Robert Beazley - Academia.edu (original) (raw)

Papers by Robert Beazley

The American Journal of Surgery, 1998

Reports vary about whether risks are greater for removal of massive (&amp;gt; or = 1500 g... more Reports vary about whether risks are greater for removal of massive (&amp;gt; or = 1500 g) spleens than for smaller (&amp;lt; 1500 g) spleens. We sought to determine the hazards of splenectomy. We reviewed 223 consecutive adults with elective splenectomies for hematologic diseases. Morbidity and mortality rates were combined with published data to create a meta-analysis. Patients with massive spleens are more likely to have postoperative complications (relative risk [RR] 2.1, 95% confidence interval [CI] 1.3 to 3.4; P = 0.003) and death (RR 4.7, 95% CI, 1.5 to 15.1; P = 0.01). However, when the investigation is restricted to comparable diagnoses, patients with massive spleens do not differ from those with smaller spleens regarding complications (RR 1.4, 95% CI, 0.8 to 2.7; P = 0.3) or mortality (RR 2.1, 95% CI, 0.5 to 9.7; P = 0.4). These observations are confirmed by metaanalysis. Furthermore, multivariate analysis indicts age as a critical risk of complications and death. Increased age and underlying illness are the predominant factors associated with morbidity and mortality following splenectomy for hematologic disease. Adjusting for age and diagnosis, spleen size is not a hazard.

Thyroid, 1999

Cathepsin (CB) is involved in the hydrolysis of thyroglobulin (Tg) and thought to be regulated by... more Cathepsin (CB) is involved in the hydrolysis of thyroglobulin (Tg) and thought to be regulated by thyroid stim¬ ulating hormone (TSH) in the normal thyroid. Our analyses of 91 thyroid tissues from 71 patients with Graves' disease (GD), multinodular goiter (MNG), papillary carcinoma (PC), or follicular carcinoma (FC), demonstrated a 2-fold increase in expression of CB in GD and an average increase of 1.5-fold in MNG (varying from 10-fold below normal to 6-fold above normal in MNG nodules), as might be predicted by the altered functional status of thyroid follicular cells in those diseases. However, CB activity was not downregulated in conjunction with the known "blocking effect" of malignancy on many thyroid functions, but rather increased on average 9-fold in pap¬ illary carcinomas (n = 33), and also showed a marked increase in 2 follicular carcinomas. Activity measurements were confirmed by CB protein detection on Western blot with moderately increased CB protein levels demon¬ strated in GD, variable expression in nodules of MNG, and markedly increased protein expression in carcino¬ mas. In all diseased states, increased protein was detected primarily as overexpression of the 27 kd heavy chain of 2-chain mature CB and less frequently as overexpression of 31 kd single-chain mature CB. However, an ad¬ ditional 35 kd protein form was noted in 3 of 9 PCs, 1 of 2 FCs, and 1 of 4 GD cases but in none of 10 MNG cases. In conjunction with elevated CB activity plus additional protein bands on Western blots, altered patterns of CB immunohistochemical staining were observed, irrespective of the type of thyroid disease, suggesting certain common changes in CB expression, posttranslational processing, and vesicular trafficking. In summary, GD and MNG thyroid tissues demonstrated altered CB expression in keeping with predicted functional changes in thy¬ roid follicular cells, while increased CB expression in carcinomas indicated a more pathological role for CB in thyroid cancers, possibly related to the processes of invasion or metastasis.

New England Journal of Medicine, 1976

Original Article from The New England Journal of Medicine Elevated Plasma Proglucagon-like Comp... more Original Article from The New England Journal of Medicine Elevated Plasma Proglucagon-like Component with a Glucagon-Secreting Tumor.

The Lancet, 1984

25 Evans DS, Evans DG, DuPont HL, et al. Patterns of loss of enterotoxigenicity by Escherichia co... more 25 Evans DS, Evans DG, DuPont HL, et al. Patterns of loss of enterotoxigenicity by Escherichia coli isolated from adults with diarrhea: suggestive evidence of an interrelationship with serotype. Infect Immun 1977; 17: 105-11. 26. Echeverria P, Seriwatana J, Chityothin O, et al. Detection of enterotoxigenic Escherichia coli in water by filter hybridization using three enterotoxin gene probes.

Journal of Surgical Oncology, 1995

Two cases of duodenal leiomyosarcoma were encountered, both of which appeared benign by gross and... more Two cases of duodenal leiomyosarcoma were encountered, both of which appeared benign by gross and histologic criteria. Both patients suffered recurrences with poor outcomes. We reviewed the literature and found four other such cases and examined the outcomes in the world literature with respect to tumor size and extent of surgical resection. Large size, limited resections, and local recurrence were associated with poor outcomes. A 6% rate of lymphatic metastases was found, and the bearing this has on the extent of resection is discussed. © 1995 Wiley‐Liss, Inc.

Endocrine Practice, 2010

Page 1. 1078 Historical Vignette David B. McAneny, MD, FACS; Robert M. Beazley, MD, FACS Submitte... more Page 1. 1078 Historical Vignette David B. McAneny, MD, FACS; Robert M. Beazley, MD, FACS Submitted for publication March 8, 2010 Accepted for publication March 19, 2010 From the Department of Surgery, Boston University School of Medicine, Boston, Massachusetts. ...

Archives of Surgery, 2002

ODAY'S RAPID changes in Surgery have for some made it more comfortable to look back at what Surge... more ODAY'S RAPID changes in Surgery have for some made it more comfortable to look back at what Surgery was in earlier times. Our training system, by its very nature, leaves deep influences and lasting memories especially regarding what we retain from our teachers and associates. I can remember the "maturity lectures" some of my fellow residents got from the "boss" and today I chuckle when compelled to help my young charges "grow up." On the complex stage of Surgery, certainly, manners have to be viewed as a lubricant of the communication that makes our interpersonal relationships, and thus society, truly work. I had the opportunity to work for a master of manners and communication during my years in the Department of Surgery at Lousiana State University under Dr Isidore Cohn. My initial motivation to accept the position he offered in 1975 was not great, but he was such a gentleman I could not think of a polite way of turning down his offer. Capitulation was to come in the Rex Room at Antoine's Restaurant where Dr Cohn entertained my wife and me so graciously that she accepted New Orleans for me. Over the ensuing years I learned a great deal from Dr Cohn. He was a disciplinarian and always communicated directly with the residents. A page to extension 4751 (Dr Cohn's office) would focus the residents' attention even during the most complex surgical procedure. While his

Archives of Surgery, 1996

The addition of splenectomy to a gastrointestinal (GI) operation may have an adverse effect on mo... more The addition of splenectomy to a gastrointestinal (GI) operation may have an adverse effect on mortality, morbidity, and even survival. To determine the risks of the converse: synchronous GI surgery appended to splenectomy for hematologic diseases. Retrospective cohort. Multiple hospitals comprising an affiliated surgical training program. Consecutive sample of 207 adults (mean age, 49 years) with splenectomies for hematologic diseases. Splenectomy and concomitant GI or biliary surgery (group 1, n=19) and splenectomy alone (group 2, n=188). Length of hospital or intensive care unit stay, later operations, postoperative infections, postoperative abdominal abscess, major complications, and death. Preoperative and intraoperative factors were similar in both groups. Operative mortality was 3 of 19 in group 1 and 8 of 188 in group 2 (p=.07). The mean number of major complications tended to be higher in group 1 (1.5 vs 0.5, P=07). Despite no difference between the incidences of overall postoperative infections, patients in group 1 were much more likely to develop an abdominal abscess (4 of 19 vs 3 of 188, P=.002). Logistic regression established that patients undergoing splenectomy and synchronous GI or biliary surgery were 25 times more likely to develop an intra-abdominal abscess than were patients with splenectomy alone, even controlling for confounding factors (odds ratio, 24.7; 95% confidence interval, 3.1 to 196; P=.002). Synchronous GI or biliary surgery with splenectomy for hematologic disease increases the risk of intra-abdominal abscess and should be avoided. Complication and mortality rates may also be increased.

The Annals of Thoracic Surgery, 2005

In this report we describe the removal of a mediastinal parathyroid adenoma in a patient who had ... more In this report we describe the removal of a mediastinal parathyroid adenoma in a patient who had two previous coronary artery bypass graft procedures. The surgical approach and intraoperative localization of the adenoma under these unusual circumstances are reviewed.

Annals of Surgery, 2000

To compare patients with gallbladder cancer presenting for therapy with and without prior operati... more To compare patients with gallbladder cancer presenting for therapy with and without prior operation elsewhere to determine if an initial noncurative procedure alters outcome. Summary Background Data Nihilism has traditionally surrounded treatment of gallbladder cancer, particularly since the majority of cases are discovered during exploration for presumed gallstone disease when unsuspected cancers cannot be handled definitively and tumor is often violated. Methods Presentation, operative data, complications, and survival were examined for 410 patients presenting between July 1986 and March 2000. In particular, the 248 patients presenting for therapy after prior operation elsewhere were compared with the remainder who presented without prior operation to determine if an initial noncurative procedure alters outcome.

Annals of Surgery, 1975

Perineal enterocutaneous fistula and hernia are unique complications of radical pelvic exenterati... more Perineal enterocutaneous fistula and hernia are unique complications of radical pelvic exenterative operations. A technique for management of these complications is presented. A vascularized segment of small bowel mesentery is interposed as a peritoneum covered pelvic "lid" to separate the abdominal contents from the pelvic defect.

American Journal of Kidney Diseases, 1998

Art magazine featuring the creative work of students, faculty and staff of the Boston University ... more Art magazine featuring the creative work of students, faculty and staff of the Boston University Medical Campus and Boston Medical Cente

The Journal of Clinical Endocrinology & Metabolism, 2004

Thyroidectomy (TX) is no longer the preferred choice for the therapy of hyperthyroid Graves' dise... more Thyroidectomy (TX) is no longer the preferred choice for the therapy of hyperthyroid Graves' disease but is an alternative in patients who are noncompliant with or have reactions to antithyroid drugs, have moderate to severe ophthalmopathy, have large goiters, or who refuse 131 I therapy and/or long-term antithyroid drug therapy. Seventeen clinically and biochemically severely thyrotoxic patients (16 female, mean age of 35 yr), all but one with large goiters, underwent TX after rapid preparation. The potent inhibitors of the deiodination of T 4 to T 3 , iopanoic acid (IOP) (500 mg twice a day) and dexamethasone (DEX) (1 mg twice a day), were given with propylthiouracil or methimazole, when possible, and ␤-blockers. Thyroid function tests were obtained before treatment and at TX. All patients were thyrotoxic (mean ؎ SE: T 4, 21.6 ؎ 1.2 g/dl; free T 4 index (FTI), 10.3 ؎ 0.8; total T 3 , 510 ؎ 48 ng/dl). IOP and DEX rapidly lowered T 3 values (P < 0.0001; total T 3 , 147 ؎ 13 ng/dl) with a smaller but significant (P < 0.05) decrease in T 4 /FTI (T 4 , 17.9 ؎ 1.3 g/dl; FTI, 7.9 ؎ 0.6). All patients were clinically euthyroid before surgery. None developed hypoparathyroidism, laryngeal nerve damage, or worsening of ophthalmopathy after surgery. The restoration of hyperthyroid Graves' disease to euthyroidism is rapidly accomplished with IOP and DEX , ␤-blockers, and, when possible, antithyroid drugs. This is especially relevant in noncompliant patients with large goiters.

The Things We Take With Us: The cover picture depicts a homoeopathic medical kit, circa 1870. In ... more The Things We Take With Us: The cover picture depicts a homoeopathic medical kit, circa 1870. In 1874 the Massachusetts Homeopathic Hospital moved into a newlybuilt Talbot Building in Boston's South End. It later abandoned homeopathic practices, and in 1929 became part of Massachusetts Memorial Hospital. This was eventually merged into the Boston University Medical Center, now part of Boston Medical Center. The Talbot Building now houses the

Journal of nuclear medicine : official publication, Society of Nuclear Medicine, 1993

Physical examination and mammography are currently the only proven and reliable methods of early ... more Physical examination and mammography are currently the only proven and reliable methods of early detection of breast cancer. Although both procedures are highly sensitive, their limited specificity often requires surgical biopsy in order to differentiate between malignant and benign lesions. The purpose of this prospective study is to investigate the diagnostic specificity of thallium imaging for breast cancer and to determine its efficacy as a complement to mammography. Two groups were studied: Group A: Patients found to have breast abnormalities and scheduled for biopsy or surgery and Group B: Patients who were suspected to have a recurrence of cancer after mastectomies or lumpectomies. In Group A, thallium scans of 32 breasts in 30 patients were performed prior to biopsy or surgery, yielding pathological diagnoses of 31 breasts in 29 patients. Results for Group A included seven true-positive thallium scans, twenty-two true-negative scans, two false-negative scans, and one false-p...