bluuebunny/crossref_metadata_2025_split huggingface dataset:
Study of intact (1–84) parathyroid hormone secretion in patients undergoing parathyroidectomy
Authors: Davies Charmian , Demeure Michael J. , John Andrew St. , Edis Anthony J. 
Published: May 2005

AbstractPatterns of intact (1–84) parathyroid hormone (intact PTH) elimination and subsequent recovery of parathyroid function were studied in 12 patients undergoing parathyroidectomy. Nine patients had primary hyperparathyroidism (HPT), with single gland disease in 6 and multiple gland disease in 3. Two patients had subtotal parathyroidectomy for HPT secondary to chronic renal failure and 1 underwent excision of a hyperfunctioning parathyroid autograft. Using a sensitive 2‐site immunochemiluminometric assay, serum intact PTH levels were measured preoperatively, intraoperatively, and postoperatively. A dual phase pattern of hormone clearance was found in 10 of the 12 patients, including the patient undergoing autograft excision. A monoexponential clearance pattern was seen in the remaining 2 patients, both of whom had subtotal parathyroidectomies for multiple gland disease. In the patients with primary HPT due to single gland disease, the early phase of intact PTH clearance had a half‐life (T1/2) of 3.3 (±standard deviation 0.9) minutes and a late T1/2 of 96.4 (±standard deviation 92.7) minutes. Calculation of decay curves and half‐lives for the patients undergoing subtotal parathyroidectomy was more difficult because of the inherent uncertainty in determining time zero. Nevertheless, in all but 2 patients, the clearance pattern was biexponential and the T1/2 measurements were very similar to those encountered in patients with single‐gland disease. In the 2 patients with monoexponential clearance, the T1/2 figures were 86.7 minutes and 26.7 minutes, respectively. In the patients undergoing parathyroidectomy for primary HPT, levels of intact PTH were lowest at 1–3 hours after surgery, recovering to normal in the majority of patients by 18–40 hours.
Gastrinomas: A 42‐year experience
Authors: Kaplan Edwin L. , Horvath Keith , Udekwu Anthony , Straus Francis , Schark Claudia , Ferguson Donald J. , Skinner David B. 
Published: May 2005

AbstractIn 1947, a patient with metastatic islet cell tumor was treated for intractable ulcer disease at the University of Chicago Medical Center. Eight years later, in retrospect, it was recognized that he and another patient had the Zollinger‐Ellison syndrome (ZE). From 1947 until the present, 30 patients with the ZE syndrome have been treated at this institution. Twenty‐one (70%) were male and 9 (30%) were female. Their ages ranged from 24 to 76 years. Most (79%) had abdominal pain, however, melena (42%), hematemesis (33%), and severe diarrhea (35%) were prominent as well. Symptoms were present for a mean of 5.8 years before diagnosis. Over their entire clinical course, duodenal ulcers occurred in 96% of patients, gastric ulcers in 24%, jejunal ulcers in 29%, esophageal ulcers in 6%, and stomal ulcerations in 58%. Eleven (38%) of all gastrinomas were proved to occur in the duodenum; 10 (34%) were pancreatic in origin, including 3 with the MEN I syndrome; 3 (10%) were extrapancreatic and extraduodenal in origin, and no tumor was found in 5 (17%). Each of the 3 patients with MEN I developed a proven pancreatic islet cell carcinoma with metastases as well as hyperparathyroidism and a pituitary lesion.Of 27 patients who were explored for gastrinoma, tumor was found in 20 (74%). Excluding patients with MEN who had multiple lesions throughout the pancreas, all tumors were found in the “gastrinoma triangle.” Total gastrectomy was performed in 10 (37%) of 27 of all patients who were explored, in 5 (71%) of 7 when no tumor was found, and in only 5 (25%) of 20 when tumor was present. Operative mortality was 15% (4 of 27), but no death has occurred since 1974. Long‐term survival has followed both tumor resection or total gastrectomy in selected individuals (including 1 patient with known multiple liver metastases who is alive 18 years after liver biopsy and total gastrectomy); however, since malignant gastrinomas were present in 46% of all patients (or 57% in whom tumor was found) and since local metastases can sometimes be removed, we favor an aggressive approach to localization and resection when liver metastases or other distant metastases are not found.Duodenal gastrinomas are particularly favorable for resection for cure. They were malignant in only 36% and their metastases were nodal in each of 4 cases. The major problem is finding them since they are often small and “occult.” All patients with ZE should have duodenoscopy preoperatively and, at operation, a wide duodenotomy with eversion of the duodenal mucosa and careful inspection and palpation should be performed. Above all, surgeons should realize that at least 38% of all gastrinomas may be duodenal in origin. Finally, since the early 1970's when serum gastrin measurements became available, 43% of our patients who were explored have been returned to basal eugastrinemia.
Piriform sinus fistula: An underlying abnormality common in patients with acute suppurative thyroiditis
Authors: Miyauchi Akira , Matsuzuka Fumio , Kuma Kanji , Takai Shin‐ichiro 
Published: May 2005

AbstractWe have previously reported that an internal fistula (piriform sinus fistula) was the apparent route of infection in 15 patients with acute suppurative thyroiditis (AST). Here, we describe 43 patients with AST, most of whom had a demonstrable fistula.The characteristic clinical features included: onset in infancy or childhood in 74% of cases, a left‐sided predominance of involvement (40∶3), and frequent recurrence. Twenty‐nine patients had had several previous episodes of AST. The fistula was demonstrable in 38 of 42 patients examined by barium meal. Twenty‐seven patients underwent fistulectomy. Six of 16 patients who declined fistulectomy had recurrences and 2 of them underwent surgery thereafter. None of 29 patients who had fistulectomy developed recurrences, except for 2 patients in whom the fistula could not be removed completely. The fistula ended medial or lateral to the thyroid lobe, attached to or entered the lobe in 6, 3, 6, and 12 cases, respectively. The thyroid specimens showed several features of inflammatory change.Thus, we concluded that the piriform sinus fistula is the most common underlying abnormality in patients with AST. Recurrence of inflammation can be prevented by complete fistulectomy.
Laboratory comparison of diagnostic specificity of intact hormone and region‐specific immunoassays of parathyroid hormone
Authors: Aston J. Paul , Wheeler Malcolm H. , Brown Richard C. , Curley Ian R. , Woodhead J. Stuart 
Published: May 2005

AbstractA 2‐site immunochemiluminometric assay (ICMA) for intact parathyroid hormone (PTH) has been developed to overcome the problems of limited sensitivity and specificity associated with conventional PTH immunoassays. The present investigation assesses the relative merits of the 2‐site intact PTH (ICMA) and a midmolecule PTH radioimmunoassay (RIA). Immunoassay profiles of dispersed hyperparathyroid cell supernatants and hyperparathyroid sera obtained during parathyroidectomy and from renal failure patients, fractionated by gel filtration chromatography, facilitated a direct comparison of the specificity of PTH immunoassays. Using gel filtration matrices which permitted the separation of intact hormone, large C‐terminal fragment(s), and a small midmolecule fragment in adenomatous cell supernatant and peripheral sera, the intact PTH (ICMA) assay consistently yielded a single peak of immunoreactivity. In contrast, the midmolecule RIA yielded 2 and 3 broad peaks of immunoreactivity after fractionation of serum and adenomatous cell supernatant, respectively. There was no evidence for the secretion of a small midregion fragment in vitro or its peripheral derivation in vivo. These studies demonstrate the superior specificity of the 2‐site intact PTH assay compared with a midmolecule RIA and, thus, confirm the potential diagnostic superiority of the ICMA.
Prediction of distant metastasis in follicular adenocarcinoma of the thyroid
Authors: Iwasaki Hiroyuki , Matsumoto Akihiko , Ito Kunihiko , Kure Yoshio , Suzuki Akira , Sugino Kiminori , Ozaki Osamu , Noh Jaeduk 
Published: May 2005

AbstractFollicular adenocarcinoma of the thyroid sometimes displays distant metastasis in spite of its low histological grade of malignancy. We have studied whether distant metastasis can be detected by the presence of blood vessel invasion. We have also examined the problem from the viewpoint of cell‐to‐cell conjugation.This study examined 160 cases of follicular adenocarcinoma of the thyroid. Histological specimens were made by sectioning tumors at their largest diameter. Blood vessel endothelia were specifically stained immunohistochemically with factor VIII‐related antigen and Ulex europeaus agglutinin I (UEA‐1). Then, the presence of blood vessel invasion was examined in detail. Furthermore, the conjugation of lectin‐derived wheat germ agglutinin (WGA) to tumor cells was examined. Conjugation of tumor cells was also examined using sialic acid as a marker.Blood vessel invasion was recognized in 95 (59.4%) of 160 cases. Distant metastases were identified in 25 cases (15.6%) in which blood vessel invasion was also found. Relative to the group without distant metastases, the group with distant metastases showed not only a significantly higher sialic acid content but also higher levels of WGA‐binding protein in the tissues. The risk of distant metastasis in patients with follicular adenocarcinoma of the thyroid appears to be related both to the extent and to the frequency of blood vessel invasion. Furthermore, assessment of the conjugation of cells appears to have predictive value for occurrence of distant metastases.
Thyroid carcinoma in Graves' disease
Authors: Ozaki Osamu , Ito Kunihiko , Kobayashi Kaoru , Toshima Koji , Iwasaki Hiroyuki , Yashiro Tohru 
Published: May 2005

AbstractThe pathogenesis of thyroid carcinoma in Graves' goiter is still obscure and the methods for preoperative diagnosis of such carcinomas is not well established. We studied the incidence, clinical features, and pathological findings of thyroid carcinoma in Graves' goiter. From October, 1983 to September, 1985, a total of 739 patients with Graves' disease underwent subtotal thyroidectomy at Ito Hospital, Tokyo. All of these patients underwent roentgenography of the neck before surgery. Thyroid carcinoma was revealed in the resected specimen in 15 (2.0%) of 739 patients. During the same period, another 4 patients underwent surgery for thyroid carcinoma who had had Graves' disease previously and these 4 cases were included in the present study. The incidence of thyroid carcinoma associated with Graves' disease was 2.6% (19 of 743 cases). Histological examination revealed 15 papillary and 4 follicular carcinomas. The size of the carcinoma foci was 13.8±15.6 mm in diameter (range: 1–60 mm), 10 (52.6%) foci being 10 mm or greater. Invasive growth into the surrounding thyroid tissue was predominant and regional lymph node metastasis was noted in all 6 patients who underwent cervical dissection. Preoperative roentgenography revealed calcification in 5 (26.3%) of 19 cases. Our present study indicates that thyroid carcinoma in Graves' goiter may show markedly invasive growth with lymph node metastasis even though the primary tumor is small in size, and it is suggested that the detection of calcification may serve as a part of the diagnostic measures when the carcinoma focus is difficult to palpate in the diffusely‐enlarged Graves' goiter.
The influence of surgery on endocrine ophthalmopathy
Authors: Frilling Andrea , Goretzki Peter E. , Grußendorf Martin , Erbslöh Markus , Röher Hans‐D. 
Published: May 2005

AbstractSince the pathogenesis of endocrine ophthalmopathy is unclear, there has been little agreement on the treatment of the disease. The influence of thyroid surgery on endocrine ophthalmopathy is controversial. To evaluate the effect of thyroid surgery on the course of the disease, we developed a special ophthalmopathy index. As a standard procedure, subtotal thyroidectomy with thyroid remnants of 3–5 g was performed. A total of 176 patients with Graves' disease underwent the above treatment between 1986 and 1988. In 78 patients suffering from concomitant endocrine ophthalmopathy, ocular status was examined prior to operation and postoperatively. The history of endocrine ophthalmopathy had been present less than 2 years preoperatively in 74% of the patients. Follow‐up ranged from 6 to 36 months. Postoperatively, 54 (69%) patients showed a marked improvement of their eye symptoms. In 18 (23%), there was no change and, in 6 (8%) patients, the severity of the eye symptoms increased after the operation. As a result of these data, a cautious and preliminary conclusion may be justified—that subtotal thyroidectomy may have a positive effect on endocrine ophthalmopathy.
The role of noninvasive testing in the evaluation of chronic venous problems
Authors: Yao James S. T. , Flinn William R. , McCarthy Walter J. , Bergan John J. 
Published: May 2005

AbstractNoninvasive instrumentation is now available to evaluate venous function in patients with a wide variety of chronic venous problems. The present analysis attempts to review the use of directional flow detection by Doppler ultrasound, venous refilling or maximal venous outflow by plethysmography, and the newly introduced venous imaging techniques (B‐mode and duplex scanning) in evaluation of patients with varicose veins, the postphlebitic syndrome, sequelae after acute deep‐vein thrombosis, and venous reconstructive surgery. Venous refilling time recorded by the photoplethysmograph is the simplest technique for assessment of venous dysfunction, and it can identify venous stasis or ulcer as a result of long saphenous vein insufficiency. Both the B‐mode and the duplex scan allow direct examination of venous valve motion and determination of valve competency. The latter technique holds promise in the evaluation of venous valve reconstructive surgery and, more important, in accurate assessment of venous valve damage following acute deep‐vein thrombosis.
The value of dynamic venous pressure measurements
Authors: Nicolaides Andrew N. , Zukowski Andrew J. 
Published: May 2005

AbstractThis article describes the technique of measuring ambulatory venous pressures and their value in the diagnosis and assessment of the severity of venous hypertension as well as their contribution toward our understanding of venous hemodynamics and the pathophysiology of venous disorders. It demonstrates that ambulatory venous pressures are not only of diagnostic significance, but also of prognostic significance. Competent popliteal valves will protect the leg from venous hypertension despite proximal (iliofemoral) occlusion. Although the measurement of ambulatory venous pressures is the “gold standard,” it is invasive and cannot be repeated frequently nor can it be used as a screening test. It has been employed in the validation of a number of noninvasive tests now used for the routine screening of patients. Nevertheless, ambulatory venous pressure measurements are essential if the beneficial hemodynamic effect of surgical reconstructive procedures is to be convincingly demonstrated.
Five years' experience with vein valve transplant
Authors: Taheri Syde A. , Heffner Reid , Budd Thomas , Pollack Larry H. 
Published: May 2005

AbstractSince 1980, the vein valve transplant has been used to treat the venous insufficiency syndrome (VIS) in 66 patients (71 limbs). Seventy‐eight percent of patients who had close long‐term follow‐up reported improvement or complete relief of symptoms. On examination, 75% had decreased or resolved leg edema. In addition, 17 of 18 ulcers healed. The vein valve transplant is an effective long‐term treatment for VIS in patients who have failed initial medical management.
Future prospects in the treatment of venous disease
Authors: Bernstein Eugene F. 
Published: May 2005

AbstractOur current knowledge of the natural history of venous disease suggests that congenital venous valve insufficiency and left iliac vein compression predispose to later deep vein thrombosis (DVT) and pulmonary embolism. Available longitudinal studies are, however, inadequate to justify prophylactic treatment of these conditions at the present time. Furthermore, our knowledge of the natural history of acute venous thrombosis, of which venous valves are critical, and of the sequelae of ileofemoral venous thrombosis is also inadequate. Finally, the long‐term results of venous reconstructive surgery are still not known. For this reason, long‐term studies of large patient cohorts for each of these areas will be necessary. Nevertheless, I believe future treatment of venous disease will include earlier widespread DVT prophylaxis using both medical and surgical methods, more effective and complete thrombolysis, earlier surgery, and the use of new reconstructive surgical methods. Early identification of patients at high risk prior to their disease, followed by selective diagnostic separation of patients with significant obstruction and/or insufficiency and the availability of long‐lasting surgical procedures that can be offered with low morbidity will justify earlier and more widespread prophylactic therapy.
New aspects in the management of alveolar echinococcosis involving the liver
Authors: Schröder Rolf , Robotti Guido 
Published: May 2005

AbstractThe experience with 8 consecutive patients with alveolar echinococcosis of the liver is reported. The follow‐up period varied between 4 and 17 years. In 4 cases, the parasite could be removed by liver resection; 3 developed subsequent inoperable recurrences. Four patients had primary inoperable disease. All patients are being treated by long‐term mebendazole. The evolution of the disease was followed by serial computed tomography scans measuring the parasitic volume. One patient is disease‐free 8 years following bilateral liver resection. The volume of the parasite remained unchanged in 6 patients. In 1 case, the lesions disappeared. The presumed parasitostatic effect of mebendazole must be taken into consideration in the management of alveolar echinococcosis.
Exposure to bile acids and bacteria over 24 hours following partial gastrectomy, vagotomy, and pyloroplasty
Authors: Poxon Valerie A. , Morris David L. , Youngs Denise J. , Albutt Eileen C. , Keighley Michael R. 
Published: May 2005

AbstractHourly measurements of bile acids, bacterial flora, and pH were made from gastric aspirates collected over 24 hours in subjects taking a controlled diet. Significantly higher concentrations of total bile acids were found following truncal vagotomy and antrectomy (TV+A), 2.73±1.16 SEM mmol/l, than after truncal vagotomy and pyloroplasty (TV+P), 0.88±0.56 mmol/l (p<0.002), and controls, 0.43±0.22 mmol/l (p<0.002). These observations were due to differences in nocturnal reflux only. Free secondary bile acids were identified more frequently after TV+A (19% of aspirates) than TV+P (6%) or controls (2%).Streptococcus faecalis andVeillonella spp, the principal organisms known to deconjugate and hydrolyze bile acids, were present in 65% of aspirates after TV+A compared with 35% after TV+P, and 33% of the controls. Mean pH values were 5.12 after TV+A, 2.82 after TV+P, and 2.14 in the controls. We conclude that antrectomy is associated with a greater incidence of duodenal reflux and a more suitable environment for the formation of secondary bile acids than vagotomy and pyloroplasty or in normal subjects.
Sphincter of Oddi and gastrointestinal motility disturbance following alcohol administration in the opossum
Authors: Coelho Julio C. U. , Gouma Dirk J. , Moody Frank G. , Senninger Norbert , Li Yong F. , Chey William Y. 
Published: May 2005

AbstractMyoelectric activity of the gastrointestinal tract and sphincter of Oddi was recorded in 7 awake opossums. The animals were subjected to gastrojejunostomy with duodenal exclusion to study the effect of alcohol on the gastric, duodenal, and jejunal mucosa. The response to intravenous infusion was also evaluated. Radioimmunoassay of motilin was performed in 5 other opossums during phases I, II, and III of the control migrating myoelectric complex (MMC) and during the phase III‐like activity following administration of alcohol. Phase III‐like activity was observed following infusion of alcohol into the duodenum in 26 studies (87%), into the stomach in 20 (67%), and intravenously in 9 (22%). Alcohol blood level after duodenal and intravenous instillation of ethanol was 45 and 190 mg/100 ml, respectively (8 experiments of each). There was no difference in the concentration of plasma motilin obtained during phase III‐like activity (41.5±4.6 pM/ml) and phase III of the MMC (35.6±4.7). We conclude that instillation of alcohol into the stomach or duodenum produces intense bursts of spike potentials in the sphincter of Oddi and duodenum. There is no correlation between alcohol blood levels and occurrence of this intense spike activity.
Prophylactic regimens in colorectal surgery: An open, randomized, consecutive trial on metronidazole used alone or in combination with ampicillin or doxycycline
Authors: Roland Magne 
Published: May 2005

AbstractIn 17 Scandinavian hospitals, an open, randomized, consecutive trial was made on the use of prophylactic antibiotics in colorectal surgery. Metronidazole used alone was compared with metronidazole supplemented by ampicillin or doxycycline. Each type of drug was given as a single preoperative intravenous infusion. With metronidazole alone, postoperative infection occurred in 12.9% of all patients. This figure was significantly reduced to 3.2% by adding ampicillin or doxycycline to the prophylactic regimen (p=0.01). The additional effect achieved by ampicillin or doxycycline was due to a significant reduction of wound infections in cases of rectal surgery. For operations on the right and left colon, no significant improvement was obtained by adding ampicillin or doxycycline to metronidazole (p=0.19). For no type of colorectal surgery was there any significant difference in infection rate between patients who received metronidazole plus ampicillin and those who were given the combination of metronidazole and doxycycline. It is concluded that ampicillin and doxycycline are equally effective. Ampicillin is recommended, however, due to the increasing selection of tetracycline‐resistant bacteria. One single preoperative infusion of each drug gave the same effect as found in a previous study after multiple infusions, the first of them being given preoperatively. It is concluded that a satisfactory prophylactic effect is obtained by a single preoperative infusion of antimicrobial drugs directed against anaerobic as well as aerobic bacteria.