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Biomedical subjects

L Delbridge

Publications and source records attributed to L Delbridge.

At least 19 recordsLinked to original sources
PubMed1992

Total thyroidectomy: its role in the management of thyroid disease.

Of 7812 patients treated for thyroid disease in the Endocrine Surgical Unit at the Royal North Shore Hospital, 825 underwent total thyroidectomy as an initial procedure. One third of these patients (269) were operated on for malignancy and the remaining 556 were treated for benign conditions such as multinodular goitre (405), Graves' Disease (79) and thyroiditis (45). The rate of recurrent laryngeal nerve palsy was 0.5% while permanent hypoparathyroidism occurred in 0.6% of cases, the low complication rate being due to the technique of capsular dissection employed in the Unit. The number of total thyroidectomies performed as a percentage of all thyroid operations has risen from 4% in 1970 to more than 40% in 1990. The majority of this increase has been due to surgery for multinodular goitre where the proportion of patients treated by total thyroidectomy now exceeds 80%. A similar but smaller increase has been seen in an analysis of the New South Wales figures for all other public and private hospitals. It is concluded that the complication rate from total thyroidectomy can no longer be used to argue against its use as the definitive operation for malignant disease of the thyroid. Furthermore, in view of the risks of re-operative surgery, total thyroidectomy should be considered the operation of choice for most benign disease affecting the whole thyroid gland such as multinodular goitre, thyroiditis, and in a significant number of goitres affected by thyrotoxicosis.

Adolescent↗
PubMed1992

Total thyroidectomy: the technique of capsular dissection.

This paper describes the technique of total thyroidectomy using capsular dissection. Total thyroidectomy is a safe straightforward anatomical procedure in which meticulous dissection can provide protection to the parathyroid glands and to the recurrent laryngeal nerve. This protection is achieved by using capsular dissection, hugging the gland and dividing the tertiary branches (i.e. the third order of division) of the vessels while dissecting the parathyroid glands with their vascular pedicles free from the thyroid surface, with minimal exposure of the recurrent laryngeal nerve and disturbance of its blood supply. Total thyroidectomy removes all visible thyroid tissue although it is permissible to leave a very small remnant of tissue (less than a fraction of a gram) in the region of the ligament of Berry in order to protect the recurrent laryngeal nerve and the blood supply to the parathyroid glands. This technique ensures that the incidence of complications, including permanent hypoparathyroidism and recurrent laryngeal nerve palsy, is reduced to a minimum.

History, 20th Century↗
PubMed1992

Microfollicular thyroid adenoma and congenital goitrous hypothyroidism.

Three patients with congenital goitrous hypothyroidism are reported. They were treated with adequate thyroxine replacement and developed well defined microfollicular thyroid adenomas despite being euthyroid clinically and biochemically throughout their clinical course. Patients with congenital goitrous hypothyroidism appear to be at increased risk of developing thyroid adenoma in childhood despite the use of replacement thyroxine treatment in physiological doses.

Adenoma↗
PubMed1992

Does Graves' disease or thyrotoxicosis affect the prognosis of thyroid cancer.

Twenty-one patients who underwent surgical treatment for thyrotoxicosis and who were found at operation to have thyroid cancer are presented. Sixteen had Graves' disease and 5 had toxic nodular goiter. The group with Graves' is compared with 110 euthyroid patients with thyroid cancer who underwent their initial surgery in the same time period and who were of the same age (+/- 1 yr) and sex as the patients with Graves' disease. None of the thyrotoxic patients died during follow-up of 2-24 yr or developed subsequent metastases. The 1 patient with a local lymph node metastasis has not shown evidence of recurrence. Hypoparathyroidism appeared as a complication in only 1 patient. The size of tumors in the patients with Graves' disease was significantly smaller than in the euthyroid group. The course of the disease in both the patients with Graves' disease and the thyrotoxic group as a whole was relatively benign. This series does not support the recent suggestions that thyroid cancer in patients with Graves' disease is more aggressive than in either patients with toxic nodular goiter or euthyroid subjects. Patients with Graves' disease and thyroid cancer should be treated identically to other patients with thyroid cancer. Therapy should consist of total thyroidectomy followed by a postoperative 131I scan. Residual tissue or metastases found on the scan should be ablated with 6 GBq 131I. The patient should receive a suppressive dose of T4.

Adult↗
PubMed1991

Longitudinal changes in forearm bone mineral content in primary hyperparathyroidism.

Forearm bone mineral content was measured in 28 patients with primary hyperparathyroidism before and 1 year after successful parathyroidectomy. The forearm bone mineral content rose from a mean value of 1.068 to 1.092 g/cm (P less than 0.05, paired t-test). Those patients with the lower initial values had the largest rise. In an additional study, the forearm bone mineral content was measured in 10 women over the age of 40 years (mean age 58.6 +/- 7.9SD years) with hyperparathyroidism before and for 2 years after successful parathyroidectomy and compared with the forearm bone mineral content measured over 2 years in 12 women (mean age 56.3 +/- 5.5SD years) with continuing hyperparathyroidism and with the forearm bone mineral content of 12 eucalcemic control women (mean age 58.8 +/- 8.2SD years), also measured over 2 years. The parathyroidectomized group gained bone, whereas the ongoing hyperparathyroid group and the eucalcemic control group lost bone. The difference between the parathyroidectomized group and the ongoing hyperparathyroid group was significant after 2 years (P less than 0.05). The percentage loss of forearm bone mineral in the eucalcemic control subjects was not significantly different from the percentage loss of forearm bone mineral in the ongoing hyperparathyroid group, although the initial mean bone mineral content in the eucalcemic group was significantly higher than in the ongoing hyperparathyroid group, suggesting that a possible determinant of bone mineral loss in women in this age group is the initial bone mineral content.

Adult↗
PubMed1991

Prognostic significance of nuclear DNA content in phaeochromocytoma.

Nuclear DNA content of 27 phaeochromocytomas was measured by image analysis of thin sections and monolayer smears of nuclei extracted from thick sections (cytospins) using archival paraffin-embedded tissue blocks. Recurrence was assessed on the basis of clinical follow-up or urinary catecholamine levels. The mean follow-up was 5.0 years, with a range of 4 months to 15 years. Although it is not possible to differentiate accurately malignant tumours using DNA analysis, prediction of benign tumours is possible. Using thin sections, all tumours were benign when the percentage of cells with a DNA content of 2.5 c (2 c = diploid) was less than 40% and the DNA content of 5 c was less than 4%. Using the cytospin preparation, all diploid tumours were benign. Thus, patients with diploid tumours may be saved intensive long-term follow-up. Aneuploid and tetraploid tumours, however, continue to require careful lifelong follow-up.

Adolescent↗
PubMed1991

Comparison of image analysis and flow cytometric determination of cellular DNA content.

A good correlation (r = 0.94) was obtained between the DNA indices (DI) using flow cytometry and image analysis of nuclei cytospins extracted from paraffin wax embedded tumour sections. Some of the limitations and problems associated with image analysis which came to light included an unacceptably high coefficient of variation (CV) and a "left-shift" in the DI in most DNA histograms obtained when using image analysis of 5 microns sections. In contrast, the DNA histograms generated using image analysis of cytospun nuclei from paraffin wax blocks were of good quality and similar to those obtained using flow cytometry. Variability in Feulgen staining was common and an important source of error despite rigorous control of the staining technique. This could be overcome by using internal controls such as fibroblasts rather than external controls (rat hepatocytes) to determine the diploid DI with image analysis. A thorough understanding and appreciation of the methodological problems associated with image analysis and flow cytometric determination of DNA content is required before these methods find widespread clinical application.

Adrenal Gland Neoplasms↗
PubMed1991

Use of X-ray diffraction in study of human diabetic and aging collagen.

Extensive investigations of the solubility and fluorescence of collagen fibers in diabetes have revealed that there are significant changes in their physical properties. These changes are associated with increased cross-link formation. We used X-ray diffraction to study these changes in human extensor tendons at a molecular level in relation to both aging and diabetes. Our results indicate that diabetes induces significant alterations in the ultrastructure of collagen in the lateral packing of the molecules and the axial structure of the specimen. These changes can be induced in normal tendon by incubation in ribose and glucose-6-phosphate but are different from those associated with the normal process of aging.

Adolescent↗
PubMed1991

Transhepatic portal vein catheterization for localization of insulinomas: a ten-year experience.

One of the most important factors in the management of insulinomas is the ability to localize the tumor accurately either before or during surgery. We prospectively carried out transhepatic portal venous sampling (THPVS) for tumor localization in 35 of 40 patients with organic hyperinsulinism during a 10-year period. In 32 patients who underwent THPVS and in whom a single tumor was subsequently identified surgically, the maximal insulin gradient was located in the vicinity of the tumor in 100% of cases. Specific regionalization of the tumor on the basis of the site of the maximal insulin gradient to one of three regions (the tail, the body/neck region, and the head/uncinate region) gave a sensitivity of 81% and a specificity of 91%. In contrast, the use of specific cutoff levels for the insulin gradient as a guide to the presence of a tumor in one of these three regions did not increase the accuracy, leading instead to a significant loss of sensitivity with no comparable increase in specificity. There were no major complications from the procedure in any patient. The initial use of computed tomographic/ultrasound scanning and selective angiography localized only 46% of tumors, whereas subsequent THPVS led to the accurate preoperative localization of 100% of all tumors submitted to surgery. Although the surgeon would have identified 81% of the tumors correctly at operation, in 19% (n = 6) he would have failed. Four tumors were in the uncinate and two were in the head. It seems that in patients with proved or established organic hyperinsulinism, THPVS may continue to be of value, if only to regionalize the tumor, especially those in the pancreatic head and uncinate process so as to preclude noncurative operations on the body and tail of the pancreas.

Adult↗
PubMed1990

Fine needle biopsy of thyroid nodules: the importance of technique.

Fine needle biopsy (FNB) is the most accurate method available for the investigation of single thyroid nodules. The exact technique employed, however, varies considerably among clinicians: in our institution the incidence of 'inadequate' specimens produced ranges from only 13 to 62%, depending on the individual performing the biopsy. In a prospective in vivo study, a variety of biopsy techniques employing different gauge needles and differing numbers of passes with and without aspiration were assessed with respect to the quality of cytological specimen produced. Criteria assessed included the number of cells or sheets of cells, cell clumping, blood contamination, amount of colloid, and overall slide quality. Samples obtained with a 21 gauge needle without aspiration consistently gave best individual cell morphology. On the other hand, samples obtained with a 23 gauge needle with five aspirated passes through the nodule gave the highest yield of cells with an acceptable minimal increase in the degree of blood contamination and cell clumping. In order to achieve consistent yields from FNB of thyroid nodules, a combination of these two techniques is recommended.

Adult↗
PubMed1990

Radical treatment of mal perforans in diabetic patients with arterial insufficiency.

Forty patients with diabetes mellitus and severe mal perforans underwent dorsal excision of the involved metatarsal head with primary closure of the plantar ulcer. Patients were screened before operation with noninvasive studies documenting pulse examination, ankle pressure index, and toe blood pressures. Fifteen of 40 patients (38%) had no palpable pedal pulses. Three patients had vascular reconstruction before metatarsal head resection. Mean toe pressure of the entire group was 135 +/- 35 mm Hg (range, 60 to 190), with six patients having a pressure less than 100 mm Hg. All patients had primary healing of the plantar wound and secondary healing of the dorsal incision with no amputations or readmissions for forefoot sepsis in the mean follow-up of 38.5 months (range, 2 to 54 months). In seven patients with recurrent ulcers, no relationship was found between measured indexes of forefoot perfusion and recurrence. However, all patients with recurrence were noncompliant in returning for follow-up orthotic care. This technique provides a means to ensure rapid healing of severe mal perforans while decreasing hospitalization, wound care, and periods of immobilization and is applicable in diabetic patients with arterial insufficiency and toe pressure of at least 60 mm Hg.

Blood Pressure↗
PubMed1989

Increase in crosslinking of nonenzymatically glycosylated collagen induced by products of lipid peroxidation.

The increase in crosslinking in normal and nonenzymatically glycosylated rat tail tendon collagen after treatment with decomposing lipid hydroperoxides was assessed by measuring the breaking time of tendons immersed in 7 M urea under a 3 g weight at 40 degrees C (thermal rupture time). The incubation of tendons in 200 mM glucose for 43 h at 40 degrees C increased thermal rupture times from 5.15 to 26.38 min, (P less than 0.001) with no significant corresponding increase in tendons incubated in buffer alone. After incubation of the glycosylated tendons in the presence of peroxidized linoleic/arachidonic acid vesicles for about 20 h, their thermal rupture time increased to 3360 min (P less than 0.001). The rupture time for normal tendons after the same treatment was 206 min. These apparent crosslinking increases cannot be fully accounted for by reactions involving malondialdehyde, as incubation of both glycosylated and normal tendons in enzymatically produced malondialdehyde resulted in a modest two- to threefold increase in thermal rupture time.

Animals↗
PubMed1989

Trainee surgery in teaching hospitals: is there a cost?

The morbidity rate for 2858 patients undergoing thyroidectomy over the 10 year period January 1977-December 1986 was examined and related to the involvement of a surgical trainee in the operative procedure. There was no overall difference in specific complication rates related to the surgical procedure, being 13.8% when the procedure was undertaken by a consultant, and 13.1% when a surgical trainee was involved in the procedure. There was a significant increase (P = 0.0025) in operative time increasing from 127 min for the consultant to 146 min when the trainee was involved (a 15% increase). There was no significant difference in bed stay for any of the groups. Surgical trainees can be safely taught operative skills under supervision without risk of increased complications. There is a cost, however, to the hospital system in terms of increased demands on time and operative facilities.

Costs and Cost Analysis↗
PubMed1988

Catalysis of lipid peroxidation by glucose and glycosylated collagen.

Peroxidation of membranes of linoleic/arachadonic acid vesicles at 40 degrees C was catalysed by glucose or glycosylated collagen. Kinetics of hydroperoxide production were similar in both cases. There was a kinetic lag, the duration of which was inversely proportional to the amount of glucose or glycosylated collagen used to initiate the peroxidation. This was followed by a rapid increase in the rate of oxidation. The final rate was independent of the amount of catalyst added. Vesicle lysis accompanied the increases in peroxidation. Addition of desferrioxamine, an iron chelator, only partially inhibited the oxidative process.

Animals↗
PubMed1987

Total thyroidectomy. The preferred option for multinodular goiter.

Total thyroidectomy is an operation that has generally been reserved for the management of differentiated thyroid carcinoma. Over the last decade total thyroidectomy has become used increasingly and is now the preferred option in the authors' unit for the management of multinodular goiter affecting the entire gland. Over the period from 1975 to 1985, 853 thyroidectomies have been performed for multinodular goiter; of these, 115 have been total thyroidectomies. During that time, the incidence of total thyroidectomy for multinodular goiter has increased in percentage terms from 9% in 1975 to 50% in 1985. There have been two cases of permanent hypoparathyroidism and one case of permanent recurrent laryngeal nerve injury, and these occurred in patients who had less than total thyroidectomy. Total thyroidectomy is an appropriate operation for the management of diffuse multinodular goiter where the entire gland is involved because it precludes patients from requiring further surgery for recurrent disease, with its high associated risks. It must be emphasized, however, that protection of the recurrent laryngeal nerve and parathyroid glands must still be paramount in dealing with benign thyroid disease.

Goiter, Nodular↗
PubMed1987

Surgery for adrenal tumours: is operation for the small incidental tumour appropriate?

The last 15 years have seen a change in the indications for adrenalectomy. On the one hand there has been a decline in the number of operations for metastatic breast cancer due principally to the introduction of effective medical therapy. Moreover, the introduction of trans-sphenoidal techniques has reduced the number of adrenalectomies for Cushing's Disease. In contrast the introduction of CT scanning has seen an increase in the diagnosis of incidental adrenal masses, most of which turn out to be benign non-functioning adrenal cortical adenomas. During the period 1970-86, 124 adrenalectomies were performed at Royal North Shore Hospital. From 1970 to 1976 the primary indication for adrenalectomy was metastatic breast carcinoma (84%). Over the past three years one of the primary indications has been the discovery of an asymptomatic, non-functional adrenal mass on CT scan (26%) and, of these tumours, 95% have been less than 5 cm in size. Yet no incidentally discovered adrenal mass was an adrenocortical carcinoma and no adrenocortical carcinoma was smaller than 7 cm in diameter. We recommend that an asymptomatic adrenal mass less than 6 cm in size, with no evidence of function, should be managed conservatively.

Adenoma↗