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Biomedical subjects

P Crummer

Publications and source records attributed to P Crummer.

10 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

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↗
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

Neuromuscular symptoms in elderly patients with hyperparathyroidism: improvement with parathyroid surgery.

In a consecutive series of 100 neck explorations for primary hyperparathyroidism, 42 patients were 60 years of age or older; in this group of elderly patients the surgical cure rate was 100%. These patients were reviewed retrospectively by means of a structure interview. Twenty-one patients had had preoperative neuromuscular symptoms that ranged from coma to subjective muscular weakness. These patients had significantly-higher preoperative serum calcium and parathyroid hormone levels than did 21 patients without neuromuscular symptoms (P = 0.003 and P = 0.046, respectively). Most of the neuromuscular symptoms improved in the postoperative period. In particular, 15 of 17 patients with muscle weakness reported a significant improvement, while 14 of 15 patients who suffered from fatigue and lethargy reported an improvement. An improvement also occurred in the level of day-to-day function in eight patients. While surgery for primary hyperparathyroidism generally is undertaken for a specific indication, such as severe hypercalcaemia or renal stones, it appears from this study that neuromuscular symptoms also may improve, particularly in elderly patients.

Adolescent↗
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

Hydatid disease at Royal North Shore Hospital: results of surgical treatment.

A study of the results of surgery for hydatid disease was undertaken at Royal North Shore Hospital for the period 1966-83. There were 51 patients who underwent surgery for this disease and follow-up was obtained in all but eight cases. Comparison of cumulative survivals for this group with that of a matched Australian population showed that patients undergoing surgical treatment of their hydatid can anticipate a normal life expectancy. There was no evidence that patients with extrahepatic disease fared any worse than those with disease confined to the liver. Documented recurrence of hydatid disease occurred in eight cases following surgery and only one patient actually died from hydatid disease. This was a case in which spillage occurred at the initial procedure. This paper is presented as a reminder that hydatid disease still occurs with sufficient frequency to pose therapeutic problems for surgeons. Whilst total eradication of the parasite will only occur with enforcement of public health measures, surgery would still appear to be effective therapy for established hydatid disease so long as care is taken to avoid cyst rupture.

Adolescent↗
PubMed1987

Thyroid surgery in the elderly.

Thyroid disease is common in the elderly but appropriate surgical procedures are frequently avoided in the belief that the patient's age precludes a successful outcome. This avoidance may result in surgery having to be performed at a later stage as an emergency when conditions are not necessarily ideal for treatment of airway obstruction by goitrous tissue. Between 1970 and 1985, 575 patients aged over sixty years underwent thyroidectomy in The University of Sydney Department of Surgery at Royal North Shore Hospital. The most commonly performed procedure was total thyroid lobectomy (185); there were however a significant number of total thyroidectomies (86), 41% for benign and 59% for malignant thyroid pathology. The complication rate was considered to be acceptably low in this group. Complications of thyroid surgery itself occurred in 1.2%, recurrent laryngeal nerve palsy 1%, and hypoparathyroidism 0.2%. Other complications (4.8%) were those to be expected in an elderly patient population with multiple pathology and comprised myocardial infarction, cardiac arrhythmias and respiratory problems. There were 2 deaths in this group (0.4%), one occurred when the endotracheal tube perforated the trachea of a patient whose thyroid malignancy proved to be invading the trachea. The accumulated data in this study showed that age, regardless of pathological classification, was the major single prognostic factor for survival in thyroid malignancy. Aged patients can undergo thyroid surgery with no significantly added risk provided specific associated problems are addressed before operation.

Aged↗
PubMed1986

The impact of fine-needle aspiration biopsy on surgery for single thyroid nodules.

Biopsy by fine-needle aspiration has emerged as the most effective single technique for the investigation of single thyroid nodules. A comparison was made of patients who underwent surgery for single nodules in 1979 (before the introduction of fine-needle aspiration biopsy to this Department) and in 1984, after this technique had become fully established. Biopsy by fine-needle aspiration proved to be reliable in the selection of patients for surgery. The incidence of malignancy in each category was: malignant, 83%; atypical, 26%; inadequate, 7%; and benign, none. This contrasted with nuclear scanning and ultrasound techniques that were in use over that period, where the malignancy rate of nodules that showed no uptake of radioisotope was 11% and that of an ultrasound scan that demonstrated a "solid" or "cystic/solid" was 16%. Similarly, nodules that showed an uptake of radioisotope or an ultrasound scan that demonstrated a "cystic" image did not exclude malignancy reliably. As a result of fine-needle aspiration biopsy, there was a 60% reduction in the number of thyroidectomies for single nodules during its use with a higher yield, but no change in the absolute number, of patients with malignancy of the thyroid gland.

Adult↗
PubMed1986

Total thyroidectomy in the management of differentiated thyroid cancer: a review of 258 cases.

Controversy continues to surround the management of differentiated thyroid cancer. For the past 20 years, a standardized protocol of total thyroidectomy followed by radioiodine ablation has been followed at Royal North Shore Hospital. During the period 1966-83, 327 cases of thyroid malignancy were treated surgically and, of these, 258 were differentiated thyroid cancer. Following total thyroidectomy, the incidence of recurrent nerve palsy was 2.8% and that of permanent hypoparathyroidism 3.2%. The overall 10 year cumulative survival for these patients was 87%. Whilst there were apparent differences in survival depending on the pathological type of tumour (papillary, follicular, mixed), further analysis shows that most of the differences in prognosis can be explained on the basis of age and sex alone. Young patients (less than 60 years) have an excellent 10 year survival (96%) whilst that for the elderly is only 61%. Males have a worse prognosis at 10 years than females. Total thyroidectomy is a safe procedure for the treatment of differentiated thyroid cancer. It allows the subsequent evaluation and treatment of unrecognized metastatic disease and offers the young patient a potentially normal lifespan.

Adenocarcinoma↗