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C B Esselstyn

Publications and source records attributed to C B Esselstyn.

At least 37 records · Page 2Linked to original sources
PubMed1993

Amiodarone-induced thyrotoxicosis: clinical presentation and expanded indications for thyroidectomy.

BACKGROUND: Amiodarone-induced thyrotoxicosis (AIT) is a rare disorder that is frequently refractory to conventional pharmacologic therapy. METHODS: An analysis of seven patients who underwent thyroidectomy for control of AIT between 1987 and 1993 was completed to examine the clinical manifestations and the indications for surgical therapy. RESULTS: Five men and two women, 53 to 72 years of age, had AIT after 3 to 55 months of amiodarone treatment (mean, 21 months). The primary manifestations of AIT were ventricular tachycardia (five), exacerbation of chronic pulmonary disease (one), and occult hyperthyroidism (one). Medical therapy included propylthiouracil in doses up to 1200 mg/day in five patients, a beta-receptor antagonist in three, and withdrawal of amiodarone in five. Near-total or total thyroidectomy resulted in resolution of thyrotoxicosis in all patients. Morbidity included pneumonia (one) and cardiac dysrhythmias (two). One patient died of ventricular dysrhythmias 4 months after thyroidectomy. The mean thyroid weight was 50 gm (range, 17 to 216 gm). Microscopic examination showed destructive follicular lesions with fibrosis in all patients. Associated thyroid pathologic condition included multinodular goiter in four patients and a follicular adenoma in one. CONCLUSIONS: AIT may be clinically occult or manifested by unusual symptoms requiring a high index of suspicion for diagnosis. Near-total thyroidectomy is safe and effective in producing rapid resolution of AIT and is indicated for the initial treatment of patients who present with a resurgence of life-threatening cardiac arrhythmias and for all patients with AIT refractory to medical therapy.

Aged↗
PubMed1993

Partial mastectomy without radiation is adequate treatment for patients with stages 0 and I carcinoma of the breast.

The treatment of potentially curable carcinoma of the breast has changed from one operation, radical mastectomy, to a flexible approach. At the Cleveland Clinic, we use four types of treatment for primary potentially curable carcinoma of the breast (Stages 0, I and II)--modified radical mastectomy, simple mastectomy, partial mastectomy with postoperative adjuvant radiation therapy and partial mastectomy without radiation therapy. The latter treatment (partial mastectomy without adjuvant radiation) is controversial. We recommend this procedure for patients with T(is) and T1 carcinomas that appear to be localized, without lymph node metastases, Stages 0 and I disease. The overall and disease-free survival rates are similar to those of patients having modified radical or partial mastectomy with radiation. Local recurrence is slightly higher at five years (11.0 percent) as compared with the other procedures, but at ten years, is only 16.1 percent, a figure comparable with patients having partial mastectomy with radiation (14.4 percent). For patients with Stages 0 and I carcinoma of the breast, the addition of postoperative radiation therapy after partial mastectomy seems to be unnecessary.

Breast Neoplasms↗
PubMed1988

Riedel's thyroiditis.

Riedel's thyroiditis is a rare chronic inflammatory disease of the thyroid gland first recognized by Bernhard Riedel in 1893. In order to clarify the clinical and pathologic features of this rare disorder, a recent case of Riedel's thyroiditis is presented, 6 additional cases from the surgical pathology files of the Cleveland Clinic Foundation are reported, and the 178 cases previously reported in the English literature are reviewed. The mean age at presentation has been 47.8 years, and 83% of patients have been female. Sixty-four percent were euthyroid, 32% hypothyroid, and 4% hyperthyroid. Antithyroid antibodies have been detected in 16 of the 25 patients tested. Since 1960, 34% of the published cases of Riedel's thyroiditis have reported the development of multifocal fibrosis. Immunohistologic study of the inflammatory infiltrate reveals a mixed population of B- and T-cells. Comparison with the infiltrate in Hashimoto's thyroiditis shows similar proportions of CD4- and CD8-positive lymphocytes. The relationship and origin of multifocal fibrosing lesions has not been defined, but an immunologic origin seems most likely. The finding of antithyroid antibodies in 67% of patients supports an autoimmune mechanism of injury.

Adult↗
PubMed1986

Parathyroid hormone assay. Unreliable and overused.

The records of 100 patients operated on for primary hyperparathyroidism, from Jan 21, 1982 to June 11, 1984, were reviewed. In each patient, hypercalcemia had been documented on at least two separate occasions. A history, physical examination, chest roentgenogram, complete blood cell count with differential, 18-factor automated blood chemistry analysis, and urinalysis were used to screen for other causes of hypercalcemia. Of the 100 patients who had surgery, 88 had a preoperative parathyroid hormone level determination. Preoperative parathyroid hormone levels were normal in 41% of patients with parathyroid disease demonstrated at surgery. Parathyroid hormone assays produce variable results even from the best laboratories. A serum calcium determination remains the best test for diagnosing primary hyperparathyroidism.

Adenoma↗
PubMed1986

Partial mastectomy: pathologic findings and prognosis.

In an attempt to identify patients best suited for limited surgery as well as those at risk for recurrence and increased mortality, the authors reviewed the clinical and pathologic features of 130 patients who had undergone partial mastectomy as primary treatment for breast cancer (adjuvant therapy was administered only after disease recurrence). Patients were followed up for 57 to 128 months (mean, 85 months). Univariate and multivariate analyses were performed for the entire group and repeated for the large subgroup of patients with infiltrating ductal cancer, not otherwise specified. Three features were independently significant in correlating with poor survival and/or tumor recurrence: lymph node metastasis, mitotic rate, and nuclear atypia. Combinations of these factors further separated survivors from non-survivors. These prognostically significant pathologic features may be helpful in both selecting patients for partial mastectomy and identifying those who may require adjuvant therapy.

Adult↗
PubMed1986

Results of surgical treatment of periampullary tumors: a thirty-five-year experience.

Data on 126 consecutive patients with periampullary tumors resected at the Cleveland Clinic between January 1950 and December 1984 were reviewed. One hundred five patients underwent pancreatoduodenal resection, 10 patients total pancreatectomy, and 11 patients local resection of the tumor. The site of tumor was ampulla of Vater (59), head of the pancreas (30), duodenum (20), and distal common bile duct (11). Six patients had benign disease. The operative mortality rate for radical resection for the entire period was 7.8%; it has declined to 5.4% since 1974. The operative mortality rate for local resection was 9.1% (one patient). The overall 5-year survival rate for all malignant tumors of the periampullary area was 28% and 25.5% for invasive adenocarcinoma. Survival was affected primarily by location and histologic findings. The 5-year survival rate for adenocarcinoma of the ampulla of Vater was 37.2%, 27.5% for the duodenum, 16.7% for the distal common bile, and 4.3% for the pancreas (p = 0.0001). Papillary adenocarcinoma had a 5-year survival rate of 49.2% in contrast to 18.4% for nonpapillary ductal adenocarcinoma (p = 0.002). Patients with ampullary adenocarcinoma treated by local resection had a 5-year survival rate of 40.9%. These data justify continued use of a selective radical approach in the resection of most periampullary tumors with local resection for small tumors in high-risk patients.

Adenocarcinoma↗
PubMed1986

Large-needle thyroid biopsy: still necessary.

Fine-needle aspiration and large-needle biopsy allow 87% of patients with nodular thyroid disease to avoid operation. We have been concerned that fine-needle aspiration used alone will miss a significant number of follicular neoplasms. Between January 1980 and April 1985, 46 patients had fine-needle aspiration, large-needle biopsy, and thyroidectomy, and the preoperative biopsy specimens suggested or the postoperative pathologic findings confirmed a follicular neoplasm. Seventeen patients had a thyroid carcinoma. All 17 patients also had hypercellular large-needle biopsies, but only nine of these patients had a fine-needle aspiration suspicious of malignancy (p = 0.0078). The inability of fine-needle aspiration to detect a significant number of thyroid cancers emphasizes the need to concomitantly perform large-needle biopsies in all acceptable cases.

Adolescent↗
PubMed1985

The advantages of subtotal thyroidectomy and suppression of TSH in the primary treatment of papillary carcinoma of the thyroid.

Patients between the ages of 6 and 45 years with distant metastases from papillary carcinoma of the thyroid can be treated as effectively by subtotal thyroidectomy and suppressive doses of thyroid hormone as by total thyroidectomy followed by treatment with iodine 131 (131I). Moreover, distant metastases can be treated by either 131I or suppression as effectively after they are apparent on x-ray as they can be when treated in a subclinical stage. Therefore, in patients younger than 45 years old it is rarely necessary to perform a total thyroidectomy or to do frequent postoperative scans. In patients older than 44 or younger than 7 who have distant metastases or extensive involvement of both lobes, total or almost total thyroidectomy is justified if it can be done with minimal morbidity. In patients of this age group whose tumors fail to respond to suppressive doses of thyroid, 131I should be used. In view of the importance of diagnostic related groups (DRG) to the economy of hospitals, we note that the cost of total thyroidectomy, ablation by 131I, and intermittent body scans is at least three times that of less radical procedures which, in conjunction with suppression by thyroid feeding, give the same survival with less morbidity.

Adolescent↗
PubMed1985

Results of conservative operations for breast cancer.

The results of conservative operations for breast cancer in 1,593 patients treated at the Cleveland Clinic between 1957 through 1975 are reported. During this period, we individualized our treatment of breast cancer depending on tumor size, location in the breast, and clinical stage of the disease. The following three principal operations were performed: modified radical mastectomy in 592 patients (37%), simple (total) mastectomy in 442 patients (28%), and partial (segmental) mastectomy in 291 patients (18%). Survival results at 5, 10, and 15 years are reported. Factors important in long-term survival included stage of the disease, number of lymph node metastases, delay in therapy, size of the tumor, histologic type, and estrogen receptor status; type of operation was not a significant factor. In this series, partial (segmental) mastectomy without radiation therapy provided five- to 15-year survival rates equal to modified radical mastectomy and simple (total) mastectomy.

Adenocarcinoma, Mucinous↗
PubMed1984

Partial mastectomy without radiation therapy.

Partial mastectomy without radiation therapy has been used at The Cleveland Clinic as a treatment option for selected patients with breast cancer since 1957. Our experience with 322 patients has been reviewed; survival results are equal to or better than the other operative procedures we have employed for the treatment of breast cancer. These results, we believe, relate more to the selection of patients with small tumors and at a more favorable stage of the disease than to the benefit of the operative procedure itself.

Axilla↗
PubMed1984

Parathyroidectomy for primary hyperparathyroidism: early discharge.

With increasing awareness of cost-containment measures, early discharge after parathyroidectomy for primary hyperparathyroidism is to be evaluated. This report concerns the Cleveland Clinic experience with the last 70 consecutive patients treated for primary hyperparathyroidism from June 1981 to June 1983. The mean postoperative hospital stay was 1.4 days. Most patients were discharged on the morning of the second postoperative day receiving oral calcium supplements for 3 weeks. Three patients were discharged on the morning of the first postoperative day. The overall mortality rate was 0%. Morbidity included two patients (2.9%) who developed symptoms of mild tetany after discharge that responded to an increased dose of oral calcium. The usual practice of most surgeons of delaying hospital discharge after neck exploration for primary hyperparathyroidism for 5 to 7 days in fear of symptomatic hypocalcemia is unnecessary. Considerable cost containment can be achieved by sparing patients from 3 to 5 extra days of hospitalization.

Adenoma↗