bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fibroadenoma
Authors: Dent David M. , Cant Peter J. 
Published: May 2005

AbstractThe common breast fibroadenoma makes up between one‐third and one‐half of biopsies for benign breast disease. The contemporary view is that it is an abnormality of normal development and involution rather than a neoplasm. Various other benign conditions may be clinically indistinguishable, and histological confirmation was only obtained in 68% of 321 masses thought to be fibroadenomas. Short‐term (13–24 mo) follow‐up of 201 masses, thought to be fibroadenomas on clinical and cytological grounds, showed resolution in 31% and regression in a further 12%, this behavior being more common with single lesions; a further 32% increased in size. There have been no long‐term studies, but it is likely that most regress toward the end of a woman's reproductive years. Aspiration cytology can differentiate malignant from benign disease with great accuracy, but had impaired sensitivity (87%) and specificity (76%) in differentiating fibroadenoma from other benign processes in an analysis of 244 successful aspirates. While these lesions may be safely left in women under 25 years of age, only 19 (27%) of 70 women of this age group chose this option and excision remains the most frequent treatment.
Breast macrocysts
Authors: Hughes Leslie E. , Bundred Nigel J. 
Published: May 2005

AbstractClinical macrocysts occur in about 7% of adult women. Modern terminology and understanding of benign breast disorders considers microcysts and macrocysts as specific clinical and pathological entities. The terminology and concepts of fibrocystic disease and its many alternative terms have been discarded.Cysts arise as an aberration of normal lobular involution (ANDI) associated with active secretion of apocrine epithelium under hormonal stimulation. They are readily managed in most cases by aspiration alone. Multiple recurrent cysts may constitute a considerable nuisance and justify short‐term therapy with danazol. There is increasing evidence that multiple recurrent cysts are associated with a small, but significant increase in breast cancer risk.
Periductal mastitis/duct ectasia
Authors: Dixon J. Michael 
Published: May 2005

AbstractPeriductal mastitis/duct ectasia affects major breast ducts and is poorly understood. A variety of different terms have been used for this condition and these probably reflect different stages in one disease process.It appears to be responsible for 1–2% of all symptomatic breast conditions. Although the incidence is higher in postmortem studies, much of what is included as so‐called “periductal mastitis” or“duct ectasia” in these studies is duct dilatation, which occurs as part of normal breast involution.Periductal mastitis appears to be the primary condition with duct ectasia being the outcome. The cause of this periductal mastitis is uncertain, although bacteria, particularly anaerobic organisms, appear to play some role. Clinically, this condition can present with noncyclical mastalgia, nipple discharge, nipple retraction, a subareolar breast mass with or without overlying breast inflammation, a periareolar abscess, or a mammillary fistula.Antibiotics effective against the organisms isolated from this condition are effective in resolving periareolar inflammation and are useful when combined with surgery in mammillary fistula.
Benign disorders of the male breast
Authors: Webster David J. T. 
Published: May 2005

AbstractGynecomastia is the dominating problem of the male breast. Other diseases are rare but mimic the same conditions in women. Gynecomastia may occur at any age either as a primary event, when it is due to a minor hormonal unbalance, or secondary to other pathology (e.g., liver failure) or drugs. Treatment consists of assessment of cause and reassurance. In a minority of patients, treatment with drugs—such as danazol—or surgical resection is indicated.
Benign breast disease in the postmenopausal woman
Authors: Devitt James E. 
Published: May 2005

AbstractBreast symptoms are surprisingly common in the postmenopausal period, especially (but not only) when taking hormonal therapy. All of the common conditions of the premenopausal period may be seen. Clinical examination is usually easier and more precise in the postmenopausal woman. The importance of accurate clinical observation is stressed, as a diagnosis can usually be made in this way, supplemented by mammography and aspiration cytology where reliable services exist.
Benign breast disorders in nonwestern populations: Part II—Benign breast disorders in India
Authors: Shukla Hari S. , Kumar Sandeep 
Published: May 2005

AbstractExperience with benign breast disorders has been analyzed in 3 nonwestern populations: Hong Kong, India, and Northern Nigeria. Similarities to and differences from Western experience are found, but of great interest are notable differences between these populations which, as yet, lack explanation. All show “fibroadenosis” and fibroadenoma as common conditions, but the frequency with which phyllodes tumor is diagnosed varies between different centers in India as well as between different racial groups. Tuberculosis is another interesting example—wide differences in the frequency of breast infection are found although tuberculosis itself is common in all 3 countries. The value of prospective studies was shown when mastalgia was studied in this way in India. Often considered a “Western” affliction, these authors have been able to study 112 cases of mastalgia and found it to be twice as common as cancer as a presentation. These differing experiences between populations have been little explored and must hold promise for unravelling some of the enigmas of benign breast disorders in all countries.
Management of breast abscesses
Authors: Benson Edward A. 
Published: May 2005

AbstractHospital experience of breast abscess is changing as nonpuerperal abscess associated with periductal mastitis assumes increasing importance. Clinical presentation, bacteriology, and management differ notably from acute puerperal abscess, but the latter can still cause severe morbidity.The standard management of puerperal abscess by incision, breaking down loculi, and dependent drainage may still be used, but the author has shown that an alternative approach—curettage and primary obliteration of the cavity under antibiotic cover—can give equally good results with reduced morbidity.
Noncosmetic operations for benign breast disease
Authors: Hadfield Geoffrey J. 
Published: May 2005

AbstractThe operation of excision of the major duct system of the breast has remained unchanged since it was first designed by Adair and described by Hadfield [1–4], Urban [5], and recently by Preece [6] from Professor Hughes' unit in Cardiff.Operations for diseases for a single major duct or the whole major duct system, namely subareolar excision of the major ducts of the breast, are discussed. Technical problems are discussed and suggestions are made on ways to avoid these problems. An adequately performed operation should render the patient free from her disease with a good cosmetic result.Operations for excision of palpable and radiologically detected lesions are described. Since a histological examination is the final arbiter; methods ensuring that the whole lesion is demonstrated, excised, and fully examined are discussed. The medico‐legal aspect of this is of obvious importance.
Reoperation following failed fundoplication
Authors: Siewert J. Rüdiger , Isolauri Jouko , Feussner Hubertus 
Published: May 2005

AbstractFifty patients reoperated for failed Nissen fundoplication are presented; 29 patients (group 2) were operated between 1983 and 1988 while 21 patients (group 1) were operated before 1983. In group 1, the “slipped Nissen” had been the most frequent cause of reoperation (48%). In group 2, the most frequent causes for the unsuccessful operation were: (1) partial or total disruption of the fundic wrap (62%), (2) slipping of the fundoplication, giving rise to the telescope phenomenon (21%), and (3) creation of a fundoplication which was too low (10%). Refundoplication was performed in cases where the dissection of the previously formed fundic wrap was possible (42/50=84%). In group 1, three patients were treated by resection of the cardia, one by an Angelchik prosthesis and one by a distal gastric resection with Roux‐en‐Y diversion.In group 2, fundectomy was performed in one patient; in another, an Angelchik device was inserted, and in a third patient, fundoplication and proximal gastric vagotomy were performed. The results were excellent or good in 66% of patients in group 1 and in 76% of group 2. Operative mortality was 2% and morbidity, 4%.In conclusion, repeat fundoplication is recommended when reestablishment of the fundic region anatomy is possible during dissection. The operation can usually be performed through an abdominal route. Meticulous preoperative evaluation of the patients including 24‐hour pH measurement and manometry is necessary. Good results of refundoplication should be expected in 66%–76% of patients with recurrent disease.
Severe chronic cephalic pancreatitis: Use of partial duodenopancreatectomy with occlusion of the pancreatic duct in 289 patients
Authors: Gall Franz P. , Gebhardt Christoph , Meister Richard , Zirngibl Hubert , Schneider Michael U. 
Published: May 2005

AbstractPartial duodenopancreatectomy and occlusion of the remaining ductal system by Ethibloc®to induce rapid exocrine atrophy for treatment of severe chronic cephalic pancreatitis was introduced in our department in January of 1978. Since then, this surgical procedure has been performed in a total of 289 patients. Postoperative morbidity was 12.2%, 5 pancreatic and 3 biliary fistulas occurred. Postoperative mortality was 1% and relapses of pancreatitis occurred in only 2.2% due to incomplete filling of ducts with Ethibloc®. A total of 88.2% of patients became pain‐free and symptomless, 10.8% voiced minor complaints, and 85.9% gained an averaged of 7.8 kg weight postoperatively.We conclude that Ethibloc®occlusion is highly effective in inducing complete exocrine atrophy, thus abolishing the inflammatory process and preventing relapses of chronic pancreatitis and preserving the endocrine function from further impairment. This was demonstrated by biochemical assays during a 36‐month follow‐up in a prospective study in 23 of 289 patients.Our results compare favorably with and are superior to results from any other operative procedure for chronic cephalic pancreatitis. We consider partial duodenopancreatectomy combined with Ethibloc®occlusion of the pancreatic duct the procedure of choice in the surgical treatment of severe chronic cephalic pancreatitis.
Surgical anatomy of the hepatic hilum with special reference to the caudate lobe
Authors: Mizumoto Ryuji , Suzuki Hideaki 
Published: May 2005

AbstractThe portal triad around the hepatic hilum, including the caudate lobe, was investigated using 106 adult cadavers. The portal vein showed regular branching at the hepatic hilum. The round ligament was attached mainly to the pars umbilicalis of the left branch of the portal vein (81.3%), especially to its lower portion (64.6%). Typical extrahepatic branching of the hepatic artery was noted in 67% of the cadavers. Intrahepatic branching of the middle and left hepatic arteries showed some variations in 9.4% and 12.5% of the cadavers, respectively. The cystic artery originated from the right hepatic artery in 84.4% of the cadavers, and a dual cystic artery was observed in 30.2%.An aberrant hepatic duct, previously reported as an accessory hepatic duct, was observed in 9.0% of the cadavers; each entered the common hepatic duct on the right side. With reference to the course of bile duct and hepatic artery, the middle hepatic artery traversed the left main hepatic duct anteriorly in 13.5% of the cadavers, and ran partly in front of the duct in 52.0%. Furthermore, the right hepatic artery or its branches traversed the right main hepatic duct anteriorly in 9.4% of the cadavers and ran partly in front of the duct in 38.5%. The caudate lobe is supplied by both the right and left branches of the portal triad, mainly by the left. The caudate process is mainly supplied by the posterior branches of the portal triad, being continuous with the posterior segment of the liver.
The role of endoscopic retrograde cholangiopancreatography in preoperative assessment of bile duct cancer
Authors: Tanaka Masao , Ogawa Yoshiaki , Matsumoto Shinji , Nakayama Fumio 
Published: May 2005

AbstractA total of 73 patients with carcinoma of the bile duct (59 patients) or duodenal papilla (14 patients) were reviewed with regard to the role of endoscopic retrograde cholangiopancreatography (ERCP) in preoperative assessment of these diseases. Percutaneous transhepatic cholangiography was preferred in most of the jaundiced patients and ERCP was performed after establishment of percutaneous or operative drainage above the obstruction. Pancreatography obtained in 19 patients with bile duct carcinoma revealed pancreatic invasion in 2 patients, and chronic pancreatitis in 1 patient. Other patients with normal pancreatograms included 2 patients whose initial diagnosis had been pancreatic cancer. The extent of bile duct carcinoma could be determined in 92% of 26 patients who had retrograde cholangiography, whereas it was known preoperatively in only 27% of 33 patients in whom retrograde cholangiography was not obtained. Combined use of antegrade and retrograde cholangiography performed in 13 patients was particularly useful to clearly delineate the lesion. In most of the patients with ampullary carcinoma, biopsy during ERCP confirmed the diagnosis preoperatively; 3 of these patients underwent ERCP with a different diagnosis. Biopsy after sphincterotomy revealed bile duct carcinoma in 2 patients in whom bile duct cancer was not suspected. Complications included 2 cases of cholangitis and 2 cases of mild pancreatitis. ERCP does not provide sufficient information as to the proximal bile duct anatomy and extent of the lesion, which are essential for appropriate surgical treatment. If used with precautions to prevent possible septic complications, however, it is useful in excluding pancreatic diseases by pancreatography, in specifying the distal bile duct, and in observing the duodenum and papilla. The use of several ERCP‐derived techniques such as perendoscopic biopsy, sphincterotomy, and balloon catheter cholangiography substantially increases the diagnostic utility of this procedure.
Extended right hepatic lobectomy, left hepatic lobectomy, and skeletonization resection for proximal bile duct cancer
Authors: Pinson C. Wright , Rossi Ricardo L. 
Published: May 2005

AbstractTumors in the proximal third of the bile duct are associated with the lowest rates of resectability and poorest survival of tumors in all locations in the duct. Of 25 patients who underwent resection for tumors located proximally, 3 had extended right hepatic lobectomy, 6 had left hepatic lobectomy, and 16 had skeletonization resection. The operative mortality rate was 4% overall and 0 for patients undergoing hepatic resection. Actuarial survival at 1, 3, and 5 years was 84%, 44%, and 35%, respectively, with almost all patients dying with disease. Survival was longer for patients who had curative resection than for those who had palliative resection. Survival was longer after hepatic lobectomy than after skeletonization resection but was not statistically significant. Survival for the 25 patients who underwent resection compared favorably with the survival of 131 patients treated by strictly palliative procedures, and the quality of life for patients with resection was also improved.We conclude that aggressive resection for cure is the procedure of choice in selected patients with proximal bile duct cancer, but that it must be performed with low operative mortality. Current patient selection and operative techniques are described.
Bypass procedure for bile duct cancer
Authors: Miyazaki Kohji , Nagafuchi Kazumitsu , Nakayama Fumio 
Published: May 2005

AbstractIn spite of the great advances made in diagnostic procedures and patient management, and the aggressive attitude adopted by most surgeons, a sizable portion of bile duct cancer remains unresectable and should be treated by palliative procedures. We reviewed 93 patients with bile duct cancer treated in our department during the 20‐year period from 1965 to 1984, and found that biliary enteric anastomosis offers the best palliation with acceptable mortality and complication rates and increases length of survival and improves quality of life. For proximal third bile duct cancer, the approach in the plane of the falciform ligament by Bismuth and Corlette and the anastomosis of the duct of the lateral inferior segment, segment III, or anterior inferior segment, segment V, to a Roux‐Y jejunal loop is recommended because of its sufficient size, accessibility, and distance from the tumor. For middle and distal thirds bile duct cancer, hepaticodochojejunostomy (Roux‐Y) is preferred by first transecting the common hepatic or common bile duct and anastomosing it to the Roux‐Y jejunal loop to delay encroachment by the distally located bile duct cancer.
Percutaneous transhepatic endoprosthesis in malignant obstruction of the bile duct
Authors: Yamakawa Tatsuo , Esguerra Ricardo D. , Kaneko Hitoshi , Fukuma Eisuke 
Published: May 2005

AbstractThis article reviews our experience with the use of a prosthetic tube, placed percutaneously across unresectable malignant obstructions of the bile duct, in 23 patients. The tube, which is available in various sizes ranging from 8 to 20 Fr., has multiple side holes that allow adequate biliary drainage. A collar at the external end, positioned at skin level, prevents inward migration of the tube. Occlusion of this end by means of a cap allows internal drainage, while external decompression is made possible by connecting it to a closed‐system drainage bottle. This tube is inserted, under fluoroscopic or choledochoscopic guidance, after dilating the sinus tract established by percutaneous transhepatic biliary drainage.Relief of obstructive jaundice was achieved in all patients and the mean survival time of the entire group was 6.8 months. In patients with obstruction at the upper third of the bile duct, survival after placement of the tube ranged from 4 to 38 months, with a mean of 12.4 months. We found this method safe even in the weak and elderly, and tube patency was easy to maintain. We advocate its use particularly in patients with unresectable bile duct cancer, in whom biliary decompression is difficult by other procedures.
The role of intraoperative radiation therapy in the treatment of bile duct cancer
Authors: Iwasaki Yoji , Todoroki Takeshi , Fukao Katashi , Ohara Kiyoshi , Okamura Takao , Nishimura Akira 
Published: May 2005

AbstractSince October, 1976, we have treated a total of 81 patients with bile duct cancer. Fifty of these patients had cancer that originated at and/or infiltrated into the main hepatic ducts. Five patients had cancer on the upper to middle portion, 19 on the middle to intrapancreatic bile duct, and the remaining 7 had diffusely involved tumors. Fifty of the 81 patients underwent resections. Of the 50 patients, 33 received curative or noncurative resection alone, 14 were treated by resection plus intraoperative radiotherapy (IORT), and the remaining 3 received postoperative external irradiation. Thirty‐one of the 81 patients did not undergo tumor resection. Of these, 6 had IORT and 4 underwent external radiotherapy after bile drainage. The remaining 21 underwent bile drainage alone. Curative resection achieved the best cumulative 5‐year survival rate of 59.3%. IORT plus noncurative resection showed a superior 2‐year survival rate of 17,1% compared to 9.0% after noncurative resection alone. Only 1 patient treated by IORT plus bile drainage survived more than 2 years and subsequently died at 34 months.In the earlier stage of the development of the combination therapy with resection and IORT, severe complications were experienced in 9 patients (so treated), including remarkable obstructive changes of the hepatic arteries. In the later stage, resection plus IORT with a reduced single dose (20 Gy), using a smaller field size (3.7±1.4 cm) and beam energy (7.3±3.0 MeV), did not result in complication and produced 2 long‐term survivors among 5 patients. Fractionated external irradiation (30–40 Gy/4–5 weeks) has been added to the IORT recently. These results indicate that noncurative resection plus IORT in combination with external radiation would improve the prognosis of the patient with advanced bile duct cancer.
Internal radiation for bile duct cancer
Authors: Meyers William C. , Jones R. Scott 
Published: May 2005

AbstractThe clinical course of 27 patients with bile duct cancer who received intraductal exposure to192iridium was reviewed. All patients exhibited evidence of biliary obstruction prior to diagnosis of cancer and all underwent intubation for relief of obstruction either by surgical or radiologic methods. The patients then received either internal irradiation alone or the combination of internal plus external irradiation. The patients lived an average of 11.5 months following internal irradiation and 13.5 months following diagnosis. Patients who received both internal and external irradiation lived longer than those who received internal irradiation alone. The 3 patients who had resection of their primary tumors lived longer than the group as a whole. All patients continued episodes of mild or severe cholangitis following irradiation. The heterogeneity of patient material, pretreatment methods, and lack of controls preclude any statement concerning effectiveness of radiation therapy for bile duct cancer. A few patients may benefit from the therapy, and use of irradiation techniques as an adjuvant modality is worth continued investigation; however, while internal irradiation for local control of proximal bile duct tumors remains theoretically attractive, there remains little evidence of its efficacy.
Treatment and prognosis in bile duct cancer
Authors: Tompkins Ronald K. 
Published: May 2005

AbstractOver the past 30 years, a total of 165 patients with bile duct cancer have been studied at the University of California at Los Angeles (UCLA), U.S.A. A review of careful retrospective analyses of surgical treatment is presented. The data support a treatment strategy of resection of those tumors which can be grossly removed at operation. Palliation of other patients is best done by biliary‐enteric bypass or operative intubation. The higher morbidity and mortality rates for palliative resections, together with a poorer quality of life in those patients surviving this procedure, argue against resection for palliative purposes.