Biomedical subjects

C B Esselstyn

Publications and source records attributed to C B Esselstyn.

At least 55 records · Page 3Linked to original sources

PubMed1982

Radiologic detection of parathyroid adenoma.

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Adenoma↗

PubMed1982

Hyperparathyroidism after radioactive iodine therapy for Graves disease.

The association of external ionizing radiation to the head and neck and the subsequent development of hyperfunctioning parathyroid glands has been documented in recent years. This also has been demonstrated experimentally in animals. Despite the numbers of patients with Graves disease who have been treated with radioactive iodine, there are no reports in the literature of parathyroid surgery for hyperparathyroidism secondary to earlier treatment with radioactive iodine for Graves disease. This report describes the operative and pathologic findings in four patients with hyperparathyroidism. These patients had previously been treated with radioactive iodine for Graves disease. The pathologic findings at surgery included in three cases a single enlarged hyperplastic gland consistent with a parathyroid adenoma. One patient had hyperplasia of all four glands. The two largest glands and halves of the two remaining glands were removed. In a long-term follow-up of children and adolescents treated with radioactive iodine for Graves disease, Levy and Schumacher found calcium elevations in 10 of 159 patients. The increased incidence of hyperparathyroidism following radioactive iodine treatment for Graves disease in children and adolescents would seem several times higher than normal. Whether adults who have radioactive iodine treatment for Graves disease have a similar increase incidence is not known. Meanwhile it would seem reasonable to suggest that patients whose hyperthyroidism is treated with radioactive iodine should have their serum calcium levels determined at 5-year intervals.

Adenoma↗

PubMed1981

Renal lithiasis and hyperparathyroidism: diagnosis, management and prognosis.

From 1969 to 1979, 448 patients underwent parathyroid exploration for presumed hyperparathyroidism. Of these patients 184 had associated renal calculus disease, 72 of whom (16 per cent) had metabolically active stone disease. Of these 72 patients 48 had adenomas, 18 had hyperplasia and 6 had normal glands. Of those patients with assessable disease none with adenomas has had recurrent calculi, whereas calculi continued to form in 45 per cent of the patients with hyperplastic glands and in 50 per cent of those with normal glands. Although most patients with adenomas had persistent calcium elevations 13 were identified with only intermittent hypercalcemia. Serum parathormone calcium elevations 13 were identified with only intermittent hypercalcemia. Serum parathormone served to confirm the presence of parathyroid pathology. Urinary calcium levels were of no diagnostic benefit.

Adenoma↗

PubMed1980

The effect of parathyroidectomy in patients with normocalcemic calcium stones.

With the entity of normocalcemic primary hyperparathyroidism increasingly prevalent in the literature the treatment of parathyroidectomy has been advocated. A total of 21 patients with recurrent calcium-containing calculi and normocalcemia underwent parathyroidectomy. Of the 21 patients 1 had an adenoma, 9 had hyperplasia and 11 had normal glands. Of the 19 patients followed stones ceased forming in 32 per cent, while in 42 per cent calculi continued to form. Of 5 patients with multiple unassessable calculi 1 ceased passing stones. We conclude that the entity of normocalcemic hyperparathyroidism is rare and repeated serum calcium determinations to identify true hypercalcemic hyperparathyroidism are necessary.

Adult↗

PubMed1980

Idiopathic infarction of intraabdominal lymph nodes. A cause of fever of unknown origin.

Infarcted peribiliary lymph nodes were found at laparotomy in a 56-year-old man who had a fever of unknown origin and transient abdominal pain. Despite thorough clinical and laboratory investigation, a cause was not demonstrated. A review of the reported cases of idiopathic or spontaneous lymph node infarction revealed a clinical presentation characterized by the sudden appearance of a painful mass, often associated with otherwise unexplained fever. Most clinical laboratory test results were negative. Although the pathogenesis is not known, histologic changes in involved lymph nodes are indistinguishable from those produced experimentally by occlusion of the vascular supply of lymph nodes. The histologic differential diagnosis includes lymphoma, metastatic carcinoma, vasculitis, and infection.

Abdomen↗

PubMed1980

Results of partial mastectomy in 173 patients followed for from five to ten years.

A series of 173 selected patients was treated by partial mastectomy. Eighteen per cent of these also had axillary dissection and another 18 per cent were irradiated. The survival rate at five years was 76 per cent. In the earlier patients, despite adverse selection in terms of age and associated disease, 44 per cent survived for ten years. Twenty per cent of these patients required some form of additional treatment for the control of local or regional disease, but mastectomy was required in only 7.5 per cent. In the others, the cosmetic results were good. Although there is an increased risk of local or regional reappearance of the cancer that may require secondary treatment, partial mastectomy is a satisfactory method of treatment for selected patients with carcinoma of the breast who wish to have some of the breast tissue preserved. These patients should be warned of the increased risk of having to have a second operation for local recurrence, but they can be assured that, in terms of survival, the results seem comparable with those reported after total mastectomy. It is possible that the use of excisional biopsy and axillary sampling followed by external and interstitial radiation with iridium seeds may further increase our ability to save the breast.

Breast Neoplasms↗

PubMed1979