bluuebunny/crossref_metadata_2025_split huggingface dataset:
Progress in the treatment of thoracic aortic aneurysms
Authors: Crawford E. Stanley 
Published: May 2005

AbstractProgress in the management of thoracic aortic aneurysm includes the following aspects:
the concepts of the disease itself, which is frequently generalized so that the second most common cause of late death is rupture of another aneurysm;
the diagnostic techniques used: computed tomographic scanning as well as aortography;
the medical treatment: with beta blockade and antihypertensive drugs in stable aortic injury in the patient with multiple critical injuries;
that hypothermic circulatory arrest with cardiopulmonary bypass and brain temperatures down to 16–20°C has increased successful aortic arch replacement from 50–75% to over 90%;
that rapid autologous transfusion by means of a modified Hemonetics machine can collect and process a unit of shed blood in 2–3 minutes and has reduced transfusion requirements by more than half;
the vigorous treatment of both consumptive and dilutional coagulopathies;
the new reconstructive techniques: involving composite valve graft replacement of the aortic valve, root, and arch as well as coronary artery reattachment;
that the use of viable tissue flaps in the treatment of infected aortic grafts as well as intravenous and local irrigation with antibiotics was successful in 8 of 9 of our cases;
that graft replacement with intensive antibiotic therapy was effective in 19 of 22 of our patients with mycotic thoracic aortic aneurysm.
Pitfalls and progress in the management of abdominal aortic aneurysms
Authors: Trede Michael , Storz Leonhardt Werner , Petermann Christian , Schiele Ulrike 
Published: May 2005

AbstractBased on a review of the literature and 241 cases of abdominal aortic aneurysm (AAA) operated at the Mannheim Surgical Clinic, the progress and pitfalls in the management of this lesion are discussed.Progress in diagnosis is based on noninvasive imaging procedures, e.g., ultrasound, which lead to the detection of more aneurysms before they rupture. Ultrasound also plays a role in the observation of small asymptomatic aneurysms in high‐risk patients, helping some to avoid operation as well as rupture.Progress in the treatment of AAA means simplification: rapid clamping of the aorta in case of rupture, minimal dissection, and aneurysmal repair with straight‐tube interposition by the inlay technique. The pitfalls of “trash foot,” colon, or renal ischemia as well as graft infection can be mostly circumvented by observance of technical detail.In this series, the mortality following repair of asymptomatic AAA was 3.7%; for symptomatic aneurysms, it was 8%; and for ruptured aneurysms, it amounted to 55%.
Function of the intrathoracic stomach as esophageal replacement
Authors: Hölscher Arnulf H. , Voit Herbert , Buttermann Götz , Siewert J. Rüdiger 
Published: May 2005

AbstractThe emptying, acid secretion, mucosal changes, and duodenogastric and gastroesophageal reflux of the intrathoracic stomach were studied in 12 patients together with the clinical course 6–12 months after esophageal replacement.Although no pyloroplasty had been performed, the emptying of a semisolid meal from the interposed stomach was significantly accelerated compared to the controls. No residual food was found in the stomach at endoscopy after an overnight fast. Distinctly accelerated gastric emptying correlated with spontaneous duodenogastric reflux across the denervated pylorus.Despite a persistent acid secretion of the vagotomized intrathoracic stomach, no pathologic gastroesophageal reflux and no esophagitis were found proximal to the cervical anastomosis. Gastric biopsies mostly revealed mild gastritis of the antral mucosa, whereas metaplasia was rare. The intrathoracic stomach does not need a drainage procedure to facilitate semisolid emptying. Postoperative reflux esophagitis is prevented by complete intrathoracic stomach transposition with cervical esophagogastrostomy.
Splenocaval shunt for selective portal decompression
Authors: Iliopoulos John I. , Thomas James H. , Pierce George E. , Hermreck Arlo S. 
Published: May 2005

AbstractSplenocaval shunt is an option for selective portal decompression in patients who are not good anatomic candidates for distal splenorenal shunts because of massive hepatosplenomegaly and downward displacement of the splenic vein. The proximity of the splenic vein to the inferior vena cava makes the construction of this type of shunt anatomically and hemodynamically advantageous over the standard Warren shunt in these cases.
Transplantation of cryopreserved human pancreatic islets into diabetic nude mice
Authors: Ricordi Camillo , Kneteman Norman M. , Scharp David W. , Lacy Paul E. 
Published: May 2005

AbstractIf pancreatic islet transplantation becomes clinically applicable, cryogenic storage of human islet preparations could solve many problems related to transportation and banking of islets, HLA matching, recipient pretreatment, or the possible use of multiple donors. The diabetic nude mouse could offer a simple model to test in vivo the function of cryopreserved human islet preparations before transplantation into diabetic patients.In this study, 6 nude mice made diabetic by an intravenous injection of streptozocin were transplanted with 400–600 cryopreserved human islets beneath the renal capsule. All the mice became normoglycemic within 3 weeks from transplantation. Nephrectomy of the kidneys bearing the grafts 45 days after transplantation resulted in an immediate return to the diabetic state, demonstrating that the only functional tissue was located in the excised kidneys. Histologic study of the renal subcapsular grafts demonstrated morphologic integrity of the islets with a normal degree of beta granulation.The results demonstrated that cryopreserved human islets will function in diabetic nude mice. This model to test human islet preparationsin vivomay be of assistance in the application of cryopreserved islet transplantation in diabetic patients.
Increased incidence of pancreatic neoplasia in pernicious anemia
Authors: Borch Kurt , Kullman Eric , Hallhagen Stefan , Ledin Torbjörn , Ihse Ingemar 
Published: May 2005

AbstractIn a Swedish population, 361 patients with pernicious anemia were followed closely during a 7‐year period with regard to the occurrence of all forms of malignant neoplasia. In addition to an increased incidence of gastric neoplasia (0.6%/year), there seemed to be an increased incidence of pancreatic neoplasia (0.3%/year) in the series. With reference to age‐ and sex‐specific incidence rates in the general population, the number of malignant pancreatic tumors observed was significantly higher than expected (p<0.02, Poisson analysis). Pancreatic malignancy was the primary cause of death in 5 (4%) of 134 patients who died during follow‐up. Among 127 unselected patients with malignant pancreatic neoplasia, the prevalence of pernicious anemia was 3%. These findings indicate that there is a linkage between the two diseases which has not been previously recognized. Atrophic gastritis with hypergastrinemia may be the key to this linkage.
Localization and surgical resection of metastatic parathyroid carcinoma
Authors: Fujimoto Yoshihide , Obara Takao , Ito Yukio , Kodama Takaya , Nobori Masakazu , Ebihara Satoshi 
Published: May 2005

AbstractSix cases of recurrent parathyroid carcinoma were reviewed. Four patients presented with local recurrence, which followed a simple tumor resection more frequently than an en bloc initial operation. The fact that the mode of recurrence varied made preoperative localization difficult. In 3 earlier patients (1978–1980), careful palpation of the neck and venous sampling for parathyroid hormone concentrations were the means of localization. In 4 recent patients (1980–1985), including 1 of the former 3, thallium‐201 scan was the most useful method for detecting the local recurrence and the regional lymph node metastases, but the method failed to localize the lung metastases. Chest x‐rays and computed tomographic (CT) scan were useful in delineating metastatic pulmonary lesions. Wide excision of the local recurrent tumor, once or twice, was curative in 3 of the 4 patients. En bloc radical dissection of the neck and mediastinum in 1 patient resulted in normocalcemia for the past 2 years. Thoracotomies carried out in 2 patients with multiple pulmonary metastases were palliative in 1 case for 5 years and curative at least at the present time (3 months after the operation) in the other case. Thus, the results in our series justify aggressive surgical treatment for the recurrence of parathyroid carcinoma.
Serum thyroglobulin concentration in nontoxic goiter and response to surgery with special reference to risk of goiter relapse
Authors: Feldt‐Rasmussen Ulla , Blichert‐Toft Mogens , Date John , Haas Vagn 
Published: May 2005

AbstractA consecutive series of 45 thyroglobulin antibody‐negative patients were operated on for nontoxic goiter and subsequently followed systematically for 3 years. Preoperative mean log serum thyroglobulin was elevated with a significantly positive correlation to the size of removed goiter tissue. No thyroid replacement was given postsurgically. Following operation, the thyroglobulin level decreased significantly reaching a minimum at 1 year. Thereafter, there was a continuous rise. Free thyroxine index and serum thyrotropin showed changes corresponding to transient hypothyroidism 1 month after surgery, being gradually normalized within 1 year. At 3 years, a thyrotropinreleasing hormone (TRH) test showed the highest thyroidstimulating hormone (TSH) response in patients with elevated baseline thyroglobulin. Clinical investigation at 3 years, however, revealed no goiter relapse. Therefore, the predictive value of thyroglobulin with reference to recurrence of goiter could not be established as yet. The hypothetical assumption that patients who postoperatively present an elevated serum thyroglobulin level are more likely to develop recurrence compared to those with low thyroglobulin levels is discussed and will be tested further by a prolonged follow‐up period.
Prospective comparison of radionuclide, computed tomographic, and sonographic localization of parathyroid tumors
Authors: Krubsack Arnold J. , Wilson Stuart D. , Lawson T. L. , David Collier B. , Hellman Robert S. , Isitman Ali T. 
Published: May 2005

AbstractControversy exists concerning the advantages and appropriateness of current imaging modalities of the localization of parathyroid tumors. We conducted a prospective, blinded study to compare the efficacy of 3 different imaging modalities in 40 patients with primary hyperparathyroidism (HPT). Patients with HPT were examined preoperatively by computer‐assisted thallium‐201/technetium‐99m scintigraphy (TTS), high‐resolution (GE 9800) computed tomography (CT), and high‐resolution (7.5 MHz) real‐time sonography (US). Each study was performed and interpreted independently. These patients then had a neck exploration and parathyroidectomy which allowed for clinical correlation of pathologic findings with the imaging results. Overall sensitivities of the 3 imaging modalities were TTS‐72%, CT‐72%, and US‐57%, with specificities of TTS‐93%, CT‐92%, and US‐96%. For lesions located below the thyroid (thymic tongue and mediastinum), sensitivities were TTS‐86%, CT‐29%, and US‐20%, all with specificities of 100%. In those HPT patients presenting with prior failed neck explorations, parathyroid tumors were detected with sensitivities of TTS‐88%, CT‐57%, and US‐67%, with specificities of 100%, 71%, and 100%, respectively. TTS with subsequent CT appears to be an optimal imaging strategy for HPT patients with prior failed neck explorations or suspected lesions below the thyroid. Since surgeons experienced in parathyroid surgery have a cure rate of 93% or greater in HPT patients without prior neck exploration, these imaging modalities may not be cost‐effective and thus not indicated for these patients.
Diazoxide in the management of patients with insulinoma
Authors: Goode Peter N. , Farndon John R. , Anderson John , Johnston Ivan D. A. , Morte Javier Abascal 
Published: May 2005

AbstractThe control of severe hypoglycemic symptoms in patients with insulin‐secreting islet tumors (insulinoma) of the pancreas is an important aspect of management. A series of 24 patients with insulinomas whose ages ranged from 5 months to 73 years seen at one center over a period of 17 years is described. The presenting symptoms and the effect of these on their lifestyles are discussed. Diazoxide has been used to control hypoglycemic symptoms in 18 of the 24 patients. Fourteen patients have received diazoxide for varying periods of time prior to successful surgery and 4 have received long‐term therapy. Three of these patients are highlighted to show various aspects of benefit and problems from the use of diazoxide. The mean dosage of diazoxide was 400 mg/day and the mean duration of therapy was 10 months. The control of symptoms was good in 8, fair in 6, and poor in 4. The main side effects observed were hirsutism (56%), ankle edema (50%), weight gain (38%), and nausea (11%). These side effects were well tolerated and the benefits of therapy were felt to outweigh disadvantages. Side effects only necessitated discontinuation of diazoxide in 1 patient who developed a severe hypersensitivity reaction. Our results show that diazoxide has a role to play in the management of patients with insulinoma during preoperative tumor localization and can also be used when surgery is contraindicated or when laparotomy is unsuccessful.
Plasma gut hormone levels in 37 patients with pheochromocytomas
Authors: Vinik Aaron I. , Shapiro Brahm , Thompson Norman W. 
Published: May 2005

AbstractPheochromocytomas are usually recognized by the effects of overproduction of catecholamines, but there are clinical features that cannot be ascribed to catecholamine excess that may be due to vasoactive peptides. We, therefore, measured blood levels of vasoactive intestinal peptides (VIP), substance P, somatostatin (SS), and motilin in 50 instances in 37 patients with pheochromocytomas‐21 malignant, 10 benign intra‐adrenal, and 6 ectopic (5 paracardial and 1 perirenal). Hormone levels were considered raised if the level was more than 3 S.D. above the mean value found in 52 healthy subjects. Of the 37 patients, 20 (54%) had an abnormality in 1 or more gut hormone levels. The most common abnormality was a raised SS in 9/37 (24%). In addition to these, however, 3 (8%) others had raised VIP, 5 (13.5%) raised motilin, and 3 (8%) raised substance P. Patients with benign adrenal adenomas had raised levels of SS and substance P. Ectopic pheochromocytomas produced only SS in addition to catecholamines, but malignant pheochromocytomas could secrete all 4 peptides, and more than 1 in the same patient. We conclude that pheochromocytomas may secrete multiple vasoactive peptides, and they are more likely to do so if malignant. Somatostatin is the most commonly secreted peptide and is found with benign adrenal and ectopic (paracardiac) tumors. If the level of more than 1 peptide is elevated, the likelihood of malignancy is significantly increased.
Evaluation of image‐diagnosing methods of enlarged parathyroid glands in chronic renal failure
Authors: Takagi Hiroshi , Tominaga Yoshihiro , Uchida Kazuharu , Yamada Nobuo , Kawai Machio , Kano Tadayuki , Funahashi Hiroomi , Mizuno Shigeru 
Published: May 2005

AbstractThree noninvasive image‐diagnosing methods, computed tomography (CT), scintigraphy with201T1C1 and99mTcOh4−, and ultrasonography (US), were preoperatively performed on 50 patients with chronic renal failure and secondary hyperparathyroidism who underwent total parathyroidectomy and parathyroid autograft. The detection rates of the 3 methods on the 191 excised parathyroid glands were compared according to weight and location. CT detected 57.1% of all glands and 78.6% of 103 glands weighing over 500 mg. Scintigraphy detected 51.8% and 75.7%, and US detected 42.4% and 53.4%, respectively. The detection rate of upper glands was best with CT at 58.9% and 89.1%; that of lower glands was best with scintigraphy at 65.3% and 80.4%. Although the combination of the 3 methods diagnosed 69.6% and 89.5%, CT and scintigraphy, the best 2 combinations, visualized 67.5% and 88.3%.
Intraoperative ultrasound and reoperative parathyroid surgery: An initial evaluation
Authors: Norton Jeffrey A. , Shawker Thomas H. , Jones Bonnie L. , Spiegel Allen M. , Marx Stephen J. , Fitzpatrick Lorraine , Aurbach Gerald D. , Doppman John L. 
Published: May 2005

AbstractWe compared intraoperative ultrasound (IOUS) to preoperative high‐resolution real‐time ultrasound in 25 consecutive patients undergoing reoperations for primary hyperparathyroidism. Intraoperative neck scanning was performed after the platysma muscle flaps were raised, and one or both sides of the neck were opened along the medial border of the sternocleidomastoid muscle. Preoperative localization studies were used to determine which side of the neck to explore. Pathologic parathyroid glands appeared sonolucent on both pre‐ and intraoperative ultrasound. Glands were always imaged in 2 planes.Neither preoperative nor intraoperative scans were able to image normal parathyroid glands. Preoperative scans were correct for abnormal tissue in 9 patients, and intraoperative scans were correct in 19 patients (p=0.01).Size of a pathologic parathyroid gland was not a factor in the ability of IOUS to detect it, but location was. Intrathyroidal and inferior glands were detected reliably, but superior glands were missed (33%). If IOUS imaged the pathologic parathyroid tissue, the length of the surgical procedure was significantly reduced [5.9 hours versus 3.1 hours (p= 0.005)].IOUS did not appear to impact on ultimate outcome as 5 of 6 patients in whom IOUS failed to image the pathologic gland had successful surgery without complication.
Primary hyperaldosteronism caused by adrenocortical carcinoma
Authors: Scott H. William , Sussman Craig R. , Page David L. , Thompson Norman W. , Gross Milton D. , Lloyd Ricardo 
Published: May 2005

AbstractSince the syndrome of primary hyperaldosteronism was described by Jerome Conn in 1955, over 300 patients with this disorder have been identified in the medical centers of Vanderbilt University and the University of Michigan. The most frequent cause of this endocrinopathy has been a solitary adenoma of the adrenal cortex (72%); bilateral adrenocortical hyperplasia has been the cause of primary hyperaldosteronism in 27% of cases; less frequently, the cause has been multiple and/or bilateral adenomas (1%). During the last 4 years in these 2 medical centers, we have encountered 3 patients who have had biochemically proven primary hyperaldosteronism due to adrenocortical carcinoma. Each of these unusual cases is summarized with review of the recent literature.
Parathyroid surgery in the multiple endocrine neoplasia type I syndrome: Choice of surgical procedure
Authors: Malmaeus Jan , Benson Lars , Johansson Henry , Ljunghall Sverker , Rastad Jonas , Åkerström Göran , Öberg Kjell 
Published: May 2005

AbstractThirty‐nine patients with hyperparathyroidism (HPT) in association with the multiple endocrine neoplasia type I (MEN‐I) syndrome underwent parathyroid surgery from 1961 to 1985. Twenty‐one patients underwent resection of 1–21/2 glands, 6 had 3–31/2 glands removed, and 18 (9 of whom had previously been subjected to parathyroid surgery) underwent total parathyroidectomy with autotransplantation to the forearm. Resection of 1–21/2 glands resulted in persistent or recurrent HPT in 18 (88%) of the 21 cases. Two (33%) of the 6 patients who underwent 3–31/2‐gland resection had recurrent disease. After total parathyroidectomy with autotransplantation to the forearm, no patient had persistent or recurrent HPT. Five (26%) of 18 patients had permanent hypocalcemia requiring supplemental therapy. After a change in the operative technique, however, only 1 of 10 was permanently hypocalcemic. It is concluded that primary HPT in the MEN‐I syndrome always should be treated with radical surgery. Total parathyroidectomy with autotransplantation seems more favorable than 3–31/2‐gland resection owing to the absence of recurrent HPT in this material and the limited number of patients with long‐standing postoperative hypocalcemia, provided that an optimal technique for autotransplantation was performed.
A computer‐assisted thyroid follow‐up system
Authors: Davies Peter D. O. , Lazarus John H. , Wheeler Malcolm H. 
Published: May 2005

AbstractThree hundred and fifty‐five patients treated for hyperthyroidism by subtotal thyroidectomy have been followed for up to 11 years (mean 5 yr) by a computer‐assisted follow‐up register (WAFUR). The system is based on a central hospital clinic with patients being reviewed regularly by their general practitioners over a wide geographic area and blood samples being mailed to the hospital. After allowing for 50 patients who were lost to follow‐up and 48 recalled because of hypothyroidism, 1,379 thyroid function tests were evaluated in the remaining 257 patients. Forty‐three of 132 surgically treated patients and 81 of 125 surgically treated patients on replacement T4 therapy had normal TSH levels throughout the follow‐up period. The other patients all had at least 1 elevated TSH level. In patients not receiving T4 therapy, 47% of tests with a normal serum T4 had elevation of TSH. In patients receiving thyroxine, 46% of tests with normal TSH showed a rise in T4. It is concluded that this computer‐assisted thyroid follow‐up system is reliable and cost‐effective. Further modification is required to identify patients lost to follow‐up, to improve the diagnostic accuracy of the thyroid function tests, and to define the pathophysiological significance of minor abnormalities in T4 and TSH in otherwise euthyroid patients.
Mediastinal parathyroid exploration: A clinical and pathologic study of 47 cases
Authors: Wang Chiu‐an , Gaz Randall D. , Moncure Ashby C. 
Published: May 2005

AbstractOf the 1,200 patients with hyperparathyroidism surgically treated at the Massachusetts General Hospital (MGH) from 1926 to 1984, there were 47 who underwent mediastinal exploration. Of these, 30 patients (64%) had hyperfunctioning parathyroid glands successfully excised by median sternotomy. Twelve of these underwent their initial neck operation at the MGH, and 18 were referred to us having undergone 1 or more previous unsuccessful neck explorations. There were 17 females and 13 males. The ages of these patients ranged from 17 to 75 years. Twenty‐four patients had nephrolithiasis or nephrocalcinosis; 15, osteitis fibrosa cystica; 14, renal and bone disease; 6, peptic ulcer disease; 2, hypertension; and 1, gouty arthritis. Two patients were asymptomatic with hypercalcemia detected by routine simultaneous multichannel analyzer. The serum calcium level ranged from 11.4 to 18.4 mg/100 ml with a mean of 13.8 mg/100 ml, and phosphorus from 1.4 to 3.3 mg/100 ml with a mean of 2.0 mg/100 ml. Of the 11 patients who had plasma parathyroid hormone determinations, the values ranged from 1 to 11 times normal. In 24 patients, the mediastinal tumor was intrathymic in location and the remaining 6 were parathymic, either adjacent to the great vessels or the pleura. The tumors varied greatly in size, ranging from 0.7 to 5.0 cm in greatest dimension, weighing 0.3 to 18.0 g. Five of these patients had hyperfunctioning supernumerary glands. Pathologic evaluation revealed 26 parathyroid adenomas and 4 primary hyperplastic glands. In 17 patients (36%) mediastinal exploration was unsuccessful. Four of the patients successfully explored developed permanent hypocalcemia. The complications included 1 recurrent laryngeal nerve injury, 1 phrenic nerve injury, 1 pneumothorax, and 1 spontaneously resolving postoperative pleural effusion. There were no deaths or other significant complications. We believe hyperfunctioning mediastinal tumors are rare and mediastinal exploration should be undertaken only when careful selective criteria are met.