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Biomedical subjects

I S Sinclair

Publications and source records attributed to I S Sinclair.

8 recordsLinked to original sources

The risk to the recurrent laryngeal nerves in thyroid and parathyroid surgery.

The incidence of vocal cord paralysis during operations on the thyroid and parathyroid glands in a single surgical unit having a special interest in this field has been reviewed over a 9-year period. 97% of all operations were reviewed, as were over 98% of nerves at risk, with a minimum follow-up period of one year in all cases of paralysis unless normal function was observed earlier. The overall rate of paralysis did not differ significantly from previous reports but analysis according to the type of goitre and surgical procedure revealed a greatly increased risk in retrosternal goitres (17.5%) and in unilateral (11.8%) as compared with bilateral resections for nodular goitre (5.2%).

Adult↗

Does calcitonin cause hypocalcaemia after thyroidectomy?

Plasma calcitonin, parathyroid hormone, total thyroid hormones and calcium were measured in 6 patients before, during and after thyroidectomy for hyperthyroidism. In 4 patients, plasma calcium fell postoperatively by 0.23--0.46 mmol/l, but there was no change in calcitonin or parathyroid hormone levels. In one patient, in whom there was a postoperative fall in plasma calcium of 0.55 mmol/l, thyroid hormones rose to a peak at 1 h and calcitonin to a peak at 12 h after resection. However, the rise in calcitonin occurred 8 h after the initial decrease in plasma calcium. In this patient, parathyroid hormone levels showed a slight rise only. It is concluded that, while thyroid hormones and calcitonin may leak from the damaged thyroid remnant after surgery, it is unlikely that calcitonin is important in the production of postoperative hypocalcaemia. However, impaired parathyroid hormone secretion may be a contributing factor.

Adolescent↗

What is the significance of raised plasma TSH levels after thyroid surgery?

Thyroid function was assessed prospectively for five years in 73 patients treated surgically for Graves's disease. No patient developed hypothyroidism after the sixth postoperative month, despite the presence of raised plasma TSH levels in 70 per cent of euthyroid patients at the end of the first year. Indeed, in those with evidence of temporary hypothyroidism (low T4, raised TSh at 3 months but normalisation of T4 at 6 months) plasma TSH continued to fall for up to three years. The majority (6) of patients developing recurrent hyperthyroidism did so within the first year, but in one of three patients who relapsed subsequently, plasma TSH had been elevated at one year. Plasma TSH cannot be used to predict thyroid status following surgery for Graves' disease. Although regular review remains necessary, it should not include measurement of TSH unless this is needed to confirm the validity of a low thyroxine level after the third postoperative month and before starting permanent replacement therapy.

Adult↗

Comparative trial of three heterologous anti-tetanus sera.

The three heterologous anti-sera currently provided for tetanus prophylaxis have been compared with reference to the production of untoward reactions in 498 patients, and to the blood antitoxin concentrations produced in 76 patients. Equine serum, although giving rise to more reactions, was the only effective agent in terms of the levels and duration of serum antitoxin concentration produced. The local response to a test dose of any of the three sera is not a reliable guide to immediate or late general reactions.

Animals↗