bluuebunny/crossref_metadata_2025_split huggingface dataset:
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

AbstractIn 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

AbstractRecurrence 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

AbstractThe 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

AbstractThe 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

AbstractFrom 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

AbstractDuring 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

AbstractThe 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

AbstractOne 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

AbstractClinical 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

AbstractFrom 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

AbstractOne 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

AbstractThis 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

AbstractPreoperative 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

AbstractOccult 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

AbstractStudies 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

AbstractDuring 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.