Management of clinically inapparent adrenal mass.
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Adrenal Gland Neoplasms↗
Biomedical subjects
M Rothberg
Publications and source records attributed to M Rothberg.
Thoracoscopic surgery: historical perspectives.
Recent technical advances have revolutionized the fields of surgical endoscopy, laparoscopy, thoracoscopy, and microsurgical spinal endoscopy. The authors discuss the rich history and recent evolution of these techniques. Thoracoscopy had been widely used for the treatment of pleural conditions associated with tuberculosis. It was largely abandoned in the 1950s when effective antituberculosis medications were introduced. In the 1980s the development of video-assisted endoscopic procedures in the fields of general surgery, orthopedics, and otolaryngology provided new impetus to revive thoracoscopy. As a result of these advances thoracoscopy replaced open thoracotomy in many cardiothoracic procedures. These improvements led to the application of these techniques to treat disorders of the spine. By the mid-1990s microsurgical endoscopy was being used effectively to treat thoracic disc disease, perform anterior surgical release procedures for scoliosis, resect tumors, and even to conduct complex spinal fusions and reconstructions. As technology continues to improve, there is no doubt that thoracoscopic surgery will find a permanent place in the armamentarium of techniques used to treat pathological entities of the spine.
Animals↗
Nicotine and 3-ethenylpyridine concentrations as markers for environmental tobacco smoke in restaurants.
The Finnish Tobacco Act has restricted smoking in public places since 1976, and in 1994 the Act was amended to include workplaces as well. In 2000, the Tobacco Act will be expanded further to restaurants. In Finland, the exposure of clients and employees to the vapor phase environmental tobacco smoke (ETS) in restaurants has not been systematically studied before by measuring ETS markers in indoor air. However, in these establishments the concentrations of ETS are expected to be much higher than in other workplaces. Gaseous nicotine and 3-ethenylpyridine were used as indicators of ETS in three different types of restaurants. Mean concentrations of nicotine ranged from 1.4-42.2 micrograms/m3 and 3-ethenylpyridine 1.4-6.3 micrograms/m3. In addition, concentrations of total volatile organic compounds (TVOC), CO and CO2 were measured and concentrations were 183-2215 micrograms/m3, 0.9-3.1 mg/m3 and 600-880 ppm, respectively. The concentrations of ETS markers were highest in discos and nightclubs and lowest in restaurants. The concentrations of total volatile organic compounds were highest in discos and nightclubs, especially when smoke generators were used.
Carcinogens↗
Commentary: resist jumping to conclusions.
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Anti-Bacterial Agents↗
Measurement and analysis of nicotine and other VOCs in indoor air as an indicator of passive smoking.
In Finland the Tobacco Act was amended in 1994 to include workplaces. The developed method for estimating passive smoking, or environmental tobacco smoke utilised the widely used measurement of volatile organic compounds in indoor air quality surveys. The method is based on active sorbent sampling, thermal desorption and gas chromatography/mass selective detection (GC/MS) analysis and it has been tested in a chamber and in field conditions. The method can be used simultaneously to measure volatile organic compounds and exposure to tobacco smoke. We recommend nicotine, collected by active sampling, as an indicator for the evaluation of the exposure to environmental tobacco smoke spreading from smoking areas.
Air Pollution, Indoor↗
Transitional cell carcinoma and right ventricular obstruction.
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Carcinoma, Transitional Cell↗
Primary PTCA in a Rural Hospital.
The results of primary percutaneous transluminal coronary angioplasty (PTCA) to treat patients with acute myocardial infarction in a rural hospital were reviewed. Thirty-five patients presenting with acute myocardial infarction, including 40% considered high risk, were treated using the strategy of primary angioplasty. Following cardiac catheterization, two patients were found to have anatomy deemed unsuitable for primary angioplasty and subsequently underwent urgent coronary artery bypass graft (CABG) surgery. Thirty-three patients underwent primary angioplasty with a procedural success rate of 94%. Procedural success was defined as reduction of the infarct arteries stenosis to less then 50% and the establishment of TIMI-III flow. Six percent of these patients required urgent CABG surgery because of unsuccessful angioplasty. In-hospital cardiac mortality was 3%. Six month follow-up was achieved for all patients. There were no cardiac deaths following hospital discharge. Recurrent ischemia occurred in 17% of the patients. Favorable in-hospital and late results were achieved. This review indicates that the strategy of primary angioplasty to treat myocardial infarction may be successfully applied in a rural setting.
Journal Article↗
Surgery and the management of peripheral lung tumors adherent to the parietal pleura.
Among 37 patients with peripheral T3 lung lesions, preoperative clinical and imaging evidence was suggestive of T3 disease in 28 and of T2 disease in nine. Intraoperatively, the T2 designation was changed to T3 on the basis of adherence of the tumor to the parietal pleura. All had mediastinoscopy followed by resection and complete lymph node dissection. There were 17 lobectomies and 20 pneumonectomies. The chest wall was resected in continuity with the lung in 21 patients, and in 16 only an extrapleural resection was done. Follow-up was completed in all patients (range 2 to 14 years, median 7 years). The 5-year actuarial survival rate for all patients was 30%. As expected, the presence of lymph node metastasis affected the 5-year actuarial survival rate: N0 = 41%; N1 = 29%, and N2 = 0%. Histologic examination of the resected specimen confirmed a T3 lesion in 30 patients. The tumor was removed completely in 100% of patients whose chest wall was resected in continuity with the lung but in only 31% in whom an extrapleural resection was done. In the absence of lymph node metastasis, the 5-year survival rate of patients after en bloc resection of the chest wall was 50% compared with 33% for those with extrapleural resection (p less than 0.05). The finding of a peripheral lung tumor adherent to the parietal pleura indicates, in most instances, extension through the parietal pleura. When tumor is firmly adherent to the parietal pleura, an en bloc resection of the chest wall rather than an extrapleural dissection should be performed. This assures complete tumor removal and improves the probability of long-term survival.
Carcinoma, Non-Small-Cell Lung↗
Airway obstruction following transhiatal esophagogastrectomy.
A 79 year old man suffered acute respiratory distress secondary to delayed gastric emptying several months following esophagogastrostomy. No drainage procedure was performed at the time of the procedure. The need for a drainage procedure is controversial. Symptoms of gastric stasis have reportedly improved with a drainage procedure and the risk of concomitant pyloromyotomy or pyloroplasty has been shown to be minimal and may prevent a potentially catastrophic complication as described in this report.
Aged↗
Lyme disease of the CNS: MR imaging findings in 14 cases.
The MR images of 14 patients with clinical diagnoses of Lyme disease, CNS complaints, and positive Lyme titers were reviewed. MR examinations were abnormal in 43%. Areas of abnormal signal were identified within the cerebral white matter as well as within the brainstem.
Adolescent↗
Injections for joint and soft tissue disorders: when and how to use them.
Joint and soft tissue injections may be the only way to differentiate various arthritic disorders, accurately identify a septic joint, and apply focused treatment. Certain considerations can make these injections safer and more effective. This article reviews the principles of diagnostic and therapeutic use of joint and soft tissue injections and makes specific recommendations for common injection sites. Also described are appropriate aseptic techniques for aspirating and injecting joints, bursae, and soft tissue, as well as the judicious use of corticosteroid injections in this age group.
Adrenal Cortex Hormones↗
Management of simple renal cysts during percutaneous nephrostolithotomy.
Simple renal cysts can coexist with renal stones. Percutaneous removal of these stones requires special considerations. We describe the management of 2 patients with this problem and propose a simple logarithm.
Aged↗
Central giant cell granuloma of the jaws: experiences in the management of thirty-seven cases.
This report reviews experiences in the management of 37 cases of central giant cell granuloma of the jaws. The statistical analysis includes location, age, sex, size on initial presentation, and other variables relating to incidence and distribution. The technique of curettage or curettage with peripheral ostectomy was used in all cases treated surgically, resulting in no evidence of disease in 21 out of 23 cases followed postoperatively for 2 or more years. Radiation therapy was curative in one instance. Preoperative endodontic therapy for teeth in the field of surgery has proved to be advantageous. The pathogenesis of the giant cell granuloma of the jaws is discussed.
Adolescent↗
Surgical treatment of the parathyroid gland in patients with end-stage renal disease.
During the period from December 1984 to December 1986, ten patients with end-stage renal disease were evaluated with hyperparathyroidism refractory to medical management. Symptoms were bone pain in eight patients and pruritus and constipation in two. Two patients with bone pain also had impaired mentation. Biochemical preoperative assessment revealed calcium levels between 8.7 and 11.2 milligrams per deciliter, with a median of 10.5 milligrams per deciliter. Phosphate levels were normal in all but three patients, and the phosphate-calcium product was greater than 80 in two. Parathyroid hormone levels assessed with the radioimmunoassay method were elevated in all patients, and results of ultrasound of the neck, done in seven patients, revealed hyperplastic glands in six patients and normal glands in one patient. All patients underwent surgical exploration of the neck with removal of four parathyroid glands and immediate autotransplantation. No complications related to the operative procedure occurred. Postoperative calcium levels ranged between 6.5 and 9.5 milligrams per deciliter on the first postoperative day and normalized by the sixth day. Four patients experienced symptomatic hypocalcemia requiring intravenous calcium supplementation for one to six days postoperatively. The mean hospital stay was four days (three to seven days). All patients had histologically confirmed four gland parathyroid hyperplasia. Marked improvement of symptoms was accomplished in all patients after a period of three to 30 days. One patient required revision of the forearm parathyroid transplant after four months. One patient required calcium supplementation taken orally, two patients required 1,25-Dihydroxyvitamin D3 and five required treatment with both. Two patients did not require any further medical treatment, and no patient had recurrent symptoms after a mean follow-up period of eight months. We recommend total parathyroidectomy with autotransplantation in patients with end-stage renal disease as a safe and effective procedure for symptomatic refractory hyperparathyroidism. Symptom relief can be accomplished in the vast majority of patients.
Adolescent↗
The unbreakable stone?
A case of a failed percutaneous ultrasonic lithotripsy is reported as an unusual occurrence.
Humans↗
CT evaluation of pancreatic injury following splenectomy.
A fluid collection in the left subphrenic space immediately after splenectomy is often associated with pancreatic injury. The configuration, location, and vascular supply of the tail of the pancreas explain this postoperative complication. Depending on the degree of injury, the CT findings may show swelling of the tail of the pancreas, ill-defined fluid collections, or a well-encapsulated pancreatic pseudocyst. The diagnosis is confirmed by percutaneous aspiration with amylase determinations and the demonstration of a pancreatic fistula. Failure to diagnose this complication promptly may lead to a protracted postoperative clinical course and the development of a subphrenic abscess or a pancreatic pseudocyst.
Adult↗
CT findings in acute renal infarction.
CT scans of 12 patients with renal infarcts were reviewed. CT findings along with the clinical presentation were diagnostic in 10 cases. Correlation with angiography (5 cases) and sonography (8 cases) was made. The diagnosis of renal infarction can usually be made on the basis of specific CT findings. Angiography is valuable in helping to establish the cause and direct treatment.
Acute Disease↗
Management of symptomatic renal angiomyolipomas by embolization.
Renal angiomyolipomas are benign tumors which occur commonly in association with tuberous sclerosis or as isolated lesions. Symptomatic angiomyolipomas, particularly those in patients with tuberous sclerosis, should be approached conservatively with the goal of preserving as much normal renal tissue as possible. We report 2 patients in whom selective embolization was used to achieve this goal.
Adult↗