PubMed Health⌕ Search

Biomedical subjects

L Zuckerbraun

Publications and source records attributed to L Zuckerbraun.

At least 19 recordsLinked to original sources
PubMed1998

Safety of completion thyroidectomy for multicentric carcinoma.

The role of completion thyroidectomy after lobectomy for well-differentiated thyroid carcinoma remains controversial. The purpose of the present study is to compare the relative safety of a one-stage versus a two-stage approach in the management of thyroid cancer. Thirty consecutive patients with thyroid carcinoma were studied. In 14 patients, frozen-section diagnosis of carcinoma allowed total thyroidectomy at the initial operation. In 16 patients, carcinoma was found only on permanent section; thus, completion thyroidectomy was undertaken as a second stage. Transient hypocalcemia occurred in one patient in each group (one-stage, 7%; two-stage, 6%). There was one unilateral recurrent nerve paresis in the one-stage group and none in the two-stage group. We conclude that a two-stage procedure is a safe and effective approach for the treatment of thyroid cancer and can be employed in those instances in which the diagnosis of malignancy is insecure at the initial operation.

Adenocarcinoma, Follicular↗
PubMed1998

Recurrent Zenker's diverticulum: treatment with crycopharyngeal myotomy.

Recurrence following treatment of Zenker's diverticulum (ZD) occurs in up to 16 per cent of patients. We have reviewed our experience with cricopharyngeal myotomy (CM) to determine its safety and efficacy in the treatment of recurrent ZD. Eight patients were treated, five with early recurrence (symptoms persisting or recurring within 6 months of their initial surgery) and three with late recurrence. Most patients with early recurrence did not have an adequate CM as part of their initial therapy, suggesting that adequate myotomy is important for early relief of dysphagia. Seven patients underwent CM alone, and one patient underwent CM with diverticulectomy. All patients experienced immediate relief of their dysphagia, with good to excellent results persisting at last follow-up (mean follow-up 53 months). Complications were seen only in the patient who underwent combined myotomy with diverticulectomy. We have found CM alone to be quite safe and effective in the treatment of recurrent ZD.

Aged↗
PubMed1998

Traumatic neuromas of the head and neck.

An interesting case of a traumatic neuroma of the greater auricular nerve provides the impetus for a discussion of head and neck neuromas. Traumatic neuromas of the head and neck are relatively rare. Division of the greater auricular nerve during parotidectomy occasionally results in a traumatic neuroma. We report a case of a 73-year-old woman who presented with a traumatic neuroma nine years after undergoing superficial parotidectomy with dissection of the facial nerve for a mixed tumor. The patient had a 1.5 cm x 1.0 cm mass located below the old surgical site over the anteromedial border of the sternocleidomastoid muscle. The patient's past history was significant for Frey's syndrome, which is the result of abnormal neurologic growth. On first impression, the tumor was thought to be a recurrence of neoplastic disease; however, because of the evaluation, traumatic neuroma was suspected. An attempt at fine-needle aspiration of the mass was too painful to be carried out. At surgery, a whitish tumor was excised which, on final pathologic examination, revealed traumatic neuroma. The surgical literature is reviewed and the subject of head and neck neuromas, including their evaluation and management, is thoroughly discussed. Knowledge of this possible diagnosis may spare the patient and the surgeon needless worry, as well as unnecessary procedures, once tumor recurrence has been ruled out.

Aged↗
PubMed1996

Recurrent secondary hyperparathyroidism. An argument for total parathyroidectomy.

OBJECTIVE: To define better the incidence and causes of recurrent secondary hyperparathyroidism. DESIGN: Review of total parathyroidectomy with autotransplantation in uremic patients and literature review. SETTING: Two teaching hospitals. PATIENTS: Nine patients treated for secondary hyperparathyroidism between 1982 and 1993 by a single surgeon. INTERVENTIONS: Total parathyroidectomy with autotransplantation into the sternocleidomastoid muscle. Recurrence was treated, if necessary, with a graft reduction procedure. MAIN OUTCOME MEASURES: The symptomatic and biochemical response to initial therapy, morbidity, and mortality, as well as the development of recurrent hypercalcemia. RESULTS: All patients were normocalcemic after their initial surgery. One patient died postoperatively (mortality, 11%). Three (38%) of the remaining patients developed recurrent hypercalcemia, 2 (25%) requiring reoperation. Of the 2 patients who underwent surgery for recurrence, 1 had an adenoma in the implant and the other had graft hyperplasia. CONCLUSIONS: Recurrence rates after total parathyroidectomy with autotransplantation are substantial and, given the pathophysiology of secondary hyperparathyroidism, unavoidable in patients with uncorrected renal failure. An argument is made for performing total parathyroidectomy alone in patients with secondary hyperparathyroidism who will not undergo renal transplantation in the near future.

Adult↗
PubMed1993

Staged Zenker's diverticulectomy with cervical esophagostomy and secondary esophagostomy closure for treatment of massive diverticulum in severely debilitated patients.

Cricopharyngeal myotomy and diverticulectomy have become the standard therapy for the vast majority of patients with pharyngoesophageal diverticula. Potential complications from this approach, however, may be devastating in debilitated, elderly patients with massive Zenker's diverticula. Because of potentially fatal complications, we advocate a staged approach to treat debilitated patients with massive Zenker's diverticula. In the first stage, myotomy, diverticulectomy, and cervical esophagostomy are performed, and a gastric feeding tube is positioned through the esophagostomy. After recovery from pulmonary complications and nutritional improvement, the feeding tube is removed and the esophagostomy is closed. From 1987 to 1992, we treated five severely debilitated patients, four men and one woman with massive Zenker's diverticula, with this novel approach. Age of the patients averaged 80 years, range 58 to 93. All patients had symptoms of pulmonary aspiration requiring multiple hospitalizations for life-threatening pneumonia. Three patients had severe malnutrition associated with major weight loss and cachexia. All patients underwent first stage repair without morbidity or mortality. After an average of 7 weeks, patients had significant nutritional improvement and the esophagostomy was closed. Local wound care adequately treated one wound infection after esophagostomy closure. Although myotomy and diverticulectomy are safe procedures, a staged approach, diverticulectomy and cervical esophagostomy, followed by esophagostomy closure, is advocated for the elderly, severely debilitated patient with massive Zenker's diverticulum.

Aged↗
PubMed1992

Treatment of Zenker's diverticula by cricopharyngeus myotomy under local anesthesia.

Optimum surgical management of the hypopharyngeal diverticulum is controversial. The authors discuss 48 consecutive patients (average age 72.1 years) with documented hypopharyngeal diverticula who were treated by cricopharyngeus myotomy, leaving the diverticula in situ. All came to the hospital with dysphagia; other symptoms included postdeglutitive cough, regurgitation, aspiration, and weight loss. Seven patients had had previous surgery for a Zenker's diverticulum with recurrence. Aspiration pneumonia was treated in 9 patients; 28 patients had concurrent chronic obstructive pulmonary disease or cardiovascular disease. Thirty-nine patients had cricopharyngeus myotomy under local anesthesia, 5 had cricopharyngeus myotomy under general endotracheal anesthesia, and 4 patients underwent myotomy with a cervical esophagostomy. There was one mortality (2.1%) and no incidence of postoperative bleeding, sepsis, or cranial nerve injury. Follow-up was done with 30 patients via telephone an average of 64 months after operation. Twenty-one of 30 patients reported excellent relief of symptoms, 5 reported improvement with occasional symptoms, and 4 patients described persistent dysphagia. Cricopharyngeus myotomy under local anesthetic is a safe and effective approach to the patient with a hypopharyngeal diverticulum. The awake patient can swallow on command, which enables the surgeon to identify the upper esophageal sphincter (UES) and to perform an accurate, complete myotomy. The absence of a pharyngeal suture line eliminates the risk of leakage and mediastinal sepsis, and allows early, postoperative feeding and discharge.

Adult↗
PubMed1990

Surgical strategy in thyroid disease.

Over the past 8 years, 311 patients have undergone surgical treatment by the senior authors for thyroid disease. Over 80% of the cases were performed by the head and neck surgical service at Olive View County Hospital, Sylmar, Calif, with the remainder performed at UCLA-affiliated institutions. This service is an important source of thyroid surgical training for UCLA head and neck residents who rotate through this major affiliate. The purpose of this communication is to review our experience with these cases; to describe our overall surgical strategy; and to detail the specifics of our surgical procedure, which we have developed to safely train residents in the treatment of these challenging cases. This article deals with the specific problems of preservation of the recurrent nerve, the parathyroid glands, and the techniques for reimplantation of injured parathyroid glands; the management of larger, substernal thyroid glands; and our techniques for partial thyroid surgery. In addition, the difficult decisions in the management of thyroid cancer, such as completion thyroidectomy; the management of lymph node mestastases; and how tracheal, esophageal, or laryngeal invasion should be managed are discussed. An initial section describing the general preoperative examination of these patients is also included, so that the proper surgical strategy can be developed prior to entering the operating room.

Adult↗
PubMed1990

Cricopharyngeal dysfunction in chronic obstructive pulmonary disease.

Dysphagia due to cricopharyngeal dysfunction is well known; however, there have been no previous data indicating an association between cricopharyngeal dysfunction and COPD. After observing marked cricopharyngeal dysfunction with aspiration in three patients who had frequent and severe exacerbations of COPD, we performed pharyngoesophageal examinations with videotaping in another 22 nonrandomized patients. Cineradiography or videofluoroscopic recording with capabilities of slow-motion and freeze-frame playback is mandatory, since the transit time of the bolus through the pharynx is rapid. Severe cricopharyngeal dysfunction was observed in 17 elderly patients with COPD. Deglutition disorders were elicited by careful questioning in 15 of these. In eight subjects, cricopharyngeal myotomy resulted in improvement of swallowing and complete or partial relief of acute exacerbations of respiratory distress. In one subject, myotomy relieved only the swallowing problem. The mechanism of cricopharyngeal dysfunction in elderly patients with COPD is unknown at this time, but may be related to gastroesophageal reflux, therapeutic agents, and/or alterations in pharyngoesophageal anatomic structures. We conclude that investigations for swallowing disorders should be considered in patients with COPD who have frequent acute exacerbations of respiratory distress.

Aged↗
PubMed1988

Physiologic exclusion of the injured esophagus.

Despite continuing advances in the surgical and nutritional management of esophageal perforation, morbidity and mortality remain significant. Described within is the successful management of two such cases by the physiologic exclusion of the esophagus. By this, we mean distal decompression and proximal diversion and decompression through a gastrostomy and cervical esophagostomy. This provides the greatest chance for protection of the esophageal suture line repair.

Aged↗
PubMed1988

Autotransplantation of parathyroid tissue into sternocleidomastoid muscle.

Four cases of secondary hyperparathyroidism were treated by total parathyroidectomy with autotransplantation into the sternocleidomastoid muscle. These total parathyroidectomy patients are presented to demonstrate the reliability of parathyroid autotransplantation into the sternocleidomastoid muscle. Our technique is described in detail, and all procedures were successful. In one case, the patient was found, in retrospect, to have an adenoma in the transplanted parathyroid tissue. When the patient developed graft-dependent hypercalcemia, a portion of the graft was easily excised under local anesthesia and the patient became normocalcemic. Parathyroid tissue should be transplanted into the sternocleidomastoid muscle rather than other sites because of easy accessibility, one operative site, less graft ischemia, a low incidence of infection, and a high success rate due to excellent blood supply.

Adult↗
PubMed1986

A systematic approach to parathyroid surgery.

In the last 8 years 33 patients with hyperparathyroidism have been surgically treated by the authors. Thirty patients had primary, 2 secondary and 1 tertiary hyperparathyroidism. In the 30 patients with the primary disorder, 26 had a single adenoma and 28 of these patients had normal calcium levels postoperatively. Two patients were hypocalcaemic following surgery and required calcium supplements for 3 months and 9 months respectively. It is recommended that when a single adenoma is found its removal will render the patient normocalcaemic. When all 4 glands are hyperplastic the surgery should be subtotal (3 1/2 glands) parathyroidectomy except in the case of secondary hyperparathyroidism when total parathyroidectomy with autotransplantation and cryopreservation of the remainder should be performed.

Adenoma↗
PubMed1985

Cervical mycobacterial lymphadenitis. Medical vs surgical management.

After years in its decrease, cervical mycobacterial adenitis is once again an increasing problem in Los Angeles County. We reviewed 54 cases of cervical lymphadenopathies treated over ten years. Twenty-five (46%) of these patients were found to have mycobacterial cervical lymphadenitis. Medical approaches often failed to conclusively diagnose this disease. In our series, none of the patients with cervical adenopathies (36%) treated only medically regressed, even after an average time of 18 months of antituberculosis drug treatment. The treatment of choice seems to be surgical excision and long-term antituberculosis drugs. Surgery provides a rapid tissue diagnosis and confirms the bacterial type, including atypical mycobacterium. This approach is simple, shortens hospitalization, is cost-effective, and carries a low morbidity.

Adolescent↗
PubMed1982

Carcinoid tumor of the thymus associated with a parathyroid adenoma.

A parathyroid adenoma occurred synchronously with a thymic carcinoid tumor in a 34-year-old man. A sibling was known to have an insulinoma, pituitary adenoma, and parathyroid hyperplasia. The simultaneous occurrence of these tumors, in association with the noted family history, suggests a possible multiple endocrine adenomatosis variant. A description of both tumors is provided along with a review of the literature on thymic carcinoid tumors.

Adenoma↗
PubMed1976

Dermoid cysts of the head and neck in children.

The sporadic occurrence of several dermoid cysts of the head and neck in children led us to investigate the relative incidence in a series of 594 epidermal cysts in which 33 such lesions were found. We review the classification of dermoid cysts according to their embryogenesis and location to help avert diagnostic or therapeutic pitfalls. This study emphasizes the importance of adequate general anesthesia and excision of these interesting lesions.

Adolescent↗
PubMedDate not supplied

Pharyngoesophageal intubation injuries: three case reports.

The hypopharynx and cervical esophagus are particularly vulnerable to intubation trauma. Contributing factors include hasty intubation by inexperienced personnel; the use of curved, beveled endotracheal tubes containing stylets; malpositioning of the head, and the application of cricoid pressure. Iatrogenic pharyngoesophageal perforations may go unsuspected until characteristic signs and symptoms are recognized. These include cervical pain, fever, dysphagia, leukocytosis, subcutaneous emphysema, and pneumomediastinum. We present three cases that illustrate important points in recognizing, evaluating, and treating pharyngoesophageal perforations. The third case presents a chronic cervical esophageal perforation with secondary pseudodiverticulum, requiring resection of the pseudodiverticulum and a primary sternocleidomastoid muscle flap repair of the cervical esophageal defect. To our knowledge, this technique has not previously been reported.

Adult↗