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Biomedical subjects

R D Liechty

Publications and source records attributed to R D Liechty.

At least 19 recordsLinked to original sources
PubMed1994

Reexploration and angiographic ablation for hyperparathyroidism.

OBJECTIVE: Persistent and recurrent hyperparathyroidism remains a challenging clinical problem. The purposes of this study were to determine the causes of initial failure, the accuracy of preoperative localization tests, the role of angiographic parathyroid ablation, and the safety and efficacy of reexploration for hyperparathyroidism. DESIGN: A retrospective review of 42 patients undergoing reexploration or angiographic ablation for hyperparathyroidism was done, with a mean follow-up of 3 years, 7 months (range, 1 month to 13 years). SETTING: This study was carried out in a university medical center and a Veterans Affairs hospital. PATIENTS: All patients who underwent reexploration or angiographic ablation for hyperparathyroidism were included. INTERVENTION: All patients underwent preoperative localization studies. The cervical approach was used when the abnormal gland was suspected to be in the neck or the mediastinum superior to the aortic arch; sternotomy was used for deeper mediastinal glands not resectable through a cervical approach. Angiographic ablation of mediastinal glands was performed using contrast administration after a catheter was wedged into the selective feeding artery. MAIN OUTCOME MEASURES: End points included causes of initial treatment failure, accuracy of preoperative localization studies, long-term correction of hypercalcemia with repeated treatment, need for subsequent intervention for hypercalcemia, and complications of therapy. RESULTS: The most common reasons for initial failure were mediastinal glands (18 patients), surgeon's inexperience (12 patients), supernumerary glands (six patients), and other anatomic anomalies. Hyperplasia accounted for hyperparathyroidism in 11 patients (26%) and adenomas in 31 patients (74%). Preoperative localization studies included technetium-Tc-99m-sestamibi scanning (sensitivity, 86%), technetium-thallium scanning (67%), arteriography (63%), venous sampling (52%), computed tomography (42%), magnetic resonance imaging (33%), and ultrasonography (27%). Thirty-three (89%) of 37 patients who underwent reexploration had resolution of hypercalcemia. Localization study results were negative in all four patients who experienced failure. Angiographic ablation was successful in four (67%) of six patients. One of the patients with a failed ablation had successful mediastinal exploration. Hypoparathyroidism occurred in six patients (14.3%) and there was no instance of recurrent nerve injury. CONCLUSIONS: The most common causes of initial failure were ectopic mediastinal glands and incomplete surgical exploration; the most sensitive preoperative localization study is the technetium-Tc-99m-sestamibi scan; angiographic ablation of parathyroid tissue is most useful for poor-risk surgical patients or to avoid median sternotomy; and reexploration and angiographic ablation yield a high success rate with acceptable morbidity and mortality.

Adenoma↗
PubMed1992

Parathyroid anatomy in hyperplasia.

Pathologically enlarged parathyroid glands offer the surgeon a vital medium for studying parathyroid anatomy. The advantages include gland magnification, rapid-section diagnosis to aid dissections, and postoperative clinical and laboratory responses to check for "missed" or supernumerary glands. In this series, each of 71 patients had at least four hyperplastic glands. Both mediastinal and intrathyroidal glands occurred in nine instances (13%), supernumerary glands in eight (11%), and ectopic neck glands in seven (10%). In total, anomalous parathyroid glands occurred in almost half (46%) of these patients with parathyroid hyperplasia.

Humans↗
PubMed1990

Spontaneous bile duct rupture in pregnancy.

Spontaneous bile duct rupture occurred in a 23-year-old who required emergency Cesarean section for fetal distress. This condition has not been reported in association with pregnancy. Only forty cases of spontaneous bile duct perforation in adults have been previously reported. Seventy percent of these perforations were related to biliary calculi. Sites of perforation were evenly distributed between common hepatic duct and common bile duct. Recommended treatment includes cholecystectomy, common bile duct exploration, T-tube placement, and Roux-En-Y ductal anastomosis if disruption is extensive.

Adult↗
PubMed1986

The tiny parathyroid adenoma.

In the past 11 years we have operated on three patients with "tiny" parathyroid adenomas (less than 60 mg). Two of these adenomas were virtually indistinguishable visually from the normal glands. (The third adenoma was found only after fixation and permanent sections.) Despite frozen-section diagnoses of "probable hyperplastic tissue" in two cases, these small hyperplastic glands proved confusing at operation. This was especially true of the hyperactive gland embedded within mediastinal tissue that, on initial examination of gross material, had been missed by surgeons and pathologists alike and was discovered only on permanent serial sections. The preoperative laboratory data did not vary substantially from that of other hyperparathyroid patients with larger adenomas; in each case two or more endocrinologists had agreed that parathyroidectomy was indicated and had referred these patients for operation. Permanent microscopic sections confirmed the diagnosis of parathyroid adenoma in all three patients. The clinical and laboratory postoperative data strongly indicate that these small adenomas, masquerading as normal-sized glands, were responsible for the hypercalcemia. These tiny adenomas should be added to the other anatomic and pathologic variations of the parathyroid glands that can prove confusing at operation.

Adenoma↗
PubMed1985

Psychiatric evaluation in gastric surgery for obesity.

Gastroplasty, a newer form of surgery for morbid obesity, produces physical and psychosocial benefits equivalent to those of jejunoileal bypass, but with fewer complications. As interest in this approach to intractable obesity has increased, surgeons have looked to psychiatrists to help them to assess psychiatric risk associated with undergoing surgery. Drawing on a review of the literature and long-term experience with patients requesting gastroplasty, this review addresses the benefits of gastroplasty and offers suggestions about when and how to perform preoperative psychiatric evaluations in patients requesting surgery for obesity.

Adolescent↗
PubMed1985

Endoscopic jejunal feeding tube through decompressing gastrostomy.

A simple technique is presented to provide rapid, accurate placement of a jejunal feeding tube through a decompressing gastrostomy using readily available supplies. Transgastrostomy feeding tube placement avoids prolonged nasal intubation and this endoscopic technique allows easy changing of the feeding tube should the need arise.

Enteral Nutrition↗
PubMed1984

The anatomy of parathyroid hyperplasia.

Parathyroid hyperplasia aids the surgeon in studying parathyroid anatomy for several reasons: (a) Nature magnifies the glands in hyperplasia; (b) there is a strong clinical imperative to find all glands; (c) histologic controls help guide the dissections; and (d) postoperative clinical and laboratory responses help determine the presence of supernumerary glands. In this study of parathyroid hyperplasia we found four glands in each of 34 patients (136 glands total--37 operations). Six patients (18%) had parathyroid glands totally covered by thyroid tissue, five patients (15%) had mediastinal glands, one patient (3%) had a retroesophageal gland, and one (3%) had a "kissing pair." In addition, after four-gland parathyroidectomy, three patients gave evidence of functioning supernumerary glands (9%). Abnormalities in parathyroid anatomy occurred in almost half (47%) of these patients with parathyroid hyperplasia.

Adolescent↗
PubMed1983

The thyrotoxicosis/thrombocytopenia connection.

The association between thrombocytopenia and thyrotoxicosis is well documented in the medical literature. The theories for this relationship include a common immunologic cause and a thyrotoxic-induced decrease in platelet survival. Twenty-two months ago, we performed a subtotal thyroidectomy on a young woman with both disorders who was referred to us for splenectomy with the sole diagnosis of idiopathic thrombocytopenic purpura (ITP). After operation she was weaned from all medications, and she remains euthyroid. Although her platelet count has recently dropped to 80,000/mm3 after a series of upper respiratory infections, she remains free of petechiae and bleeding diathesis. She illustrates two points: thyrotoxicosis should be ruled out in all patients with ITP, and when the two diseases coexist, treatment of the thyrotoxicosis should precede splenectomy. In most instances, this will induce a remission in the ITP that may be permanent.

Adult↗
PubMed1983

Modified subtotal thyroidectomy for Graves' disease: a two-institution study.

In an effort to decrease the large number of patients who develop hypothyroidism after operations for Graves' disease, an identical modification of the conventional subtotal thyroidectomy (CST) was independently designed and tested in a prospective study at two institutions. The modified subtotal thyroidectomy (MST) essentially consists of leaving an accurately measured 5 gm thyroid remnant and an intact inferior thyroid artery on each side of the neck. By use of MST, euthyroidism, as demonstrated by serial clinical and thyroid function tests, has been achieved in 92% of a combined group of 107 patients followed longer than 2 years (average 62.1 months). Postoperative hypothyroidism developed in only two cases (2%), representing a marked improvement over the 40% to 75% rate of hypothyroidism resulting from CST. Recurrent hyperthyroidism occurred in only six cases, a rate of recurrence indistinguishable from that resulting from the more extensive resection required by CST. Enlargment of total remnant size to a total of 10 gm significantly improves long-term postoperative functional results without risking an increase in recurrence. The functional results obtained after MST are superior to those obtained after treatment with radioiodine and justify renewed interest in the surgical treatment of Graves' disease.

Adolescent↗
PubMed1981

Limited subtotal thyroidectomy for Graves' disease.

Limited subtotal thyroidectomy was performed in 42 of 43 patients with Graves' disease. Twenty of 23 patients (87%) who were followed up for an average of 54 months after operation remained euthyroid. Only one patient (4.3%) had recurrent thyrotoxicosis. There were no deaths and no permanent complications. A coexisting, invasive papillary cancer necessitated total thyroidectomy in one patient, and occult papillary cancers were discovered histologically in three others. This study supports the thesis that postoperative thyroid function depends on the volume of remaining thyroid tissue. While preserving thyroid function, limited subtotal thyroidectomy lowers postoperative complications and induces no increase in recurrent thyrotoxicosis.

Adolescent↗
PubMed1981

Traumatic thrombosis of the inferior vena cava.

A case of a 21-year-old male with blunt abdominal trauma and subsequent acute thrombosis of the inferior vena cava, presenting as abdominal pain, is reported. The apparent mechanism of proximal inferior vena cava thrombosis with distal extension into the iliac veins differs from that suggested in earlier reports. Resolution of symptoms was achieved by heparinization and bedrest alone, in spite of thrombus in the suprarenal vena cava.

Abdominal Injuries↗
PubMed1977

Solitary thyroid nodules.

A study was made of 67 patients with solitary thyroid nodules in which strict criteria to eliminate the probability of cancer, including a history of radiation to the neck, were used. Twelve (17.9%) were found to have histologic malignancy. This figure is threefold that of a study made by one of the authors 11 years earlier, but comparable to others more recently reported from cancer centers elsewhere. It is not certain whether the apparent increase is actual or merely the result of more careful screening of patients for referral. Shrinking of the nodule by thyroid suppression therapy had been definite but incomplete in three nodules, one of which was found to be malignant. Excision is recommended for all persistent thyroid nodules.

Adenoma↗
PubMed1975

Cholecystectomy with and without surgical drainage.

Thirty-seven patients who met specific criteria had cholecystectomy without drainage, and thirty-seven matched control patients had cholecystectomy with drainage. This study suggests that surgical drainage after every uncomplicated cholecystectomy is unnecessary and may be unwise. Such drainage may result in an increased incidence of postoperative morbidity and prolonged hospital stay.

Adolescent↗