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Biomedical subjects

K S Heller

Publications and source records attributed to K S Heller.

At least 19 recordsLinked to original sources
PubMed2001

Re-operation for bleeding after thyroidectomy and parathyroidectomy.

BACKGROUND: This study was undertaken to determine the frequency and timing of re-operation for bleeding following thyroidectomy (THY) and parathyroidectomy (PARA) as well as the implications of this concerning the safety of ambulatory surgery. METHODS: Patients requiring re-operation after THY and PARA were identified from a computerized database of patients undergoing surgery between 3/l/95 and 12/31/99. The medical records of these patients were reviewed in detail. RESULTS: Six of 918 THY (0.7%) and 4 of 350 PARA (1.1%) required re-operation for bleeding. In two cases the wounds were opened emergently at the bedside due to worsening airway obstruction. One patient required an emergency tracheostomy. There were no deaths. Excluding one patient who bled five days post-operatively, the time interval from the completion of surgery to the identification of postoperative hematoma ranged from 2 to 48 hours, the median being 16 hours. CONCLUSIONS: Postoperative bleeding is an uncommon but unavoidable complication of THY and PARA. If treated promptly, serious consequences can be avoided. The relatively long interval between the initial operation and the development of the hematoma needs to be considered when recommending the performance of these procedures on an ambulatory basis.

Hemorrhage↗
PubMed2001

The incidence of carcinoma in cytologically benign thyroid cysts.

BACKGROUND: The management of cytologically benign thyroid cysts is controversial. Treatment options include observation, chemical sclerosis, and surgery. This study was undertaken to determine the incidence of carcinoma in cytologically benign thyroid cysts that recur after complete aspiration and to determine the indications for surgery in these patients. METHODS: The medical records of 1189 consecutive patients undergoing thyroid surgery between July 1995 and November 2000 were reviewed. In 34 patients the indication for surgery was a thyroid cyst with benign cytologic findings that refilled at least once after complete aspiration. These patients were selected for further study. RESULTS: The 26 women and 8 men had a median age of 42 years. Fine-needle aspiration cytology was consistent with a benign cyst in all these cases. Final pathologic findings revealed the nodule to be a papillary carcinoma in 4 patients (12%). In another 4 patients (12%) an incidental microscopic papillary carcinoma, separate from the cyst, was identified on final pathologic findings. In all 4 patients with papillary carcinoma the cyst size was greater than 3 cm (range, 3.4 to 5.0 cm). CONCLUSIONS: The incidence of malignancy in cytologically benign thyroid cysts that recur after aspiration is high enough to warrant surgical excision, especially if the cyst is greater than 3 cm in size.

Adult↗
PubMed1997

Cytologic determinants of well-differentiated thyroid cancer.

OBJECTIVE: Fine-needle aspiration biopsy (FNAB) is the preferred diagnostic study for evaluating thyroid nodules. Despite its accuracy, many patients undergo thyroidectomy for benign nodules. This study was undertaken to identify risk factors that might increase the specificity of FNAB. METHODS: Medical records of 422 patients who underwent thyroid surgery between 1986 and 1996 were reviewed. All patients had FNAB prior to surgery. RESULTS: Of the 422 patients, 36% had benign cytology, 46% had indeterminate cytology, and 13% had cancer. In the indeterminate group, 29% of patients had cancer at surgery. Of patients with papillary cytology, 84% had malignancies. Five percent of FNABs were nondiagnostic. Neither age, gender, nor tumor size was associated with increased specificity of FNAB. CONCLUSION: There is no subpopulation of patients with indeterminate FNAB cytology at increased risk of having well-differentiated thyroid cancer.

Biopsy, Needle↗
PubMed1995

Photoperiodic exposure and time of day modulate the expression of arginine vasopressin mRNA and vasoactive intestinal peptide mRNA in the suprachiasmatic nuclei of Siberian hamsters.

In hamsters, changes in ambient photoperiod lead to alterations in the circadian rhythm of pineal melatonin secretion and subsequent changes in reproductive function. The present study examined whether photoperiod also alters 24-h rhythms in neuropeptide mRNA levels in the SCN of Siberian hamsters. In situ hybridization and quantitative autoradiography were used to assess messenger RNA levels for vasopressin (AVP) and vasoactive intestinal peptide (VIP) in the SCN of hamsters sacrificed at six times of day following exposure to long (16 h light/day) or short (10 h light/day) photoperiod for 2 weeks. Both AVP mRNA and VIP mRNA in the SCN were significantly affected by time of day and photoperiodic exposure. The 24-h profiles of AVP mRNA and VIP mRNA showed different relationships to the light: dark cycle, suggesting that these profiles are differentially regulated. In general, short photoperiod tended to suppress AVP mRNA and VIP mRNA in the SCN; this effect on AVP mRNA was significant at two times of day. These results complement and extend previous findings of 24-h h profiles in neuropeptide mRNA expression in the rat SCN by showing that these 24-h profiles are also characteristic of the Siberian hamster SCN and that they can be modulated by photoperiod.

Animals↗
PubMed1995

Long-term evaluation of patients undergoing immediate mandibular reconstruction.

BACKGROUND: Immediate reconstruction following segmental mandibulectomy is an accepted surgical technique. The benefits and patient selection criteria need to be established. PATIENTS AND METHODS: Forty-seven patients who underwent immediate reconstruction of the mandible were followed for up to 14 years. Survival, complication rates, and functional results were analyzed. RESULTS: Median survival was 39 months and actuarial 5-year survival was 40%. Two patients died in the postoperative period, and 9 suffered major reconstruction-related complications. The majority of these complications were related to the use of reconstruction plates, and occurred when the mandibular defect included the arch or when the plates were covered by pectoralis flaps. Half of the patients interviewed were able to eat a regular diet. CONCLUSIONS: Mandibular reconstruction can be performed safely and expeditiously in nearly all patients undergoing segmental mandibulectomy. Functional results and long-term survival will be acceptable in many cases.

Actuarial Analysis↗
PubMed1993

Investigations of the regulation of specific 2-[125I]iodomelatonin binding sites in Siberian hamsters by endogenous and exogenous melatonin.

These studies used quantitative in vitro autoradiography to investigate whether endogenous or exogenous melatonin modulate specific 2-[125I]iodomelatonin binding sites in the pars tuberalis or suprachiasmatic nuclei of Siberian hamsters. Saturation analyses were conducted on tissue sections from hamsters that were pinealectomized, exposed to constant illumination (72 h), or injected with melatonin, and from hamsters that were treated as controls. High affinity (Kd approximately 20-75 pM) specific 2-[125I]iodomelatonin binding sites were detected in the suprachiasmatic nuclei and pars tuberalis of all animals. Neither pinealectomy nor constant illumination significantly affected either the affinity or the density of the specific 2-[125I]iodomelatonin binding sites in either region. Melatonin injections led to a decrease in specific 2-[125I]iodomelatonin binding to the pars tuberalis at 3-4 h after the last injection. However, washing the sections before incubation with 2-[125I]iodomelatonin eliminated this effect, suggesting that melatonin was occupying the binding sites rather than decreasing their actual number. Furthermore, when hamsters were sacrificed 18 h after the last melatonin injection, no effect of melatonin on either the affinity or density of specific 2-[125I]iodomelatonin sites was observed. These data suggest that 2-[125I]iodomelatonin binding sites in Siberian hamsters are not regulated by changes in circulating melatonin levels.

Animals↗
PubMed1993

Parathyroid localization: inability to predict multiple gland involvement.

Preoperative localization using various imaging techniques can accurately predict the location of solitary parathyroid adenomas in about 75% of patients. Its value has been questioned because of the high success rate of parathyroid exploration without localization. The ability of localization studies to differentiate preoperatively between patients with solitary adenomas and those with multiple gland disease would be valuable because bilateral exploration might be avoided in many cases. Ultrasonography, thallium-201/technetium-99m subtraction scintigraphy, and magnetic resonance imaging were used to evaluate 16 patients with primary hyperparathyroidism who were ultimately found at surgery to have multiple enlarged parathyroid glands. No single imaging technique was able to identify more than 53% of enlarged glands, and only four patients were accurately predicted preoperatively to have enlargement of multiple parathyroid glands. Existing imaging techniques cannot be relied on to predict multiple gland involvement preoperatively. Bilateral surgical exploration is mandatory in all patients with primary hyperparathyroidism.

Humans↗
PubMed1993

Accuracy of frozen section in the evaluation of salivary tumors.

The records of 333 patients who underwent surgery were reviewed to document the accuracy of frozen section in the evaluation of salivary gland tumors. Frozen sections were obtained in 310 patients. The final pathologic diagnoses included 210 benign tumors and 45 malignancies. The sensitivity for the detection of malignancy was 69%, and the specificity was 96%. The specific accuracy to correctly identify the type of malignancy present was only 51%. In four patients, a false-positive diagnosis of malignancy was made. Frozen section was much more accurate in the evaluation of benign salivary tumors. Forty-three of 45 Warthin's tumors were correctly identified by frozen section. Two tumors thought to be Warthin's tumors on frozen section proved to be low-grade mucoepidermoid carcinomas. One tumor reported to be a benign mixed tumor was actually a malignant mixed tumor. In this series of patients, frozen section proved to be no more accurate in the evaluation of salivary tumors than what has been reported in the literature for fine-needle aspiration biopsy.

Adenolymphoma↗
PubMed1992

Value of fine needle aspiration biopsy of salivary gland masses in clinical decision-making.

The accuracy of fine needle aspiration biopsy (FNAB) in the diagnosis of salivary tumors has been well established. This study was undertaken to determine the impact of FNAB on patient management. One hundred one patients underwent FNAB of major salivary gland masses. The physician's initial clinical impression was compared with the FNAB diagnosis and the final diagnosis in each case. Forty patients had solitary masses thought to be benign tumors other than Warthin's tumors. FNAB in 13 of these patients (33%) yielded a diagnosis permitting modification of the planned procedure. The diagnosis of Warthin's tumor was suspected clinically in 23 patients. In nine of these patients (39%), FNAB resulted in a different diagnosis. Of the 10 patients believed to have malignant tumors, using FNAB, 1 was found to have sialadenitis and 1 a lymphoma. Overall, FNAB resulted in a change in the clinical approach to 35% of the patients. We recommend the performance of FNAB in almost all patients with salivary masses.

Adenolymphoma↗
PubMed1992

Reinnervated radial forearm free flaps in head and neck reconstruction.

The radial forearm flap has proved to be a reliable free flap for intraoral reconstruction after major head and neck ablative surgery for cancer. In contrast to the myocutaneous flap, it is thin and flexible, and as a result, it is better suited to conforming to the irregular surface which remains over an intact or restored mandible. A criticism of both techniques however, is that while the flap effectively fills the defect, it serves as an insensate reservoir in which food and saliva can collect. A modification of the reinnervated radial forearm free flap is presented, with discussion of its use in three patients, following extensive resection of the floor of the mouth and tongue.

Combined Modality Therapy↗
PubMed1988

Treatment of Warthin's tumor by enucleation.

Among 162 patients with Warthin's tumor, 113 had removal by enucleation. The others, in whom parotidectomy and facial nerve dissection were performed, were not suspected of having Warthin's tumor preoperatively or had tumor too close to the facial nerve to be safely enucleated. Patients were generally older and more likely to be male than patients with other benign parotid tumors. Fifteen patients had multiple Warthin's tumors at the time of initial presentation; in an additional 12 patients, Warthin's tumor developed in the opposite parotid gland after the initial operation. In only two patients did an additional tumor develop in a gland from which a Warthin's tumor had previously been enucleated. No permanent injuries to the facial nerve occurred. Because of the safety and efficacy with which enucleation can be performed and because the risk of malignant transformation of Warthin's tumors is extremely small, we believe that enucleation is the treatment of choice in most cases.

Adenolymphoma↗
PubMed1987

The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) following neck dissection.

The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is characterized by hyponatremia and urinary osmolality generally greater than serum osmolality. It is due to inappropriate water retention resulting from excessive release of antidiuretic hormone (ADH). Seventeen patients undergoing neck dissection were studied. Six developed SIADH and two became symptomatic due to profound hyponatremia. Five of the six patients who developed SIADH had previously undergone a neck dissection and/or had received radiation therapy. A suggested pathophysiologic mechanism for this phenomenon is discussed. The syndrome can usually be prevented by fluid restriction during and after surgery.

Aged↗
PubMed1979

Carcinoma of the lip.

(1) Carcinoma of the lip occurs predominantly in men in their seventh and eighth decades of life. (2) Epidermoid carcinoma is the most common malignant lip tumor. (3) Metastases to cervical lymph nodes are uncommon. (4) Elective neck dissection is not indicated. (5) Therapeutic radical neck dissection can benefit the patient in the presence of proved suprahyoid lymph node metastases. (6) The five year survival rate for epidermoid carcinoma of the lip is higher than the rate for epidermoid carcinoma of other sites in the oral cavity or pharynx. (7) Local recurrence does not correlate with the size of the primary tumor. (8) Initial treatment failures can frequently be salvaged surgically.

Aged↗
PubMed1979

Carotid arterial hemorrhage after radical head and neck surgery.

From 1960 to 1974, 63 patients treated by the Head and Neck Service of Memorial Hospital underwent carotid arterial ligation for control of actual or threatened carotid rupture. Twenty-one of these patients died without leaving the hospital. Fourteen of these deaths were the direct result of carotid ligation or hemorrhage. Five of the surviving patients suffered permanent neurologic damage. Factors predisposing to carotid rupture included a history of radiation, advanced disease, the presence of an oral or pharyngeal suture line in continuity with a dissected neck, and the postoperative development of skin necrosis or fistulas. Because elective carotid ligation did not prevent the consequences of carotid rupture and because reestablishment of vascular continuity is almost never possible, all attempts should be made to avoid the conditions that are precursors to this most serious complication of radical head and neck surgery.

Aged↗
PubMed1978

Male breast cancer: a clinicopathologic study of 97 cases.

From 1949 through 1976, 97 men have been treated at Memorial Hospital for primary operable breast cancer. Seven per cent had intraductal carcinoma. Of the patients with invasive carcinoma 30% were pathologic stage I, 54% stage II, and 16% stage III. Fourty-six per cent had pathologically negative axillary lymph nodes. The most common type of tumor was infiltrating duct carcinoma. Fourty per cent of the patients had microscopic gynecomastia. None of the eight patients with intraductal or intracystic carcinoma died of cancer. Survival of the entire group of men with invasive carcinoma was 40% after ten years. The ten year survival for men with negative nodes was 79%, for men with positive nodes 11%. Comparison with a series of 304 women with breast cancer operated on at Memorial Hospital in 1960 revealed no difference with regard to incidence of positive axillary lymph nodes or stage of disease. There was, however, a significantly lower survival rate for men. This poorer prognosis was limited to those men with pathologically positive axillary nodes.

Age Factors↗