyroidectomy for renal osteodystrophy, but can also be used in primary hyperplastic hyperparathyroidism, re-exploration of the neck and radical neck surgery. The success of the technique ranges from 75 to 100 per cent.
Surgical management of palmar hyperhidrosis.
Hyperhidrosis is an idiopathic pathologic condition characterized by excessive sweating beyond that required to cool the body. Disturbance of the central nervous system, endocrine system, or obesity has been associated with this condition. Patients have a history of several years of occupational or social embarrassment. Individuals of Japanese ancestry and Jews of Northern African, Yemeni, or Balkan descent are predisposed to the condition. Nonoperative therapy is merely temporizing and unacceptable because of lack of efficacy or side effects. Surgical intervention provides effective and permanent control. The key to surgical correction appears to be the division of the sympathetic chain above the T-2 ganglion and below the T-3 ganglion of the involved side with removal of the entire T2-3 segment with its corresponding spinal nerves. This paper presents our experience with the dorsal thoracic approach for interruption of sympathetic innervation for severe palmar hyperhidrosis. We also review surgical efficacy of various approaches to the sympathetic chain, as well as possible side effects of operative intervention.
The effect of bending on canine and human arterial walls and on blood flow.
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Impedance plethysmography: its limitations as a substitute for phlebography.
Impedance plethysmography (IPG) was used to study 132 legs: 100 in normal volunteers not subjected to radiocontrast phlebography, seven in patients whose limbs were phlebographically normal, and 25 proven by phlebography to have deep venous thrombosis (DVT). There were no false positive IPG results when a maximum venous outflow of 0.2% was the discriminant. However, in the 25 legs with thrombosis in calf, popliteal, femoral, and iliac veins, clots were not detected by IPG in 44--51% of legs, depending upon the discriminant. These results, which are in agreement with data reported elsewhere, indicate that it is reasonable to use the IPG method as the sole diagnostic maneuver when the test result is clearly abnormal, but that if the result is not abnormal, a radiocontrast phlebogram is necessary.