bluuebunny/crossref_metadata_2025_split huggingface dataset:
Six‐year results of annual colonoscopy after resection of colorectal cancer
Authors: Juhl Greg , Larson Gerald M. , Mullins Richard , Bond Sheldon , Polk Hiram C. 
Published: May 2005

AbstractColonoscopy is an important diagnostic and therapeutic tool that may also be useful in the surveillance of patients after curative resection of colorectal cancer. The yield of colonoscopy and the frequency with which it should be performed after operation, however, have not been clearly defined. Over the past 10 years, we have examined these patients annually with colonoscopy or barium enema. This study evaluates the results of a specifically designed protocol that followed 174 patients.Counting all sites, colorectal cancer recurred in 57 of 174 patients, three‐quarters within the first 24 months. Nine anastomotic recurrences were detected in the 12–30 month interval; none was reoperated for cure; however, 4 metachronous colon cancers were found and resected for cure. In addition, 30 polyps larger than 1 cm in size and 7 villous adenomas were removed in 30 patients. Combined, these findings represent an interval yield of 3–5% per year. Based on these results and other reports, we recommend that patients undergo colonoscopy annually at least for the first 6 years postresection of colorectal cancer. The detection of new primary tumors and possibly predisposing lesions becomes more important in these patients than detection and cure of recurrent disease.
Acute and perforated appendicitis: Current experience with ultrasound‐aided diagnosis
Authors: Schwerk Wolf B. , Wichtrup Britta , Rüschoff Joseph , Rothmund Matthias 
Published: May 2005

AbstractThe clinical value of high‐resolution real‐time sonography for the diagnosis of acute and complicated appendicitis was prospectively investigated in 857 patients admitted with suspected appendicitis. The ultrasound findings were correlated with history and physical examination on admission. Sonography was able to make the diagnosis of appendicitis with a sensitivity of 89.7%, a specificity of 98.2%, an overall accuracy of 96.3%, and a positive and negative predictive value of 93.6% and 97%, respectively. Routine use of ultrasound before making therapeutic decisions has reduced the rate of unnecessary laparotomies from 20.3% to 11.3%. In 48 (24.7%) of 194 patients with proven appendicitis, the disease had progressed to perforation at laparotomy. History and clinical findings on admission classified 30 (62.5%) of these patients as “highly suspect;” however, 9 (18.8%) were classified as “equivocal” and 9 (18.8%) as “very unlikely.” Only half (48%) of the patients with appendiceal rupture had white blood cell counts higher than 13,000/mm3 or fever above 38°C (50%). Sonography enabled the visualization of the inflamed appendix and/or appendicular abscess in 44 (91.7%) patients with perforation. In 47 of 48 patients with appendiceal rupture, the ultrasoundaided diagnosis was made on hospital admission. Thus, the incidence of complicated appendicitis (24.7%) in our study population must be attributed to disease progression before admission and preclinical diagnostic delay.
Cellular physiology and pathophysiology of the parathyroid glands
Authors: Åkerström Göran , Rastad Jonas , Ljunghall Sverker , Ridefelt Peter , Juhlin Claes , Gylfe Erik 
Published: May 2005

AbstractThis report provides insight into parathyroid gland physiology and the pathophysiology of hyperparathyroidism (HPT). Increases in the extracellular calcium concentration constitute the primary physiological signal for inhibition of parathyroid hormone (PTH) release. Transduction of the external signal into a cellular response involves activation of a cation receptor mechanism on the plasma membrane with rapid rise in the cytoplasmic calcium concentration of the cells. This recently discovered parathyroid calcium receptor has been characterized as a glycoprotein of unusually high molecular weight, which may play a key role in calcium homeostasis since it is also expressed in the kidney and placenta. Binding of external calcium to the receptor is associated with mobilization of intracellular calcium as well as calcium influx into the cells and phosphoinositol hydrolysis. These events rapidly interfere with the release process through essentially unknown mechanisms and probably also at sustained stimulation inhibit PTH gene transcription. The relative calcium insensitivity of the PTH release in HPT is associated with a deranged regulation of cytoplasmic calcium within pathological parathyroid cells. The molecular basis for this disturbance comprises down regulation of the cation receptor, whereby external calcium is translated into abnormally low levels of cytoplasmic calcium and insufficient inhibition of PTH release. Studies on expression of the functionally important cation sensing glycoprotein and its associated cellular signal systems may provide novel means for interference with the pathophysiological derangements of HPT.
Surgical treatment of primary hyperparathyroidism: An institutional perspective
Authors: van Heerden Jon A. , Grant Clive S. 
Published: May 2005

AbstractThree hundred and eighty‐four consecutive patients with primary hyperparathyroidism (HPT) were surgically treated at a single institution during the 2 year period 1983 through 1984. Two patients were found to have benign familial hypocalciuric hypercalcemia and a single patient had parathyroid carcinoma. In the remaining 379 patients, the cure rate was 99.5%, the operative mortality 0.3%, persistent vocal cord paralysis 0.8%, and permanent hypocalcemia 0.3%. This data supports a liberal policy regarding cervical exploration in patients with HPT and questions any policy of observation without surgical intervention.
Pre‐Operative localization and interventional treatment of parathyroid tumors: When and how?
Authors: Miller Donald L. 
Published: May 2005

AbstractA variety of diagnostic tests are currently used for parathyroid localization. In patients who have not had previous surgery, none of these are as sensitive or specific for the localization of abnormal parathyroid glands as an experienced surgeon. In these patients, no pre‐operative localization procedures are normally needed.Patients who have had previous thyroid or parathyroid surgery require pre‐operative localization. Noninvasive imaging procedures (ultrasound, scintigraphy, computed tomography, magnetic resonance imaging) should be performed until an abnormal gland is identified in the same location on at least 2 examinations. The order in which these studies are performed is not important. In the 50% to 70% of patients in whom noninvasive studies are inconclusive, suspicious lesions may be aspirated or biopsied with imaging guidance. If this cannot be done or is nondiagnostic, angiography and, if necessary, parathyroid venous sampling should be done. Intra‐operative ultrasound examination of the neck is helpful during re‐operations.In selected patients, parathyroid tumors may be ablated by injection of contrast material through an angiographic catheter into the artery supplying the gland, or by percutaneous injection of alcohol into the gland itself. Angiographic ablation is best used for mediastinal glands supplied by the internal thoracic artery or by a descending branch of the inferior thyroid artery. Percutaneous alcohol injection may injure the recurrent laryngeal nerve permanently and should be limited to the rare patient with a neck lesion who has a prohibitive surgical risk. Neither technique is as effective as surgery.
Management of patients with persistent or recurrent primary hyperparathyroidism
Authors: Carty Sally E. , Norton Jeffrey A. 
Published: May 2005

AbstractThe surgical management of patients with persistent or recurrent primary hyperparathyroidism is reviewed. The several factors allowing the surgeon to formulate a correct working diagnosis and to successfully remove all abnormal parathyroid tissue are individually discussed and recent results of re‐operative parathyroid surgery are presented. In particular, direct surgical exploration based on aggressive pre‐operative localization studies, the use of intra‐operative ultrasound to facilitate intra‐operative dissection, cryopreservation of excised parathyroid tissue with potential for delayed autograft to avoid permanent hypoparathyroidism, and the use of intra‐operative monitoring of urinary cyclic adenosine monophosphate levels in patients with parathyroid hyperplasia in whom the surgeon is uncertain whether all abnormal parathyroid tissue has been removed, each contribute to a high rate of successful management (>95%) for patients with the difficult problem of persistent or recurrent primary hyperparathyroidism.
Asymptomatic primary hyperparathyroidism
Authors: Harrison Barnard J. , Wheeler Malcolm H. 
Published: May 2005

AbstractThe criteria used in selecting patients with asymptomatic hyperparathyroidism (HPT) for surgery remain controversial. Do patients with asymptomatic HPT have less severe disease (smaller glands and less derangement of biochemistry) than those with symptoms? We studied a consecutive series of 111 patients with HPT surgically treated and compared the symptomatic patients (n=83) and asymptomatic patients (n=28). There were no significant differences between the two patient groups with respect to age, serum calcium, PTH (intact 1–84), and excised gland weights (adenomas). Hypercalcemia was cured in all patients. The natural history of mild or asymptomatic HPT is unknown, but we summarize the current knowledge relating to mortality, cardiovascular/ renal disease, psychiatric and neuromuscular disorders, and bone disease. Symptoms of HPT do not correlate with the degree of biochemical and pathological derangement. Furthermore clinical assessment does not predict severity of disease and should not be the sole basis of selection for surgery. The results of surgery for primary HPT permit us to advocate a liberal approach to the selection of asymptomatic patients for operation.
Management of hyperparathyroid patients with grave hypercalcemia
Authors: Tisell Lars‐Erik , Hedbäck Gunilla , Jansson Svante , Lindstedt Göran , Zachrisson Bo‐Fredrik 
Published: May 2005

AbstractDuring recent years the total number of patients undergoing surgery for hyperparathyroidism has markedly increased, but the annual number of cases with substantial hypercalcemia has remained unchanged. Parathyroid carcinoma and water clear cell hyperplasia cause more severe hypercalcemia than other kinds of hyperparathyroidism. Grave hypercalcemia due to hyperparathyroidism is more common among the elderly, but can occur during pregnancy and also among children. Occasionally, a patient with hyperparathyroidism can also have another cause of the hypercalcemia and does not become normocalcemic until adequately treated for both. The suspicion of grave hypercalcemia should arise due to its clinical features. Determination of serum calcium and intact parathyroid hormone concentrations establishes the diagnosis. The basic treatment of grave hypercalcemia is to rehydrate the patient and to restore the sodium losses. To further lower the serum calcium value we have found bisphosphonates to be very effective. The definitive treatment of grave hypercalcemia due to hyperparathyroidism is surgery. As a last resort, frail patients with grave hyperparathyroidism can undergo surgery under local anesthesia. Repeat operations can improve the prognosis of patients with metastatic parathyroid carcinoma. Selective venous catheterization with blood sampling for determination of intact parathyroid hormone can be helpful in localizing recurrent disease.
The molecular biology of parathyroid disease
Authors: Backdahl Martin , Howe James R. , Lairmore Terry C. , Wells Samuel A. 
Published: May 2005

AbstractAdvances in molecular genetics have shed important new light on the understanding of the basis for human tumors. The application of these methods has allowed for characterization of endocrine neoplasms at a level of resolution that was not previously possible. A variety of molecular techniques have been apph'ed to the study of parathyroid tumors at the DNA level. Studies of the clonal derivation of adenomas and hyperplasia suggest that these entities arise through fundamentally different mechanisms. The gene for parathyroid hormone (PTH) has been cloned and mapped within the human genome. In a small subset of parathyroid tumors, a rearrangement of the PTH gene has been described which may have contributed to their pathogenesis. A separate gene has been identified which appears to be responsible for the humoral hypercalcemia of malignancy. Chromosomal deletions which appear to be involved in the pathogenesis of multiple endocrine neoplasia type 1 have also been found in sporadic parathyroid adenomas. Characterization of tumors at the DNA level may make it possible to correlate specific genetic abnormalities with the biologic behavior of different parathyroid neoplasms and may be useful in distinguishing between adenoma, hyperplasia, and carcinoma.
A new technique of “Marlex®‐peritoneal sandwich” in the repair of large incisional hernias
Authors: Matapurkar B. G. , Gupta Arun Kumar , Agarwal Anil Kumar 
Published: May 2005

AbstractRepair of a large abdominal wall incisional hernia is a difficult surgical problem with recurrence being a common complication. In addition, other complications such as hematomas, seromas, and sinus formation result from the use of foreign material. A new technique to obviate these complications was used in 60 patients with large incisional hernias repaired over the last 15 years. Marlex® polypropylene mesh was used for repair, sandwiched between 2 layers of peritoneum of the overstretched hernia sac. There was no operative mortality and no recurrence in follow up from 3 years to 7 years. Postoperative complications encountered could be managed conservatively, without necessitating any major surgical procedure or mesh removal.
Prognostic factors in primary gastrointestinal leiomyosarcoma: A retrospective study
Authors: Kimura Hironobu , Yonemura Yutaka , Kadoya Naotaka , Kosaka Takeo , Miwa Kouichi , Miyazaki Itsuo , Sawa Toshiharu , Yoshimitsu Sotohiro , Nishida Yoshio , Kamata Touru , Hirono Teisuke , Takayanagi Nobutatsu 
Published: May 2005

AbstractThirty‐six patients who were admitted for surgical resection of leiomyosarcomas of the gastrointestinal tract to the Department of Surgery II, Kanazawa University Hospital, Kanazawa, Japan and its affiliates are included in the study. Follow‐up data on survival is available for 32 patients. The clinico‐pharmacologic variables, such as tumor site, tumor size, cellularity, mitotic index, and DNA ploidy pattern were analyzed and the results proved to correlate with the prognosis. Thirteen (41%) of the patients presented with distant metastases and/or recurrences, with hematogenous metastasis being the predominant type of recurrence. Local recurrences and/or distant metastases were significantly correlated with survival (p<0.001), as was tumor site (p<0.03), tumor size (p< 0.04), surgical treatment (p=0.05), and DNA ploidy pattern (p=0.06). Neither the mitotic index nor the cellularity proved to be significantly correlated with survival. Furthermore, some of the patients with local recurrences or distant metastases survived long after resection of recurrent tumors. In view of the results, aggressive surgical resection may be an efficient treatment of recurrences.
Cytogenetic studies in patients with gastric cancer
Authors: Abarbanel Joseph , Shabtai Fiorella , Kyzer Shlomo , Chaimof Chaim 
Published: May 2005

AbstractBanded Cytogenetic studies of gastric carcinoma are still relatively scarce, comprised of only a small number of patients. This study was performed on peripheral blood lymphocytes and malignant cells of 16 patients with gastric carcinoma. The lymphocytes were analyzed by standard techniques. All patients had a normal constitutional karyotype; 90% of the patients presented an increased breakage rate and nonrandom chromosomal instability mainly in the heterochromatic regions of chromosomes 1, 9, and 16. Decreased response to phytohemagglutinin was observed in 6 (38%) patients. The tissue specimens were analyzed using direct techniques. Normal ploidy was observed in only one patient, 3 tumors were near‐diploid, 4 hyperdiploid, 4 near‐triploid, and 4 near‐tetraploid. Those with the near‐triploid or near‐tetraploid constitution were in a more advanced pathological stage, most of them with a more complex Cytogenetic profile. Particular involvement was found for chromosomes 1 to 4, 7 to 9,17, and 20, but the more specific nonrandom changes seemed to involve chromosomes 7, 8, 9, and 17.
Foreign body ingestion: Management of 167 cases
Authors: Barros J. L. , Caballero A. , Rueda J. C. , Monturiol J. M. 
Published: May 2005

AbstractWe reviewed the management of 167 patients with foreign body ingestion from 1980 to 1986. Two patients (1.1%) refused treatment. Nonoperative management was attempted in 14 (8.4%) patients. Endoscopy was performed on 117 patients with an overall success rate of 85.5% and a complication rate of 1.7%. Surgical treatment was required in 51 (30.0%) patients, 14 of whom had previous unsuccessful endoscopy.
New aspects of craniofacial surgery
Authors: Marchac Daniel , Renier Dominique 
Published: May 2005

AbstractThe concept of craniofacial surgery, introduced by a French plastic surgeon named Paul Tessier, has completely transformed the treatment of facial deformities affecting the skeleton. Two of the more spectacular operations are correction of teleorbitism by orbital mobilization, and correction of facial retrusion by facial or fronto‐facial advancement. These operations have evolved with the bipartition principle and the monobloc and splitting techniques. Craniofacial techniques applied in infancy for correction of craniosynostosis have proved very successful in most cases. The increasing use of miniplate fixation and utilization of cranial bone grafts are mentioned, as well as advances made in genetic and fetal diagnosis.
Functional reconstruction after facial paralysis: A survey
Authors: Berger Alfred , Bargmann Hans J. G. 
Published: May 2005

AbstractThe attempt to achieve symmetrical harmonious facial expression represents a complex surgical challenge, necessitating an individualized approach. Clinical investigations and laboratory experiments have demonstrated how to better reconstruct a “smile.” In long‐standing deformities, ipsilateral or crossfacial nerve grafting followed by functional muscle transfer in a 2‐stage procedure seems to give the most acceptable results; however, hypoglossal‐facial anastomosis and dynamic muscle techniques such as temporal muscle transposition and others can result in adequate functional reconstruction. The development of these techniques with special emphasis on those made during the last 10 years is discussed and compared with our own experiences.
Progress in free tissue transfer
Authors: McC O'Brien Bernard , Vinod Kumar P. A. 
Published: May 2005

AbstractThe development of microsurgical techniques has supplied plastic surgery with a new chance to transfer tissue to nearly any recipient site of the body. Classical methods still have their value but also their limits in many circumstances. Free tissue transfer has proved its advantages, especially in covering defects in the lower extremity; but microsurgical flaps also gain ground in reconstructive surgery of the head and neck, the female breast, the abdominal wall, and the hands.This article will survey well‐classified microsurgical flaps, their indications, and their limits. In addition to a description of skin, fasciocutaneous, septocutaneous, and musculocutaneous flaps, we also include the latest detailed knowledge of free transfer of muscles, vascularized tendons, nerves, bones, and even joints, digits, and jejunal transfer. An outlook toward new perspectives with so‐called prefabricated flaps will also be discussed.
Progress in limb and digital replantation: Part B
Authors: Berger Alfred , Brenner Peter , Flory Peter , Schaller Eberhard , Schneider Wolfgang 
Published: May 2005

AbstractProgress in micro‐ or macroreplantation has resulted in higher survival rates of formerly amputated parts. Progress has been made as a result of intensive laboratory training and considerable experience due to the popular application of microsurgical techniques. More amputated digits or limbs may survive because the time of ischemia can be exceeded in using cold storage or perfusion. Homo‐ or heterodigital vessel transposition, expanded indications for vein graft interposition, as well as heterotopic transplantation allow for extremity preservation even in crush injuries, and in disastrous multiple amputations combined with contusion or avulsion. Nowadays, microvascular digital replantation with vessel anastomosis distal to the distal interphalangeal joint in adults is technically feasible. Finger amputations in children are a prime indication for replantation. Maintenance of extremity length is possible in applying external fixation. Emergency free flaps or compound tissue transfer under the “Urgence differée” condition may provide reliable soft tissue coverage. Secondary reconstruction with regard to bone defects, tendon repair, and eventual nerve grafting have to be aspired, finally leading to an improvement of functional results in daily and leisure activities as well as in early professional readaptation.
Progress in burn treatment and the use of artificial skin
Authors: Tompkins Ronald G. , Burke John F. 
Published: May 2005

AbstractRecently improved survival from thermal injuries has been demonstrated both in children and adults. This increase in burn injury survival rates is the result of multiple changes in treatment; probably the most important changes are, first, a more aggressive management of the wound with prompt excision of devitalized tissues and immediate closure of the wound, and, second, a better understanding and management of metabolic, immunologic, and nutritional aspects of the injuried patient. Artificial skin is a very important additional treatment modality that has more recently become available and promises to contribute significantly to improvements in wound management and survival rates by its ability to physiologically close a burn wound immediately after its excision.
Premature death in patients operated on for primary hyperparathyroidism
Authors: Hedbäck Gunilla , Tisell Lars‐Erik , Bengtsson Bengt‐åke , Hedman Ingmar , Oden Anders 
Published: May 2005

AbstractTo investigate long‐term survival after operation for primary hyperparathyroidism, a follow‐up study was performed on 896 consecutive patients in whom this diagnosis had been clinically and microscopically verified. These patients were operated on in the years 1953–1982. Their mean age at operation was 57.3 years [standard deviation (SD) 13.1], overall cure rate was 97.0%, and postoperative mortality was 0.89%. Follow‐up was 99.8% complete by the end of 1986. Mean follow‐up time was 12.9 years (SD: 6.1). Two‐hundred ninety‐four patients were deceased, which was 118 more than in a control group (p<0.001). The latter was based on Swedish population statistics, matched for age, sex, and calendar year. Each year, the control group was the same size as the hyperparathyroid population. The risk of premature death remained increased (p<0.001) even after exclusion of poor‐risk patients having their hyperparathyroidism diagnosed when being treated or followed because of other serious diseases. The main causes of premature death for the hyperparathyroid patients were cardiovascular and malignant diseases. Both occurred more often than in the control group (p<0.001). The results demonstrate that primary hyperparathyroidism causes damage that is not reversed by surgery.