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S Tibblin

Publications and source records attributed to S Tibblin.

At least 19 recordsLinked to original sources
PubMed1991

Current trends in the surgical treatment of solitary parathyroid adenoma. A questionnaire study from 53 surgical departments in 14 countries.

Current trends in the surgical treatment of primary hyperparathyroidism due to solitary parathyroid adenoma were evaluated in a questionnaire study. Response was obtained from 53 departments highly active in endocrine surgery in 14 countries (response rate 95%). Intraoperative histologic examination is widely (70%) regarded as necessary, but utilized more in North America and Scandinavia (87%) than elsewhere (45%). Intraoperative fat staining is used in one-third of the departments. Excisional biopsy including one whole gland is preferred by 32% to multiple incisional biopsies. Gross inspection of three normal parathyroid glands without histologic identification is favoured in 21% of the departments, while 31% prefer bilateral exploration and incisional biopsy. When an adenoma is found on the first side to be explored, 17% advocate bilateral exploration with incisional biopsy of all three normal glands, whereas unilateral exploration with excisional or incisional biopsy of the ipsilateral normal gland is preferred by a similar percentage.

Adenoma↗
PubMed1991

Drain vs. no drain in primary thyroid and parathyroid surgery.

The need for drainage after primary thyroid or parathyroid surgery was evaluated in a prospective study in which 100 consecutive patients were randomly allocated to drainage or no drainage. Seroma developed in the wound in seven of the 50 patients without drainage and in two of the 50 with drainage. There were no residual effects of the seromas, which resolved spontaneously. The incidence of wound complication was unrelated to the surgeon's opinion on the need for drainage. The study provided no statistical report for routine use of drains in primary thyroid or parathyroid surgery.

Drainage↗
PubMed1991

The influence of different degrees of chronic lymphocytic thyroiditis on thyroid function after surgery for benign, non-toxic goitre.

Of 220 patients, surgically treated for benign, non-toxic goitre with unilateral procedures during a six-year period, 201 could be followed up, on average, 8 years postoperatively. Twenty-four patients were treated with thyroxine immediately postoperatively ("recurrence prophylaxis"); in the other patients thyroxine was only given in cases of hypothyroidism (significant increase of S-TSH). Occurrence of lymphoid infiltration in the removed lobe was subjectively quantified according to a five point scale. Five of the 15 patients with pronounced inflammation developed hypothyroidism whereas 5 of the 137 patients without inflammation had hypothyroidism (p less than 0.05). There was a significant difference in S-TSH postoperatively between patients with no or, only a slight degree of, chronic inflammation, and patients with pronounced inflammation. This study indicates that histologic grading of lymphocytic infiltration in the thyroid gland may be useful for predicting the risk of postoperative hypothyroidism.

Adenoma↗
PubMed1991

Primary hyperparathyroidism due to solitary adenoma. A comparative multicentre study of early and long-term results of different surgical regimens.

Surgical regimens for treatment of solitary parathyroid adenoma were compared in a multicentre study in five departments of surgery in the United States and Europe. Three hundred and twenty-five patients fulfilled the inclusion criteria. Eight years after the operation 272 patients (84%) were available for follow-up investigation. Severe postoperative hypocalcaemia (less than 2.00 mmol) was significantly more common after bilateral than unilateral exploration (p less than 0.001), and in women (p less than 0.01). Neither age nor preoperative serum calcium concentration was related to the severity of postoperative hypocalcaemia. At follow-up, 96% of the patients who had had unilateral, and 89% of those who had had Bilateral exploration had remained normocalcaemic without further treatment. Of the patients who had had incisional biopsies of normal glands 8% had hypercalcaemia and 8% had hypocalcaemia. Of patients operated on without a biopsy being taken or who had had one whole normal gland removed 1% were hypercalcaemic and 4% were hypocalcaemic. Early and late hypocalcaemia are reduced by atraumatic handling of the normal parathyroid gland without increasing the risk of persistent or recurrent hypercalcaemia.

Adenoma↗
PubMed1990

Mortality in patients surgically treated for primary hyperparathyroidism due to solitary adenoma.

In a multicentre study including 5 surgical departments in Europe and USA the results of surgical treatment in primary hyperparathyroidism (HPT) due to single adenoma were analysed. At long term follow-up 60 out of 282 patients operated on for solitary parathyroid adenoma were found to be dead. The average age at operation was 69.2 years and the time of survival after surgery 3.9 years. The cumulative relative survival in patients aged 60-64 years was reduced by 18% (P less than 0.01) as compared to a control group corrected for nationality, age and gender. In patients above the age of 65 no such reduction could be demonstrated. The operative mortality was 1% and attributed to cardiac failures. Late mortality was caused by cardiovascular conditions in 52% and by malignant disease in 15%. None of these figures were statistically different from the age, gender and nation corrected control group. Among the miscellaneous causes of death were two patients who committed suicide during the first postoperative year. The results indicate that surgery for parathyroid adenoma can be performed with low morbidity and mortality.

Adenoma↗
PubMed1988

Preoperative treatment of thyrotoxicosis in developing countries: a comparative study of carbimazole and propranolol.

Preoperative management of treatment in thyrotoxicosis was investigated in a comparative study of carbimazole and propranolol in 41 consecutive patients collected during a 3-year period. The groups included 20 and 21 patients respectively, of equal sex and age distribution and of similar severity. The length of the preoperative treatment was significantly reduced in the propranolol pretreated patients (P greater than 0.001). Intraoperative blood loss, postoperative function with regard to the thyroid, parathyroids and vocal cords were similar in both groups. Three and two patients respectively had permanent hypothyroidism requiring thyroxin treatment. In patients with therapy compliance problems treatment with propranolol would entail a definite advantage, particularly in developing countries.

Adolescent↗
PubMed1987

Splenic implants: evaluation with radionuclide methods.

The viability of omental splenic implants placed in 16 patients who had undergone splenectomy was assessed with 37 technetium-99m tin colloid studies and five studies with Tc-99m-labeled denatured red blood cells (RBCs). Indications for splenectomy included trauma in eight patients, schistosomal (Bilharzial) portal hypertension in six, splenic artery aneurysm in one, and Wiskott-Aldrich syndrome in one. Studies were done within the 1st month and at various intervals up to 13 months after surgery. Implants in five of eight trauma patients were seen during the 1st month, and implants in seven of seven were seen after 6 months (one patient could not be followed up). Three of six implants in cases of portal hypertension were seen in the 1st month and four of four at 6 months (two patients were not followed up). In two of the five studies with denatured RBCs, Tc-99m tin colloid study was also done 48 hours later; in these cases denatured RBCs were more successful in showing the implants. The authors conclude that radioisotopic procedures are valuable in following up the viability of splenic implants. The "take" of splenic implants in patients with schistosomiasis is equally successful to that in trauma patients.

Adolescent↗
PubMed1987

Catecholamine release after physical exercise. A new provocative test for early diagnosis of pheochromocytoma in multiple endocrine neoplasia type 2.

A simple and practical provocative test is needed for early asymptomatic pheochromocytoma, which is a major risk for patients with multiple endocrine neoplasia type 2 (MEN-2). We measured plasma catecholamines before and after submaximal exercise in 26 MEN-2 gene carriers, eight of whom with asymptomatic pheochromocytoma, nine with medullary thyroid carcinoma and 10 after uni- or bilateral adrenalectomy. Seventeen clinically healthy individuals and 11 patients with neurovegetative lability and symptoms mimicking pheochromocytoma served as controls. Plasma adrenaline, noradrenaline and dopamine increased after exercise except for adrenaline after bilateral adrenalectomy. The post-exercise levels of adrenaline and the adrenaline/dopamine ratio were significantly higher in the pheochromocytoma patients compared to the healthy controls and the patients with neurovegetative lability, while the patients with medullary thyroid carcinoma represented an intermediate group with a high probability of developing adrenal tumors. The present method is a physiological test with a high sensitivity and specificity. It is practical and well suited for repeated examinations and seems to be of value for the detection of early pheochromocytoma in MEN-2 patients. Furthermore, the test could be used in the differential diagnosis between pheochromocytoma and neurovegetative lability.

Adrenal Gland Neoplasms↗
PubMed1985

Fat staining in parathyroid disease--diagnostic value and impact on surgical strategy: clinicopathologic analysis of 191 cases.

The study comprised 191 cases of surgically treated hyperparathyroidism, with all principal types of parathyroid disease represented. At least two complete glands stained with a modified isopropanol oil red O method for fat, in addition to sections stained with hematoxylin-eosin, were available in each case. On the basis of the morphologic evaluation and the clinical follow-up data, it is concluded that access to two complete glands and the use of fat staining allow highly reliable intraoperative distinction between adenoma and hyperplasia. Of 105 patients followed up for at least one year (mean, 20 months) in whom adenomas were diagnosed, a single possible error was identified. In each of 68 cases classified as hyperplasia on the basis of two abnormal glands, every additional complete gland available (total, 182 glands) was at least partially abnormal, with distinct signs of hyperactivity, irrespective of size. The rate of equivocal findings for cases in which two glands were available (probably adenoma but hyperplasia not excluded) was 8 per cent in 165 cases of primary hyperparathyroidism. These results justify limitation of surgery to one side of the neck in patients in whom adenoma is diagnosed on the basis of a complete, functionally normal (inactive) gland in addition to the presumed adenoma. Thus, the methods described provide a basis for optimal utilization of imaging techniques that allow preoperative localization of parathyroid adenomas.

Adenoma↗
PubMed1985

Surgical strategy in nonfamilial primary parathyroid hyperplasia: long-term follow-up of thirty-nine cases.

The extent and result of surgery in 39 cases of nonfamilial primary parathyroid hyperplasia followed from 2 to 20 years are reported. Thirteen patients had been subjected to subtotal parathyroidectomy leaving no gland intact, while 26 had undergone less extensive surgery leaving at least one grossly normal or near-normal gland intact without biopsy. In the former group two patients (15%) developed permanent hypoparathyroidism requiring vitamin D treatment. In the latter group there were two patients (8%) with persistent hypercalcemia, which might have been avoided with a subtotal parathyroidectomy. Judging from these results, we believe that an individualized surgical approach is justifiable in nonfamilial primary parathyroid hyperplasia. Subtotal parathyroidectomy, leaving no gland intact, is advocated as the method of choice only when all four glands are enlarged. If one or more glands are grossly normal or near normal, factors such as degree of hypercalcemia, symptoms, age, general condition, and life expectancy should be taken into consideration when the extent of the operation is decided. A more conservative operation leaving at least one grossly normal gland intact without biopsy appears to be sufficient for cure in most of these cases and minimizes the risk for development of permanent hypoparathyroidism.

Adolescent↗
PubMed1985

The reliability of the clinical examination of the thyroid gland. A prospective study of 100 consecutive patients surgically treated for hyperparathyroidism.

One hundred consecutive patients referred to us for surgical treatment of hyperparathyroidism were examined for thyroid disorders before and during surgery. Examination during surgery was supplemented by thyroid biopsy or by lobectomy in 49 cases. The sensitivity of clinical examination of the thyroid was 38%, its specificity 100%. Most clinically occult changes were discrete but four patients had nodules of 2 cm or more in diameter. The prevalence of thyroid disorders in our patients was 50%. The question whether this figure can be generalized to the population at large is briefly discussed. Our findings suggest that the sensitivity of clinical examination of the thyroid is low, even in the hands of trained clinicians.

Adenoma↗
PubMed1979

Metabolic studies and glucagon gel filtration pattern before and after surgery in a case of glucagonoma syndrome.

A case of glucagonoma syndrome with necrolytic migratory erythema, glossitis, anemia, hyperglucagonemia and a malignant, pancreatic A-cell tumour in a 68-year-old male is described. Gel filtration of the highly elevated circulating glucagon immunoreactivity (2200 pg/ml) demonstrated 60% pancreatic glucagon and 30% "proglucagon". Metabolic studies before operation demonstrated suppression of the total plasma glucagon concentration on oral glucose tolerance test, unchanged total plasma glucagon concentration during intravenous glucose tolerance test and insulin-induced hypoglycemia. Administration of arginine was followed by a rise in both the pancreatic glucagon and the "proglucagon", whereas alanine increased only the pancreatic glucagon. The plasma somatostatin level was immeasurable preoperatively. Somatostatin infusion completely suppressed the release of the pancreatic glucagon but did not significantly affect the "proglucagon". After removal of the tumour the skin lesions disappeared and the total plasma glucagon values fell to normal levels (120 pg/ml). Also, other abnormal laboratory findings returned to normal, including the preoperatively observed renal glucosuria.

Adenoma, Islet Cell↗
PubMed1979

Active and inactive thyroid hormone levels in elective and acute surgery.

The changes in the plasma or serum concentration of thyrotrophin (TSH), thyroxine (T4), 3,5,3'-triiodothyronine (T3), 3,3',5-triiodothyronine (reverse T3, rT3) and cortisol were examined in patients undergoing elective cholecystectomy (n = 10) or acute laparotomy due to peritonitis (n = 11). TSH and T4 showed no essential changes in either group. T3 was reduced already during initiation of anaesthesia and continued to fall during and after surgery in both groups. In the peritonitis group, T3 was reduced already before medical intervention. rT3 displayed changes opposite to those of T3. An increase in cortisol peceded the changes in T3 and rT3 in both groups. T3 and rT3 returned towards normal levels when the patients recovered and resumed oral nutrition. It seems likely that both elective and acute uncomplicated surgery is accompanied by a transient reduction in the extrathyroidal production of the most active hormone, T3, and by a reciprocal increase in the levels of the virtually inactive rT3. The underlying mechanism behind this metabolic adaptation is unclear but may be related to adrenocortical activation and/or to changes in the mode of nutrition.

Aged↗
PubMed1979

Peroperative fat staining of frozen sections in primary hyperparathyroidism.

Roth and Gallaher recently described a fat staining method for rapid peroperative differentiation between parathyroid adenoma and chief cell hyperplasia. They used Sudan IV in a solution of ethanol and acetone. This solution, however, was found to cause a considerable dissolution of small lipid droplets from the tissue; in our hands sections stained with this technique were diffcult to interpret. To diminish the loss of fat from the tissue, we have used a modification of Lillie's supersaturated ispropanol method with oil red O. This method gave a deeper staining and increased the difference between hyperfunctioning and unnivolved parathyroid tissue with respect to the amount of stainable lipid in the chief cells. It was found to be a valuable supplement, adding a functional dimension to the structural interpretation of the tissue, and it facilitated the peroperative distinction between ademona and hyperplasia. The pattern of lipid distribution within the glands from patients with nodular hyperplasia suggests that the compact nodules of such glands are autonomously hyperfunctioning, whereas the intervening parts of the parenchyma are more or less responsive to the serum calcium level.

Adenoma↗