bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevention and treatment of infection in colorectal surgery
Authors: Keighley M. R. B.
Published: May 2005

The results of a personal series of clinical trials on the use of antimicrobial agents for treatment and prevention of infection in colorectal surgery are presented, together with a review of the recent literature. The studies indicate that colorectal surgery is associated with a high sepsis rate which may lead to serious complications. In elective operations, an efficient mechanical bowel preparation is extremely important if antimicrobial prophylaxis is to succeed. Short‐term systemic antimicrobial prophylaxis with an agent specifically active against anaerobic bacteria is effective for elective operations. In emergency colorectal operations in which mechanical bowel preparation is not possible and the operative field is already contaminated, more prolonged antimicrobial cover is advised using a combination of agents effective against both the principal aerobic and anaerobic pathogens. In contaminated operations, wounds should also be left open to avoid synergistic infection in the subcutaneous tissues.
Preservation of the ruptured spleen by gluing with highly concentrated human fibrinogen: Experimental and clinical results
Authors: Brands W. , Mennicken C. , Beck M.
Published: May 2005

Preservation of the ruptured spleen with fibrin glue was accomplished in 2 series of laboratory studies with Wistar rats. Subsequent clinical trials in repair of ruptured spleens in children are also reported. Direct gluing constitutes an excellent alternative in preserving functional splenic tissue.
Catheterization of the internal jugular vein for total parenteral nutrition
Authors: Yakoun M. , Joyeux H. , Solassol C.
Published: May 2005

A safe technique of catheterization by surgical denudation of the internal jugular vein is presented. Through a radiopaque silicone catheter, total parenteral nutrition can be infused for more than 2 months. This vascular access avoids the risks of the blind punctures such as pneumothorax or arterial punctures.
Historical development of intestinal antisepsis
Authors: Poth Edgar J.
Published: May 2005

The study of intestinal antisepsis has been the concern of the author for the past 40 years. Pioneer studies of sulfanilamide, sulfanilylguanidine, succinylsulfanilamide, succinylsulfathiazole, and phthalylsulfathiazole in dogs are reported, and subsequent clinical trials are detailed. By 1948, intestinal antisepsis had become an established procedure to complement adequate mechanical cleansing. Careful attention to meticulous, gentle handling of tissues, preservation of maximum blood supply, and strict aseptic technique should be continued; intestinal antisepsis is not a substitute for surgical principles. A combination of neomycin‐phthalylsulfathiazole, together with the above‐named practices, has resulted in an abdominal wall wound infection rate below 3%, with no intra‐abdominal complications due to postoperative infection.
The effect of bowel preparation on colonic surgery
Authors: Hares Mark M. , Alexander‐Williams John
Published: May 2005

In colorectal surgery, formed feces within the colon pose an obstructive threat to a colonic anastomosis and an infective threat to the patient. If the colon is not cleared of feces before operation, and if antibiotic prophylaxis is not given, anastomotic dehiscence and postoperative sepsis are common after colorectal operations. Preoperative mechanical bowel preparation reduces the obstructive threat by clearing the colon of feces, and with good bowel preparation the incidence of anastomotic dehiscence is reduced from 24% to 7%.

Sepsis after colorectal surgery is caused by aerobic and anaerobic bacteria. Antibiotics effective against both types of organisms are, therefore, required for effective prophylaxis. Oral antibiotic prophylaxis does not diminish significantly the fecal infective threat but, nevertheless, reduces the incidence of postoperative sepsis to 15–20%. Oral prophylaxis may be complicated by diarrhea and antibiotic‐associated colitis. After systemic prophylaxis, the incidence of postoperative sepsis can be reduced to 5–10%, and antibiotic‐associated diarrhea and colitis are less common.
The influence of antibiotics on infection and anastomotic recurrence after colon resection for cancer
Authors: Herter Frederic P. , Colacchio Thomas A.
Published: May 2005

Two hundred‐thirty bowel resections for cancer, performed during the 3‐year period 1975–1977, were reviewed with respect to the influence of antibiotic prophylaxis on wound infection rates and anastomotic recurrences. A large number of surgeons were involved, offering a variety of approaches and skills.

The overall infection rate after surgery was a disappointing 16.8%. Sixty‐seven patients had no antibiotic prophylaxis of any kind, and the infection incidence in this group was 32.8%. In contrast, there was a 9.8% infection rate in the 163 patients who had received antibiotic prophylaxis in one form or another, a highly significant difference. Systemic perioperative therapy reduced the incidence of infection to 6.9%, and a combination of preoperative oral antibiotic therapy with perioperative systemic treatment resulted in a further reduction to 3.1%. There were no untoward consequences of short‐term oral antimicrobial therapy in terms of postoperative enterocolitis.

Anastomotic recurrences were noted in 4 patients only, an incidence of 1.7%, all following anterior resection. Because of the small number, no correlations could be drawn between this form of recurrence and the use of oral intestinal antibiotics.

It is concluded that both short‐term oral antibiotic bowel preparation and the systemic perioperative use of antimicrobial agents are effective in the control of infection after bowel surgery and carry little risk of “superinfection.” The combination of these 2 regimens appears to offer the highest degree of protection. The use of antibiotics should not be curtailed because of the theoretical risk of encouraging anastomotic recurrences.
Septic complications and bile cultures in 800 consecutive cholecystectomies
Authors: Reiss Raphael , Eliashiv Avinoam , Deutsch Alexander A.
Published: May 2005

Benign disease of the biliary tract has become the most common indication for major abdominal surgery. Septic complications play an increasingly important role in the morbidity and mortality of biliary tract disease and biliary surgery. This prospective study deals with 800 consecutive cholecystectomies in which bacteriology data were studied and correlated with clinical data. The general incidence of positive bile cultures was 27%. Patients with a high incidence of positive cultures (high‐risk group) included those with acute cholecystitis, jaundice, choledochal stones, diabetes mellitus, nonfunctioning gallbladders, and patients over 70. Patients not presenting any of the above features (low‐risk group) had a very low incidence of positive bile cultures (less than 7.1%). The types of bacteria cultured were gram‐negative bacteria in the great majority of cases, gentamicin showing the highest sensitivity rate (91%). Close correlation was found between positive bile cultures and the incidence of septic complications. The results of this study support the view that perioperative antibiotic prophylaxis in biliary surgery should be given only to those patients defined as high risk. In the low‐risk group, about 60% of all cases, antibiotics can be omitted safely.
Resection of liver metastases
Authors: Mühe E. , Gall F. P. , Angermann B.
Published: May 2005

At the Erlangen Surgical Clinical Hospital, we have resected 49 liver metastases in 38 patients. The 5‐year survival rate is 20%. One female patient has survived for 17 years. The prognosis is most favorable in solitary metastases, and in cases in which local resections of metastases have proven adequate for the removal of metastases. If primary tumors and liver metastases are removed at the same time, obviously the prognosis is better than in cases of later diagnosis and resection. If the liver is the first filter for disseminated cells from the primary tumor, the survival rates are higher than if the lungs represent the primary filter.

Solitary liver metastases must be removed in any case. If the patient has been operated on locally and curatively with extirpation of the primary tumor, solitary liver metastases should be removed at the same operation. Lobectomies are required only in cases in which substantial metastases already are present. Local resection with a 2‐cm margin of normal tissue is adequate.
Reconstruction of the pylorus
Authors: Martin C. J. , Kennedy T.
Published: May 2005

Reconstruction of the pylorus has been performed on 12 patients who had previous vagotomy and pyloroplasty and whose symptoms of bile reflux and vomiting, dumping, or diarrhea had not been satisfactorily controlled medically. This technically simple operation was followed by marked improvement in 60% of patients. We have not had problems with gastric outlet obstruction in the long term.
Remote salmonella infections
Authors: Higgins George A. , Sandiford John A. , Blair Willie C.
Published: May 2005

The salmonella group of bacteria, consisting of over 1,700 subtypes, causes widespread gastroenteric disease throughout the world, there being approximately 2,000,000 cases yearly in the United States alone. An uncommon but interesting complication is the hematogenous lodgment of organisms in other areas of the body with resultant localized abscess formation, often months or years later.

Remote salmonellosis most often occurs in patients with underlying disease such as lupus, malignancy, diabetes, or anemia (especially sickle cell disease), or in association with factors that suppress host resistance including steroids and cancer chemotherapy. The most frequent sites of involvement are bone marrow, joints, meninges, pleura, and blood vessels (mycotic aneurysms), or in an area of “locus minoris resistentiae.” These latter include scars, hematomas, fracture sites, prosthetic devices, and neoplasms.

Our experience would suggest that salmonella infections, remote both in location and in time from the original gastrointestinal episode, are perhaps more frequent today than is generally realized. This has led us to present our recent experience with a group of 13 patients suffering from this intriguing problem which frequently goes undiagnosed because it is often omitted from the list of diagnostic possibilities. Treatment consists of drainage of the localized abscess process combined with appropriate long‐term antibiotics.
Nitroprusside‐ and nitroglycerin‐induced hypotension: Effects on hemodynamics and on the microcirculation
Authors: Hauss Jan , Schönleben Klaus , Spiegel Hans Ullrich , Themann Hermann
Published: May 2005

After a short summary of the effects and metabolism of sodium nitroprusside (SNP) and nitroglycerin (NTG), the influence of induced hypotension on hemodynamics and on the microcirculation is investigated. The continuous registration of the local tissue pO2in skeletal muscle, myocardium, and liver with the multiwire surface electrode provides the opportunity to recognize immediately a change in the microcirculatory bed. This new method shows in animal experiments that the local oxygen supply during SNP‐induced hypotension is dramatically reduced, while the arterial pO2remains in a normal range. These changes are not found during NTG‐induced hypotension. Electron microscopic examination of various organs, and especially of the myocardium, shows that the alterations of the oxygen supply found after application of SNP were connected with changes in the ultrastructure.
Cytomegalovirus cecal erosion causing massive hemorrhage in a bone marrow transplant recipient
Authors: West John C. , Armitage James O. , Mitros Frank A. , Klassen Lynell W. , Corry Robert J. , Ray Thomas
Published: May 2005

A 24‐year‐old male underwent bone marrow transplantation for severe aplastic anemia. Posttransplantation complications included severe graft‐versus‐host disease and cytomegalovirus (CMV) infection manifested by gastrointestinal bleeding and apparent pneumonitis. Massive rectal bleeding necessitated exploratory laparotomy at which time a right colon resection was performed. Fifteen cecal ulcers were present which on histologixc examination revealed numerous cells containing characteristic intranuclear inclusions.

Life‐threatening gastrointestinal lesions associated with CMV infection will be seen with increasing frequency as more patients undergo the severe immunosuppression associated with bone marrow and organ transplantation. Prompt recognition and expeditious surgical management will result in improved survival in this high‐risk population.
Thirty years' experience with gastrinoma
Authors: Zollinger Robert M. , Ellison E. Christopher , O'Dorisio Thomas M. , Sparks Joann
Published: May 2005

Over a 30‐year period (1947–1977), 40 patients with gastrinoma have been studied. Fifteen of the 19 survivors have lived 10 to 28 years following surgical treatment. Recent multiple endocrine studies in the long‐term survivors have verified the clinical importance of including at least prolactin, parathormone, and catecholamine levels in addition to gastrin and calcium in every patient whose risk of other endocrine adenomas increases with time. Five‐year survival was 62.5%, and 10‐year, 47.5%. The absence of gross tumor at operation, origin within the submucosa of the duodenum or antrum, or proof of hyperparathyroidism favorably influenced long‐term survival, regardless of the type of surgical procedure. Survival was improved following removal of a rare solitary tumor or combined aggressive tumor removal, hemipancreatectomy, and total gastrectomy for extensive disease.
Mechanisms for increased adenylate cyclase responsiveness to TSH in neoplastic human thyroid tissue
Authors: Clark Orlo H. , Gerend Patricia L. , Nissenson Robert A.
Published: May 2005

We have previously examined TSH receptors and adenylate cyclase (AC) activity in normal and neoplastic human thyroid tissue. We found only minor differences in the affinity and capacity of the TSH receptor between the normal and neoplastic tissue, and yet there was a five‐fold greater AC responsiveness in the neoplastic thyroid tissue. To determine why there was a greater AC responsiveness to TSH in most differentiated thyroid neoplasms, we probed the receptor‐cyclase unit which consists of at least 3 classes of components: the receptor (R), the guanyl nucleotide regulatory unit (G), and the catalytic unit (C). The G unit binds GTP and forms a link between R and C. We studied the effects of TSH, Gpp(NH)p (a non‐hydrolyzable GTP analog) and sodium fluoride (NaF) (which act on G), and forskolin (which acts on C) on the receptor‐cyclase unit. The results of these studies demonstrate that: (a) there was a greater AC response to TSH (5/6), Gpp(NH)p (3/5), and NaF (5/6) in T than N; (b) the AC response to forskolin was comparable in T and N in 5/6 patients and higher in T in 1 patient; (c) Gpp(NH)p, NaF, and forskolin all had an additive or synergistic effect when added to TSH in both N and T; (d) NaF and forskolin also had an additive or synergistic effect on AC, whereas Gpp(NH)p and forskolin together in N and Gpp(NH)p and NaF together in T caused a considerably less than additive AC response.

These studies demonstrate that Gpp(NH)p, NaF, and forskolin at optimal concentrations have an additive effect on the AC response to TSH in both normal and neoplastic thyroid tissue and that the altered AC responsiveness to TSH in most, but not all, benign thyroid tumors and differentiated thyroid carcinomas appears to be secondary to an altered guanyl nucleotide regulatory protein.
Chromosomal instability in medullary carcinoma of the thyroid
Authors: Samaan Naguib A. , Pathak Sen , Saad Mohammed F. , Ordonez Nelson G. , Hickey Robert C.
Published: May 2005

Measurement of serum calcitonin (CT) at basal levels and after pentagastrin stimulation is presently the most reliable method for detection of medullary carcinoma (MCT), but not for detection of patients who carry the disease while in the pretumorous stage. Our aim is to use cytogenetic analyses to identify the phenomenon of genetic instability in patients and family members as a second marker to predict the possibility of neoplastic development. We found that in cultured lymphocyte samples taken from MCT patients, the chromosomes exhibited a relatively higher frequency of spontaneous aberrations (average 10.2±3.1% metaphases). The close relatives of 3 families with high CT levels and surgical neoplastic findings showed such a trait. In lymphocytes of normal persons, chromosome aberrations, usually of chromatid type, are rarely encountered (average about 3.2±1.6%). Our conclusions are: (a) patients with MCT show an increased spontaneous chromosomal aberration rate (SCAR), in brief a chromosomal instability (CI); (b) increased chromosomal aberration in family members with multiple endocrine neoplasia type IIa (MEN IIa) kindreds is present; (c) such patients with high SCAR should be tested with CT measurement at basal levels and after stimulation; (d) if serum CT is high, thyroidectomy should be considered; (e) if CT is low, the patient should be followed at regular intervals; and (f) SCAR is a useful practical marker; it may be used in screening, especially when pentagastrin studies are impractical, as with children.
Localization procedures in patients requiring reoperation for hyperparathyroidism
Authors: Clark Orlo H. , Stark David D. , Gooding Gretchen A. W. , Moss Albert A. , Arnaud Sara B. , Newton Thomas H. , Norman David , Bank William O. , Arnaud Claude D.
Published: May 2005

Numerous techniques have been described for the preoperative localization of hyperfunctioning parathyroid glands. During the past 2 years, 18 patients have had operations for persistent (14) or recurrent (4) hyperparathyroidism. One or more hyperfunctioning parathyroid glands were identified at operation in all but 1 patient and all but 2 patients became normocalcemic.

Eighteen patients had ultrasonography, 17 patients had computed tomography (CT) scanning, and 13 patients had selective venous sampling (SVS) for parathyroid hormone (PTH) assay. These studies correctly identified the lesion(s) in 9 (50%), 8 (47%), and 9 (69%) of the patients, respectively. In 3 patients, probable parathyroid tumors were identified by ultrasonography and confirmed by aspiration biopsy cytology under ultrasonic guidance. All had parathyroid tumors confirmed at operation. The smallest tumor localized by ultrasonography was 0.6×0.6×0.6 cm and by CT scanning was 0.9×0.9×0.8 cm. There was 1 false‐positive CT scan and 1 false‐positive SVS. In the 2 patients who failed to become normocalcemic no localization study was positive. One of these patients subsequently had a 0.6×0.6×0.5 cm mediastinal adenoma localized by CT scan, nuclear magnetic resonance, and SVS. The tumor was removed via median sternotomy and the patient is now normocalcemic.

Digital angiography has recently been helpful for “mapping out” the venous pattern for venous sampling for PTH. Ultrasonography and CT scanning complemented each other, since one or the other of these studies was positive in 15 patients, yet only 2 patients had both a positive ultrasound and CT scan. When any 2 localizing tests suggested the same site for the parathyroid lesion, the tumor was found in all cases.

One patient developed post‐pericardotomy syndrome after a medium sternotomy, but there were no other complications. Localization procedures expedite surgical treatment, decrease morbidity, and are strongly recommended in patients requiring reoperation for hyperparathyroidism.
The density test for the intraoperative differentiation of single or multigland parathyroid disease
Authors: Welsh Christopher L. , Taylor Gerard W.
Published: May 2005

The differentiation between parathyroid adenoma and hyperplasia can be difficult even for the experienced pathologist working with definitive material. The surgeon must make this distinction at the time of surgery so that the extent of the resection can be determined.

A simple density test has been used in 100 patients undergoing neck explorations for parathyroid disease. Eight tests were invalid for various technical reasons, leaving 92 for analysis. On the basis of the density test, 65 were graded as single gland disease and 27 as multi‐gland disease. The extent of the resection was in accord with the density test findings. The follow‐up period ranges from 9 to 64 months (mean 31.7 months). There has been 1 case of persistent hypercalcemia, but the remainder are normocalcemic. Of interest is the discrepancy between the density test grading and the histological report. To date the clinical outcome favors the density test result rather than the histological diagnosis.
Indications and late results of subtotal parathyroidectomy for hyperparathyroidism after renal transplantation
Authors: Sitges‐Serra Antonio , Esteller Eduardo , Ricart M. José , Caralps Antonio
Published: May 2005

In view of the current controversy about the relative merits of subtotal versus total parathyroidectomy plus autograft for the treatment of parathyroid hyperplasia, we reviewed the results of subtotal parathyroidectomy in 6 patients with hyperparathyroidism after successful renal transplantation. All had normal renal function and hypercalcemia (mean 11.4 mg/100 ml). The time elapsed between renal transplantation and parathyroidectomy ranged from 3 months to 10 years (mean 42 months). The indications for subtotal parathyroidectomy were: severe acute hypercalcemia after transplantation (1 case), persistent asymptomatic hypercalcemia (2 cases), allograft lithiasis (2 cases), and bone disease (1 case). Subtotal parathyroidectomy was performed, aiming to leave about 30–50 mg of parathyroid tissue, and included a routine transcervical thymectomy. The weight of resected tissue ranged between 0.6 and 2.4 g per patient (mean 1.58 g). Immediate control of hypercalcemia was achieved in all cases. No patient needed replacement therapy with calcium and/or vitamin D after the operation. The 6 patients were followed from 8 months to 4.5 years (mean 34 months) and all had normal calcium, phosphate, and alkaline phosphatase serum values at the time of their last visit. A reappraisal of the surgical indications for hypercalcemia after renal transplantation is needed because severe longterm complications (allograft lithiasis) may develop in patients with minimal hypercalcemia. Subtotal parathyroidectomy is a good operation for treating hyperparathyroidism in patients with functioning renal allografts.
Parathyroid autografts—morphology and function: Six years' experience with parathyroid autotransplantation in uremic patients
Authors: Klempa I. , Frei U. , Röttger P. , Schneider M. , Koch K. M.
Published: May 2005

Recurrence of hyperparathyroidism (HPT) following total parathyroidectomy and autotransplantation (APTX) has been reported before. However, no data about the time interval between grafting and relapse and about morphology were given. Only 1 case of primary hyperparathyroidism with APTX has been extensively analyzed.

We have performed autotransplantation in 42 patients with HPT due to chronic renal failure. Implanted parathyroid tissue showed typical chief cell hyperplasia. Within 4–33 months, 6 patients developed recurrent HPT with serum iPTH levels being highest in venous blood of the grafted arm. Grafts had to be removed. Although only 20–40 mg of parathyroid tissue had been implanted, removed grafts weighed from 0.9 to 3.1 g. Explanted grafts were examined by light and electron microscopy. The size and DNA content of nuclei were determined. In all cases the explanted material showed a distinct invasive growth into the adjacent connective tissue and muscles and in 2 cases mitotic figures were demonstrated, a finding resembling malignant neoplasia of the parathyroid.

From our clinical and morphological observations we draw the following conclusions:

Surgical treatment of renal hyperparathyroidism by PTX + Auto‐TX unforeseeably may result in very accelerated growth of grafted tissue.

Because of invasive growth there exists the risk of uncontrolled spread of parathyroid tissue.

Graft removal may turn out to be difficult and possibly necessitate repeated and extensive surgery.

Before the observed phenomenon is totally understood, we no longer recommend PTX + Auto‐TX as an alternative to subtotal PTX in the surgical treatment of renal hyperparathyroidism.
Further experience with Pseudo‐Zollinger‐Ellison syndrome: Its Place in the management of neuroendocrine duodenal ulceration
Authors: Friesen Stanley R. , Tomita Tatsuo
Published: May 2005

The diagnostic and therapeutic criteria that allow differentiation of the Pseudo‐Zollinger Ellison syndrome (PsZES) from other ulcerogenic states including neurogenic duodenal ulcer disease, the retained, excluded antrum syndrome (REAS), and the Zollinger‐Ellison syndrome (ZES) are documented. Ten additional patients having clinical and diagnostic features of Ps‐ZES demonstrated hypergastrinemia of an antral source. Three of the patients had had failed complete vagotomy and drainage procedures and another had a retained excluded antrum after partial gastrectomy. Postoperatively, normal serum gastrin concentrations were attained in the 9 patients who had a definitive antrectomy, with and without concomitant vagotomy. Provocative tests demonstrate that patients with Ps‐ZES have an exaggerated serum gastrin response to a meal but not to intravenous secretin. Antral G‐cell hyperplasia (AGCH) was observed histochemically in all but one surgically treated patient who is presumed to have G‐cell hyperfunction due to pyloric obstruction. One patient with REAS exhibited no appreciable response to a meal or to secretin stimulation; the G cells of the excluded antrum were hyperplastic. None of the patients had historical or endocrine features of multiple endocrine adenopathy, type I (MEA I).

Provocative testing and histochemical determination of the antral G‐cell population permits a selective approach to the surgical treatment of patients with persistent or recurrent ulceration due to hyperchlorhydria. Patients with neurogenic duodenal ulcer without hypergastrinemia may reasonably be treated by surgical vagotomy with pyloroplasty or parietal cell vagotomy. Patients proven to have an antral source (without tumor) for their hypergastrinemia (Ps‐ZES) should have antrectomy, with or without vagotomy. Patients with gastrinoma (ZES) require excision of tumor(s) with or without total gastrectomy.
Percutaneous transhepatic portal vein catheterization for localization of insulinoma
Authors: Hsien‐chiu Tseng , Chong‐zheng Yao , Shou‐xian Zhong , Jian‐xi Zhang , Yu Zhu
Published: May 2005

The experiences of percutaneous transhepatic catheterization of the portal vein and immunoassay for insulin of blood samples taken from the splenic and portal veins for localization of isulinoma are reported. This method was carried out in 17 patients, including 11 cases of clinically diagnosed insulinoma (with pathological proof in 9), 2 patients with residual symptoms following previous excision of an insulinoma, and 4 cases eventually proven not to be insulinomas. The results showed that a high value of insulin was present at or near the site of the tumor in 8 single benign insulinomas, while a sustained elevation of plasma insulin throughout the course of the veins was seen in a patient with malignant insulinoma and widespread metastases. The insulin values were not elevated in the 4 patients without insulinomas. Although this method is useful in preoperative localization of insulinomas, it cannot replace thorough and careful palpation of the pancreas at the time of operation.
Extra‐adrenal and metastatic pheochromocytoma: The role of131I meta‐iodobenzylguanidine (131I MIBG) in localization and management
Authors: Thompson Norman W. , Allo Maria D. , Shapiro Brahm , Sisson James C. , Beierwaltes William
Published: May 2005

From June, 1980, to August, 1983,131I MIBG scintiscans were performed in 353 patients with suspected pheochromocytomas. Extra‐adrenal pheochromocytomas were identified in 15 of 18 patients who at operation were proven to have such tumors and normal adrenal glands. Conventional localization studies, often repeated, had failed to localize these tumors in nearly all cases. Nine of the extraadrenal pheochromocytomas were found within the middle mediastinum. This group of unique tumors required further specialized localization studies with augmented computed tomography (CT) scans for specific anatomical delineation. These complementary studies allowed for precise planning of surgical excision of the tumors, which required cardiopulmonary bypass in some patients. Extraadrenal pheochromocytomas were identified in a family with no other endocrinopathies. The tumors in 3 patients from 3 different generations all were perirenal and involved the vena cava.

131I MIBG scintiscans detected metastatic lesions in 40 patients with malignant pheochromocytomas. Metastases were not readily demonstrated in 4 patients. The diagnosis of malignant and metastatic pheochromocytoma was first made by the scintiscan findings in 5 patients.131I MIBG scans were not false‐positive in any cases and were falsenegative in 10.5% of 95 patients proven to have pheochromocytomas by biochemical evidence or operation.

Ten patients have been treated for malignant pheochromocytomas with therapeutic doses of131I MIBG. Five patients have had objective responses with diminution in size of metastases or primary malignant tumor and a decrease in the secretion of catecholamines.

This agent has been found to be of great value in detecting pheochromocytomas that often have defied all other means of localization.131I MIBG concentrates in most malignant pheochromocytomas, and preliminary results suggest that it will be very useful in the treatment of this disease.
Surgical management of the adrenal glands in the multiple endocrine neoplasia type II syndrome
Authors: van Heerden Jon A. , Sizemore Glen W. , Carney J. Aidan , Grant Clive S. , ReMine William H. , Sheps Sheldon G.
Published: May 2005

During a 30‐year period (1951–1981), seventeen patients underwent bilateral adrenalectomy for established adrenal medullary disease with catecholamine excess. Fourteen patients had the MEN IIa syndrome and 3 had the MEN IIb syndrome. There was no major operative morbidity and no operative mortality.

One patient died 23 months after initial operation because of metastatic pheochromocytoma. The remaining patients were followed for a mean of 129 months and all were personally interviewed. Three patients had 7 uneventful pregnancies. Twelve patients underwent 23 other surgical procedures requiring general anesthesia during the followup period without any morbidity. Two patients have metastatic pheochromocytoma; 3 have clinical metastatic medullary thyroid carcinoma; 5 patients have high calcitonin values and 6 patients are in excellent health at intervals of 15, 27, 58, 110, 134, and 373 months following resection. The need for adrenal replacement therapy has not caused significant problems in any patient.

The results of this study confirm that bilateral total adrenalectomy is a safe modality for the treatment of adrenal medullary disease in this syndrome and that it does not produce significant long‐term morbidity.
A prospective evaluation of serum carcinoembryonic antigen (CEA) levels in the management of colorectal carcinoma
Authors: Boey John , Cheung H. C. , Lai C. K. , Wong John
Published: May 2005

The relationship between the pattern of carcinoembryonic antigen (CEA) changes and the types of recurrence was investigated in a prospective study of 146 patients who underwent curative operations for adenocarcinoma of the colon or rectum. Recurrences developed in 51 patients (34.9%) and was local in 14, distant in 23, and both local and distant in 14 of them. CEA slope values were individually calculated beginning with an initial rise of more than 1 ng/ml, and expressed as the % rise in CEA per month. Patients who relapsed had significantly higher slopes than those who remained well (median 20.0% versus 0.3% rise,p<0.001). A slope value of 5% rise per month broadly separated the two groups with an overall accuracy of 79.4%, sensitivity rate for recurrence of 86.3%, and specificity rate for no relapse of 75.8%.

Median CEA slope values did not differ significantly among patients with different types of relapse. However, compared with patients who had any distant recurrence, more patients with localized recurrence had slope values of less than 5% rise per month (8.1% versus 28.6%, respectively; one‐tailedp=0.04). Nevertheless, a slope exceeding a 5% rise per month was observed in 10 of the 14 patients with local recurrence.

We conclude that serial postoperative CEA monitoring is useful in detecting both local as well as distant recurrence. Furthermore, the use of slope analysis may enhance the sensitivity of postoperative CEA monitoring for detecting relapse.
Early gastric cancer: Results in a general hospital in Japan
Authors: Abe Shun'ichi , Ogawa Yuichiro , Nagasue Naofumi , Sasaki Yukiharu , Akamizu Hiroshi , Hirose Sozo , Yukaya Hirofumi , Suehiro Shinichi
Published: May 2005

One hundred and forty patients underwent surgical treatment for early gastric cancer. Cumulative and age‐corrected cumulative 5‐year survival rates were 87.5% and 96.2%, respectively. Cumulative and age‐corrected 10‐year survival rates were 68.5% and 88.3%, respectively. When cancerous tissue did not remain in the resectional stumps and no regional lymph node was metastasized, the survival was almost equal to that of the general population. Resection of the secondary lymph nodes is considered beneficial, since 13.9% of cases had metastasized lymph nodes in our series. The 5‐year survival of 90% is a realistic figure for early gastric cancer, attainable in a general hospital which does not specialize in cancer research.
Gastric cancer in patients above 70 years of age
Authors: Oohara Takeshi , Johjima Yoshiaki , Yamamoto Osamu , Tohma Hiroyuki , Kondo Yoshio
Published: May 2005

Clinical records of 406 patients over 70 years of age with gastric cancer operated on during the past 22 years were analyzed. These cases amounted to 11.8% of the 3,425 patients with gastric cancer treated surgically at our hospitals during the same period.

The primary tumor was confined to the upper one‐third portion of the stomach in 15.8% of the cases, which was significantly higher than that usually reported. Macroscopic staging of the lesion revealed that more than two‐thirds of the patients were suffering from highly advanced disease. The size of the tumor was larger than 50 mm in diameter in 50.8% of the cases. The tumor was predominantly of Borrmann II and III types. Early gastric cancer was observed in only 14.8% of the cases, which was approximately one‐half of the usual rate. However, histological study revealed well‐differentiated adenocarcinoma in two‐thirds of the lesions, a remarkable characteristic of gastric cancer in the elderly.

Resection was possible in 70.9%, and curative resection was performed in 46.8%. The over‐all hospital mortality rate was 16.5%. The prognosis of curative resection cases yielded a 5‐year survival rate of 51.5% and 10‐year survival rate of 25.5%. These results would justify the practice of early diagnosis and aggressive surgery in every acceptable risk patient, if no contraindication exists.
Long‐term follow‐up study of 50 patients with pancreaticoduodenectomy for chronic pancreatitis
Authors: Moreaux Jean
Published: May 2005

From 1963 to 1976, fifty patients, all male and alcoholic, underwent pancreaticoduodenectomies for chronic pancreatitis. Prior operation(s) had already been performed for 17 patients.

There was 1 postoperative death. The main late complications were anastomotic peptic ulcer (5 cases) and acute cholangitis (3 cases). In 1981, four patients were lost to follow‐up, 23 patients were dead, and 22 patients were reviewed with a mean follow‐up period of 10.7 years. Secondary deaths mainly occurred during the 5 years following surgery (17 of 23). Other complications of chronic alcoholism, together with smoking‐related diseases, were the cause of death in 8 patients. Symptomatic and clinical results were excellent or good in 16 of 22 reviewed patients. Persistent alcoholism (50% in patients who died and 10% in living patients) and low socioeconomic level were the main factors affecting long‐term survival.
Results of a prospective randomized double‐blind trial of aprotinin in colonic surgery
Authors: Young Howard L. , Wheeler Malcolm H.
Published: May 2005

One hundred patients undergoing colorectal surgery were entered into a prospective, randomized, double‐blind trial of the collagenase inhibitor aprotinin (Trasylol®). Postoperative assessment of the integrity of the anastomoses was performed and the overall radiological leakage rate was 22% for the aprotinin group and 35% for the placebo group. The overall clinical leakage rate was 8% and 15% for aprotinin and placebo, respectively. This reduction in the leakage rates may be of clinical importance and further studies are therefore warranted.
Surgical treatment of ten cases of parathyroid carcinoma: Importance of an initial en bloc tumor resection
Authors: Fujimoto Yoshihide , Obara Takao , Ito Yukio , Kanazawa Kyotaro , Aiyoshi Yuji , Nobori Masakazu
Published: May 2005

This report examines the charcteristics of 10 patients surgically treated for unequivocal parathyroid carcinoma. Seven cases were from our series of 165 patients with primary hyperparathyroidism. Routine determination of serum calcium level by an automated analyzer occasionally led to early tumor detection. A spectrum of clinical and pathological variation was evident in our series. One of 3 patients with simple tumor resection and 1 of 4 patients with wide local excision in the initial operation showed local recurrence. Regional lymph node metastases without local recurrence occurred in another patient 3 years after the initial wide local resection and he was treated by neck and mediastinal dissections.

Three additional parathyroid carcinoma patients with simple tumor resection were referred to us from elsewhere for recurrent hypercalcemia. Aggressive surgical resections of locally recurrent tumors or metastatic nodules brought marked alleviation of hypercalcemic symptoms, although none was curative.

Although the prognosis of parathyroid carcinoma greatly depends on the biological malignancy of the tumor in individual cases, our ongoing data confirm the importance of thorough identification and en bloc removal of the tumor at the time of the initial operation. A neck dissection is necessary when there is evidence of lymph node metastasis.
Is preoperative radiographic localization of islet cell tumors in patients with insulinoma necessary?
Authors: Böttger Thomas C. , Junginger Theo
Published: May 2005

Preoperative localization tests [sonography, computed tomography, angiography, percutaneous transhepatic portal venous sampling for insulin radioimmunoassay (PTP)] have a sensitivity of 60% to 90% in cases of organic hyperinsulinism. In all publications, however, the sensitivity of intraoperative localization, 75% to 100%, is distinctly higher. With the exception of PTP, all tumors that can be identified by preoperative localization can also be detected using palpation or intraoperative sonography. Preoperative localization diagnosis is therefore not absolutely necessary prior to primary operation in the case of organic hyperinsulinism. It is requested by many surgeons because: (1) only a few clinics have extensive experience with patients with an organic hyperinsulinism; (2) only a few clinics have extensive experience with intraoperative sonography; (3) the accuracy of palpation is improved following appropriate preoperative localization; and (4) in rare cases, the results of a PTP influence the operative procedure.
Intraarterial calcium stimulation test for detection of insulinomas
Authors: Doppman John L. , Miller Donald L. , Chang Richard , Gorden Phillip , Eastman Richard C. , Norton Jeffrey A.
Published: May 2005

Occult insulinomas are adenomas not visualized by routine preoperative imaging studies, including ultrasonography (US), computed tomography (CT), magnetic resonance imaging (MRI), and arteriography. Reliance for detecting occult insulinomas has been placed on portal venous sampling (PVS), a sensitive (> 75%) but invasive procedure that requires considerable experience to enable sampling of small veins about the pancreatic head. For the past 2 years we have attempted to localize insulinomas by stimulating the release of insulin with a selective intraarterial injection of calcium gluconate and sampling for insulin gradients in the hepatic veins. This study replaces PVS by indicating the region of the pancreas within which the tumor lies, although, like PVS, it does not directly visualize the tumor. Our experience in 9 patients with surgically proved insulinomas is reviewed, comparing the results with PVS as well as with US, CT, MRI, and arteriography.
Duodenal gastrinomas, duodenotomy, and duodenal exploration in the surgical management of Zollinger‐Ellison syndrome
Authors: Thompson Norman W. , Pasieka Janice , Fukuuchi Atsushi
Published: May 2005

Studies have shown that the duodenum is a more common site (30–40%) of primary gastrinomas than previously reported. These tumors are often occult to conventional exploration, and their detection requires duodenotomy and meticulous evaluation of the mucosa by eversion and direct palpation. Furthermore, tumors as small as 1 to 2 mm may be associated with lymph node metastases. Seven patients with duodenal gastrinomas treated during a 2‐year period are reported. Four had sporadic Zollinger‐Ellison syndrome (ZES), and three had multiple endocrine neoplasia type I (MEN‐I) syndrome. All seven patients had malignant duodenal gastrinomas as proved by metastatic lymph nodes and in one case a large liver metastasis as well. Local excision of the tumor, lymph node excisions, and in one case liver lobectomy resulted in eugastrinemia in the 4 with sporadic ZES. Two of the three with MEN‐I were also eugastrinemic after similar procedures, with the addition of distal pancreatectomy. Duodenotomy is considered an essential procedure in sporadic ZES patients when no pancreatic tumor is found and in all MEN‐I/ZES patients, regardless of the pancreatic findings. Regional lymph node excisions are essential when a duodenal tumor has been found.
Control of gastric acid hypersecretion in the management of patients with Zollinger‐Ellison syndrome
Authors: Metz David C. , Pisegna Joseph R. , Fishbeyn Vitaly A. , Benya Richard V. , Jensen Robert T.
Published: May 2005

During the last 5 years important advances have occurred in the control of gastric acid hypersecretion in Zollinger‐Ellison syndrome (ZES). The increased availability of potent gastric acid antisecretory agents such as histamine H2‐receptor antagonists and more recently the H+K+‐ATPase inhibitors such as omeprazole and lansoprazole have made it possible to medically control acid secretion in all patients. Increased understanding of the variation in antisecretory drug dosage between individual patients has led to identification of criteria to ensure effective antisecretory control and to the recognition of subgroups of patients who require special monitoring. Effective regimens for parenteral antisecretory control during surgery have been established. The importance of parathyroidectomy in patients with multiple endocrine neoplasia type I with ZES and the possible usefulness of highly selective vagotomy have been investigated. We review here the new data that led to increased understanding in each of these areas from our studies and studies by others.
Pathologic aspects of gastrinomas in patients with Zollinger‐Ellison syndrome with and without multiple endocrine neoplasia type I
Authors: Pipeleers‐Marichal Miriam , Donow Christian , Heitz Philipp U. , Klöppel Günter
Published: May 2005

During the three decades since the recognition of the Zollinger‐Ellison syndrome (ZES), major progress has been made in the diagnosis and treatment of this disease. However, the many failed operations in patients with ZES, the existence of primary lymph node gastrinomas, and the surgical approach of patients with ZES and multiple endocrine neoplasia type I (MEN‐I) have remained controversial issues. In this review, our experience with the pathology of immunocytochemically identified gastrinomas in 44 patients with ZES is presented and related to the relevant literature. (1) Gastrinomas occur frequently in the duodenum (> 40%) and are commonly small (< 1 cm). They can therefore easily be missed at surgical exploration; lymph node metastases from such occult gastrinomas may be mistaken for primary tumors. (2) Most pancreatic gastrinomas reside in the head of the gland and have a diameter of 1 to 3 cm. (3) Gastrinomas associated with MEN‐I are predominantly of duodenal origin and frequently multicentric; sporadic gastrinomas are single and more often pancreatic. Because MEN‐I associated pancreatic tumors seldom contain gastrin, ZES in MEN‐I patients is almost never cured by resection of the pancreatic tumors. (4) The metastatic potential of most small duodenal gastrinomas seems to be restricted to the regional lymph nodes.
Current approach to the management of gastrinoma and insulinoma in adults with multiple endocrine neoplasia type I
Authors: Mignon Michel , Ruszniewski Philippe , Podevin Philippe , Sabbagh Luis , Cadiot Guillaume , Rigaud Daniel , Bonfils Serge
Published: May 2005

The difficult and controversial diagnostic and therapeutic management of patients having gastrinoma or insulinoma with multiple endocrine neoplasia type I (MEN‐I) has been discussed by reference to the literature and a personal series of 45 gastrinoma/MEN‐I patients followed consecutively at Bichat Hospital. In both gastrinoma/ and insulinoma/MEN‐I patients, anatomic distribution and morphology of tumoral process(es) are usually multiple, diffuse, of small size, and associated with endocrine cell hyperplasia and even nesidioblastosis. These features enhance the difficulty of tumor localization and eradication. Despite the dramatic development of modern medical imagery and surgical experience, the real possibility, on a long‐term basis, of curing the patients from their disease remains limited, especially in the gastrinoma/MEN‐I patients. In the latter group, according to our experience, persistence or recurrence of the disease after surgery is usual, and metachronous hepatic metastasis development is frequently observed when the follow‐up is long enough. Patients with liver metastases, however, seem to undergo a more indolent course than sporadic gastrinoma cases. In insulinoma/MEN‐I patients, removal of the functionally dominant islet cell area(s) is essential. Various preoperative and intraoperative localization techniques allow efficacious selective pancreatic surgery in many cases. The latter refinements and the promises of long‐acting somatostatin analogs, if confirmed, might restrict to exceptional circumstances the indication of near‐total or total pancreatectomy.