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Biomedical subjects

R T Myers

Publications and source records attributed to R T Myers.

At least 19 recordsLinked to original sources
PubMed1989

Rupture of the liver and right hemidiaphragm presenting as right hemothorax.

A young man hit by a car while riding his motorcycle presented with reversible hypotension, a compression fracture of C6, fractures of the left femur and of ribs 9-12 on the right, and right hemothorax. A falsely negative peritoneal lavage delayed laparotomy, which, when done, demonstrated two right diaphragmatic rents with bleeding into the right chest from a severe liver injury. Presentation of this case demonstrates that while peritoneal lavage is an excellent way to exclude intraperitoneal hemorrhage following blunt abdominal trauma, false-negative results may occur in the setting of hemorrhage with diaphragmatic rupture.

Abdominal Injuries↗
PubMed1988

Causes of the failed cervical exploration for primary hyperparathyroidism.

Over a period of 42 years, 581 patients with presumed hyperparathyroidism underwent an initial cervical exploration. Abnormal parathyroid glands were removed from 495 patients (85.2%). There was a greater probability of operative success in women, patients over 50 years of age, and patients with hypercalcemia, hypertension, or nonspecific abdominal pain. There was no association of operative outcome with some of the "classic" manifestations of hyperparathyroidism--peptic ulcer disease, neuropsychiatric symptoms, pancreatitis, bone disease, or urolithiasis. The probability of surgical success improved with time, increasing from 56 per cent in the 1950s to 97 per cent in the present decade. This improvement appears to be related to greater operative experience, since all four parathyroid glands were more likely to be found with increased experience, and there was a strong correlation between finding four parathyroids and achieving persistent normocalcemia. The most common causes of operative failure were inaccurate calcium assays (the patient was not truly hypercalcemic), an inappropriate diagnosis ("normocalcemic hyperparathyroidism"), and surgical inexperience. These three factors accounted for at least three fourths of all negative explorations. More accurate diagnostic studies, and careful exploration by an experienced surgeon should maximize the probability of a successful operation for primary hyperparathyroidism.

Calcium↗
PubMed1987

The significance of nuclear diameter in the biologic behavior of thyroid carcinomas: a retrospective study of 127 cases.

The relationship between nuclear diameter and biologic behavior was studied in 127 cases of thyroid carcinoma. Using a sonic digitizer coupled to a minicomputer, nuclear diameters of 200 randomly selected cancer cells from each case (hematoxylineosin-stained paraffin sections) projected at X 400 magnification were traced and averaged. A total of 25,400 measurements were made. The nuclear diameters varied from 4.7 to 13.1 micron. By analysis of variance, the nuclear diameters were significantly different (p = 0.0007) among the four types of thyroid cancers, being largest in the undifferentiated cancers (8.7 +/- 0.8 micron) and smallest in the medullary cancers (6.6 +/- 0.1 micron). Nuclear diameter was also significantly correlated with degree of tumor differentiation (p = 0.002), maximal tumor diameter (p = 0.03), mitotic rate (p = 0.002), and 5-year survival (p less than 0.05) for all types of tumors. The correlation between nuclear diameter and disease stage was significant only for undifferentiated cancers (p = 0.04). No significant correlations were seen between nuclear diameter and duration of disease, sex, or age of the patient.

Adolescent↗
PubMed1986

Occult lesions of the breast.

The biopsy of 148 clinically occult lesions of the breast found at mammographic examination yielded 21 instances of carcinoma (14.2 per cent). Five malignant lesions were lobular or in situ carcinoma, 16 were infiltrating ductal carcinomas and 11 were minimal carcinoma of the breast. Carcinomas found by mammographic examination were smaller and less likely to be associated with metastases to the axillary nodes than carcinomas of the breast diagnosed by palpation during the same time period. Biopsy of the breast was performed by several methods: 1, quandrantectomy with the patient under general anesthesia (the results of 29 biopsies yielded five instances of carcinoma, 17.2 per cent); 2, generous excision of breast tissue with the patient under general anesthesia and the lesion being localized by geometric co-ordinates based upon the mammograms (the results of 35 excisions yielded four instances of carcinoma, 11.4 per cent), and 3, mammogram-directed needle localization (the results of 84 procedures yielded 12 instances of carcinoma, 14.3 per cent). Because needle-directed biopsy causes less distortion of the breast, we prefer it to other biopsy techniques in the evaluation of occult lesions of the breast.

Adenofibroma↗
PubMed1986

Inhibition of bacterial adhesion by antibacterial surface pretreatment of vascular prostheses.

Polytetrafluoroethylene grafts were pretreated with oxacillin, with the cationic detergent benzalkonium, or with both substances, either at room temperature or at 90 degrees C. Inhibition zones ranging from 6.4 to 15.2 mm formed around all grafts incubated on Staphylococcus aureus-streaked agar plates except control disks and those treated with oxacillin. Treated grafts were exposed in vitro to S. aureus in high concentration, followed by distilled water lavage. The graft surface was then stained with ruthenium red to stain polysaccharides and studied by scanning and transmission electron microscopy. Colonization of the graft surface by adhesive bacteria was demonstrated in all cases, although it was less prevalent on grafts pretreated with benzalkonium bound at 90 degrees C.

Adhesiveness↗
PubMed1986

Is serum parathormone assay necessary in evaluating primary hyperparathyroidism?

Serum parathormone (PTH) values are believed useful in diagnosing hyperparathyroidism and in evaluating patients before parathyroid operation. From 1975 through 1983, 328 adults patients with persistent hypercalcemia and normal renal function underwent cervical exploration for presumed primary hyperparathyroidism. Preoperative serum PTH values were obtained in 137 patients. Eight had negative explorations (5.8%): serum PTH values were normal in three patients and elevated in five. Serum PTH values were normal or low in 31 of the other 129 patients (false-negative rate = 24%). Of 191 patients for whom neither serum PTH nor nephrogenic cyclic adenosine-3',5'-monophosphate values did not were obtained preoperatively serum PTH values did not reduce the incidence of negative cervical explorations and, when obtained, they were misleading in one fourth of patients who benefitted from parathyroid exploration.

Adenoma↗
PubMed1985

The significance of mitotic rate: a retrospective study of 127 thyroid carcinomas.

The association between mitotic rate and biologic behavior was studied in 127 cases of thyroid cancer. Based on the observation of 12,700 high-power fields (HPF), the mitotic rate varied from 0 to 316 (33.3 +/- 4.9) mitoses/100 HPF. Mitotic rate differed among the four types of thyroid cancers and correlated inversely with the differentiation of the tumors, being highest (156.8 +/- 32.9) in the undifferentiated tumors and lowest (17.3 +/- 2.4) in the papillary tumors. By analysis of variance (AOVA), the relations between mitotic rate and the sex or age of the patient, maximal diameter of the tumor, and vascular or capsular invasion were assessed, but significant relations were not found (r2 = 44.2 per cent). Follow-up observation, possible in 74 patients, showed mitotic rate to be significantly related to the survival period (Student's t-test; P values ranging from 0.02 to 0.05). The patients who were alive five and ten years after surgery had had lower mitotic rates than those who had died during the same follow-up period. The correlation of low mitotic rate with a high degree of differentiation and low potential for invasion might, in part, explain the better surgical cure rates for papillary thyroid carcinoma than for other types of thyroid cancers.

Adenocarcinoma↗
PubMed1985

Modified Thiersch operation for rectal prolapse. Technique and results.

Rectal prolapse is best treated by intra-abdominal or perineal procedures that either resect the redundant rectosigmoid colon or fix the rectum within the pelvis. We have found the Thiersch procedure to be adequate treatment in patients who are high risk or who have only mild to moderate prolapse of the rectum. Over the past 20 years, we have treated 15 patients with a modified Thiersch procedure, using a knitted Dacron vascular graft to encircle the anus. One patient required a second Thiersch procedure after failure of a Ripstein procedure that followed failure of a Thiersch procedure done with wire. A second Thiersch procedure was required in two patients after suture breakage, and in one patient after removal of an infected graft. Two other patients had graft infections necessitating removal of the Dacron graft; one patient had a perianal infection that was treated without removing the graft. Continence was achieved in six of nine patients previously incontinent, and maintained in the six patients who had been continent before operation. Prolapse was corrected in 13 of the 15 patients. Although the Thiersch procedure is not applicable to all patients with rectal prolapse, it can be used successfully when performed properly.

Aged↗
PubMed1985

Subtotal parathyroidectomy versus total parathyroidectomy with autotransplantation for secondary hyperparathyroidism.

A retrospective review of patients treated for secondary hyperparathyroidism by total parathyroidectomy with parathyroid autotransplantation (tPTX) and subtotal parathyroidectomy (sPTX) is presented. Ten patients underwent tPTX, and 22 patients underwent sPTX between 1977 and 1982. Hypocalcemia and complications of its treatment were a problem in the tPTX patients. One patient in the tPTX group and no patients in the sPTX group have required reoperation for recurrence. Both procedures were highly successful in relieving symptoms of secondary hyperparathyroidism and in reversing renal osteodystrophy. The authors believe that sPTX is a proven, effective operation and the operative treatment of choice for secondary hyperparathyroidism.

Adult↗
PubMed1984

Abdominal wound closure. A comparison of polydioxanone, polypropylene, and Teflon-coated braided Dacron sutures.

A midline abdominal wound was made in 135 Harlan Sprague-Dawley rats, and the fascia was then closed by the continuous suture technique with 4-0 absorbable monofilament polydioxanone sutures (n = 45 rats), 4-0 permanent monofilament polypropylene sutures (n = 45 rats), or 4-0 Teflon-coated braided Dacron sutures (n = 45 rats). At 1-, 2-, and 6-month intervals, wound-bursting pressures were determined in 15 animals from each group. At 1 month and at 6 months, there was no significant difference in wound-bursting strength among the three types of sutures. At 2 months, wounds closed with Teflon-coated braided Dacron were significantly stronger than wounds closed with the other types of sutures. In most of the braided Dacron suture animals, the fascia burst in areas other than the abdominal wound, indicating that the wound was stronger at that time than was the surrounding fascia. There is no advantage to that added strength, and braided Dacron sutures have been shown to cause greater tissue reaction than monofilament sutures. Therefore, except in patients with poor wound healing who are highly susceptible to dehiscence and in whom permanent low-tissue-reaction sutures may be beneficial, the authors recommend a running suture technique using absorbable monofilament suture, such as polydioxanone, for the routine closure of clean abdominal wounds.

Abdomen↗
PubMed1984

Suture technique and wound-bursting strength.

Despite advances in wound healing, fascial dehiscence continues to be a problem in celiotomy wounds. Experimental and clinical studies on suture material and on patient-related factors in wound disruption are abundant, but little attention has been given to mechanical factors in wound closure, although they may be of greater importance. A midline abdominal wound was made in 120 Harlan Sprague-Dawley rats, and the fascia was closed with Dacron in one of six ways: simple interrupted, interrupted figure-of-eight, and running, each tied loosely in one half of each group and tightly in the other half. One week later, the rats were reanesthetized and wound-bursting strength was measured. In general, the running suture technique resulted in the greatest wound-bursting pressures. A loosely tied figure-of-eight technique was nearly as good as a loosely tied running stitch, but tying figure-of-eight sutures tightly caused a significant decrease in wound-bursting pressure. The simple interrupted technique was unaffected by suture tension but was generally inferior to the running stitch in terms of wound-bursting strength. Histologic studies were performed, but most of the disparity in wound strength among the suture techniques apparently was due solely to mechanical factors. Closing midline abdominal fascial wounds with a running suture may be a superior method of closure in clean, incised wounds.

Abdomen↗
PubMed1984

Postmastectomy angiosarcoma.

Six cases of postmastectomy angiosarcoma of the upper extremity have been treated at the North Carolina Baptist Hospital/Wake Forest University Medical Center over the past 25 years. Five patients had typical ductal carcinoma; one patient had mammary Paget's disease. Two patients, including the patient with Paget's disease, had bilateral mastectomies. The five patients with ductal carcinoma had received postoperative radiation therapy. The mean interval between mastectomy and the appearance of angiosarcoma was 17.5 years. Significant lymphedema of the upper extremity preceded the appearance of angiosarcoma in all six patients, and it appears important that special care be taken during mastectomy to preserve the integrity of the lymphatic system. The patient treated with interscapulothoracic amputation is alive at 2 years postamputation; the five patients whose angiosarcomas were treated with wide excision or radiotherapy died an average of 4.5 years later. Interscapulothoracic amputation is recommended as the initial treatment of postmastectomy angiosarcoma of the upper extremity.

Adult↗
PubMed1984

Diaphragmatic rupture from blunt trauma.

Records of 31 patients who sustained a ruptured diaphragm from blunt trauma form the basis for this report. There were 23 left-sided ruptures, one bilateral rupture, and seven right-sided ruptures. Viscus had herniated into the chest in 30 patients. Right-sided ruptures were associated with greater morbidity and mortality, mostly due to the more serious associated injuries. Chest roentgenograms were abnormal in all 31 patients; bowel could be seen in the chest in 11 patients. Pneumoperitoneum, upper gastrointestinal barium studies, and liver/spleen scans were all diagnostically helpful in selected patients. The correct diagnosis was made preoperatively in 25 of the 31 patients; one-third of all diagnoses were delayed. All exploratory laparotomies for blunt trauma should include careful inspection of the diaphragm, especially in the posterolateral region, and the area close to the esophageal hiatus to detect diaphragmatic rupture and prevent chronic herniations.

Adult↗
PubMed1983

Normocalcemic hyperparathyroidism revisited.

From 1957 through 1981, 550 cervical explorations for presumed primary hyperparathyroidism were performed in 536 patients at the North Carolina Baptist Hospital. Fifty-one of those patients who did not have persistent hypercalcemia are the basis of this report. Twenty-six patients with hypercalciuria and normal renal function had recurrent passage of calcium-containing renal stones, but never had documented hypercalcemia. Only five patients (19%) had positive findings at exploration: small, hyperplastic glands (n = 3); small adenomas (n = 2). Seventeen of the 23 patients for whom follow-up data were available continued to form and pass renal stones postoperatively, including three of the five patients with "pathologic" glands (follow-up range: 4 months to 21.3 years; mean--7 years, 9 months). Twenty-five patients (also with normal renal function) had chronic calcium nephrolithiasis, hypercalciuria, and isolated or occasional elevations of serum calcium ranging from 10.6 to 10.9 mg/dl. Thirteen of these patients had abnormal parathyroid glands: adenomas (n = 12); hyperplasia (n = 1). All but two of the 13 were cured of their nephrolithiasis, but all ten of the patients with no abnormal glands for whom follow-up data were available continued to pass renal stones (follow-up range--8 months to 18 years; mean--5 years, 7 months). Thus, our experience with treating "normocalcemic" hyperparathyroidism has been disappointing. Although a substantial number of patients with occasional mild hypercalcemia may benefit from cervical exploration, those patients are not, by definition, truly normocalcemic. Metabolic evaluation can separate hypercalciuric recurrent stone formers with autonomous secondary hyperparathyroidism from patients with suppressible secondary hyperparathyroidism, and can thus more accurately identify patients who may benefit from parathyroid exploration.

Adult↗
PubMed1982

Malignant fibrous histiocytoma of the mediastinum and lung: a report of three cases.

One case of primary malignant fibrous histiocytoma of the lung and two cases of that tumor in the mediastinum are reported. Primary malignant fibrous histiocytoma is rare in those areas, appearing more commonly in deep fascia and skeletal muscles of the extremities and torso and in the retroperitoneum. Most of the tumors contain both fibroblast-like and histiocyte-like cells; some contain pleomorphic giant cells and inflammatory cells. They are often confused with other sarcomas, and their true biologic potential is not clearly defined. Radiation appears to be a very useful adjunct to surgical therapy and was used in the cases reported here.

Female↗