bluuebunny/crossref_metadata_2025_split huggingface dataset:
The value of the clonidine‐suppression test in the diagnosis of pheochromocytoma
Authors: Karlberg Bengt E. , Hedman Lisbeth , Lennquist Sten , Pollare Thomas 
Published: May 2005

AbstractWe assessed the clinical value of a clonidine‐suppression test in the diagnosis of pheochromocytoma. Three different groups were investigated: group I, 10 patients with operatively verified catecholamine‐secreting tumors (1 extra adrenal paraganglioma); group II, 34 patients with “neurogenic” hypertension; and group III, 14 normotensive, healthy subjects.Clonidine, 300μg given orally at time zero, significantly reduced mean systolic/diastolic blood pressure (MBP) in all 3 groups: group I, maximum MBP fall ‐19/0 mm Hg; group II, ‐43/21 mm Hg; and group III, ‐25/9 mm Hg, respectively. The maximal MBP fall was seen between 2 and 3 hours after administration of clonidine. Mean plasma concentrations of noradrenaline/norepinephrine (NA) decreased in groups II and III, in group II from 2.6±0.3 to 0.7±0.05 nmol/l (p<0.001), and in group III from 1.3±0.2 to 0.6±0.06 nmol/l, respectively. Plasma concentrations of adrenaline/epinephrine (A) were low < 0.2 nmol/l and remained unchanged during the test. In contrast, in patients with pheochromocytoma (group I), NA and A mean plasma concentrations were high before clonidine, 7.7±2.2 nmol/l for NA and 4.0±1.7 nmol for A, and remained high or somewhat elevated during the 3 hours of observation. No patient showed a decrease in plasma catecholamines during the test.After successful operation for the catecholamine‐secreting tumors, all 10 patients achieved normal BP (mean 135/83 mm Hg supine) and had normal basal plasma catecholamine concentrations (NA 2.8± 0.5 nmol/l, A<0.2 nmol/l) with normal suppression of NA after clonidine to 1.1± 0.2 nmol/l (p<0.01 compared with basal values). We conclude that the clonidine‐suppression test is a safe and simple diagnostic method for verification or exclusion of pheochromocytomas, especially in patients with normal resting (baseline) catecholamine levels (4 patients in the present study). No significant or clinically relevant side effects were noted during the test apart from some sedation and dry mouth.
Cytostatic drug therapy in anaplastic thyroid carcinoma
Authors: Wenisch Hubertus J. C. , Wagner Roland H. , Schumm‐Draeger Petra ‐Maria , Encke Albrecht 
Published: May 2005

AbstractAnaplastic thyroid carcinomas are relatively rare and have a poor prognosis. In most cases, radical surgical procedures are impossible. Recently, a combination therapy of surgical resection, percutaneous irradiation, and chemotherapy has been described in the literature. After xenotransplantation in athymic nude mice, anaplastic thyroid carcinomas show the same histological features compared to the donors. By passing the tumor over several generations of nude mice, a constant growth rate has been observed. The model allows testing of therapeutic approaches in thyroid carcinoma tissues under in vivo conditions. In 2 different studies with 2 different anaplastic transplants, a statistically significant growth inhibition could be observed using doxorubicin therapy. In one study, combination therapy was performed. The results show no statistically significant difference in the group treated by doxorubicin alone. Further investigations, under in vivo conditions, will show whether a suitable combination therapy for anaplastic thyroid carcinoma can be developed.
TSH suppression in the management of autonomously functioning thyroid lesions
Authors: Thomas Colin G. , Tawil Mark , Berman Marvin I. , Nayfeh Shihadeh N. 
Published: May 2005

AbstractSolitary autonomously functioning thyroid lesions (AFTL) are discrete hyperfunctioning nodules whose growth and function do not appear to be dependent on thyroid‐stimulating hormone (TSH). Although they gradually increase in size and function over years, rarely do they progress to produce hyperthyroidism. This article presents the thesis that this “self‐limiting feature” is related to their growth and function being modulated by levels of TSH. Thyroid membranes from autonomously functioning thyroid lesions were examined in 6 patients. A nonlinear Scatchard plot was obtained with the hyperfunctioning thyroid lesion demonstrating high‐affinity, low‐capacity TSH receptor components. These exhibited a binding capacity ranging from 7 to 600 fmol/mg protein in patients with suppressed TSH levels to 1,450 in a euthyroid patient. All lesions exhibited basal adenylate cyclase activity which was stimulated 2–3‐fold by Bovine TSH. A review of the natural history of the lesion demonstrates a decremental increase in size and function with time. In 9 patients receiving thyroid hormone as suppressive therapy observed over a period of 4–14 years, the lesions partially regressed in 4 and did not progress in 5. This concept of growth and function of AFTL being modulated by TSH levels has therapeutic implications when such nodules are identified early in the course of their development. At this time, TSH suppression may be inhibitory to increase in nodule size and secretion of thyroid hormones.
The effect of varying levels of vagotomy on postprandial lower esophageal sphincter pressure and pancreatic polypeptide
Authors: Olinde Andrew J. , Maher James W. , McGuigan James E. 
Published: May 2005

AbstractFeeding produces a sustained increase in lower esophageal sphincter pressure (LESP) that is impeded by vagolytic blockade with atropine. This study determines the effect of varying levels of vagotomy on postprandial LESP and hormones known to stimulate LESP. Six dogs had measurement of fasting and postprandial LESP at 15‐min intervals after a 60 g beef meal. Blood was drawn for gastrin and pancreatic polypeptide (PP). The animals then had proximal gastric vagotomy (PGV) and subsequently, truncal vagotomy and pyloroplasty (TVP). The studies were repeated after recovery. Feeding produced a marked increase in LESP during the control period (p < 0.001) that was not affected by PGV (p > 0.6). In contrast, TVP completely abolished the LES response to feeding (difference from controls and PGV significant atp < 0.01). Gastrin response to feeding was accentuated by PGV, but this response normalized after TVP. Pancreatic polypeptide increased postprandially during the control period (p < 0.001). These increases were not affected by PGV (p > 0.6), but were completely abolished by TVP (difference:p < 0.001). Truncal vagotomy abolishes the postprandial rise in both LESP and pancreatic polypeptide. This suggests that vagal influences may play a role in the normal postprandial rise in LESP, possibly by release of pancreatic polypeptide, a hormone known to increase LESP.
Papillary cystic neoplasm of the pancreas: A curable pancreatic tumor
Authors: Kaufman Steven L. , Reddick Robert L. , Stiegel Mark , Wild Ronald E. , Thomas Colin G. 
Published: May 2005

AbstractPancreatic neoplasms are common and a leading cause of death from malignant disease. Their aggressiveness as well as the poor results of treatment has led to a somewhat nihilistic attitude in their surgical management with an emphasis on palliation rather than cure. Papillary cystic neoplasm of the pancreas, although rare, is frequently confused with more malignant tumors which are less successfully treated by pancreatic resection. This neoplasm arises from ductular epithelium, usually occurs in young women, and often remains asymptomatic until it becomes manifest as an abdominal mass or by a complication, e.g., rupture, hemorrhage, or secondary infection. Because of lack of familiarity with the tumor as well as its unusual presentation, the diagnosis is infrequently made at the initial operation. Our experience with 3 young females with papillary cystic neoplasms of the pancreas is reported. Included is a review of the literature indicating the unique characteristics of the tumor. Although locally invasive, these tumors appear to have limited malignant potential and rarely metastasize. An aggressive surgical approach seems fully justified.
Comparison of sonography, computed tomography, angiography, and percutaneous transhepatic portography in detection of portal tumor thrombus in hepatoma
Authors: Igawa Sumito , Sakai Katsuji , Kinoshita Hiroaki , Hirohashi Kazuhiro , Inoue Tadashi 
Published: May 2005

AbstractWe operated on 108 patients with hepatocellular carcinoma between July 1980 and July 1985. Eighteen (16.7%) had a tumor thrombus in the portal branch. The sensitivity of detection of these thrombi was 11.1% (2/18) by computed tomography, 22.2% (4/18) by transarterial portography, 50% (9/18) by sonography, and 70.6% (12/17) by percutaneous transhepatic portography. The outcome of hepatocellular carcinoma in the patients with such a tumor thrombus was poor. We think that percutaneous transhepatic portography should be done before operating for hepatocellular carcinoma to see if there is a tumor thrombus in the portal branch.
Gallstones and gastric cancer: A matched case‐control study
Authors: Sarli Leopoldo , Gafa Matteo , Lupi Marco , Sansebastiano Giuliano , Longinotti Ernesto , Peracchia Anacleto 
Published: May 2005

AbstractA matched case‐control study was carried out in order to verify the association of gastric neoplasms and lithiasic biliary disease and to clarify the nature of this association in 157 patients operated on for gastric cancer. Each patient was examined for previous cholecystectomy. Concomitant cholelithiasis was identified by ultrasonographic and intraoperative exploration. A statistically significant incidence of concomitant cholelithiasis (p<0.01) was found in patients affected by cancer of the antropyloric region (27% versus 11.7%), in female patients (24.7% versus 11.8%, p<0.05), and in patients over the age of 65 (32.2% versus 17.2%, p<0.05). No association with cholecystectomy was revealed in any of the cases. On the basis of these results, it may be concluded that the association found is not to be attributed to well‐known risk factors that are common to both diseases or to alterations in the bile composition caused by lithiasic disease. It appears that cholecystectomy has a protective effect as regards the increased risk of gastric cancer in patients with cholelithiasis.
Isolated splenic vein thrombosis
Authors: Moossa A. R. , Gadd Michele A. 
Published: May 2005

AbstractIsolated splenic vein thrombosis is being recognized more frequently as a complication of pancreatic disease and as the cause of gastrointestinal hemorrhage in patients without liver disease. The increased incidence reflects advances in diagnostic radiology and a higher index of suspicion for the diagnosis.Splenic vein thrombosis should be suspected in: (a) a patient with a history of pancreatitis and gastrointestinal blood loss; (b) a patient with splenomegaly in the absence of portal hypertension, cirrhosis, or hematologic disease; and (c) in the setting of isolated gastric varices.Celiac angiography has replaced splenoportography as the definitive diagnostic tool for splenic vein thrombosis and is indicated prior to operation for suspected portal hypertension or for complications of pancreatitis. The importance of making the diagnosis lies in differentiating the lesion from the more common case of hepatic and extrahepatic portal hypertension. The treatment of choice is splenectomy.
Splenic trauma in children and techniques of splenic salvage
Authors: Buntain William L. , Gould Howard R. 
Published: May 2005

AbstractThe increased risk of sepsis after splenectomy applies to any age for any reason. Splenic injuries consequently are now managed when possible by salvage procedures or nonoperative observation. This is not without controversy and in an attempt to define these injuries more appropriately and so predict optimal management, a quantitative and qualitative classification of presence and severity is presented, based on computed tomography. Type I injuries consist of localized capsular disruption or subcapsular hematomas, without significant parenchyma injury. Type II injuries consist of single or multiple capsular disruptions, with parenchymal injury that does not extend into the hilum or involve major vessels, with or without intraparenchymal hematoma. Type III injuries consist of deep fractures, single or multiple, that extend into the hilum and involve major vessels. Type IV injuries are those in which the spleen is completely shattered, fragmented, or separated from its normal blood supply. Added to this is the subclassification A for splenic injuries without associated intra‐abdominal injuries; B for splenic injuries with associated intra‐abdominal injuries, B1 for injuries involving a solid viscus, B2 for injuries involving a hollow viscus; and E for splenic injuries with associated extra‐abdominal injuries.Surgical techniques for splenic salvage consist of the application of topical hemostatic agents or omentum with or without simple capsular sutures, direct suturing of capsule and parenchyma, ligation of individual or segmental vessels, partial splenectomy, application of an absorbable net or ladder, and large entire organ through‐ and‐through sutures. These techniques are illustrated and alternatives to salvage are discussed.
Splenic abscess
Authors: Gadacz Thomas R. 
Published: May 2005

AbstractSplenic abscess is an unusual disease and may be present either as a localized area of infection in the spleen or as a part of generalized sepsis. There are no specific clinical findings for a splenic abscess; the symptoms and signs of sepsis should arouse a suspicion of splenic abscess. Computerized axial tomography (CAT) scan probably offers the most direct way of evaluating the spleen and making an early diagnosis. Although gram‐positive cocci are most frequently reported in splenic abscesses, there is enough variation of organisms that specific combination of antibiotics cannot be recommended. Antibiotic selection should be based on positive blood cultures and intraoperative cultures. The preferred treatment is splenectomy, although occasionally external drainage may be required. A successful outcome is dependent on an early diagnosis and prompt treatment by splenectomy. When splenic abscess is part of an overall septic process, the prognosis is generally very poor.
Splenectomy for thrombocytopenia
Authors: Schwartz Seymour I. 
Published: May 2005

AbstractThe effects of splenectomy in 49 thrombocytopenic patients managed since 1979 were assessed and compared with our previous experience of 174 patients. Idiopathic thrombocytopenic purpura (ITP) constitutes a common indication for splenectomy, which effects a cure in 86% of these patients. The platelet count rises above 100,000/mm3 by the eighth postoperative day in 88% of responders. Urgent splenectomy is indicated for patients with thrombotic thrombocytopenic purpura (TTP) because it is associated with the highest cure rate. Splenectomy in patients with myeloproliferative disorders causing thrombocytopenia effectively raises the platelet count but has been followed by the greatest incidence of complications among the hematologic disorders studied. In patients with chronic lymphatic or hairy cell leukemia, splenectomy almost always returns platelet counts to normal levels and there is an impressive improvement in the quality of life. A wide variety of disorders characterized by thrombocytopenia is responsive to splenectomy. Accessory spleens have been removed in 17% of ITP patients and are often present in patients with myeloproliferative disease, but only rarely noted in other patients with thrombocytopenia.
Splenectomy for myeloproliferative disorders
Authors: Wilson Richard E. , Rosenthal David S. , Moloney William C. , Osteen Robert T. 
Published: May 2005

AbstractSplenectomy is highly successful in reversing hypersplenism associated with myeloproliferative disorders (MPD). Significant improvement in leukocyte, platelet, and erythrocyte counts usually occurs within 1 week of splenectomy. Relief of symptoms associated with progressive splenomegaly seen with these entities is also achieved by splenectomy. Splenectomy, however, does not affect the inexorable course of these MPD, which appear to be caused by repeated damage to the pluripotential hematopoietic stem cell population. Hypercellular and hypocellular responses to this bone marrow injury result in a variety of disease states. A review of 50 patients treated with splenectomy for MPD from 1967 to 1980 demonstrated that the operation can be performed with a low mortality rate and minimal morbidity. About 15% of those patients presenting with MPD required splenectomy. Preoperative radionuclide ferrokinetic and sequestration studies, while good predictors of hematological response to splenectomy, do not provide information that impacts on the eventual outcome of splenectomized patients. Selection of patients with MPD for splenectomy is best made on clinical grounds.
Splenectomy for splenomegaly and secondary hypersplenism
Authors: Coon William W. 
Published: May 2005

AbstractSplenomegaly and secondary hypersplenism may be associated with acute and chronic infections, autoimmune states, portal hypertension or splenic vein thrombosis, and a number of infiltrative and neoplastic conditions involving the spleen. Our experience and that of others with these various conditions demonstrates that the decision to perform splenectomy should be based on well‐defined and often strictly limited indications. Except for idiopathic splenomegaly, the presence and severity of secondary hypersplenism or severely symptomatic splenomegaly should be well documented. In each case, the potential for palliation and known mean duration of expected response must be weighed against the increased morbidity and mortality of splenectomy (as compared to operation for “primary” hypersplenism).
Staging laparotomy with splenectomy for Hodgkin's disease: The Stanford experience
Authors: Taylor Mark A. , Kaplan Henry S. , Nelsen Thomas S. 
Published: May 2005

AbstractThe results of 825 staging laparotomies performed by surgeons at Stanford University Hospital are presented. The clinical stage was changed as a result of laparotomy in 43.2% of cases. Preoperative lymphangiography proved accurate in 78–80% of cases. In 321 patients (38.9%) the test results for the spleen were positive, and in161 (50.2%) of these, the spleen was the only positive tissue sampled. Major complications occurred in 9.6% of cases; most were wound and upper respiratory infections. The results of laparotomy have identified a subgroup of stage NIA patients who benefit from early systemic chemotherapy. Staging laparotomy with splenectomy has proven to be a useful and safe clinical research tool and has been one of the major factors in increasing survival from Hodgkin's disease.
Partial splenic embolization: Experience in 136 patients
Authors: Jonasson Olga , Spigos D. G. , Mozes Martin F. 
Published: May 2005

AbstractWe report our experience with transcatheter partial splenic embolization (PSE) in 136 patients; 124 patients were treated in association with renal allograft protocols, 8 patients for hematologic disorders, and 4 patients for portal hypertension and esophageal varices. A total of 15 patients have died over the 1–8 year follow‐up period. Three deaths were a direct result of the procedure. Long‐term follow‐up for up to 8 years of the patients who underwent transplantation has revealed good renal allograft survival and no apparent increased mortality from late septic episodes. Seventeen major complications have occurred including pancreatitis (2), pseudocyst formation (2), splenic hematoma (1), pleural effusion (10), and splenic abscess (2). Fever, atelectasis, leukocytosis, pain, and hyperamylasemia were commonly seen and resolved rapidly. Children withβ‐thalassemia major, spherocytosis, andα1‐antitrypsin deficiency were benefited by PSE with no serious morbidity and no mortality. Two patients with splenic vein thrombosis and one with alcoholic cirrhosis were successfully managed by sequential PSE, as was 1 patient with massive splenomegaly from myelofibrosis. We conclude that PSE is a relatively safe and effective procedure in the management of certain patients with hypersplenism and portal hypertension, and that the long‐term risks of postsplenectomy sepsis may not be incurred.
Tumors of the spleen
Authors: Morgenstern Leon , Rosenberg James , Geller Stephen A. 
Published: May 2005

AbstractSplenic tumors are uncommon lesions that can be divided into two main categories: nonlymphoid and lymphoid. The most common nonlymphoid tumors are the vascular tumors, which include benign and malignant hemangiomas, lymphangiomas, and hemangioendotheliomas. The remaining nonlymphoid tumors, such as fibrosarcoma and lipoma, are so uncommon as to be only anecdotally reported. Of the lymphoid tumors, Hodgkin's lymphoma may rarely occur as a primary splenic tumor, but more commonly is seen as part of disseminated disease. The same is true of histiocytic lymphoma and plasmacytoma. Rare benign lymphoid lesions may simulate lymphoid tumors. Of the metastatic tumors to the spleen, melanoma, breast, and lung are the principal lesions, but metastases from many other neoplasms occur. Metastases to spleen are less common than to other parenchymatous organs for reasons yet unknown. The surgical approach to splenic tumors should conform to the principles of good tumor surgery with good access, extirpation without rupture, and correct handling of tissue for study. Partial splenectomy is an acceptable procedure for benign splenic cysts, and possibly for polar hamartomas.
Is choledochoduodenostomy in the treatment of stones in the common bile duct an obsolete technique?
Authors: Cubillos Lorenzo , Fiallo Rodrigo , Rodríguez Jorge 
Published: May 2005

AbstractThe complex pathogenesis of bile duct stones, the anatomical properties of the biliary tree, the patient's age, associated diseases, as well as the technical devices available, may explain the great variety of procedures and preferences of different groups in the treatment of choledocholithiasis. Since no technique is infallible or free of complications, it seems unfair to argue that procedures whose efficacy has been proven by many authors are obsolete. This is the case of choledochoduodenostomy (CDS) in the treatment of common bile duct (CBD) stones. The complications associated with CDS, (ascending cholangitis, and “sump” syndrome) have been overemphasized and have led CDS to be rejected by many surgeons. Our experience with this technique is good and concurs with that of Madden and others.Data on 125 patients with CBD stones treated with CDS between 1968 and 1982 are analyzed. Sixty‐eight of them were female and the mean age was 61.4 years; 73.6% were more than 50 years old. There were frequent accompanying diseases, especially cardiovascular ones. More than half of the patients had a previous operation on the biliary tree. The duct diameter was always greater than 20 mm and it was frequently associated with stenosis of the distal choledochus. Floercken's technique of CDS was the most frequently used, after Kocher's maneuver had been performed. There was no intraoperative mortality. Postoperative mortality was 3.2% and is analyzed in detail. The incidence of postoperative complications was 42.4%. Most were septic complications or those ascribed to accompanying diseases. Late operative cholangitis was present in 1.6% of patients, comparable with reports of other authors. We encourage the use of CDS in the treatment of CBD stones provided that: (a) careful attention is paid to its clinical indications, considering that the patient may benefit from alternative techniques, for example, duodenoscopic papillotomy; and (b) choledochal dilatation is greater than 20 mm in diameter and the choledochal and duodenal walls are normal. We specifically recommend CDS as the primary operation for patients with “choledochal funnel syndrome.” The operation is simple, restores normal digestive function, and almost always resolves the problems of CBD stones in high‐risk patients.