Herbert D. Adams

Carcinoma in nodular goiter of childhood.

From 1930 to 1960, Lahey Clinic physicians saw 79 children under 15 years of age with nodular goiter. Thirteen were referred with an established diagnosis of carcinoma, and nine of the 66 patients first seen at the Clinic also had carcinoma. In most cases, surgeons removed the lobe with the cancer, excised a generous portion of the opposite lobe and isthmus, and dissected the neck on the involved side.

Essentials in Diagnosing and Treating Hyperparathyroidism

Early diagnosis and surgical correction are essential for cure in hyperparathyroidism. Recognition of the protean manifestations of the disease and strong confirmatory evidence from laboratory tests allow reliable case selection for surgery. If exploration shows hyperplastic parathyroid glands, all glands should be identified and all but one removed. If glands are hypoplastic, adenoma can be diagnosed and must be accurately localized and removed.

Symptomatic Hiatus Hernia and Associated Esophagitis

Symptomatic sliding hiatus hernia is caused by a combination of two factors: (1) a disruption of the cardias valvelike mechanism resulting in reflux esophagitis, and (2) a coexisting ulcer diathesis. Diagnosis is by radiography and esophagoscopy, and the medical management of the patient includes a permanent ulcer regimen. If such disorders are neglected, progression may eventually necessitate extensive surgery.

Dysphagia Causes and Treatment

Dysphagia associated with benign esophageal lesions usually is of long duration. Dysphagia resulting from carcinoma is of relatively short duration. The benign lesions are a heterogeneous group of congenital, acquired and miscellaneous disorders. Carcinoma of the esophagus can be safely resected if the diagnosis is made at an operable stage. Resection of malignant lesions in upper, middle and lower segments is described. In general the higher lesions are far more serious, largely because of profound cardiorespiratory disturbances accompanying the surgical procedure.

Surgical Management of Obstructing Lesions of the Esophagus

A considerably greater variety of lesions of the esophagus and stomach are now being treated surgically. These include such important clinical diseases as diverticulum, cardiospasm, mega-esophagus, esophagitis, stricture, benign tumors and carcinoma. Procedures for the surgical management of these obstructing lesions are presented, many of which are now highly standardized operations, giving excellent results.