bluuebunny/crossref_metadata_2025_split huggingface dataset:
Partial superior laryngeal nerve (SLN) lesions before and after thyroid surgery
Authors: Jansson Svante , Tisell Lars ‐Erik , Hagne Ingrid , Sanner Esbjörn , Stenborg Rune , Svensson Per 
Published: May 2005

AbstractThe incidence of superior laryngeal nerve (SLN) lesions and their consequences in terms of voice quality was studied in 20 patients undergoing thyroid surgery, performed by surgeons who were not specialists in endocrine surgery. The SLN function was examined by electromyography (EMG) of the cricothyroid muscles before and after surgery. Voice analysis was performed through the registration of the average pitch and range of the speaking voice and the upper pitch limit. The perceptual voice quality was judged by a panel of listeners. Voice problems were registered through a questionnaire. The larynx status was examined by indirect laryngoscopy before and after surgery. Three patients who had not previously been operated on in the neck had partial SLN lesions before surgery. According to the EMG, no SLN at risk developed a complete lesion, but 58% of the SLN's developed partial lesions which persisted 1 year after surgery in all but 1 of the examined patients. Seven of 10 patients with isolated SLN lesions had postoperative voice problems, which had disappeared after 1 year in 4 of them. Standard indirect laryngoscopy failed to diagnose an isolated partial SLN paresis. A significant correlation was found between SLN lesion and a reduction in the average pitch of the speaking voice (p < 0.05). Partial SLN lesions cannot be diagnosed exclusively on voice symptoms and standard indirect laryngoscopy. EMG registrations make a definite diagnosis possible. Measurements of the average pitch of the voice could be used as a noninvasive screening procedure.
Adenylate cyclase activity as a predictor of thyroid tumor aggressiveness
Authors: Siperstein Allan E. , Zeng Qui ‐Hua , Gum Elizabeth T. , Levin Kenneth E. , Clark Orlo H. 
Published: May 2005

AbstractPrior studies in our laboratory have shown that human thyroid neoplasms have a greater adenylate cyclase activity in response to thyroid stimulating hormone (TSH) than does the adjacent histologically normal thyroid tissue. However, there is little information relating activity of the TSH receptor‐adenylate cyclase system to the type of thyroid neoplasm. Thyroid tissue from 67 patients was divided by clinical and histological criteria into 6 categories: normal (59), benign tumors (20), stage 1 carcinoma—intrathyroidal involvement only (25), stage 2 carcinomaregional lymph node involvement (6), stage 3 and 4 carcinoma—tissue invasion or distant metastasis (11), and medullary carcinoma (3). Adenylate cyclase activity in an 8,000 x g thyroid membrane preparation was determined in the basal state and when maximally stimulated with 300 mU/ml TSH. The cyclase responsiveness was the ratio of TSH stimulated adenylate cyclase activity compared to basal adenylate cyclase activity. The cyclase responsiveness by category is: normal, 2.8±0.2 (mean ± SEM); benign, 17.9±2.4; stage 1 carcinoma, 9.2±1.9; stage 2 carcinoma, 4.0±1.0; stage 3 and 4 carcinoma, 1.6±0.4; and medullary carcinoma, 1.05±0.04 (for the neoplasms,p <0.02 by ANOVA). Tumor stage was the only correlate with this trend as other prognostic risk factors (age, sex, a history of neck irradiation, or papillary versus follicular histology) showed no difference in cyclase responsiveness. These studies demonstrate a consistent inverse correlation between adenylate cyclase responsiveness and tumor stage or aggressiveness. Cyclase responsiveness appears to have clinical application for predicting which thyroid tumors will behave aggressively.
Cervical exploration for suspected primary hyperparathyroidism in renal stone formers: A challenge to the surgeon
Authors: Farnebo Lars ‐Ove , Sandersjöö Gunnar , Granberg Per ‐Ola 
Published: May 2005

AbstractA retrospective analysis of 579 patients operated on for suspected primary hyperparathyroidism (PHPT) shows that male stone formers are younger, have less hypercalcemia, fewer neuromuscular symptoms, and a higher frequency of parathyroid hyperplasia or normal findings than men without renal stones. On the other hand, female stone formers do not differ from female patients without renal stones with regard to age, degree of hypercalcemia, or preoperative symptoms, but, like the male stone formers, they have a higher frequency of hyperplasia. This circumstance means that female as well as male patients present special problems at cervical exploration.
Guanyl nucleotide regulatory proteins in neoplastic and normal human thyroid tissue
Authors: Clark O. H. , Gum E. T. , Siperstein A. E. , Gerend P. L. 
Published: May 2005

AbstractPapillary and follicular thyroid neoplasms have been documented to have thyrotropin (TSH) receptors and an intact receptor‐adenylate cyclase (AC) system. The AC response to TSH in most benign and malignant thyroid neoplasms is greater in the neoplasms than in the adjacent normal thyroid tissue. This increased AC response could be due to abnormal amounts of guanyl nucleotide regulatory (G) proteins, to an altered ratio of stimulating to inhibiting G proteins, or to the coupling of the G proteins—to either the receptor or to the catalytic unit of AC. To study why tumors have a greater AC response to TSH, we first extracted the G proteins from normal and neoplastic human thyroid tissue and placed them in membranes from cyclase minus S49 mouse lymphoma cells that lack a stimulating guanyl nucleotide regulatory protein (Gs). These studies demonstrated that there were comparable amounts of guanyl nucleotide regulatory protein in normal and neoplastic thyroid tissue. We next investigated whether there was an alteration in the ratio of inhibiting (Gi) to stimulating (Gs) guanyl nucleotide regulating proteins in thyroid neoplasms. Pertussis toxin (PT) (10 μg/ml) was used to study the activity of the inhibiting G protein since it stimulates AC activity by inhibiting the inhibitory regulatory protein by adenosine diphosphate ribosylating the alpha subunit of the Gi protein. Cholera toxin (CT) (10 ng/ml) was used because it selectively activates the stimulating G proteins. AC activity was determined by the conversion of [α‐32P]ATP to cAMP in pmol/mg protein per 30 minutes. In 11 patients, PT‐stimulated AC levels [8.55±1.7 SEM, (mean±standard deviation)] in normal tissues were higher than basal levels of AC (5.14±0.9,p< 0.01). However, there were no differences in basal and PT‐stimulated levels in neoplastic tissues (6.43±1.0 and 6.87 ±1.8, respectively). This suggests that there is less Gi protein in the neoplasms since the AC response to PT was greater in normal tissues by 170%, but there was no significant stimulation in neoplastic tissues. In contrast, the AC response to CT (10 μg/ml that directly activates the stimulatory guanyl nucleotide regulatory proteins was greater in neoplastic thyroid tissue (174.3±30.1) than in normal thyroid tissue (78.5±16.3) from the same patients (p<0.01).These experiments demonstrate that most thyroid neoplasms have less Gi and more Gs protein, which probably accounts for the greater AC response to TSH in thyroid neoplasms. The greater stimulation of Gs and the greater AC response in the neoplasms may be one reason for the more rapid growth of benign and malignant thyroid tumors.
Spectrum of pheochromocytoma in the131I‐MIBG era
Authors: Cheung Polly S. Y. , Thompson Norman W. , Dmuchowski Carl F. , Sisson James C. 
Published: May 2005

Abstract131I‐metaiodobenzylguanidine (131I‐MIBG) scintigraphy allows for both functional diagnosis and anatomical localization of pheochromocytoma. The spectrum of pheochromocytoma since the routine use of preoperative131I‐MIBG scan was studied.From 1980 to 1986, a total of 34 patients were primarily diagnosed and treated at the University of Michigan Medical Center, Ann Arbor, Michigan, U.S.A. There were 16 males and 18 females. The mean age was 38 years and 4 patients (11.8%) were under 18 years of age. Six patients (17.6%) had family history of pheochromocytoma or multiple endocrine neoplasia (MEN) II syndrome. The presenting symptoms were hypertension in 29 patients (85.3%); attacks of headache, palpitation, sweating, and flushing in 4 (11.8%), and 1 patient presented with a neck mass.Plasma catecholamines were elevated in 97% of patients while urinary catecholamines and metabolites were elevated in 93.5%.131I‐MIBG was accurate in 82.3%, partly positive in 11.8%, and false‐negative in 5.9% of patients. CT scan was accurate in 80%, partly positive in 10%, but failed to show the tumor in another 10% of patients.At operation, extraadrenal lesions were found in 38.2% of the patients and among these, one‐third were extraabdominal. Multiple tumors occurred in 5 (14.7%), and bilateral adrenal lesions occurred in 4 patients (11.8%). Malignancy was diagnosed in 3 patients (8.8%) after an average follow‐up period of 2 years.We conclude that the use of routine preoperative131I‐MIBG scanning improves localization of pheochromocytoma and earlier diagnosis is possible in patients with MEN II syndrome. Multiple tumors, extraadrenal and extraabdominal lesions occur more often than commonly believed. The low rate of confirmed malignancy is probably related to the short period of follow‐up.
When is total thyroidectomy indicated as a treatment of “follicular carcinoma”?
Authors: Yamashita Tomoyuki , Fujimoto Yoshihide , Kodama Takaya , Hirayama Akira , Obara Takao , Ito Yukio , Aiba Motohiko , Kusakabe Kiyoko 
Published: May 2005

AbstractClinicopathologic studies were performed to establish rational criteria for total thyroidectomy as a treatment of follicular carcinoma. During the 4‐year period from 1981 to 1984, total thyroidectomy was carried out on 23 patients in whom unequivocal vascular invasion and/or obvious extracapsular extension were disclosed on pathological study of the primary thyroid lesion. Although occult metastatic lesions were detected postoperatively in 5 patients, no distant metastases have been found in 12. Distant metastasis was clinically manifest on admission in the other 6 patients. The degree of vascular invasion at the primary lesion was not correlated with the occurrence of distant metastasis. However, 10 of the 15 patients with tumors characterized by a thick fibrous capsule had distant metastases, while all but 1 of 8 patients with a thin capsule showed no metastasis. Apparent capsular invasion seemed to increase the relative risk of distant metastasis. On the other hand, solid clusters of tumor cells containing a variable number of small follicles, which characterize “Langhans' wuchernde Struma,” were found in 6 patients, and 5 of them showed distant metastases. Thus, total thyroidectomy should be considered when (a) distant metastases are clinically apparent, (b) the primary lesion has a thick fibrous capsule with or without obvious capsular invasion, or (c) solid clusters of tumor cells are demonstrated microscopically.
Familial occurrence of differentiated, nonmedullary thyroid carcinoma
Authors: Ozaki Osamu , Ito Kunihiko , Kobayashi Kaoru , Suzuki Akira , Manabe Yoshitaka , Hosoda Yasuhiro 
Published: May 2005

AbstractFamilial occurrence of differentiated, nonmedullary thyroid carcinoma in 23 patients from 11 families is reported. Five patients were male and 18 were female. The familial relationship of patients was “parent and child” in 12 cases from 6 families, and “siblings” in 11 cases from 5 families. Carcinoma of other organs was noted in other members in 8 families. Histological examination revealed 18 papillary, 2 follicular, and 2 anaplastic carcinomas (the 2 anaplastic carcinomas were considered to be transformed from preexisting differentiated carcinoma). In 1 case, the histological type was unknown. The average diameter of the primary lesion was 29.9 mm. Cervical lymph node metastasis was found in 77.8% and local recurrence in 28.6% of the patients. Solid and invasive growth was dominant. On HLA typing, phenotypes of B7 and DR1 were significantly redominant in familial patients compared with nonfamilial patients and normal Japanese. Moreover, the haplotype of B7‐Cw7‐DR1 was observed in 5 of 13 patients tested.It is suggested from these observations that some types of differentiated, nonmedullary thyroid carcinoma may show familial occurrence and that they may have common factors with regard to the genetic and immunologic basis of the disease.
Perigraft reaction: Incompatibility of synthetic vascular grafts? new aspects on clinical manifestation, pathogenesis, and therapy
Authors: Paes E. , Vollmar J. F. , Mohr W. , Hamann H. , Brecht‐Krauss D. 
Published: May 2005

AbstractPerigraft reaction can be defined as an aseptic biological incompatibility of synthetic vascular prostheses. The clinical picture is characterized by an indolent fluctuating swelling around the prosthesis, consisting of sterile fluid surrounded by a fibrous capsule. Since 1979, a total of 22 perigraft reactions in 2,554 implanted vascular grafts were observed and analyzed. The incidence of this complication is about 8/1,000 both for Dacron ® double‐velour and expanded polytetrafluoroethylene (PTFE). Including 306 reports from the literature, prostheses in the extraanatomical position comprise nearly 75% of the material analyzed.The time interval between graft implantation and clinical manifestation is, on average, 25 months. Although the etiology is still unclear, the pathogenesis is supposed to be multifactorial: (a) there is mechanical trauma due to continuous shifting of the prosthesis in the surrounding tissue (especially in the case of extraanatomic grafts), (b) there is physicochemical irritation of the tissue bed by the graft material (velour surface, organic solvents), and (c) poor incorporation of the graft may lead to periprosthetic gap formation and fluid accumulation around the prosthesis. Infections, or immunologic or allergic causes can be excluded.Therapy includes total or partial replacement of the affected portion of the graft and cyst wall with substitution by a prosthesis of a different synthetic material. Repeated aspiration of the periprosthetic cyst should be avoided because of the high failure rate and danger of secondary infection.
Extracranial vascular disease: Advances in operative indications and technique
Authors: Imparato Anthony M. 
Published: May 2005

AbstractAlthough the major concern in preventing perioperative strokes incident to carotid endarterectomy has been protection of the brain from clamping ischemia, analysis of over 2,000 operative procedures performed in conscious patients in whom vigorous efforts were made to discover the cause of perioperative neurologic deficits revealed that clamping ischemia accounted for 0.5% of the neurologic deficits while rethrombosis of the operative site, cerebral embolization during or immediately postoperatively, and intracerebral hemorrhage each accounted for 0.5%. In a fifth group, the diagnosis was not clear. The total incidence of neurologic cerebral deficits was 2.5% and the incidence varied markedly with the neurologic status of the patient at the time of operation, the condition of the contralateral carotid artery, and the tolerance to clamping ischemia while awake.Postoperative follow‐up indicates that if operative complication rates can be kept well below 3%, surgical intervention can be expected to favorably alter the natural course of ischemic stroke syndromes.
Factors contributing to success and failure of femorotibial bypass grafts
Authors: Courtney Donal F. , Flinn William R. , McCarthy Walter J. , Yao James S. T. , Bergan John J. 
Published: May 2005

AbstractFemorodistal bypass grafting is an important technique in the armamentarium of vascular surgeons, and it has been found that the cost of such procedures justifies their performance in patients who have sustained critical ischemia. Graft material remains the most important factor in causation of graft failure, with all prosthetics having disadvantages when compared to the saphenous vein. In attempts to use biological materials, both bovine heterografts and human umbilical vein grafts have been seen to form aneurysms and undergo thrombosis. Meanwhile, many variations on the theme of prosthetic grafts have been tried and found wanting when used as bypasses from the femoral artery to the distal circulation. Among configurations tried have been polytetrafluoroethylene with and without external support; Dacron® in woven and knitted format, with or without internal and external velour; and combinations of these. As patency rates of these reconstructions have proven inferior to others using the saphenous vein, attempts have been made to extend the use of autogenous biologic material. Such attempts have included cephalic vein bypass grafts, short vein bypass grafts originating distal to the femoral artery, deep veins used as grafts, and the in situ bypass. Lately, it has been recognized that the in situ bypass, when compared to concurrent controls, shows no significant advantage to the popliteal level but is the technique of choice when distal anastomoses are at or distal to the midcalf. Compositesequential bypasses represent another technique developed to utilize the autogenous vein as a distal segment. While this has increased the rate of patency of distal bypass grafting, other aids to patency such as use of anticoagulants, antiplatelet agents, and adjunctive arteriovenous fistula have not. Dynamics of the coagulation system show an intrinsic change in patient status toward coagulation in the postoperative period, and although this factor is of some significance in causing early graft thrombosis, technical defects do not seem to play an important part. This review details some of these important causes of graft failure and places them in proper perspective.
The challenge of the middle mediastinal parathyroid
Authors: Curley I. R. , Wheeler M. H. , Thompson N. W. , Grant C. S. 
Published: May 2005

AbstractIn most cases of persistent or recurrent hyperparathyroidism (HPT), the pathological parathyroid (PT) will be in the neck or accessible through the cervical approach, and in only a small percentage will median sternotomy be required. We present 3 cases of persistent HPT where the PT tissue was in the middle mediastinum. We acknowledge that this is a rare occurrence and that it cannot be explained adequately by standard embryological teaching. In cases requiring formal mediastinal exploration, the mediastinal exploration is not complete unless the middle mediastinum is carefully explored to exclude ectopic PT tissue.
Modified neck dissection for patients with nonadvanced, differentiated carcinoma of the thyroid
Authors: Ozaki Osamu , Ito Kunihiko , Kobayashi Kaoru , Suzuki Akira , Manabe Yoshitaka 
Published: May 2005

AbstractTo determine if it is truly unnecessary to perform modified neck dissection in nonadvanced, differentiated thyroid carcinoma, the extent of metastases in regional lymph nodes in 586 patients were studied. Four hundred and fifteen patients (70.8%) underwent neck dissections, and lymph node metastasis was disclosed in 339 cases (81.7%). Of the 78 cases judged as stage N0 during the operation, histological examination revealed metastasis in 34 cases (43.6%). Metastatic nodes were found in the central region in 300 cases (72.3%) and within the jugular region in 278 cases (67.0%). Neck dissections were carried out in 277 of 401 nonadvanced cases and in 138 of 185 advanced cases. In the former, metastasis was disclosed in the central region in 68.6% and within the jugular region in 62.1%. In the latter, on the contrary, the percentages were 79.7% and 76.8%, respectively.It is evident from these data that it is not reasonable to judge the presence of lymph node metastasis during operation, and that lymph node metastases are found in patients with nonadvanced disease as frequently as in patients with advanced disease. It is suggested that adequate modified neck dissection should be performed even in patients with nonadvanced, differentiated carcinoma of the thyroid.
Prospective comparison of radionuclide, ultrasound, and computed tomography in the preoperative localization of parathyroid glands
Authors: Carmalt Hugh L. , Gillett David J. , Chu John , Evans Richard A. , Kos Susan 
Published: May 2005

AbstractA total of 51 patients undergoing neck exploration for primary (n=29) or secondary (n=22) hyperparathyroidism were studied by 3 localization techniques: high‐resolution computed tomography (CT) scanning, ultrasonography (US), and thallium‐technetium subtraction scanning (TTS). The accuracy for locating single adenomas was 93% by CT, 88% by US, and 86% by TTS. The sensitivity for each test was 77%, 52%, and 58%, respectively. At surgery, the mean measurement of the long axis of these glands was 20 mm. The accuracy for locating diffusely hyperplastic glands was 37% by CT, 49% by US, and 31% by TTS. The sensitivity was 33%, 50%, and 26%, respectively. The longest axis averaged 11 mm. No advantage was shown by the use of multiple tests.Our results show that CT is the single most effective localization technique in patients with primary disease; however, in hyperplastic disease, the tests gave such poor results that further studies will be required to develop a technique with acceptable sensitivity.
In situ breast carcinomas: A population‐based study on frequency, growth pattern, and clinical aspects
Authors: Blichert‐Toft M. , Graversen H. P. , Andersen J. , Dyreborg U. , Green A. 
Published: May 2005

AbstractThis study comprises 78 consecutive women, within situ carcinoma of the breast and no evidence of invasion, who were diagnosed and treated surgically from October, 1979 to June, 1986. Lobular carcinoma in situ (LCIS) was found in 30 patients (38%) and ductal carcinoma in situ (DCIS) was identified in 48 patients (62%). The series is a study based in the county of Funen, which has a total female population of 230,028 inhabitants.Epidemiological calculations were carried out in 5 municipalities in the area of Odense University Hospital with 77,477 female inhabitants 20+ years of age according to a predetermined referral scheme and diagnostic procedures. This sub‐study revealed a frequency of 9.0 cases ofin situ carcinomas per 105 woman‐years and a cumulated risk of 0.53% of havingin situ carcinoma demonstrated within the age range of 20–75 years.In situ lesions made up about 6% of all newly diagnosed breast carcinomas in the region. Furthermore, in about 3% of all breast biopsies and in about 0.3% of all women having mammography due to breast symptoms, anin situ finding was the only malignant change.Pathoanatomically, a distinction could be made between 3 different growth patterns: microfocal, tumor‐forming, and diffuse growths. Microfocal lesions comprised a major part (60%) of in situ carcinomas. With one exception, the microfocal cases were chance findings in an otherwise benign breast biopsy, whereas the more aggressive growth patterns (tumor‐forming and diffuse) were predominantly clinical and/or mammographic findings, all belonging to the DCIS type. Excisional biopsy or partial mastectomy was performed in 85% of the women with microfocal cases, while such breast preservation procedures were used in only 27% of patients with tumor‐forming or diffuse growths.
Carotid body tumors at high altitudes: Quito, Ecuador, 1987
Authors: Pacheco‐Ojeda Luis , Durango Enrique , Rodriquez Clara , Vivar Nicolas 
Published: May 2005

AbstractCarotid body tumors seem to be encountered more frequently in people living at high altitudes. Twenty lesions operated in 19 patients at a general hospital in Quito, Ecuador over a period of only 5 years are reported. All patients lived in the highlands of the Andean region. There was no operative mortality, and morbidity was comparable to other series. No malignant cases were found. A higher degree of suspicion to recognize tumors and to operate at an earlier stage of development and thereby diminish operative morbidity is recommended. The great reliability of contrast angiogram and the development of other noninvasive diagnostic techniques is stressed. A study of the incidence of this lesion in the entire country should be made in the future.