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Biomedical subjects

N W Thompson

Publications and source records attributed to N W Thompson.

At least 181 records · Page 10Linked to original sources
PubMed1981

Scintigraphic localization of pheochromocytoma.

We used a new radiopharmaceutical agent, [131I]meta-iodobenzylguanidine ([131I]MIBG), to produce scintigraphic images of pheochromocytomas in eight patients. One day or more after injection, the only normal organ that displayed distinct concentrations of radioactivity was the urinary bladder. The [131I]MIBG was probably concentrated in adrenergic vesicles; in tissues where vesicles are numerous, such as pheochromocytomas, the radionuclide was retained for days. The spectrum of pheochromocytomas shown the scintigrams was broad: intra-adrenal and extraadrenal in location, benign and malignant in character, 0.2 to 65 g in weight, and with different hormone patterns in secretion. Tumors in four patients were not detected by computed tomography. In one patient, reoperation was undertaken only because the scintigram located the extra-adrenal tumors and thereby directed the surgeon's exploration. The method offers hope of safe and reliable localization of pheochromocytomas in their many guises.

3-Iodobenzylguanidine↗
PubMed1981

Nesidioblastosis in adults. A surgical dilemma.

Nesidioblastosis is the leading cause of hyperinsulinemia in newborns and infants. To our knowledge, it has not been previously reported in adults unless associated with other diseases. Three males and three females, aged 11 to 57 years, are described. Pancreatic resections ranged from 50% to 100%. Postoperatively, three patients were normoglycemic, two were insulin-dependent diabetics, and one had recurrent hypoglycemia controlled by drugs. The histologic findings in adults were very similar to those in infants with nesidioblastosis. It appears that a minimum resection of 75% to 80% of the pancreas will benefit the majority of patients, alleviating hypoglycemia and preventing the development of diabetes.

Adult↗
PubMed1981

Selective management of penetrating neck trauma. Cost implications.

Many authors advocate mandatory surgical exploration for all patients with penetrating neck trauma, while other maintain that with careful diagnostic evaluation some patients safely can be spared an operation. From our hospitals, 65 cases of penetrating neck trauma were reviewed, 27 of which showed no mortality without operation. Surgical exploration of the neck showing no injury added $1,930 to the cost of hospitalization. Review of the surgical literature discloses that mortalities reported by authors advocating selective and mandatory exploration are similar. The incidence of missed significant injury is low among patients observed selectively. A management algorithm for the diagnostic evaluation and treatment of patients with penetrating neck trauma is advocated. All stable patients should undergo four-vessel angiography. Studies of the cervical esophagus may be performed. Patients with entirely normal diagnostic evaluations may be observed safely, sparing unnecesary operation.

Adolescent↗
PubMed1981

Pancreaticoduodenectomy and celiac occlusive disease.

Pancreaticoduodenectomy is currently associated with an average perioperative mortality rate of 25%. Breakdown of the pancreaticojejunal anastomosis accounts for the greatest morbidity and usually results from technical complications. The potential contribution of unsuspected celiac occlusive disease to anastomotic dehiscence remains unclear. Two patients with biopsy-proven carcinoma of the head of the pancreas, in addition to arteriographic evidence of hemodynamically significant stenosis or occlusion of the celiac artery, recently underwent potentially curative pancreaticoduodenal resection and simultaneous celiac revascularization using a splenic to superior mesenteric artery reimplantation technique. Neither patient experienced postoperative complications. Inadvertent sacrifice during pancreaticoduodenectomy of celiacomesenteric collateral pathways which have developed in response to chronic celiac artery insufficiency may predispose to ischemia of the upper abdominal viscera and this contribute to postoperative complications such as liver failure and anastomotic breakdown. Selective celiac and superior mesenteric arteriography is recommended prior to pancreaticoduodenectomy. If high grade ostial stenosis or occlusion of the celiac axis is demonstrated by preoperative arteriography, strong consideration should be given at the time of pancreaticoduodenal resection to simultaneous celiac revascularization.

Adenocarcinoma↗
PubMed1981

Spontaneous cervical hematoma: a rare manifestation of parathyroid adenoma.

Extracapsular hemorrhage from spontaneous rupture of a hyperplastic parathyroid gland is exceedingly rare. Rupture of an intrathoracic parathyroid adenoma mimicking a dissecting thoracic aortic aneurysm has been reported in two cases. Hypercalcemic crisis associated with contained hemorrhage within a parathyroid adenoma has been well documented. We present the first reported case of spontaneous rupture and extracapsular hemorrhage of a cervical parathyroid adenoma. Serum calcium levels should be obtained when spontaneous cervical or mediastinal hemorrhage develops without obvious cause.

Adenoma↗
PubMed1981

Mesenteric angiopathy, intestinal gangrene, and midgut carcinoids.

Twenty-six cases of carcinoid-related mesenteric angiopathy and intestinal infarction (three from our institution and 23 previously reported cases) were reviewed. Twenty patients presented with acute abdominal findings, including peritonitis (13 cases), intestinal obstruction (five cases), and bleeding per rectum (two cases). Fifteen patients (75%) experienced antecedent symptoms of abdominal pain and/or diarrhea, averaging 2.5 years in duration. Twelve patients (46%) exhibited symptoms of carcinoid syndrome. Mesenteric angiography in three cases demonstrated encasement and segmental branch narrowing or occlusion of major mesenteric vessels. Eleven patients underwent resection and primary bowel anastomosis with an early survival rate of 91%. Four additional patients who underwent lesser surgical procedures and five patients who did not undergo operation all died. Elastic vascular sclerosis (EVS) was identified in 19 of 22 cases with available histologic material (86%). These changes were observed in proximity to as well as distant to the primary tumor. In general, the severity of EVS did not correlate with the likelihood of gut ischemia. Although not the sole cause of intestinal gangrene in patients with midgut carcinoids, EVS may contribute significantly to the evolution of these ischemic changes.

Adult↗
PubMed1980

Technical dilemmas in portacaval shunt operations as a consequence of replaced right hepatic artery.

Surgical procedures designed to decompress the portal venous system in patients with cirrhosis and bleeing esophageal varices may be complicated by anatomic variations in the extrahepatic arterial circulation. Anomalous right hepatic arteries which arise from the superior mesenteric artery may be encountered in 18 to 20 per cent of the normal population. Replaced arteries are not accessory vessels but rather provide the sole arteries circulation to well defined segments of the liver. Unfortunate injury may result in severe ischemic truama of the liver. Preoperative vicseral arteriography is essential prior to any contemplated portosystemic shunt procedure. The unusual anatomic relationship of such an anomalous right to hepatic artery to the portal vein may contraindicate standard portacaval, interposition portacaval or portarnal shunt procedures; graft angulation and anastomotic distortion may jeopardize shunt patancy and result in recurrent variceal hemmorrhage. A technique for portal vein-hepatic artery transposition and end-to-side portacaval shunt is presented as a feasible alternative if anomalies of the hepatic artery preclude standard shunt procedures.

Hepatic Artery↗
PubMed1979

Multiple adenomas of the parathyroids: do they exist?

Since Cope's original description of chief cell hyperplasia in 1958, there has been general agreement that this entity is the most common cause of multiple parathyroid enlargement. Whether or not multiple adenomas of the parathyroid glands ever occur has been seriously questioned. Criteria are proposed for defining the entity of multiple parathyroid adenomas in contrast with hyperplasia. With the use of these criteria, five patients with multiple adenomas were found in our last 300 cases of primary hyperparathyroidism.

Adenoma↗
PubMed1978

Hereditary neonatal hyperparathyroidism.

Neonatal hyperparathyroidism usually presents as a "failure to thrive" syndrome. It may be transmitted as an autosomal dominant trait and may involve more than one offspring. We report on two brothers with neonatal primary hyperparathyroidism. One underwent a total parathyroidectomy and has lived for 14 years. Hyperparathyroidism was found in their father, suggesting autosomal dominant inheritance. The disease is fatal unless recognized early and treated. The characteristic pathological change is chief cell hyperplasia of the parathyroid glands. Near-total parathyroidectomy is the minimal operation required to control the hypercalcemia. Permanent hypoparathyroidism may be the sequel of appropriate surgical management. Treatment of the totally parathyroidectomized infant, however, is possible and can result in normal growth and development.

Adult↗
PubMed1978

Management of severe hypercalcemia caused by primary hyperparathyroidism.

Hypercalcemic crisis is a rare but often fatal complication of hyperparathyroidism (HPT). The reported mortality of 60% has been related to delay in diagnosis and appropriate treatment. During a 16-year period (1961 to 1977), 29 patients with severe symptomatic hypercalcemia caused by primary HPT were treated at the Surgical Service at the University of Michigan Hospital. This group represents 6% of the patients with primary HPT treated during this period. All but one patient had an exploration of the neck when the serum calcium level had been decreased to 12 mg/100 ml by intravenous hydration with saline, furosemide diuresis, and mithramycin when a hypocalcemic agent was required. One comatose patient died of irreversible shock. All of the 28 patients who had parathyroidectomies survived the early postoperative period. One patient died three weeks later of a myocardial infarction. This study demonstrates that emergent nonoperative care of parathyroid crisis, followed promptly by parathyroidectomy, can be successful in nearly all cases.

Adult↗
PubMed1978

MEN type IIa syndrome: dilemmas in modern management.

With the use of newer techniques, the multiple endocrine neoplasm II-A syndrome can now be diagnosed early in its evolution. This article discusses the clinical course of the syndrome, the diagnostic modalities employed, and the therapeutic interventions required. An approach to the individual patient with this syndrome is presented.

Adolescent↗
PubMed1978

Follicular carcinoma of the thyroid with massive angioinvasion: extension of tumor thrombus to the heart.

Angioinvasion is a well documented microscopic characteristic of follicular carcinoma of the thyroid. Patients with untreated tumors may die from local invasion or metastases to the lungs, bones, or other organs. A less well recognized cause of morbidity and death from this neoplasm is angioinvasion of cervical veins with direct extension into the great veins of the chest, to the heart. Six instances of this complication have been reported previously. The most common clinical presentation of patients with neoplastic thrombus within the great veins is the superior vena cava syndrome. In each case the patient died as a result of the vascular or cardiac involvement, shortly after diagnosis. The patient reported is the first in which follicular carcinoma with extensive angioinvasion was treated. A clinical diagnosis of superior vena cava syndrome was confirmed by angiographic studies. Resection of the primary thyroid tumor and the angioinvasive extension to the heart plus 131I therapy have controlled the malignancy for at least 3 years.

Adenocarcinoma↗
PubMed1977

Intermittent dislocation of the liver. A syndrome associated with volvulus of the transverse colon and stomach and obstructive jaundice.

Displacement of the right lobe of the liver into the left upper abdominal quadrant can occur only if the diaphragmatic attachments are congenitally absent or traumatically disrupted. To our knowledge, the former situation has not been previously described in an adult patient. A young man with a lifelong history of unexplained intermittent, bizarre upper abdominal pain was found to have a freely movable right lobe of the liver that was attached only to the inferior vena cava. When this lobe was intermittently displaced into the left upper abdomen, volvuli of both the stomach and transverse colon developed. Stretching and tension of the common bile duct on the round ligament resulted in intermittent jaundice. At operation, these findings were confirmed, and the right liver lobe was secured to the diaphragm in its normal position. In addition, the mesenteric attachments of the liver, stomach, and colon were plicated. The patient has had complete relief of all symptoms for the two years since his operation.

Adult↗