Caldwell B. Esselstyn

Partial mastectomy and breast reconstruction. A comparison of their effects on psychosocial adjustment, body image, and sexuality

Background. This retrospective study compared psychosocial adjustment, body image, and sexual function in women who had either breast conservation or reconstruction for early stage disease.

Reappraisal of Parathyroid Pathology in Hyperparathyroidism

Since 1969 it has been the policy at the Cleveland Clinic to identify and biopsy all parathyroid glands in each case of hyperparathyroidism. The incidence of abnormal location of the glands and the incidence of adenoma and primary hyperplasia were both greater than usually reported.

Parathyroid surgery in the treatment of renal osteodystrophy and tertiary hyperparathyroidism.

When patients with secondary hyperparathyroidism receive a renal transplant, they have a temporary hypercalcemia. If this persists, the patient is said to have tertiary hyperparathyroidism, because the parathyroid glands have begun to function autonomously, irrespective of the patients needs. This continued hypercalcemia is injurious to the transplanted kidney as well as to other vital systems, and correction consists of parathyroid surgery.

Partial Mastectomy without Radiation Therapy

Partial mastectomy without radiation therapy has been used at The Cleveland Clinic as a treatment option for selected patients with breast cancer since 1957. Our experience with 322 patients has been reviewed; survival results are equal to or better than the other operative procedures we have employed for the treatment of breast cancer. These results, we believe, relate more to the selection of patients with small tumors and at a more favorable stage of the disease than to the benefit of the operative procedure itself.

Renal lithiasis and hyperparathyroidism: diagnosis, management and prognosis.

From 1969 to 1979, 448 patients underwent parathyroid exploration for presumed hyperparathyroidism. Of these patients 184 had associated renal calculus disease, 72 of whom (16 per cent) had metabolically active stone disease. Of these 72 patients 48 had adenomas, 18 had hyperplasia and 6 had normal glands. Of those patients with assessable disease none with adenomas has had recurrent calculi, whereas calculi continued to form in 45 per cent of the patients with hyperplastic glands and in 50 per cent of those with normal glands. Although most patients with adenomas had persistent calcium elevations 13 were identified with only intermittent hypercalcemia. Serum parathormone calcium elevations 13 were identified with only intermittent hypercalcemia. Serum parathormone served to confirm the presence of parathyroid pathology. Urinary calcium levels were of no diagnostic benefit.

Parathyroid surgery. How many glands should be excised? Is there still a controversy?

The controversy over how much parathyroid tissue to remove has been resolved by a consensus to individualize treatment according to the extent of disease. Autotransplantation of parathyroid tissue now reduces hypocalcemia following operation.

Parathyroidectomy for the Treatment of Renal Osteodystrophy and Tertiary Hyperparathyroidism: Progress Report

Indications for total or subtotal parathyroidectomy in a series of 34 patients were based on the anticipated future course of the renal disease. The effects on the bone lesions are described, and the present status of the patients 1 to 75xa0months after surgery is summarized.

A Technique for Parathyroid Surgery

The basis for sound parathyroid surgery is the necessity for gross and histologic identification of all four glands whenever possible. The authors’ technique of parathyroidectomy is reviewed, based on a personal experience of more than 320 cases and the gross and histologic observations of about 1100 parathyroid glands.

Surgical Management of Actively Bleeding Duodenal Ulcer

To control hemorrhage and eliminate the ulcerogenic mechanism, some surgeons have favored gastric resection with or without vagotomy; others have preferred the more conservative approach of a vagotomy, oversewing of the bleeding site, and pyloroplasty. This discussion examines the advantages, disadvantages, and results of each approach.

A Technique for Partial Mastectomy

Operations less than mastectomy for carcinoma of the breast are not new. Adair in this country, Porritt in England, and Muskatallio in Scandinavia reported early results of operations less than mastectomy, and more recently, Wise et al. in England, and Crile et al. in this country have published their results. The term partial mastectomy has often been labeled lumpectomy, a deplorable term, and much confusion exists concerning the proper technique of partial mastectomy and its application. The purpose of this article is to discuss the selection of patients for partial mastectomy and to review the fundamental techniques of the procedure.