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Biomedical subjects

Larry R Lloyd

Publications and source records attributed to Larry R Lloyd.

4 recordsLinked to original sources
PubMed2006

Detection of parathyroid adenoma in patients with primary hyperparathyroidism: the use of office-based ultrasound in preoperative localization.

BACKGROUND: The purpose of this investigation is to show that preoperative localization of the parathyroid gland using office-based ultrasound (US) and Tc-99m sestamibi scan is superior to all other approaches in detecting a parathyroid adenoma. METHODS: We performed a retrospective analysis of 43 patients who underwent parathyroidectomy for primary hyperparathyroidism. All patients underwent office-based US and sestamibi scintigraphy. Upon completion of the localization studies, a plan for focused or full operation was determined. RESULTS: In 42 of 43 patients, office-based US performed by a surgeon and sestamibi scintigraphy successfully detected the location of a parathyroid abnormality (42/43 cases, sensitivity = 98%, P < .05 =.0001). Office-based US localized the abnormal gland to the specific side (right/left) in 36 of 43 cases (84%). Sestamibi alone localized to the specific side in 29 of 43 cases (67%) for a statistically significant difference (P = .03). US localized the abnormal gland to the specific quadrant (34/43 cases [79%] sensitivity versus 23/43 cases [53%] sensitivity using sestamibi scan alone to localize to the specific quadrant, P = .03). CONCLUSION: It is clear that the combined modalities of office-based US and sestamibi scintigraphy in preoperative localization have a high success rate and should be considered in parathyroid surgery.

Adenoma↗
PubMed2004

Inguinal hernia recurrence following preperitoneal Kugel patch repair.

Three hundred eighty-six preperitoneal inguinal herniorrhaphies using a polypropylene Kugel patch (Davol) were performed in 355 consecutive patients by six surgeons. Variables for recurrence evaluated included age, gender, hernia type, whether the Kugel patch was placed for a primary or recurrent hernia, and the experience of the surgeon. Of 336 patients with long-term follow-up available (18 months to 63 months, median 42 months) 28 recurrences developed 1 to 48 months (mean 16 months) after 366 Kugel patch repairs (7.7%). Recurrence was highest (27.8%) in the subset of patients who had a Kugel patch placed for recurrent inguinal hernias (P < 0.05). Patients with direct primary hernias involving the entire floor had a recurrence rate of 22.7 per cent (P < 0.05). Patient age and gender had no bearing on recurrence. Surgeon experience did play a role, as the recurrence rate was 18.2 per cent during each surgeon's first 36 cases and 2.9 per cent thereafter (P < 0.0005). Surgeons using a preperitoneal Kugel patch for inguinal herniorraphy had a recurrence rate that was unacceptably high. The technique may not be suitable for repair of recurrent inguinal hernias or primary large direct inguinal hernias. Surgeons in this study saw a learning curve of 36 cases.

Digestive System Surgical Procedures↗
PubMed2002

An analysis of filtration and volume of radionucleotide in sentinel lymph node biopsy in breast cancer patients.

Controversy has occurred regarding whether to filter or not to filter the radionucleotide and what the optimal volume is when performing sentinel lymph node biopsies. To try and resolve this question we retrospectively looked at sentinel-node biopsies for breast cancer performed at our institution over an 18-month period. One hundred seven patients underwent sentinel node biopsy. Ninety-four patients had an axillary-node dissection. Twelve patients did not have a nodal dissection based on National Surgical Adjuvant Breast and Bowel Project protocol, and one patient refused dissection. Patients fell into three groups: Group I, filtered 8 cm3; Group II, unfiltered 8 cm3; and Group III, unfiltered 16 cm3 (NSABP protocol). Sentinel nodes were identified in 96.3 per cent of Group I, 84.9 per cent of Group II, and 96.3 per cent of Group III. These groups were not statistically different. With the addition of blue dye the ability to identify the sentinel lymph node was for Group I 96.3 per cent, for Group II 96.2 per cent, and for Group III 100 per cent. The false negative biopsy result was 0 per cent for all groups. The patients receiving 16-cm3 volume complained about a greater level of discomfort compared with the lower-volume patients. In conclusion neither the volume nor the filtration process affected the surgeon's ability to find the sentinel lymph node or the false negative rate. The higher injection volumes resulted in more pain. The costs and radiation exposure of the filtration process are not warranted.

Breast Neoplasms↗