bluuebunny/crossref_metadata_2025 huggingface dataset:
Long‐term evaluation following resection of apparently benign pheochromocytoma(s)/paraganglioma(s)
Authors: van Heerden Jonathan A. , Roland Christopher F. , Carney J. Aidan , Sheps Sheldon G. , Grant Clive S.
Published: May 2005

In the absence of distant disease, the pathologic diagnosis of malignancy in pheochromocytoma or paraganglioma is impossible. In an effort to establish the true incidence of recurrence in this disease, we have analyzed long‐term follow‐up (average, 15.8 years) of 98 patients who underwent complete resection of localized, noninvasive, histologically‐benign pheochromocytomas and paragangliomas at our institution between 1960 and 1976.

Eighty‐eight patients had nonfamilial, sporadic pheochromoctyoma/ paraganglioma. Nine had multiple endocrine neoplasia (MEN) type 2 (2A: 7, 2B: 2), and 1 had familial pheochromocytoma. Seventy‐nine patients had single pheochromocytomas; 10 had single extraadrenal tumors (paragangliomas); and 9 had multicentric or bilateral adrenal tumors.

Six patients (6.5%) developed recurrent pheochromocytoma after documentation of normal postoperative urinary catecholamine levels. One of these patients had MEN 2A. The recurrences developed at intervals from 5 to 13 years following initial resection. These were distant in 3 patients, local in 2, and both local and distant in a single patient. None of the recurrences occurred in the 13 patients who, on pathologic rereview, had either local or vascular invasion. No paraganglioma recurred.

Life‐long follow‐up of all patients who have had pheochromocytomas or paragangliomas resected is mandatory.
Undescended parathyroid adenoma: An important etiology for failed operations for primary hyperparathyroidism
Authors: Fraker Douglas L. , Doppman John L. , Shawker Thomas H. , Marx Stephen J. , Spiegel Allen M. , Norton Jeffrey A.
Published: May 2005

From July, 1982 to April, 1989, a total of 145 patients with persistent or recurrent primary hyperparathyroidism (HPT) were explored; 105 patients had an adenoma as the cause of HPT, and in 9 patients (9%), the abnormal gland was located at or superior to the carotid bifurcation (undescended parathyroid gland). These 9 patients had 14 prior explorations for HPT including 4 median sternotomies and 5 thyroidectomies.

Each of the 9 patients was symptomatic of HPT, including bone disease in 8 of 9 patients and renal stones in 4 of 9 patients. Seven patients had an undescended parathyroid adenoma correctly localized preoperatively by ultrasound (n=5), angiography (n=5), venous sampling (n=1), or computed tomography scan (n=4). These 7 patients with accurate preoperative localization were explored by an incision anterior to the sternocleidomastoid muscle high in the neck that avoided the previous operative field and allowed rapid resection of the parathyroid adenoma. In the 2 patients who did not have accurate preoperative localization, the undescended adenoma was found after long tedious exploration including median sternotomy in 1 patient. Each patient (n=9) who had an undescended parathyroid adenoma removed was cured of hypercalcemia, and 5 patients required postoperative 1,25‐dihydroxy vitamin D3 for hypocalcemia.

We conclude that undescended parathyroid adenomas comprise a significant proportion (9%) of adenomas during reoperations for persistent HPT. The majority of these glands (78%) can be accurately imaged preoperatively and, when imaged, can be easily resected by a rapid, direct, surgical approach.
Stricture and perforation of the esophagus: Overlooked threats in the Zollinger‐Ellison syndrome
Authors: Bondeson Anne‐Greth , Bondeson Lennart , Thompson Norman W.
Published: May 2005

This study was undertaken to assess the frequency of significant esophageal involvement in the Zollinger‐Ellison syndrome (ZES). In a consecutive series of 24 patients with this disease, 9 (37%) showed endoscopic evidence of acid‐induced esophageal lesions ranging from erosive inflammation to ulceration with massive bleeding, severe stricture formation, and perforation. In 3 cases, pronounced esophagitis was known 1–5 years before the underlying disease was diagnosed. Severe esophageal complications developed despite treatment with antisecretory drugs. It is emphasized that the best way to limit such complications is by excision of the underlying gastrin‐secreting tumor(s) when possible.
Surgical treatment of mid‐gut carcinoid tumors
Authors: Makridis Charlie , Öberg Kjell , Juhlin Claes , Rastad Jonas , Johansson Henry , Lörelius Lars Erik , Åkerström Göran
Published: May 2005

Coincident with medical antitumor treatment of 138 patients suffering from mid‐gut carcinoid tumors, 51 patients were subjected to surgery with the principal aims of removing primary tumors and debulking mesenteric or liver metastases. Sixteen patients had previously been operated with intestinal resection or, when the tumors had been considered inexcisable, with intestinal bypass or laparotomy alone. Apart from exhibiting symptoms related to the carcinoid syndrome, the majority (approximately 60%) of the 51 patients had generally intermittent, subileus‐like abdominal pain and weight loss. In 18 patients, these symptoms were pronounced and associated with intestinal obstruction or severe malnutrition. Computed tomography and arteriography efficiently demonstrated mesenteric and liver metastases. At laparotomy, the primary intestinal tumors were small, mainly less than 1 cm in diameter, and they were multiple in 39% of the patients. Mesenteric metastases measuring up to 12 cm in diameter were present in 86% of the patients. These metastases were frequently associated with a pronounced mesenteric and retroperitoneal fibrosis causing fixation, angulation, and obstruction of the bowel as well as incipient intestinal gangrene in 8 patients. In all but 6 patients, the primary tumors could be removed by comparatively limited intestinal resections although bulky mesenteric metastases were often dissected from the mesenteric vessels. Liver metastases, found in 49% of the patients, were generally bilateral and multiple, and major hepatic metastases were resected in 6 patients. The results support a role for surgery also in the more compromised patients with mid‐gut carcinoid tumors and that such intervention may be associated with considerable symptomatic relief and substantial periods of survival.
Monoclonal antibodies raised against mid‐gut carcinoid tumor cells
Authors: Juhlin Claes , Papanicolaou Vasilis , Backlin Karin , Klareskog Lars , Wilander Erik , Åkerström Göran , Öberg Kjell , Rastad Jonas
Published: May 2005

Three monoclonal IgG 2a antibodies were produced after immunization of mice with dispersed cells from a human mid‐gut carcinoid tumor. Acetone‐fixed cryosections of 57 primary and metastatic mid‐gut carcinoid tumors as well as 2 hind‐gut (rectal) carcinoids showed a conspicuous immunoreaction while a thymic carcinoid was essentially unstained with the antibodies. The 3 antibodies yielded a similar pattern of immunostaining. The immunoreaction comprised more than 95% of the carcinoid tumor cells, and it was more uniform and intense in primary tumors than in mesenteric, hepatic, and ovarian metastases of the mid‐gut carcinoid tumors. Immunofluorescence studies on suspended carcinoid tumor cells showed that the antibodies bound to the surface membrane of the cells. The antibodies immunostained enterocytes of the small and large bowel, intestinal metaplasia of the stomach mucosa as well as colorectal adenocarcinomas. Endocrine pancreatic tumors producing vasoactive intestinal polypeptide, gastrin, somatostatin, and/or pancreatic polypeptide as well as the epithelium of pancreatic ducts were also stained with the antibodies, whereas a large number of other normal and abnormal human tissues, including benign and malignant insulinomas, were unreactive. The findings indicate that the antibodies recognize differentiation antigens on the carcinoid tumor cell surface preserved also on endocrine and nonendocrine cells of the normal bowel mucosa. The restricted tissue reactivity of the antibodies suggests that they may constitute useful tools in the histological characterization of carcinoid tumors. Further studies may reveal if they are applicable for immunolocalization and perhaps even immunotherapy of these neoplasms.
Surgery for benign insulinoma: An international review
Authors: Rothmund Matthias , Angelini Lucio , Brunt L. Michael , Farndon John R. , Geelhoed Glenn , Grama Dimitrie , Herfarth Christian , Kaplan Edwin L. , Largiader Felix , Morino Francesco , Peiper Hans‐Jürgen , Proye Charles , Röher Hans‐Dietrich , Rückert Klaus , Kümmerle Fritz , Thompson Norman W. , van Heerden Jon A.
Published: May 2005

In a multiinstitutional review, data on 396 patients with benign solitary or multiple insulinomas operated on in 15 centers were collected. In these 396 patients, 419 laparotomies (375 primary procedures and 44 reoperations) were performed. The rate of unnecessary laparotomies was 1.7%. Complications occurred after 132 operations (31.5%), requiring 27 reinterventions (6.4%). Ten (2%) patients died within 30 days of surgery. The success rate of first procedures in the centers was 94.9%. After reoperation, all but 2 (99.5%) of these patients were cured. The overall cure rate including those patients who had their primary operations elsewhere was 97.5%.
Scan‐directed unilateral cervical exploration for parathyroid adenoma: A legitimate approach?
Authors: Russell Colin F. J. , Laird James D. , Ferguson W. Rodney
Published: May 2005

Thallium‐Technetium isotope subtraction scanning was used routinely as a preoperative localization investigation in 90 patients with primary hyperparathyroidism who were submitted to “first‐time” cervical exploration from 1985 to 1988. When the scintigram demonstrated a single focus of activity suggesting the site of a solitary parathyroid adenoma, a scan‐directed exploration was carried out. If the tumor was found at the location suggested by the scan, it was then removed and the ipsilateral normal parathyroid was biopsied. The contralateral side of the neck was not explored in these patients. A total of 48 patients underwent unilateral cervical exploration while the remaining 42 individuals had a standard bilateral neck operation performed.

The difference in operating times for patients who had a solitary adenoma and who underwent unilateral and bilateral neck exploration, respectively, was statistically highly significant (71 minutes versus 97 minutes,p<0.001).

At mean follow‐up of 16.8 months, no patient who had a unilateral neck exploration performed for solitary parathyroid adenoma demonstrated persistent or recurrent hypercalcemia.
Epidermal growth factor receptors and adenylate cyclase activity in human thyroid tissues
Authors: Duh Quan‐Yang , Siperstein Allan E. , Miller Rebecca A. , Sancho Joan J. , Demeure Michael J. , Clark Orlo H.
Published: May 2005

Thyroid stimulating hormone (TSH) and epidermal growth factor (EGF) are growth factors for some thyroid cells in cultures. We have previously found more EGF receptors in neoplastic human thyroid tissues than in normal thyroid tissues. We have also found a higher TSH‐stimulated adenylate cyclase (AC) activity in neoplastic human thyroid tissues than in normal thyroid tissues. To clarify the relationship between the effect of EGF and TSH on thyroid tissue, we measured the binding of EGF and TSH and the basal, TSH‐stimulated and forskolin‐stimulated adenylate cyclase activity in 49 normal, hyperplastic and neoplastic human thyroid tissues (5 normal, 2 Hashimoto thyroiditis, 5 Graves' disease, 14 multinodular goiters, 9 follicular adenomas, S follicular carcinomas, 8 papillary carcinomas, and 1 undifferentiated carcinoma). Specific binding of EGF and TSH were measured by radioreceptor assays using competitive inhibition of radio‐labeled ligand by unlabeled ligand. Basal, maximally (300 mU/ml) TSH‐stimulated, and maximally (100 mM) forskolin‐stimulated adenylate cyclase activities were also measured in the same membrane particulate fractions from the thyroid tissues. We found: neoplastic thyroid tissues bind more labeled EGF than nonneoplastic thyroid tissues; follicular adenomas and carcinomas have higher EGF binding than other thyroid tissues; a weak but significant correlation between specific EGF binding and specific TSH binding, and between specific EGF binding and TSH‐stimulated adenylate cyclase activity of the thyroid membrane preparations. These findings are consistent with the hypothesis that TSH stimulates an increase in thyroid EGF receptors by increasing intracellular cAMP. The higher binding of EGF and the higher TSH‐stimulated AC activity may explain why thyroid neoplasms grow to a larger size than normal thyroid tissues.
Serum bone Gla protein as an indicator of parathyroidectomy in patients with secondary hyperparathyroidism
Authors: Takami Hiroshi , Shikata Jun‐ichi
Published: May 2005

Bone Gla protein (BGP) is a vitamin K‐dependent protein which is a marker of bone turnover. To determine whether serum BGP is a useful indicator for parathyroidectomy in patients with secondary hyperparathyroidism, we measured serum BGP levels. Thirty‐seven patients with secondary hyperparathyroidism who were followed up for more than 1 year after parathyroidectomy were studied. All patients underwent total parathyroidectomy and autotransplantation. Controls were 46 patients who were treated by chronic hemodialysis for more than 3 years. Serum BGP levels (normal: <6.5 ng/ml) were markedly increased in 37 patients with parathyroidectomy, ranging from 4.2 ng/ml to 645 ng/ml, with a mean value of 278.8±159.8 ng/ml (mean±standard deviation) versus 65.0±85.2 ng/ml in the 46 controls (p<0.001). Patients with a high BGP level had severe bone and joint pain. Serum BGP in patients with parathyroidectomy was significantly correlated with serum alkaline phosphatase and mPTH (p<0.001 for both). The total weight of resected parathyroid tumors was 2,152±1,368 mg, and tumor weights ranged from 200 mg to 5,600 mg. There was a highly significant correlation between BGP level and tumor weight (r=0.656,p<0.001). The 2 patients who showed BGP levels below 10 ng/ml had tumor weights of only 470 mg and 240 mg, respectively, and revealed no improvement of pain postoperatively, although their mPTH levels were increased. These results suggested that BGP measurement is a sensitive method for detecting increased bone turnover and is possibly useful as an indicator for parathyroidectomy in patients with secondary hyperparathyroidism.
Epidemiology of varicose veins
Authors: Beaglehole Robert
Published: May 2005

The prevalence rate of varicose veins in adults varies from less than 1% in lowland New Guinea women to over 50% in women in south Wales. Within populations the prevalence increases with age, is generally greater in women, is directly related to body mass, has an inconsistent relationship with occupation, and usually increases with increasing parity. None of these factors explain the striking geographic variation in the occurrence of varicose veins. The 2 most plausible hypotheses implicate low‐fiber diets and prolonged chair‐sitting as the primary causal factor. Epidemiological studies are required within populations to establish the merits of these 2 competing hypotheses. Since varicose veins are potentially preventable, further research is well justified.
Noninvasive testing for the evaluation of chronic venous disease
Authors: Kohler Ted R. , Strandness D. Eugene
Published: May 2005

Noninvasive tests for chronic venous disease include continuous wave Doppler to assess deep and superficial vein patency and valvular function, strain gauge plethysmography for measurement of venous capacitance and the rate of venous outflow, photoplethysmography to determine venous refilling time (a measure of valvular competence), and duplex scanning, which provides detailed information about the size and location of thrombi and flow patterns in normal and diseased valves. The physiologic information gained with these tests allows more rational treatment and provides insight into the pathophysiology and natural history of varicose veins, postthrombotic limbs, and venous claudication. The crucial distinction between primary and secondary varicose veins is readily made by determining the patency of deep veins with the continuous wave Doppler. Development of late sequelae following deep venous thrombosis (DVT) may be predicted by noninvasive testing. While venous outflow is uniformly decreased following DVT, venous refilling time is abnormally shortened in symptomatic limbs, indicating that postthrombotic sequelae occur in association with valvular incompetence. Further natural history studies with duplex scanning may provide important data on the cause of this valvular incompetence and its time course. Noninvasive testing can also aid in the diagnosis of venous claudication, which is associated with decreased venous outflow.
Chronic venous insufficiency: A challenge for the vascular laboratory
Authors: Browse N. L.
Published: May 2005

The application of the noninvasive techniques of the vascular laboratory has increased our understanding of arterial disease. The complex physiology of the venous system has proven to be far more difficult to unravel. This article assesses the value of vascular laboratory techniques in the investigation and diagnosis of venous problems. It concludes that many of our methods of investigation are inadequate and that much more research and development is needed to produce objective quantitative measurements of calf pump function, deep vein obstruction, and deep and superficial vein reflux.
Congenital vein valve aplasia
Authors: Plate Gunnar , Brudin Lars , Eklöf Bo , Jensen Ragnar , Ohlin Per
Published: May 2005

Congenital vein valve aplasia is often misdiagnosed and its symptoms misinterpreted as being caused by previous deep venous thrombosis. The present article reviews the literature providing data on etiology, symptomatology, and phlebographic appearance in congenital vein valve aplasia. A personal experience with 10 cases focuses on the clinico‐physiological results with compression therapy and surgical treatment of superficial venous insufficiency. Compressive support with a tourniquet or a compressive stocking did not improve muscle pump function or venous reflux, as assessed by foot volumetry, and venous hypertension was not affected. Nevertheless, no patient developed leg ulcers during consistent use of compressive stockings. Surgical removal of incompetent saphenous veins, perforators, and varicosities in a subgroup of 6 patients (8 limbs) was followed by an improved muscle pump function and decreased venous hypertension which persisted 4 years post‐operatively. Only 1 patient has been suited for deep venous reconstruction with transplantation of a valve‐containing vein segment from the axillary vein to the popliteal vein, but it is still too early to assess the results of this procedure. Our findings demonstrate that consistent compressive therapy is paramount in the management of patients with congenital vein valve aplasia. Surgical treatment of the superficial venous insufficiency provides a long‐lasting improvement of muscle pump function and venous hypertension. “Curative” vein valve transplantation or transposition is possible only in a minority of these patients.
The etiology of venous ulceration
Authors: Browse N. L.
Published: May 2005

Venous ulceration is caused by the disorganization of the microcirculation that is induced by prolonged venous hypertension. The most common cause of calf pump inefficiency that permits superficial venous hypertension during exercise is deep vein thrombosis. Venous hypertension causes venular dilatation and an increased capillary permeability. Fibrin is deposited around the capillaries and not removed because of a vein wall deficiency of the fibrinolytic activator. The fibrin acts as a diffusion barrier and the overlying dermis becomes anoxic. Any minor trauma then causes an ulcer. Ulcers can be cured by restoring calf pump function to normal. Postthrombotic skin changes caused by irreparable calf pump damage can be reversed by the regular use of elastic compression and the pharmacological long‐term enhancement of fibrinolysis.
Recurrent varicose veins
Authors: Royle John P.
Published: May 2005

When Doppler ultrasound was introduced for the assessment of patients with varicose veins, a more accurate clinical appraisal of the pathophysiology of this condition became possible. In particular, it enabled identification of those patients with recurrent varicose veins who had had inappropriate or inadequate initial treatment. It facilitated planning of appropriate further treatment.

The more widespread use of radiology, in particular varicography, as a means of preoperative assessment of recurrent varicose veins has enabled a more accurate definition of the abnormal anatomical features. The extension of this principle to the operating room has made surgery for recurrent varicose veins more precise.

Patients with varicose veins secondary to deep venous disease remain a problem. When both superficial and deep venous disease are present, superficial venous disease should be treated as appropriate. Deep venous insufficiency will require continued supervision of support maintained by bandages or graduated elastic stockings.
Statistical evaluation of the prognostic value of nuclear DNA content in papillary, follicular, and medullary thyroid tumors
Authors: Bäckdahl Martin , Carstensen John , Auer Gert , Tallroth Eva
Published: May 2005

The prognostic value of tumor cell nuclear DNA content and various pre‐ and postoperative prognostic factors (pre‐ and postoperative TNM, tumor size, resection margins involved by tumor, age, and treatment) have been evaluated by means of bivariate correlations and multiple linear regression analyses in 182 patients with either papillary, follicular, or medullary thyroid carcinomas, or follicular adenomas. Fifty‐one patients died of diseases and 131 patients were alive at least 10 years after diagnosis. The strongest correlation between tumor cell nuclear DNA content and survival was obtained in the group with papillary carcinoma, followed by follicular and medullary carcinoma. Nuclear DNA content alone had a predictive power equivalent to and, in papillary carcinoma, significantly greater than, that of all other prognostic factors combined. When DNA was added to all other prognostic factors, a statistically significant increase of the prognostic value in the present 3 kinds of thyroid carcinomas, both pre‐ and postoperatively, was obtained.
Consequences of routine peroperative cholangiography during cholecystectomy for gallstone disease: A prospective, randomized study
Authors: Hauer‐Jensen Martin , Kåresen Rolf , Nygaard Knut , Solheim Kaare , Amlie Einar , Havig Øyvind , Viddal Karl O.
Published: May 2005

To assess the value of routine peroperative cholangiography (PC), 457 patients undergoing cholecystectomy for gallstone disease were prospectively screened for the presence of 11 predefined criteria indicating possible choledocholithiasis. Two hundred and eighty patients who had no positive criteria and in whom preoperative endoscopic retrograde cholangiography (ERC) had not been performed were randomized to PC or no PC. The patients were followed up 12 months postoperatively, and those who had signs or symptoms of possible retained common bile duct calculi were referred to ERC. The difference in mean operative time between the 2 treatment groups was 23.3 minutes. Four patients (2.8%) in the PC group had unsuspected common bile duct calculi, and in 3 patients (2.1%), the PC was false‐positive. On follow‐up, no case of retained common bile duct calculi was found in either group. The rate of postoperative complications was significantly higher in the PC group than in the non‐PC group. It is concluded that PC should be performed only in patients with indications of common bile duct disease or in whom clarification of the anatomy is necessary.
Selective use of operative cholangiography
Authors: Grogono J. L. , Woods W. G. A.
Published: May 2005

Operative cholangiography (OC), although available, was withheld in 330 (68.2%) of a series of 484 consecutive cholecystectomies performed for gallstones. A follow‐up study, conducted between 1 and 2 years after the operation, revealed 1 patient with a retained stone in the group not submitted to operative cholangiography. Although there is a strong case in favor of performing OC routinely, this has yet to be shown to be safer than selective use.
Hepatic incidentaloma: A modern problem
Authors: Little J. M. , Kenny J. , Hollands M. J.
Published: May 2005

As clinical skills give way to increased reliance on organ imaging, a new clinical problem is identified‐the hepatic “incidentaloma.” This may be defined as an unexpected solid filling defect in the liver of a well patient. Thirty‐six such lesions have been seen in one practice over a period of 36 months. Twenty‐nine (81%) were benign: 24 (67%) nonneoplastic conditions and 5 (14%) benign tumors. The remaining 7 (19%) were malignant: 5 secondary tumors and 2 primary tumors. Patients with physical signs of liver mass or enlargement were more likely to harbor malignancies. An elevated serum alkaline phosphatase (SAP) was suggestive of malignancy. Hepatic hemangioma was the most common single diagnosis (20 patients, 56%). We propose a regimen of investigation which should allow diagnosis to be reached in about one‐half of these patients without admission to the hospital. The rest will need at least a short hospital admission for angiography and fine‐needle aspiration biopsy.
Symptomatic nonparasitic cysts of the liver
Authors: Lai Edward C. S. , Wong John
Published: May 2005

A retrospective study of 14 patients who had symptomatic congenital liver cysts managed at the Department of Surgery, University of Hong Kong at Queen Mary Hospital together with a literature review was conducted to evaluate the current surgical practice for the condition. Seven patients were managed either expectantly (N=5) or by percutaneous aspiration (N=2). Surgery which included total cystectomy (N=3), external drainage (N=1), and marsupialization with (N=2) or without (N=1) fenestration was done for the remaining 7 patients, among whom 1 developed bleeding after total cystectomy. While percutaneous aspiration provides adequate symptomatic palliation in selected patients, eventual recurrent cyst formation is frequent, especially when the cyst exceeds 10 cm in diameter. Despite technological advances, the presence of biliary communication and malignancy could not be accurately determined preoperatively. Careful examination of the cyst cavity at surgery remains the most reliable guide. Drainage into the peritoneal cavity in the presence of infection or bile content provides satisfactory drainage with minimal morbidity and mortality. Since total cystectomy could be done safely without partial hepatectomy, it can even be considered in patients with deeply‐seated lesions. The role of aggressive hepatic resection or liver transplantation for the management of liver cysts remains to be validated by further clinical evaluation.
Investigation of focal hepatic lesions: Is tomographic red blood cell imaging useful?
Authors: Farlow David C. , Chapman Peter R. , Gruenewald Simon M. , Antico Vincent F. , Farrell Geoffrey C. , Little J. Miles
Published: May 2005

Noninvasive diagnosis of cavernous hemangioma of the liver is an important step in the investigation of patients with focal hepatic lesions since biopsy may result in life‐threatening hemorrhage. To determine the diagnostic accuracy of 99m‐technetium red blood cell (99mTc‐RBC) imaging with tomography, 50 patients with various types of focal liver lesions were studied. Thirty‐two patients had 45 hemangiomas and 7 other benign lesions while 18 patients had either primary (n=8) or secondary (n=10) hepatic malignancies. Tomographic imaging identified 12 more hemangiomas than planar imaging, improving sensitivity from 53% to 80%, and was found most useful for detection of smaller lesions (mean size, 2.1 cm). Specificity for hemangiomas was 100% with all lesions greater than 1.9 cm showing the characteristic scintigraphic pattern of blood‐pooling on delayed images. There was excellent agreement between 2 independent observers concerning interpretation of tomographic images (89% for the hemangioma group and 100% for other patients). Therefore99mTc‐RBC scintigraphy with tomography is an accurate diagnostic technique in the investigation of cavernous hemangiomas. Its major value resides in its ability to distinguish hemangiomas from other types of hepatic pathology.
Hepatic hemangiomas
Authors: Hobbs K. E. F.
Published: May 2005

There are 2 main and different forms of hepatic hemangiomas‐those of early childhood and those of later adult life. The former, called infantile hepatic hemangioendothelioma, may be life‐threatening due to arteriovenous shunting in extensive lesions resulting in cardiac failure. Although they may resolve spontaneously, if cardiac failure develops, they must be treated aggressively by arterial ligation or embolization. The adult form rarely gives rise to symptoms and should be left alone. Spontaneous rupture is extremely rare but may follow needle biopsy and it is in this group of patients that the occasional death has been reported. Biopsy should, therefore, be avoided. Symptomatic lesions should be resected in a specialized center where the morbidity and mortality of liver resection is acceptably very low.
The role of hepatic resection in the management of blunt liver trauma
Authors: Hollands Michael J. , Little J. Miles
Published: May 2005

Forty‐two (14%) of 306 patients with liver injuries presenting to Westmead Hospital over a 10‐year period required hepatic resection as their definitive treatment. Two types of resection were performed: Resectional debridement utilized the plane of injury as the line of resection while anatomical resection utilized anatomical planes. Resectional debridement was used in 35 patients. In 29, the major technical problem was bleeding and 21 of these patients had associated hepatic vein injuries. In 5, the major problem was devitalized parenchyma, and, in 1, it was an intrahepatic bile duct injury. Anatomical resection was performed in 7 patients: 3 with bleeding, 2 with devitalized parenchyma, and 2 with intrahepatic bile duct injuries.

Overall, 15 patients died (36%). The most common cause of death was bleeding in 9 of the 15 patients. Survivors spent a median of 32 days in hospital (range: 11–162 days) and sustained a median of 2 complications (range: 0–6). The most common complications were respiratory infection and/or failure, coagulopathy, and sepsis.

Resection successfully addressed bleeding, devitalized parenchyma, and intrahepatic bile duct injuries with an acceptable mortality in critically ill patients who would otherwise have died.
Percutaneous drainage of pyogenic liver abscesses
Authors: Wong K. P.
Published: May 2005

Twenty‐one patients with liver abscesses were treated by percutaneous drainage over a 2 1/2‐year period. Percutaneous drainage was successful in 18 (85%) of 21 patients. Complications include 2 inadvertently dislodged catheters, 1 septicemia and 1 pleural effusion. There were 2 deaths. The low morbidity and high success rate in treating hepatic abscesses by percutaneous drainage suggest that this therapy should be tried before operative intervention is considered.
Surgical management of hepatic abscesses
Authors: Pitt Henry A.
Published: May 2005

Amebic and pyogenic hepatic abscesses are rare liver lesions that may require surgical intervention. Amebic liver abscesses are more common in subtropical and tropical climates and in areas with poor sanitation. The majority of pyogenic liver abscesses are caused by infections in the biliary or intestinal tracts. These lesions can be differentiated on clinical grounds and by amebic serology. Ultrasound and computed tomography are the imaging techniques of choice. The initial management of amebic hepatic abscesses is treatment with amebicidal agents. Most patients respond rapidly so that surgery is reserved for patients with complications including secondary bacterial infection, impending rupture, or rupture into the pericardium or peritoneum. Patients with pyogenic hepatic abscesses require a prolonged course of antibiotics and appropriate drainage. Selected solitary abscesses can be managed with percutaneous abscess drainage. Similarly, some abscesses of biliary origin will respond to percutaneous biliary drainage. Surgical drainage has several advantages including: the ability to explore the abdomen for a source, excellent exposure of the entire liver, accurate assessment, sometimes with ultrasound, of the best drainage site, and access to the biliary tree for cholangiography and drainage.
Splenic abscess
Authors: Cohen Miguel A. Alonso , Galera Maria J. , Ruiz Miguel , La Calle J. Puig , Rius Xavier , Artigas Vicente , La Calle Jorge Puig
Published: May 2005

We present 7 cases of splenic abscess collected in our hospital from 1980 to 1988 as well as a review of 227 cases of the world literature. The signs and symptoms are nonspecific in all of them, fever being the most constant. Computed tomography scan followed by sonography were demonstrated to be the best methods of diagnosis. The treatment carried out on all of our patients was splenectomy followed by antibiotic coverage. Two of them died 15 days after the operation due to persistence of the septic state. In our review of the literature, we observe a rise in the population at risk for splenic abscess due to an increase in the use of immunosuppressive agents, to the higher survival of leukemic patients, and to the great incidence of drug abuse among others. Nevertheless, the advances in the use of sonography and computed tomography scan have made possible a more accurate diagnosis, therefore making possible an earlier treatment and a better prognosis. We believe that the treatment of choice is splenectomy with conservative treatment used only in specific cases where surgery represents a high risk for the patient.
Comparison between Savary‐Gilliard and balloon dilatation of benign esophageal strictures
Authors: Shemesh Eliahou , Czerniak Abraham
Published: May 2005

The efficiency and safety of the 2 most commonly used endoscopic dilators, Savary‐Gilliard and pressure balloons, were compared in 2 groups, each including 30 patients, with benign esophageal strictures. Four additional patients with tight and tortuous cervical esophageal strictures were initially managed by balloon dilatation followed by Savary‐Gilliard dilatation. These patients could not be dilated by each of the methods alone. Sixty patients [35 males and 25 females with a mean age of 52 years (range, 4–91)] underwent 165 esophageal dilatations. The etiologies of strictures included reflux esophagitis (65%), caustic damage (18.3%), and postoperative (anastomotic, or post‐Nissen operation) in 16.7%. Dysphagia improved in all patients; however, 2 patients (1 from each group) with hard postoperative anastomotic stricture eventually underwent surgical resection of stricture. There were no major complications or mortality related to the dilatations. Both methods were highly effective and well tolerated, yet Savary‐Gilliard dilators were slightly more effective and simpler to use than balloons. Nevertheless, tortuous cervical strictures and multiple closely‐placed strictures were more effectively managed by initial use of balloon followed by Savary dilators.
Bilateral breast carcinoma: 28 years' experience
Authors: Gülay Hüseyin , Hamaloglu Erhan , Bulut Orhan , Göksel Hüsnü Aziz
Published: May 2005

From 1959 to 1987, a total of 1,182 histologically proven breast cancer patients were followed. Of these, 48 (4.06%) with bilateral breast carcinoma were reviewed. Eight patients (0.68%) had simultaneous breast carcinomas and the remaining 40 (3.38%) had nonsimultaneous breast carcinomas. The period between the development of the first and second primary carcinoma ranged from 17 to 200 months (mean, 86 months). The second primary carcinoma was found symetrically located with the first primary carcinoma in only 34.5% of the cases. No significant differences were observed between the bilateral carcinoma patients and the unilateral carcinoma patients with respect to pregnancy, delivery, family history, and the size and localization of the carcinomas. Axillary metastasis was seen in a higher percentage of the second primary carcinomas (48% versus 37.5%). It was observed that the shorter the time interval between the presentation of the carcinomas, the shorter the survival.
Comparison of deoxyribonucleic acid ploidy and nuclear expressed p62 c‐myc oncogene in the prognosis of colorectal cancer
Authors: Rowley S. , Newbold K. M. , Gearty J. , Keighley M. R. B. , Donovan I. A. , Neoptolemos J. P.
Published: May 2005

A simultaneous flow cytometric assay of the nuclear expressed protein product of the c‐myc oncogene p62 and deoxyribonucleic acid (DNA) ploidy in archival paraffin‐embedded tumor material was undertaken in 179 patients with colorectal cancer, followed for up to 9 years. DNA ploidy showed a survival advantage for diploid tumors (χ12=5.39,p= 0.020) and could be used to further divide patients with Dukes' A tumors (χ12=4.87,p=0.027) and Dukes' C tumors (χ12=5.33,p=0.021). By dividing patients into 2 levels of tumor expression of p62 c‐myc, there was a trend for improved survival in patients with low expression (χ12=3.65,p=0.056). A combination of ploidy status and p62 c‐myc expression improved upon survival prediction by ploidy alone in providing 3 groups (χ22=7.86,p=0.0197). While these results do not suggest a replacement for the Dukes' staging for prognosis (χ32=33.82,p<0.00001), they strongly support the concept that enhanced expression of c‐myc oncogene is associated with the progression of colorectal cancer.
Management of esophageal atresia
Authors: Spitz L. , Kiely E. , Brereton R. J. , Drake D.
Published: May 2005

A total of 303 infants with esophageal atresia and/or tracheoesophageal fistula were treated over 10 years (1980–1989). The overall survival rate was 86.5%. Associated anomalies were identified in 51.8% of patients, the most common being cardiac malformations which affected 24.4% of infants and was responsible for the majority of deaths. The dramatic increase in survival of infants with esophageal atresia in the past half century is due to improvements in pre‐ and postoperative management, meticulous operative technique to reduce anastomotic complications, and aggressive treatment of associated congenital anomalies.
Diagnosis and treatment of jejunoileal atresia
Authors: Touloukian Robert J.
Published: May 2005

A total of 116 cases of intestinal atresia or stenosis were encountered at the Yale‐New Haven Hospital between 1970 and 1990. Sites involved were the duodenum (n=61; 53%), jejunum or ileum (n=47; 46%), and colon (n =8; 7%). All but two patients underwent operative correction, for an overall survival rate of 92%. Challenging problems were the management of apple‐peel atresia (five patients), multiple intestinal atresia with short‐gut syndrome (eight patients), and proximal jejunal atresia with megaduodenum requiring imbrication duodenoplasty (four patients). Major assets in the improved outlook for intestinal atresia are prenatal diagnosis, regionalization of neonatal care, improved recognition of associated conditions, innovative surgical methods, and uncomplicated long‐term total parenteral nutrition.
Malrotation of the intestine
Authors: Torres A. Margarita , Ziegler Moritz M.
Published: May 2005

Malrotation of the intestinal tract is a product of a well defined aberrant embryology. Because the consequences of malrotation associated with a midgut volvulus may be catastrophic, an understanding of the anatomy, diagnostic criteria, and appropriate therapy for this putative emergency illness is imperative. This report summarizes a recent 18‐month experience with this diagnosis and contrasts this experience with that in the published literature. More than half (14/22) of the patients presented during the first month of life, and all had vomiting, which in most cases was bilious. The barium upper gastrointestinal series was the preferred diagnostic study, being both sensitive (18/19, 95%) and accurate (18/21, 86%). In this series two‐thirds of the patients presented with volvulus (15/22, 68%) of whom five had ischemic intestine requiring resection. One of these children died of overwhelming sepsis. A Ladd procedure was the preferred treatment, which as defined by us includes evisceration and inspection of the mesenteric root, counterclockwise derotation of a midgut volvulus, lysis of Ladd's bands with straightening of the duodenum along the right abdominal gutter, inversion‐ligation appendectomy, and placement of the cecum into the left lower quadrant. A high index of suspicion in the neonate with vomiting, rapid diagnosis, and appropriate operative therapy results in a predictable favorable outcome for children with intestinal malrotatioh.
Gastroschisis and omphalocele
Authors: Molenaar Jan C. , Tibboel Dick
Published: May 2005

It has been widely acknowledged that exomphalos and gastroschisis are two different clinical entities. Their etiology and pathogenesis, however, remain controversial. Several techniques are available for making a prenatal diagnosis of these as well as many other malformations. Some prenatal treatment is possible, but operative management is the more usual course. In most cases, of omphalocele and gastroschisis, treated either conservatively or by any kind of surgery, intensive care is mandatory to support nutrition and often ventilation as well. Enterai nutrition at an early stage during the postoperative period might lead to bouts of necrotizing enterocolitis requiring aggressive medical treatment and sometimes even operative treatment.
Management of the fetus with a cystic adenomatoid malformation
Authors: Adzick N. Scott , Harrison Michael R.
Published: May 2005

Prenatal detection and serial sonographic study of fetuses with congenital cystic adenomatoid malformation (CCAM) now makes it possible to define the natural history of this lesion, determine the pathophysiologic features that affect clinical outcome, and formulate management based on prognosis. In a series of 22 prenatally diagnosed cases, the overall prognosis depended on the effects of the lung mass and the consequent physiologic derangement: A large mass may cause mediastinal shift, hypoplasia of normal lung tissue, polyhydramnios, and cardiovascular compromise leading to fetal hydrops. Two types of CCAM were distinguished by gross anatomy, ultrasonographic findings, and prognosis. Microcystic lesions (cysts < 5 mm; solid appearance) are often associated with fetal hydrops and have a poor prognosis. Macrocystic lesions (single or multiple cysts > 5 mm) are not usually associated with hydrops and have a more favorable prognosis. Four initially large lesions partially disappeared on serial prenatal sonography, suggesting that improvement can occasionally occur during fetal life. The finding that fetuses with hydrops are at high risk for fetal or neonatal demise led to fetal surgical resection of the massively enlarged pulmonary lobe (fetal lobectomy) in two cases. Fetuses with CCAM but without hydrops have a good chance for survival with maternal transport, planned delivery, and immediate neonatal resuscitation and surgery.
Necrotizing enterocolitis: A continuing problem in the neonate
Authors: Amoury Raymond A.
Published: May 2005

Necrotizing enterocolitis (NEC) is a syndrome of diverse etiologies with a significant mortality rate affecting mostly prematurely born stressed infants. Now recognized as a discrete entity, it had been poorly defined because other conditions seem to represent the same entity. A number of risk factors have been identified that appear to “trigger” NEC, though these have been questioned because they have been present just as frequently in premature and older infants who did not develop NEC as in those that did. Recently, maternal cocaine use has been added to the suspected risk factors. A steady improvement in the survival of babies with NEC has been due largely to a high index of suspicion of the disease and early, aggressive medical management.
Hirschsprung's disease: Clinical and experimental observations
Authors: Puri Prem
Published: May 2005

Hirschsprung's disease (HD) is a relatively common cause of intestinal obstruction in the newborn. It is characterized by an absence of ganglion cells in the distal bowel beginning at the internal sphincter and extending proximally for varying distances. The etiology of HD‐associated enterocolitis remains a complex issue. This study has provided further support for a possible infectious etiology of enterocolitis complicating HD.
Management of anorectal malformations during the newborn period
Authors: Peña Alberto
Published: May 2005

Anorectal malformations comprise a spectrum of disease. Some of these defects are minor, with an excellent functional prognosis. Others are complex and may be associated with other defects in the urinary tract that may risk the patient's life. The decision‐making process for the management of a newborn with anorectal malformations is crucial; the timing and establishment of priorities are the key to success. Because the management of affected males and females differs significantly, they are discussed separately.
Successful treatment of early hepatocellular carcinoma and concomitant esophageal varices
Authors: Higashi Hidefumi , Matsumata Takashi , Utsunomiya Tohru , Koyanagi Nobuhiro , Hashizume Makoto , Sugimachi Keizo
Published: May 2005

Twenty‐two cirrhotic patients with hepatocellular carcinoma (HCC) and concomitant esophageal varices underwent aggressive hepatic resection accompanied by simultaneous devascularization, perioperative endoscopic injection sclerotherapy, or both (group A). To evaluate this treatment, 37 cirrhotic patients without esophageal varices who underwent hepatic resection for small HCC (2 cm or less) during the same period (group B) were studied to compare clinical data, preoperative laboratory data, pathologic findings, disease‐free rates, and survival rates. The operative time, blood loss, and resected liver weight did not differ between the two groups; however, the tumor size of group A (2.7±1.6 cm, mean±SD) was significantly larger than that of group B (1.5±0.3 cm). The preoperative liver function of group A was also more severe than that of group B except for prothrombin time. Despite these disadvantages, the 1‐, 3‐, and 5‐year disease‐free rates of the two groups were 72% versus 94%, 48% versus 54%, and 38% versus 45%, respectively, and the 1‐, 3‐, and 5‐year survival rates were 91% versus 97%, 79% versus 79%, and 54% versus 67% (group A versus group B), respectively, which showed no significant differences. Furthermore, there was no variceal bleeding in group A after treatment. Based on the above findings, for treatment of HCC and concomitant esophageal varices, aggressive hepatic resection accompanied by simultaneous devascularization, perioperative endoscopic injection sclerotherapy, or both is the preferred form of treatment.