bluuebunny/crossref_metadata_2025_split huggingface dataset:
Acute volvulus of the sigmoid colon
Authors: Welch G. H. , Anderson J. R. 
Published: May 2005

AbstractFifty patients presenting with acute volvulus of the sigmoid colon have been analyzed. The diagnosis was made in 39 patients from the presenting features and abdominal radiographs. Deflation by sigmoidoscopy and flatus tube was performed in 19 patients with initial success in 15. Recurrent volvulus occurred in 6 of these patients. Laparotomy was carried out in 36 patients and colonie gangrene was present in 6 patients. The operative mortality rate was 42%. Mortality was related to a combination of age, intercurrent medical illness, and sepsis. Simple operative reduction was associated with a lower mortality when compared to resection but had a higher incidence of recurrent volvulus. This study supports the use of sigmoidoscopic reduction as the primary treatment of acute sigmoid volvulus. Laparotomy and colonic resection should be reserved for those patients who are medically fit and should ideally be performed on an elective basis after preliminary decompression. In unfit patients in whom sigmoidoscopic reduction fails, detorsion and colopexy is advocated.
Surgery of thyroid cancer
Authors: Cady Blake 
Published: May 2005

AbstractOccult and microscopic differentiated carcinoma of the thyroid is a clinically benign lesion, even when accompanied by lymph node metastases, and should be treated surgically by conservative procedures. Clinically detectable thyroid carcinomas may be of low‐risk types in younger patients or high‐risk types in older patients. Age is the primary determinant of risk. Low‐risk patients should be treated conservatively since the risk of death is currently no higher than 1.5%. High‐risk patients should be treated more aggressively since recurrence rates may be high and risk of death from disease may reach 15% to 20%. In all patients, total thyroidectomy should be avoided since it does not improve local control rates or cure rates and exposes the patient to considerable risk of iatrogenic hypoparathyroidism and recurrent nerve injury. This recommendation is particularly true for occult and microscopic disease as well as for low‐risk disease, because risk of death from disease is so low.
Medullary carcinoma of the thyroid
Authors: Lynn John , Gamvros Orestis I. , Taylor Selwyn 
Published: May 2005

AbstractMedullary carcinoma of the thyroid (MCT) is a rare tumor which, since its identification by Hazard et al. [2] in 1959, has attracted interest for 2 reasons. First, the secretion of the tumor marker, thyrocalcitonin, provides a means of making the diagnosis of MCT before the tumor is clinically evident. Second, MCT may be associated with pheochromocytoma and parathyroid hyperplasia as the autosomal dominant familial syndrome of multiple endocrine neoplasia, type II (MEN II). MCT may occur sporadically. When MCT is encountered in the familial form the natural history varies from family to family and also in individuals within a specific kindred. This variation creates difficulties in management and in reaching the decision for an aggressive approach to surgical treatment.
Primary lymphoma of the thyroid: A review of the mayo clinic experience through 1978
Authors: Devine Richard M. , Edis Anthony J. , Banks Peter M. 
Published: May 2005

AbstractAt the Mayo Clinic, 103 patients with primary malignant lymphoma of the thyroid have been diagnosed and treated through 1978. This study examines the clinical findings in the 57 new cases seen since the last review in 1966; pathology and survival are evaluated for the series as a whole, including the 46 patients reported previously. Age and sex patterns were unchanged since the earlier review; thyroid lymphoma tended to occur in middle‐ to older‐aged women, and patients typically presented with a fairly rapidly enlarging, painless, and firm thyroid mass. The most common histologic subtype of lymphoma encountered was diffuse large cell (diffuse histiocytic). Hashimoto's disease was found in 36% of the pathologic specimens available for review. Follow‐up was completed for all patients up to 1979. Age, sex, and histologic subtype of tumor did not appear to be significant determinants of prognosis. Patients in whom the lymphoma was confined to the thyroid (intrathyroidal type) had a better overall 5‐year survival rate (86%) than those in whom tumor invaded soft tissues surrounding the hyroid or involved regional cervical nodes (38% for the extrathyroidal type). Almost all of the patients who had intrathyroidal tumors underwent surgical resection before irradiation. However, 3 of the 5 patients in this group who were treated by radiotherapy alone survived more than 5 years. There were approximately equal numbers of patients with the extrathyroidal type of lymphoma who were treated either by radiotherapy combined with surgical resection or by radiotherapy alone. The one form of therapy was just as effective as the other.
Methods of investigation in the diagnosis and management of thyroid carcinoma
Authors: Maisey M. N. 
Published: May 2005

AbstractPreoperative investigation of thyroid nodules is discussed with emphasis on the use of radionuclide scanning, ultrasound examination, and x‐ray fluorescence to decrease the need for unnecessary surgical excision. A follow‐up program is described involving the use of131I imaging techniques and serial thyroglobulin measurements in patients postoperatively for evaluation of response to treatment and detection of recurrence.
Aspiration biopsy cytology in diagnosis of thyroid cancer
Authors: Löwhagen Torsten , Willems Jan‐Silvester , Lundell Göran , Sundblad Rolf , Granberg Per‐Ola 
Published: May 2005

AbstractAspiration biopsy cytology (ABC) is a diagnostic method that has been used extensively in Sweden for a quarter of a century. The technical steps involved in this biopsy procedure are described, and the differences from large needle biopsy techniques are pointed out. An overview is given of the different pathologic conditions that present as thyroid nodules and are recognizable by ABC. The accuracy of the method as a preoperative diagnostic tool has been shown to be superior to other clinical methods. ABC enables the surgeon not only to better select patients with thyroid nodules for surgery, but also to plan a definite operative strategy in papillary, medullary, and anaplastic neoplasms. In follicular neoplasms, however, the method cannot distinguish with certainty between adenoma and carcinoma. ABC has drastically reduced the number of diagnostic surgical operations for benign lesions. It requires no anesthesia. It has no complications and there is good patient acceptance, even in children.
External radiotherapy and radioiodine in the treatment of thyroid cancer
Authors: Tubiana Maurice 
Published: May 2005

AbstractSurgery remains the most effective treatment for thyroid cancer. The indications for radiotherapy and radioiodine treatment should take into account the nature and extent of the surgical excision. There is not yet convincing evidence of the effectiveness of prophylactic postoperative radiotherapy. For patients under 45 years of age, the results obtained by complete surgical excision are excellent, and the degree of improvement that may be obtained from radiotherapy is not sufficient to justify the sequelae associated with beam therapy and the long‐term hazards induced by radioiodine. On the other hand, for patients over 45 years of age and, in particular, when the cancer is of the moderately differentiated follicular type, the prognosis is clearly much less favorable and there is an indication for additional treatment. Furthermore thyroid ablation by radioiodine facilitates the early detection of local recurrence or metastases by whole body scintiscans or serum thyroglobulin immunoassay. After grossly incomplete surgery, the efficacy of high dose (over 5000 rads) beam therapy has been demonstrated by a low incidence of local recurrence. Combination of external radiation therapy and radioiodine is indicated and well tolerated. For inoperable tumors the results of radiotherapy are limited; although complete remissions are sometimes obtained the incidence of local recurrence is high. However, the palliative effect of radiotherapy should not be overlooked. Patients with lung metastases that take up radioiodine have a high survival rate; about 50% of them survive for 15 years after the first administration of radioiodine. Cure is probably achieved in a large proportion of these patients. The survival of patients without significant radioiodine uptake after thyroid ablation is much shorter. The results obtained in treatment of bone metastases are less satisfactory. Combination of radioiodine and external therapy is advocated. External radiotherapy is effective in medullary carcinoma despite the slow shrinkage of the tumor after irradiation. Calcitonin assay can help to select those patients who need postoperative irradiation. In undifferentiated carcinoma, radiotherapy is recommended even after complete surgical excision although the results are generally poor.
Results of operative treatment of 615 patients with primary hyperparathyroidism
Authors: Bruining Hajo A. , van Houten Herman , Juttmann Jacob R. , Lamberts Steven W. J. , Birkenhäger Jan C. 
Published: May 2005

AbstractThis is a report of 615 patients who were operated on for primary hyperparathyroidism during the 20 years from 1950 to 1979. There were twice as many females in the series as males, mainly because of a sharp rise in the incidence in females over the age of 45 years. Identification of all parathyroid glands and confirmation by frozen section was always attempted. Only macroscopically enlarged glands were removed, regardless of histologic findings. Enlargement of 1 gland was found in 433 patients, of 2 glands in 106, and of 3 glands in 43. In 33 patients all glands were enlarged. Bilateral exploration of the neck is mandatory in order to prevent persistent hyperparathyroidism. An abnormal location of parathyroid glands was found in 263 patients; location within the thymus was the most frequent. Most ectopically located parathyroids can be removed through the neck. Sternotomy gave disappointing results; in only 3 of 9 patients was an enlarged parathyroid found. Persistent hyperparathyroidism necessitating reoperation occurred in 25 patients. The results of reoperation were not as favorable as those of primary operations and gave rise to more complications, especially inadvertent removal of all parathyroid tissue. The mean follow‐up time was 5.6 years. During this period no patient developed true recurrent hyperparathyroidism arising in a previously identified normal appearing gland. Therefore, we advise removal of only those glands that are macroscopically enlarged.
The localization of parathyroid tissue by ultrasound scanning prior to surgery in patients with hyperparathyroidism
Authors: Barraclough Bruce H. , Reeve Thomas S. , Duffy Peter J. , Picker Richard H. 
Published: May 2005

AbstractUltrasonic localization of parathyroid tissue has been attempted in 24 patients with hyperparathyroidism prior to surgical exploration of the neck. All 24 patients had biochemically proven hyperparathyroidism. Standard contact diagnostic ultrasound equipment fitted with a 5 MHz transducer was used, and transverse and longitudinal scans of the region of the thyroid gland were performed at 5 mm intervals. The normal anatomical structures identified were the lobes of the thyroid gland, trachea, common carotid arteries, and jugular veins. The longus colli muscle on each side was used as a major landmark. These structures define the site where most parathyroid glands are found in the neck. In 18 of the 24 patients the suspected parathyroid tumor was visualized preoperatively and confirmed at operation. The abnormal glands ranged in size from 5 to 12 mm in transverse diameter. In 3 patients false‐positive diagnoses were made by ultrasound; at operation the abnormalities proved to be thyroid nodules protruding from the posterior surface of the thyroid gland. Ultrasonography is of little value in the presence of multinodular goiter. Three adenomas and 3 hyperplastic parathyroid glands greater than 5 mm in diameter were not identified. Localization of enlarged parathyroid glands by echography may be difficult when normal anatomical landmarks are altered by the presence of multinodular goiter or because of previous surgery. The sensitivity of this technique for identifying in the neck parathyroid glands larger than 5 mm in diameter was found to be 79.3% with 11.5% false‐positive and 8.6% falsenegative results.
Analysis of 242 cases of gastric carcinoma
Authors: Ribeiro Manuel Moutinho , SimÕes Manuel A. Sobrinho , Bastos Joaquim 
Published: May 2005

AbstractClinical and pathological features of 242 patients with gastric cancer seen consecutively at the Department of Surgery (Cirurgia 4) of the Hospital de S. JoÃo in Porto, Portugal from 1970 to 1977 were analyzed. There were 140 men and 102 women and their mean age was 57.7 years. The overall 5‐year survival rate was 16.1%, and that of patients undergoing a curative resection was 42.6%. Duration of symptoms and tumor site did not influence survival rate. The expanding‐type of cancer was more frequent than the infiltrative‐type in a ratio of 2.8 to 1 and gave a significantly higher 3‐year survival rate. This better prognosis of the expanding‐type did not depend on sex, age, duration of symptoms, tumor site, or pattern of nodal metastases, reinforcing the prognostic significance of this classification. The high 5‐year survival rate may reflect the relatively high frequency of gastric carcinoma of the expanding‐type of northern Portugal. A relationship between this high frequency and the recent increase in the mortality rate of gastric cancer in Portugal is suggested.
Comparison of extended deep femoral angioplasty and femoropopliteal bypass graft in severe ischemia of the leg
Authors: Meyer Eugene , Adar Raphael 
Published: May 2005

AbstractExtended deep femoral angioplasty (EDFA) as a single procedure in 33 patients for revascularization of the severely ischemic lower extremity was compared with femoropopliteal bypass graft (FPBG) in 34 patients in a nonrandomized study. Severity of ischemia, incidence of diabetes, and frequency of cardiovascular diseases were comparable in the 2 groups. The pathology of the occlusive disease as delineated by angiographic criteria was worse in patients in the EDFA group, who had more severe disease in the profunda and in the outflow tract. Life table analysis to 3 years showed better overall results for FPBG than for EDFA. This difference was mainly attributed to the fact that FPBG was performed more often in patients with better outflow tracts. Significant angiographic correlates of success in EDFA were: (a) a good quality distal popliteal segment, (b) 2 or 3 vessel outflow tract below the knee, and (c) a patent and normal profunda femoral artery or a profunda femoral lesion limited to the proximal few centimeters of the artery.On the basis of our results we prefer FPGB in the presence of ischemic ulcer or gangrene if anatomic conditions offer a reasonable chance of success. In patients with severe claudication or rest pain, the choice between EDFA and FPBG is made on the basis of the above mentioned angiographic criteria that are weighted against other clinical considerations.
Medical and surgical indications for treatment of morbid obesity
Authors: Diaz S. Garcia , Fernandez S. Garcia 
Published: May 2005

AbstractIndications for operative intervention for morbid obesity are well established for most of the cases: overweight of 35–50 kg or twice or more the ideal body weight; the type of obesity; age between 20 and 55 years; no existence of metabolic or endocrine diseases causing obesity; and no hepatic dysfunction. We consider it absolutely essential to limit surgery to cases of hyperplastic and mixed obesity, excluding patients with hypertrophic obesity. Relative indications, especially orthopedic problems, as well as social and psychological situations, modify patient selection, including certain peculiarities of the Latin patient.
Surgical treatment of massive obesity: Our experience with jejunoileal bypass
Authors: Montorsi W. , Doldi S. B. 
Published: May 2005

AbstractThe authors relate their experience with surgery for massive obesity, reporting the results obtained in 76 severely obese patients submitted to jejunoileal bypass. The average body‐weight of the 76 operated patients is 151 kg. With a maximum follow‐up of 8 years, 88% of bypassed patients have returned to a normal body weight, their occupation, and a full social life.The most severe complication of jejunoileal bypass was hepatic failure, requiring the reestablishment of bowel continuity in 3 patients. The adoption of the end‐to‐side jejunoileal bypass, as well as greater clinical experience, contributed to an improvement in results, with a mortality rate of zero.
Management of morbid obesity by jejunoileal bypass
Authors: Schwartz Marshall Z. , Rucker Richard D. , Schneider Philip D. , Coyle John J. , Guzman Ignacio J. , Varco Richard L. , Buchwald Henry 
Published: May 2005

AbstractJejunoileal bypass has been the subject of over 350 reports in the literature. The initial enthusiasm for massive intestinal bypass seems to be declining because of its association with numerous and occasionally severe or fatal complications. In the past 9 years, there have been 800 jejunoileal bypass procedures performed at the University of Minnesota. A specific protocol for preoperative, intraoperative, and postoperative care has been, devised to minimize the perioperative and long‐term morbidity and mortality. The most frequent complications in the immediate postoperative period were urinary tract infection (11.9%), wound infection (6%), and thrombophlebitis (2.9%). There were 2 deaths which occurred in the early postoperative period.In our patient series, 80.5% sustained a weight loss in excess of 30 kg by 1 year. This weight loss has been associated with many beneficial effects including reduction in serum lipid levels, blood pressure, and blood sugar in the diabetic patients. There has also been a marked improvement in self‐esteem and socialization.The severe adverse sequelae of jejunoileal bypass have occurred in approximately 8%–10% of our patients. Many of the electrolyte and liver dysfunction problems have been minimized by close and frequent follow‐up. Fatigue (8%), cholelithiasis (4%), urolithiasis (9%), and bypass enteritis (10%) have been other adverse results of massive intestinal bypass. There were 5 additional deaths (total mortality rate of 1%) in our series related to sepsis and/or hepatic failure.The reanastomosis rate has been under 2% in our series to date.
Gastric bypass for morbid obesity
Authors: Griffen Ward O. , Bivins Brack A. , Bell Richard M. , Jackson Kathleen A. 
Published: May 2005

AbstractThis is a report on 402 consecutive gastric bypass operations performed for morbid obesity. The operation involves the construction of a small (30–60 ml) upper gastric pouch connected to a Roux‐en‐Y jejunal limb by an anastomosis no larger than 1.2 cm in diameter. Concomitant patient ailments included hypertension, gallbladder disease, arthritis, and diabetes. Three patients died postoperatively, and the overall immediate morbidity was 4.2%. Ninety percent of the patients have achieved and maintained a satisfactory weight reduction. However, residual problems include anastomotic leaks, inadequate weight reduction, and few but significant difficulties such as anemia, kidney stones, and marginal ulcer. All of the obesity‐associated diseases responded favorably, either disappearing or being greatly ameliorated.
Gastroplasty in morbid obesity: A progress report
Authors: Gomez Cesar A. 
Published: May 2005

AbstractThe lower mortality and morbidity rates of the gastric partitioning operations seem to be the primary reason for their increasing popularity among surgeons everywhere. Two hundred patients in our series underwent gastroplasty for morbid obesity. A measured 60‐ml proximal gastric pouch is formed as the TA‐90 is doubly applied across the upper stomach, just distal to the esophagogastric junction. The egress channel is located on the greater curvature, supported by a continued seromuscular inverting layer using 2‐0 polypropylene suture and a second interrupted inverting layer using 4‐0 Dacron® sutures. There were 154 females and 46 males in the series. The mean age was 34.2 years and the mean kg overweight, 67.4. The early postoperative complication rate was 19%, including 1 cardiac death, for a 0.5% mortality rate. Twelve percent revision rate included 15 staple line disruptions, 3 enlarged channels, 4 channel stenoses, and 2 enlarged pouches. Staple line dehiscence continues to be of concern with stapling in continuity. Liquid or pureed diet restriction for the first 12 postoperative weeks decreases the incidence of this complication. The second application of TA‐90 and the preservation of adequate blood supply to the pouch are important factors in the preservation of the integrity of the staple line. Ninety percent of total weight loss occurred at 12 months. Weight loss was maintained at 18 and 24 months.
Treatment of morbid obesity by gastric partitioning
Authors: Carey Larry C. , Martin Edward W. 
Published: May 2005

AbstractThe surgical treatment of morbid obesity by partitioning the gastric reservoir was designed to reduce caloric intake while avoiding alteration of the normal digestive process. Use of a single row of staples with a TA‐90 apparatus followed by a solid diet provided disappointing weight loss after 12 months, despite early gratifying results. Restricting patients to a liquid diet for 8 weeks postoperatively improved the efficacy of the procedure, but after the superior integrity of a double staple application was proven in the laboratory, that technique has been adopted. Without exception, patients are limited to liquids for 8 weeks postoperatively. Essential to a successful outcome of this procedure is continuing, understanding, skilled support by the nurse and the dietitian, who with the surgeon, comprise the team dedicated to the care of these patients.