bluuebunny/crossref_metadata_2025_split huggingface dataset:
The effects of positive airway pressure and intra‐abdominal pressure in diaphragmatic rupture
Authors: Ali Jameel , Qi Wan 
Published: August 2005

AbstractArterial blood gases (80% oxygen), intraperitoneal pressure (IP), stomach position relative to the diaphragm (S/D by fluoroscopy), blood pressure, and cardiac output were monitored in 16 anaesthetized New Hampshire piglets with a 12 cm laceration of the left hemidiaphragm. Group I (8 animals) were spontaneously breathing. Group II (8 animals) had a pneumatic antishock garment (PASG) inflated to an IP of 40 torr for 15 mins followed by positive pressure ventilation (PPV) of 20 cm H2O for 15 min and PPV of 40 cm H2O (PPV‐40) for 30 more minutes.All Group I animals survived. Three Group II animals died by 15 min after PASG inflation. Seven Group I animals showed no displacement of the stomach above the diaphragm. Blood pressure, cardiac output, and blood gases remained unchanged in Group I compared to baseline with pO2 varying from 436 ± 44 torr to 417 ± 31 torr, pCO2 from 38 ± 1 torr to 39 ± 1 torr, and pH 7.4 ± 0.02. Blood pressure in Group I was 109 ± 3 torr at baseline to 110 ± 2 torr at 60 mins, and baseline cardiac output was 3.9 ± 0.2 L/min and 3.8 ± 0.2 L/min at 60 min.Group II animals had a baseline arterial pO2 of 423 ± 15 torr and 100 ± 15 torr at 15 min after PASG. With PPV‐20 arterial pO2 increased to 178 ± 13 torr and further increased to 230 ± 9 torr at PPV‐40. pCO2 increased from 38 ± 1 torr to 78 ± 4 torr after PASG and with PPV‐20 pCO2 decreased to 60 ± 1 torr and further decreased to 49 ± 2 torr at PPV‐40. pH varied from a baseline of 7.4 ± 0.02 to 7.2 ± 0.01 in this group. Blood pressure fell from 110 ± 2 torr and 60 ± 10 torr post‐PASG and improved to 89 ± 3 torr after PPV‐20 and 93 ± 2 torr at PPV‐40. Cardiac output decreased from 3.8 ± 0.1 L/min to 1.2 ± 0.2 L/min post‐PASG and improved to 1.8 ± 0.1 L/min at PPV‐20 and 2.1 ± 0.1 L/min at PPV‐40. With PASG inflation to an IP of 40 torr S/D was 13.8 ± 1.3 cm. With PPV‐20 S/D decreased to 10.5 ± 1.5 cm and to 8.2 ± 0.8 cm at PPV‐40.In this porcine model of diaphragmatic rupture cardiorespiratory function is not severely compromised during spontaneous breathing. Increased intra‐abdominal pressure produces marked visceral herniation with cardiorespiratory deterioration which is partially reversed with positive pressure ventilation.
Long‐term functional results and quality of life after ileal pouch‐anal anastomosis and cholecystectomy
Authors: Köhler Lothar W. , Pemberton John H. , Hodge David O. , Zinsmeister Alan R. , Kelly Keith A. 
Published: August 2005

AbstractAmong 971 patients with chronic ulcerative colitis who underwent ilealpouch anal anastomosis during an 8‐year period from January, 1982 to December 1989, 30 patients were randomly selected from each year (total = 240 patients) for an assessment of their long‐term functional results and quality of life as of 1990. Patients undergoing cholecystectomy during each of the same years served as “controls” (20 patients/year, total = 160 patients). All 400 patients completed a written questionnaire that measured bowel habits, overall quality of life, general health, and performance in sports/recreation, travel, sex life, family relationship, occupational work, social activities, and household activities. Ileo‐anal patients had more frequent stools (median, 6 stools/day) and more fecal spotting (68% of patients had episodes) than cholecystectomy patients (median, 1 stool/day, 13% had episodes,p<0.05). In spite of the altered bowel habits, 90% of ileo‐anal patients had an excellent overall quality of life, 76% enjoyed good health, and 91% had good performance scores in the areas examined. In fact, quality of life and performance were similar among ileo‐anal patients and cholecystectomy patients. Moreover, quality of life and bowel habits remained steady in both groups of patients during the 8‐year follow‐up. In conclusion, functional results were satisfactory and quality of life was excellent after ileal pouch‐anal anastomosis; neither deteriorated as patients aged over an 8‐year period after operation.
Routine versus selective intra‐operative cholangiography during laparoscopic cholecystectomy
Authors: Soper Nathaniel J. , Dunnegan Deanna L. 
Published: August 2005

AbstractOpinion is divided whether intra‐operative cholangiography should be performed routinely or on a selective basis during laparoscopic cholecystectomy. We therefore performed the first prospective randomized trial of static cholangiography in patients who did not have indications for cholangiograms. Laparoscopic cholecystectomy was attempted on 164 consecutive patients, of whom 49 (30%) patients were excluded from the trial due to indications for or against cholangiography. In the remaining 115 (70%) patients, 56 were randomized to the cholangiography group while 59 patients did not receive cholangiograms. Duration of postoperative hospitalization and interval to return to full activity were identical in the two groups. Static cholangiograms added 16 ± 1 min (mean ± SEM) to the procedures (p<0.01). Cholangiography increased the total charges for the operation by almost $700 (p<0.01). Cholangiograms were performed successfully in 94.6% of the patients and changed the operative management in 4 (7.5%) patients. There was 1 (1.9%) false negative study. Intra‐operative cholangiography did not reveal aberrant bile ducts at risk of injury from the operative dissection. There was no mortality or cholangiogram‐related morbidity in either group. In follow‐up ranging from 2–12 months, there has been no clinical evidence of bile duct injury or retained common bile duct stones. In summary, in patientswithout indications for cholangiography, the performance of static cholangiograms markedly increased the operative time and cost of laparoscopic cholecystectomy. The operative management of a minority of patients was changed by the information obtained, but laparoscopic cholecystectomy may be performed safely in the absence of cholangiograms with little risk of injury to the major ductal system or retained calculi.
Thromboembolic complications in thermally injured patients
Authors: Rue Loring W. , Cioffi William G. , Rush Robert , McManus William F. , Pruitt Basil A. 
Published: August 2005

AbstractThe frequency of thromboembolic complications in burn patients has been estimated to range from 0.4% to 7%. The clinical significance of these events is often debated and has prompted some centers to adopt the routine prophylactic use of low dose heparin prophylaxis. A 10 year review of 2,103 burn patients treated at this institution was undertaken. Twenty‐five (1.2%) patients, with a mean age of 40.0 years and an average burn size of 49.3% total body surface area (TBSA), were identified as having significant pulmonary thromboembolism (PTE). In only 3 (0.14%) patients was the thromboembolism considered to be a cause of death. Nineteen (0.9%) patients, with an average age of 36.7 years and a mean burn size of 48.3% TBSA, developed clinically evident deep venous thrombosis (DVT); however, in only 1 (0.05%) patient did the disease progress to fatal PTE.A review of the literature reveals a 0.6% to 5% incidence of complications related to low dose heparin therapy which includes bleeding, thrombocytopenia, and arterial thrombosis. We feel that the infrequency of clinically significant PTE and DVT in burn patients and the comparable or greater rate of complications associated with heparin prophylaxis mitigate against the routine use of low dose heparin therapy except in patients at high risk for these events.
Acute acalculous cholecystitis complicating trauma: A prospective sonographic study
Authors: Imhof M. , Raunest J. , Ohmann Ch. , Röher H. ‐D. 
Published: August 2005

AbstractAcute acalculous cholecystitis (AAC) is a well known complication in severely traumatized patients. Existing data of AAC originate from retrospective analyses and episodic case reports. In a prospective study 45 polytraumatized patients admitted to our intensive care unit from January 1989 to June 1990 were clinically and sonographically screened for this condition at defined time intervals. Trauma scoring was performed according to the injury severity score and polytrauma score. AAC was defined as a combination of hydrops of the gallbladder, an increased wall thickness (>3.5 mm), and the demonstration of sludge. We were able to document this diagnostic triad in 8 (18%) of 45 patients. As a consequence early elective cholecystectomy was performed in 1 of the 8 patients. The remaining patients were treated conservatively. The incidence of AAC in severely traumatized patients is higher than figures so far published suggest. Ultrasound is a reliable method of early detection and follow‐up of this complication.
Repeat operation for nodular recurrent hepatocellular carcinoma within the cirrhotic liver remnant: A comparison with transcatheter arterial chemoembolization
Authors: Jeng Kuo‐Shyang , Yang Fi‐Sh , Chiang Hsein‐Jar , Ohta Ikuho 
Published: August 2005

AbstractManagement of recurrent hepatocellular carcinoma in a cirrhotic liver remnant is a difficult but challenging problem. To investigate the difference in survival between treatment by repeat resection and treatment by transcatheter arterial chemoembolization (TAE), a retrospective controlled study was conducted. Four patients with nodular recurrence received limited second operations which included right hepatic segmentectomy (2 patients), left lateral segmentectomy (1 patient), and subsegmental wedge resection (1 patient). Eight matched patients received a total of 16 repeated sessions of chemoembolizations. Complications of the TAE group consisted of gastrointestinal bleeding (2 patients), acute pancreatitis (1 patient), and acute cholecystitis (1 patient). No complication developed in the resection group. The 4 patients undergoing a second operation have survived 21, 26, 34, and 54 months after repeat surgery. Seven (87.5%) of the 8 patients receiving TAE died 4 to 11 months after TAE. The resection group survived significantly longer than the TAE group (p<0.01). Our results suggest that it is more advisable to perform a second operation than to undertake chemoembolizations for patients with cirrhosis and nodular recurrent hepatocellular carcinoma with acceptable functional liver reserve.
Effect of somatostatin on adenylate cyclase activity in normal and neoplastic thyroid tissue
Authors: Siperstein Allan E. , Levin Kenneth E. , Gum Elizabeth T. , Clark Orlo H. 
Published: August 2005

AbstractThyroid stimulating hormone (TSH) and other substances increase adenylate cyclase (AC) activity and growth of normal and neoplastic thyroid tissue. Factors that inhibit cAMP may provide targeted therapy to tumors dependent on cAMP for growth. Somatostatin has been reported to inhibit the growth of gastrinomas and carcinoid tumors. We therefore studied the effects of somatostatin on basal, TSH, pertussis toxin, and forskolin stimulated adenylate cyclase activity in normal and neoplastic thyroid tissue from 19 patients. Adenylate cyclase (AC) activity was determined by the conversion of alpha32P‐ATP to32P‐cAMP in pmoles/mg protein/30 minutes in an 8000 × g particulate fraction rich in thyroid plasma membranes.TSH (300 mU/ml) and forskolin (100 mM) (a diterpine that directly stimulates the catalytic unit of AC) increased AC activity in normal and neoplastic thyroid tissue. The AC stimulation was greater in the neoplasms (p<0.01). Somatostatin (5 × 10−6M) decreased basal and TSH stimulated AC activity below basal levels in both normal and neoplastic thyroid tissue (including papillary, follicular, and medullary carcinomas). The inhibition of AC by somatostatin was greater in neoplastic tissue (p<0.025). Pertussis toxin (which blocks the inhibitory guanyl nucleotide regulatory protein) was able to partially reverse the effect of somatostatin. Somatostatin partially inhibited forskolin stimulated AC activity.Somatostatin inhibits basal and TSH stimulated AC activity in both normal and neoplastic human thyroid tissue, with a greater effect on neoplasms. These studies establish that somatostatin blocks a major regulator of thyroid growth and provides the rationale for the use of somatostatin analogs in the treatment of thyroid cancers.
Causes of failed primary exploration and technical aspects of re‐operation in primary hyperparathyroidism
Authors: Åkerström G. , Rudberg C. , Grimelius L. , Johansson H. , Lundström B. , Rastad J. 
Published: August 2005

AbstractHypercalcemia was corrected in 62 (90%) of 69 patients after re‐operation for primary hyperparathyroidism during a mean follow‐up of 6.3 years. Failed primary exploration was mainly due to inadequate visualization of the pathological parathyroid glands, often in association with misleading or absent peroperative histology. Other causes included seeding of parathyroid adenoma tissue, truly recurrent adenomas, and recurrent hyperplasia, especially in patients with multiple endocrine neoplasia type 1. A considerable number of parathyroid glands missed at the primary operations were subsequently found in essentially normal positions. Ectopic superior glands were most frequently positioned para‐esophageally or retro‐esophageally, while abnormally placed inferior glands were generally situated within or close to the thymus. Glands in 3 patients were dissected from around the large vessels in the mediastinum. Concomitant thyroid procedures during the primary operation yielded few abnormal parathyroids and made the re‐exploration considerably more difficult. We suggest a semilateral approach and caudal identification of the recurrent laryngeal nerve to reduce the hazards of difficult parathyroid re‐operations. Mediastinal exploration may require total removal of the thymus and careful dissection of the middle mediastinum.
Parathyroid adenomectomy under local anesthesia with intra‐operative monitoring of UcAMP and/or 1‐84 PTH
Authors: Chapuis Y. , Icard Ph. , Fulla Y. , Nonnenmacher L. , Bonnichon Ph. , Louvel A. , Richard B. 
Published: August 2005

AbstractBecause 80% of patients with primary hyperparathyroidism have a single adenoma and because most adenomas are now visualized by ultrasonography, we have attempted to remove these suspected single adenomas under local anesthesia with intra‐operative monitoring of urinary cAMP (UcAMP) and 1‐84 parathyroid hormone (PTH) serum levels. In the last 2 years, 45 patients (mean age 65 years) with primary hyperparathyroidism underwent surgery with local anesthesia when a single adenoma was strongly suspected by ultrasonography. Patients with equivocal or misleading ultrasonography, e.g., those with associated thyroid or multiglandular pathology and those who were non‐cooperative, were excluded from this procedure. UcAMP and 1‐84 PTH were determined prior to the incision, at the time of removal of the adenoma, and at regular intervals until 120 minutes after the operation. Results were available 45 min to 60 min after sampling for PTH and 60 min to 80 min for UcAMP. Forty‐two adenomas were removed through a 2 cm to 3 cm skin incision in a mean time of 25 minutes, with no adverse effect, no morbidity, and minimal discomfort. The 42 patients were normocalcaemic on follow‐up. The monitorings always predicted the success of the operation. In the 3 remaining patients, because the monitorings remained elevated at the end of the procedure, the patients underwent classical bilateral neck dissection under general anesthesia. This new approach can be safely accomplished with short operative time and hospital stay. The absence of general anesthesia is reassuring for the patients who are reluctant to undergo general anesthesia. The intra‐operative monitoring which predicts the cure of primary hyperparathyroidism with high accuracy allows the surgeon to conclude the operation with confidence.
Outcome of long standing solitary thyroid nodules
Authors: Kuma Kanji , Matsuzuka Fumio , Kobayashi Akira , Hirai Keisuke , Morita Sinji , Miyauchi Akira , Katayama Shoichi , Sugawara Masahiro 
Published: August 2005

AbstractWe investigated the outcome of long standing palpable solitary thyroid nodules by surveying 441 patients and examining 140 patients who had untreated thyroid nodules for 15±4.5 years. In our clinical survey, the most common outcome was disappearance of the thyroid nodule (38.3%). Also a significant number of patients (36.3%) underwent surgery in other hospitals. Five (1.1%) patients died of thyroid cancer. When thyroid nodules were re‐examined, most nodules indeed decreased in size or disappeared; however, 13% of nodules increased in size. Ultrasound of the nodules showed that most solitary nodules were multiple and partially cystic and solid. There was an increased incidence of calcification in long standing nodules. Thyroid cancer was found by fine needle aspiration biopsy in 26.3% of enlarging nodules and 6.4% of nodules without changing size. The risk of cancer decreased when the size of the nodule decreased. A total of 15 patients with suspicion of malignancy underwent surgery. Surgical procedures were lobectomy, near total thyroidectomy, or resection of nodules with or without modified neck dissection. Seven patients had papillary carcinoma and 2 patients with benign cytology had microscopically evident papillary carcinoma. In our study, the majority of palpable solitary thyroid nodules tended to decrease in size; these nodules do not require treatment. Enlarging solid nodules are a definite risk for thyroid cancer. If the size of the nodule remains the same, judicious approach with fine needle aspiration biopsy is needed.
Prominent corneal nerves in patients with multiple endocrine neoplasia type 2A: Diagnostic implications
Authors: Takai Shin‐Ichiro , Kinoshita Shigeru , Tanaka Fumi , Ikeda Masataka , Tanaka Norifumi , Kobayashi Tetsuro 
Published: August 2005

AbstractWe examined corneal nerves of 22 patients from 10 families with multiple endocrine neoplasia type 2A (MEN‐2A). According to the findings in slit‐lamp biomicroscopic examination and photographic documentation, the increased visibility of corneal nerves were classified into 5 grades (Grade 0=invisible to Grade 4=as thick as in MEN‐2B). All eyes of normal subjects, 19 of 20 eyes of patients with anterior keratoconus, and 11 of 12 eyes of patients with non‐hereditary medullary thyroid carcinoma (MTC) were either grade 0 or 1, and the remaining 2 eyes were evaluated as grade 2. Of the 44 eyes of MEN‐2A patients, 5 (11.4%) eyes were grade 0, 11 (25%) eyes were grade 1, 19 (43.2%) eyes were grade 2, 8 (18.2%) eyes were grade 3, and 1 (2.3%) eye was grade 4. Thus, more than 60% of eyes of MEN‐2A patients showed pathologically thickened corneal nerves of varying degree (grade 2 or higher). There was no definite relationship between the grade of corneal nerve thickening and the patient's age or presence of pheochromocytoma. Differences in the grade of corneal nerve thickening were observed among affected members belonging to the same MEN‐2A family, but unaffected members of the family never showed prominent corneal nerves of grade 2 or higher. Our findings suggest that MTC patients with thickened corneal nerves might actually be MEN‐2A patients and should be carefully followed for other components of this syndrome.
Dynamics of parathyroid hormone release and serum calcium regulation after surgery for primary hyperparathyroidism
Authors: Graf Wilhelm , Rastad Jonas , Åkerström Göran , Wide Leif , Ljunghall Sverker 
Published: August 2005

AbstractAnalysis of 14 patients with primary hyperparathyroidism (HPT) prior to and during the first year after parathyroid surgery disclosed that the operation was associated with rapid reductions of intact serum parathyroid hormone (PTH) and total serum and ionized plasma calcium values. A decreased urinary calcium excretion, a gradual elevation of renal calcium reabsorption, a transient reduction of serum calcitriol, and a late increase in 25‐hydroxycholecalciferol values were also noted. Dynamic tests of parathyroid function by EDTA infusion and an oral calcium load revealed a sigmoidal relationship between serum PTH and calcium levels, and that parathyroid surgery induced considerable changes in both the position and slope of the dose‐response curve. It was also apparent that PTH release was submaximally stimulated event at periods of hypocalcemia. The findings substantiate that adjustments of PTH release to acute alterations of serum calcium occur along the prevailing dose‐response relationship, while stimuli being maintained for longer periods of time induce compensatory shifts in the position and slope of this curve. It is further suggested that unknown factors with PTH‐like function may participate in the calcium regulation after surgery for primary HPT.
Is it still worthwhile to treat bone metastases from differentiated thyroid carcinoma with radioactive iodine?
Authors: Proye C. A. G. , Dromer D. H. R. , Carnaille B. M. , Gontier A. J. P. , Goropoulos A. , Carpentier P. , Lefebvre J. , Decoulx M. , Wemeau J. L. , Fossati P. , Sulman C. 
Published: August 2005

AbstractFrom 1964 to 1989, bone metastases were found in 28 of 600 patients operated on for differentiated thyroid carcinoma. Bone metastasis was the presenting symptom in 15 (54%) patients, was detected from the initial symptom in 4 (14.5%) patients, and occurred subsequently in 9 (32%) patients, with an average lag time of 4.5 years after surgical treatment. Pathological pattern of the thyroid cancer was follicular in 26 (93%) patients and papillary in 2 (7%) patients. Bone metastatic involvement was multiple in 21 (75%) patients and associated with other synchronous or metachronous distant metastases in 13 (46%) patients, especially in the lung (10 patients) or the brain (3 patients).The primary treatment of thyroid carcinoma was total thyroidectomy in all 28 patients, with additional modified neck dissection in 8 patients. All 15 patients presenting with symptoms had bone metastases demonstrated by x‐ray studies. Six of the bone metastases only took up radioactive iodine 6 weeks after total thyroidectomy, as did 2 of 4 bone metastases detected at initial observation and 4 of 9 metachronous bone metastases. All 12 patients with functioning bone metastases were given radioactive iodine therapy; 4 of the metastases were surgically resected. Only 2 patients with bone metastases showed a complete response after an ablative dose of I‐131; none of the metastases had been demonstrated by x‐ray studies.Radioactive iodine therapy cures no more than 17% of patients with bone metastases taking up radioactive iodine and 7% of all patients with bone metastases. All patients cured of bone metastases were given radioactive iodine, either alone, or combined with other treatment. Bone metastases, when evident on x‐ray examination, never disappear after radioactive iodine therapy alone.