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On 25.7.34 she was discharged home improved with a pulse of 110-120, and instructed to
return in October.
She was readmitted on 12.10.34, and had her fourth operation on 19.10.34, when the left
lobe was dealt with.
She was discharged home on 7.11.34 when her general condition was good, pulse 90-100,
free from symptoms and generally much improved.
The patient who died 20 hours after operation was a girl of 14 years who had been at Carshalton
for 11 months prior to coming to New End hospital. Her condition was very serious,
her pulse rate had been continually high for months, from 110 to 160. A preliminary ligature
of the superior vessels was done with benefit, and 27 days afterwards half the gland was dealt
with, but the patient died 20 hours after operation.
The following was a case of parathyroid tumour :—
Emily F., aged 60, was transferred to New End hospital from one of the Council's hospitals
as a case of fibrocystic disease of bone—? hyperparathyroidism.
History.—Fracture of humerus in 1930. Fracture of right humerus and left femur on 19.9.33.
On 13.11.33 fracture of right femur after a fall.
X-Ray examination revealed characteristic fibrocystic disease of bone " indistinguishable
from the hype rpara thyroid type of charge."
Operation on 18.5.34 by Sir Thomas Dunhill. The thyroid gland was displayed through a
collar incision. The right lobe was explored and found to be normal. The left lobe was then
explored—the posterior margin of this was thicker than usual, but otherwise normal. Behind
and to the outer side of the lower margin of the thyroid and behind the common carotid artery
a mass was felt. This was enucleated from the surrounding tissues. It was really situated in
the upper part of the thorax—it was large, U to 2 inches in diameter, three-cornered in shape
and slightly lobulated. The bulbous portion of the left lobe of the thyroid was excised as it was
of unusual shape. Lateral drainage was provided for and the neck wound closed in layers.
The pathologist's report on a section of the parathyroid tumour was as follows :—" A typical
adenoma of the parathyroid gland. The histological structure recalls that of the parathyroid
and presents compact columns of epithelium with several alveolar arrangements of varying sizes,
the alveoli being lined by cuboidal cells."
Progress after operation.—Calcium sodium lactate was given by mouth, calcium lactate
intravenously. Parathormone, 3 c.c., given intramuscularly every second day. Progress was
satisfactory. On the 6th day after operation she had slight twitching and spasm of the ulnar sides
of hands. On the 9th day after operation the wound was healed—there was no evidence of
tetany and her general condition appeared satisfactory, but she was depressed and anxious to
be transferred back to the hospital from which she came in order to be near her friends.
Eleven days after operation she was transferred, developed signs of tetany later, and died.
At autopsy the following conditions were found : Transverse operation scar over thyroid perfectly
healed. Gross deformity of L. femur due to old fracture, similar deformity of R. femur, but less
marked. Deformity of R. humerus, also due to old break. (Edema of both lower limbs. Postural
kyphosis with secondary lordosis—no fracture of spine. Old healed superficial ulcer of right leg.
Every bone examined was the seat of fibro-cystic disease, especially the femora, humerus and
skull bones. The fractures were all firmly united, but with deformity. The right lobe only of the
thyroid was found. No trace was found of the left parathyroid body. The right one was doubtful.
The pituitary gland was notably enlarged, as were the adrenals which had a greater amount of
lipoid than normal. The colloid of the thyroid was perhaps in excess.
Results.
The immediate results of operation are almost uniformly good. A post-operative
reaction occurs and the pulse rate increases and persists for usually about 48 hours
and then commences to fall slowly. At the end of 7 to 14 days the rate has fallen
to the normal for the particular patient. The patient almost invariably feels improved,
and weight is gained.
After results.
A follow-up scheme has been instituted and many patients report personally
and others report on the special form sent out periodically. The results as ascertained
in these ways are as follows :—
(a) Considerable improvement 30
(b) Slight improvement 10
(c) No information 8
(d) Recurrence of symptoms 1
(a) These patients all report definite improvement indicated by improved health,
gain in weight and freedom from, or diminution of, symptoms previously complained
of, with increased capacity for work. Expressions such as " vastly improved,"
" general improvement," " very much better " are used in some of the reports.