bluuebunny/crossref_metadata_2025_split huggingface dataset:
Serum bone Gla protein as an indicator of parathyroidectomy in patients with secondary hyperparathyroidism
Authors: Takami Hiroshi , Shikata Jun‐ichi 
Published: May 2005

AbstractBone Gla protein (BGP) is a vitamin K‐dependent protein which is a marker of bone turnover. To determine whether serum BGP is a useful indicator for parathyroidectomy in patients with secondary hyperparathyroidism, we measured serum BGP levels. Thirty‐seven patients with secondary hyperparathyroidism who were followed up for more than 1 year after parathyroidectomy were studied. All patients underwent total parathyroidectomy and autotransplantation. Controls were 46 patients who were treated by chronic hemodialysis for more than 3 years. Serum BGP levels (normal: <6.5 ng/ml) were markedly increased in 37 patients with parathyroidectomy, ranging from 4.2 ng/ml to 645 ng/ml, with a mean value of 278.8±159.8 ng/ml (mean±standard deviation) versus 65.0±85.2 ng/ml in the 46 controls (p<0.001). Patients with a high BGP level had severe bone and joint pain. Serum BGP in patients with parathyroidectomy was significantly correlated with serum alkaline phosphatase and mPTH (p<0.001 for both). The total weight of resected parathyroid tumors was 2,152±1,368 mg, and tumor weights ranged from 200 mg to 5,600 mg. There was a highly significant correlation between BGP level and tumor weight (r=0.656,p<0.001). The 2 patients who showed BGP levels below 10 ng/ml had tumor weights of only 470 mg and 240 mg, respectively, and revealed no improvement of pain postoperatively, although their mPTH levels were increased. These results suggested that BGP measurement is a sensitive method for detecting increased bone turnover and is possibly useful as an indicator for parathyroidectomy in patients with secondary hyperparathyroidism.
Epidemiology of varicose veins
Authors: Beaglehole Robert 
Published: May 2005

AbstractThe prevalence rate of varicose veins in adults varies from less than 1% in lowland New Guinea women to over 50% in women in south Wales. Within populations the prevalence increases with age, is generally greater in women, is directly related to body mass, has an inconsistent relationship with occupation, and usually increases with increasing parity. None of these factors explain the striking geographic variation in the occurrence of varicose veins. The 2 most plausible hypotheses implicate low‐fiber diets and prolonged chair‐sitting as the primary causal factor. Epidemiological studies are required within populations to establish the merits of these 2 competing hypotheses. Since varicose veins are potentially preventable, further research is well justified.
Noninvasive testing for the evaluation of chronic venous disease
Authors: Kohler Ted R. , Strandness D. Eugene 
Published: May 2005

AbstractNoninvasive tests for chronic venous disease include continuous wave Doppler to assess deep and superficial vein patency and valvular function, strain gauge plethysmography for measurement of venous capacitance and the rate of venous outflow, photoplethysmography to determine venous refilling time (a measure of valvular competence), and duplex scanning, which provides detailed information about the size and location of thrombi and flow patterns in normal and diseased valves. The physiologic information gained with these tests allows more rational treatment and provides insight into the pathophysiology and natural history of varicose veins, postthrombotic limbs, and venous claudication. The crucial distinction between primary and secondary varicose veins is readily made by determining the patency of deep veins with the continuous wave Doppler. Development of late sequelae following deep venous thrombosis (DVT) may be predicted by noninvasive testing. While venous outflow is uniformly decreased following DVT, venous refilling time is abnormally shortened in symptomatic limbs, indicating that postthrombotic sequelae occur in association with valvular incompetence. Further natural history studies with duplex scanning may provide important data on the cause of this valvular incompetence and its time course. Noninvasive testing can also aid in the diagnosis of venous claudication, which is associated with decreased venous outflow.
Chronic venous insufficiency: A challenge for the vascular laboratory
Authors: Browse N. L. 
Published: May 2005

AbstractThe application of the noninvasive techniques of the vascular laboratory has increased our understanding of arterial disease. The complex physiology of the venous system has proven to be far more difficult to unravel. This article assesses the value of vascular laboratory techniques in the investigation and diagnosis of venous problems. It concludes that many of our methods of investigation are inadequate and that much more research and development is needed to produce objective quantitative measurements of calf pump function, deep vein obstruction, and deep and superficial vein reflux.
Congenital vein valve aplasia
Authors: Plate Gunnar , Brudin Lars , Eklöf Bo , Jensen Ragnar , Ohlin Per 
Published: May 2005

AbstractCongenital vein valve aplasia is often misdiagnosed and its symptoms misinterpreted as being caused by previous deep venous thrombosis. The present article reviews the literature providing data on etiology, symptomatology, and phlebographic appearance in congenital vein valve aplasia. A personal experience with 10 cases focuses on the clinico‐physiological results with compression therapy and surgical treatment of superficial venous insufficiency. Compressive support with a tourniquet or a compressive stocking did not improve muscle pump function or venous reflux, as assessed by foot volumetry, and venous hypertension was not affected. Nevertheless, no patient developed leg ulcers during consistent use of compressive stockings. Surgical removal of incompetent saphenous veins, perforators, and varicosities in a subgroup of 6 patients (8 limbs) was followed by an improved muscle pump function and decreased venous hypertension which persisted 4 years post‐operatively. Only 1 patient has been suited for deep venous reconstruction with transplantation of a valve‐containing vein segment from the axillary vein to the popliteal vein, but it is still too early to assess the results of this procedure. Our findings demonstrate that consistent compressive therapy is paramount in the management of patients with congenital vein valve aplasia. Surgical treatment of the superficial venous insufficiency provides a long‐lasting improvement of muscle pump function and venous hypertension. “Curative” vein valve transplantation or transposition is possible only in a minority of these patients.
The etiology of venous ulceration
Authors: Browse N. L. 
Published: May 2005

AbstractVenous ulceration is caused by the disorganization of the microcirculation that is induced by prolonged venous hypertension. The most common cause of calf pump inefficiency that permits superficial venous hypertension during exercise is deep vein thrombosis. Venous hypertension causes venular dilatation and an increased capillary permeability. Fibrin is deposited around the capillaries and not removed because of a vein wall deficiency of the fibrinolytic activator. The fibrin acts as a diffusion barrier and the overlying dermis becomes anoxic. Any minor trauma then causes an ulcer. Ulcers can be cured by restoring calf pump function to normal. Postthrombotic skin changes caused by irreparable calf pump damage can be reversed by the regular use of elastic compression and the pharmacological long‐term enhancement of fibrinolysis.
Recurrent varicose veins
Authors: Royle John P. 
Published: May 2005

AbstractWhen Doppler ultrasound was introduced for the assessment of patients with varicose veins, a more accurate clinical appraisal of the pathophysiology of this condition became possible. In particular, it enabled identification of those patients with recurrent varicose veins who had had inappropriate or inadequate initial treatment. It facilitated planning of appropriate further treatment.The more widespread use of radiology, in particular varicography, as a means of preoperative assessment of recurrent varicose veins has enabled a more accurate definition of the abnormal anatomical features. The extension of this principle to the operating room has made surgery for recurrent varicose veins more precise.Patients with varicose veins secondary to deep venous disease remain a problem. When both superficial and deep venous disease are present, superficial venous disease should be treated as appropriate. Deep venous insufficiency will require continued supervision of support maintained by bandages or graduated elastic stockings.
Statistical evaluation of the prognostic value of nuclear DNA content in papillary, follicular, and medullary thyroid tumors
Authors: Bäckdahl Martin , Carstensen John , Auer Gert , Tallroth Eva 
Published: May 2005

AbstractThe prognostic value of tumor cell nuclear DNA content and various pre‐ and postoperative prognostic factors (pre‐ and postoperative TNM, tumor size, resection margins involved by tumor, age, and treatment) have been evaluated by means of bivariate correlations and multiple linear regression analyses in 182 patients with either papillary, follicular, or medullary thyroid carcinomas, or follicular adenomas. Fifty‐one patients died of diseases and 131 patients were alive at least 10 years after diagnosis. The strongest correlation between tumor cell nuclear DNA content and survival was obtained in the group with papillary carcinoma, followed by follicular and medullary carcinoma. Nuclear DNA content alone had a predictive power equivalent to and, in papillary carcinoma, significantly greater than, that of all other prognostic factors combined. When DNA was added to all other prognostic factors, a statistically significant increase of the prognostic value in the present 3 kinds of thyroid carcinomas, both pre‐ and postoperatively, was obtained.
Consequences of routine peroperative cholangiography during cholecystectomy for gallstone disease: A prospective, randomized study
Authors: Hauer‐Jensen Martin , Kåresen Rolf , Nygaard Knut , Solheim Kaare , Amlie Einar , Havig Øyvind , Viddal Karl O. 
Published: May 2005

AbstractTo assess the value of routine peroperative cholangiography (PC), 457 patients undergoing cholecystectomy for gallstone disease were prospectively screened for the presence of 11 predefined criteria indicating possible choledocholithiasis. Two hundred and eighty patients who had no positive criteria and in whom preoperative endoscopic retrograde cholangiography (ERC) had not been performed were randomized to PC or no PC. The patients were followed up 12 months postoperatively, and those who had signs or symptoms of possible retained common bile duct calculi were referred to ERC. The difference in mean operative time between the 2 treatment groups was 23.3 minutes. Four patients (2.8%) in the PC group had unsuspected common bile duct calculi, and in 3 patients (2.1%), the PC was false‐positive. On follow‐up, no case of retained common bile duct calculi was found in either group. The rate of postoperative complications was significantly higher in the PC group than in the non‐PC group. It is concluded that PC should be performed only in patients with indications of common bile duct disease or in whom clarification of the anatomy is necessary.
Selective use of operative cholangiography
Authors: Grogono J. L. , Woods W. G. A. 
Published: May 2005

AbstractOperative cholangiography (OC), although available, was withheld in 330 (68.2%) of a series of 484 consecutive cholecystectomies performed for gallstones. A follow‐up study, conducted between 1 and 2 years after the operation, revealed 1 patient with a retained stone in the group not submitted to operative cholangiography. Although there is a strong case in favor of performing OC routinely, this has yet to be shown to be safer than selective use.
Hepatic incidentaloma: A modern problem
Authors: Little J. M. , Kenny J. , Hollands M. J. 
Published: May 2005

AbstractAs clinical skills give way to increased reliance on organ imaging, a new clinical problem is identified‐the hepatic “incidentaloma.” This may be defined as an unexpected solid filling defect in the liver of a well patient. Thirty‐six such lesions have been seen in one practice over a period of 36 months. Twenty‐nine (81%) were benign: 24 (67%) nonneoplastic conditions and 5 (14%) benign tumors. The remaining 7 (19%) were malignant: 5 secondary tumors and 2 primary tumors. Patients with physical signs of liver mass or enlargement were more likely to harbor malignancies. An elevated serum alkaline phosphatase (SAP) was suggestive of malignancy. Hepatic hemangioma was the most common single diagnosis (20 patients, 56%). We propose a regimen of investigation which should allow diagnosis to be reached in about one‐half of these patients without admission to the hospital. The rest will need at least a short hospital admission for angiography and fine‐needle aspiration biopsy.
Symptomatic nonparasitic cysts of the liver
Authors: Lai Edward C. S. , Wong John 
Published: May 2005

AbstractA retrospective study of 14 patients who had symptomatic congenital liver cysts managed at the Department of Surgery, University of Hong Kong at Queen Mary Hospital together with a literature review was conducted to evaluate the current surgical practice for the condition. Seven patients were managed either expectantly (N=5) or by percutaneous aspiration (N=2). Surgery which included total cystectomy (N=3), external drainage (N=1), and marsupialization with (N=2) or without (N=1) fenestration was done for the remaining 7 patients, among whom 1 developed bleeding after total cystectomy. While percutaneous aspiration provides adequate symptomatic palliation in selected patients, eventual recurrent cyst formation is frequent, especially when the cyst exceeds 10 cm in diameter. Despite technological advances, the presence of biliary communication and malignancy could not be accurately determined preoperatively. Careful examination of the cyst cavity at surgery remains the most reliable guide. Drainage into the peritoneal cavity in the presence of infection or bile content provides satisfactory drainage with minimal morbidity and mortality. Since total cystectomy could be done safely without partial hepatectomy, it can even be considered in patients with deeply‐seated lesions. The role of aggressive hepatic resection or liver transplantation for the management of liver cysts remains to be validated by further clinical evaluation.
Investigation of focal hepatic lesions: Is tomographic red blood cell imaging useful?
Authors: Farlow David C. , Chapman Peter R. , Gruenewald Simon M. , Antico Vincent F. , Farrell Geoffrey C. , Little J. Miles 
Published: May 2005

AbstractNoninvasive diagnosis of cavernous hemangioma of the liver is an important step in the investigation of patients with focal hepatic lesions since biopsy may result in life‐threatening hemorrhage. To determine the diagnostic accuracy of 99m‐technetium red blood cell (99mTc‐RBC) imaging with tomography, 50 patients with various types of focal liver lesions were studied. Thirty‐two patients had 45 hemangiomas and 7 other benign lesions while 18 patients had either primary (n=8) or secondary (n=10) hepatic malignancies. Tomographic imaging identified 12 more hemangiomas than planar imaging, improving sensitivity from 53% to 80%, and was found most useful for detection of smaller lesions (mean size, 2.1 cm). Specificity for hemangiomas was 100% with all lesions greater than 1.9 cm showing the characteristic scintigraphic pattern of blood‐pooling on delayed images. There was excellent agreement between 2 independent observers concerning interpretation of tomographic images (89% for the hemangioma group and 100% for other patients). Therefore99mTc‐RBC scintigraphy with tomography is an accurate diagnostic technique in the investigation of cavernous hemangiomas. Its major value resides in its ability to distinguish hemangiomas from other types of hepatic pathology.
Hepatic hemangiomas
Authors: Hobbs K. E. F. 
Published: May 2005

AbstractThere are 2 main and different forms of hepatic hemangiomas‐those of early childhood and those of later adult life. The former, called infantile hepatic hemangioendothelioma, may be life‐threatening due to arteriovenous shunting in extensive lesions resulting in cardiac failure. Although they may resolve spontaneously, if cardiac failure develops, they must be treated aggressively by arterial ligation or embolization. The adult form rarely gives rise to symptoms and should be left alone. Spontaneous rupture is extremely rare but may follow needle biopsy and it is in this group of patients that the occasional death has been reported. Biopsy should, therefore, be avoided. Symptomatic lesions should be resected in a specialized center where the morbidity and mortality of liver resection is acceptably very low.
The role of hepatic resection in the management of blunt liver trauma
Authors: Hollands Michael J. , Little J. Miles 
Published: May 2005

AbstractForty‐two (14%) of 306 patients with liver injuries presenting to Westmead Hospital over a 10‐year period required hepatic resection as their definitive treatment. Two types of resection were performed: Resectional debridement utilized the plane of injury as the line of resection while anatomical resection utilized anatomical planes. Resectional debridement was used in 35 patients. In 29, the major technical problem was bleeding and 21 of these patients had associated hepatic vein injuries. In 5, the major problem was devitalized parenchyma, and, in 1, it was an intrahepatic bile duct injury. Anatomical resection was performed in 7 patients: 3 with bleeding, 2 with devitalized parenchyma, and 2 with intrahepatic bile duct injuries.Overall, 15 patients died (36%). The most common cause of death was bleeding in 9 of the 15 patients. Survivors spent a median of 32 days in hospital (range: 11–162 days) and sustained a median of 2 complications (range: 0–6). The most common complications were respiratory infection and/or failure, coagulopathy, and sepsis.Resection successfully addressed bleeding, devitalized parenchyma, and intrahepatic bile duct injuries with an acceptable mortality in critically ill patients who would otherwise have died.
Percutaneous drainage of pyogenic liver abscesses
Authors: Wong K. P. 
Published: May 2005

AbstractTwenty‐one patients with liver abscesses were treated by percutaneous drainage over a 2 1/2‐year period. Percutaneous drainage was successful in 18 (85%) of 21 patients. Complications include 2 inadvertently dislodged catheters, 1 septicemia and 1 pleural effusion. There were 2 deaths. The low morbidity and high success rate in treating hepatic abscesses by percutaneous drainage suggest that this therapy should be tried before operative intervention is considered.
Surgical management of hepatic abscesses
Authors: Pitt Henry A. 
Published: May 2005

AbstractAmebic and pyogenic hepatic abscesses are rare liver lesions that may require surgical intervention. Amebic liver abscesses are more common in subtropical and tropical climates and in areas with poor sanitation. The majority of pyogenic liver abscesses are caused by infections in the biliary or intestinal tracts. These lesions can be differentiated on clinical grounds and by amebic serology. Ultrasound and computed tomography are the imaging techniques of choice. The initial management of amebic hepatic abscesses is treatment with amebicidal agents. Most patients respond rapidly so that surgery is reserved for patients with complications including secondary bacterial infection, impending rupture, or rupture into the pericardium or peritoneum. Patients with pyogenic hepatic abscesses require a prolonged course of antibiotics and appropriate drainage. Selected solitary abscesses can be managed with percutaneous abscess drainage. Similarly, some abscesses of biliary origin will respond to percutaneous biliary drainage. Surgical drainage has several advantages including: the ability to explore the abdomen for a source, excellent exposure of the entire liver, accurate assessment, sometimes with ultrasound, of the best drainage site, and access to the biliary tree for cholangiography and drainage.
Splenic abscess
Authors: Cohen Miguel A. Alonso , Galera Maria J. , Ruiz Miguel , La Calle J. Puig , Rius Xavier , Artigas Vicente , La Calle Jorge Puig 
Published: May 2005

AbstractWe present 7 cases of splenic abscess collected in our hospital from 1980 to 1988 as well as a review of 227 cases of the world literature. The signs and symptoms are nonspecific in all of them, fever being the most constant. Computed tomography scan followed by sonography were demonstrated to be the best methods of diagnosis. The treatment carried out on all of our patients was splenectomy followed by antibiotic coverage. Two of them died 15 days after the operation due to persistence of the septic state. In our review of the literature, we observe a rise in the population at risk for splenic abscess due to an increase in the use of immunosuppressive agents, to the higher survival of leukemic patients, and to the great incidence of drug abuse among others. Nevertheless, the advances in the use of sonography and computed tomography scan have made possible a more accurate diagnosis, therefore making possible an earlier treatment and a better prognosis. We believe that the treatment of choice is splenectomy with conservative treatment used only in specific cases where surgery represents a high risk for the patient.
Comparison between Savary‐Gilliard and balloon dilatation of benign esophageal strictures
Authors: Shemesh Eliahou , Czerniak Abraham 
Published: May 2005

AbstractThe efficiency and safety of the 2 most commonly used endoscopic dilators, Savary‐Gilliard and pressure balloons, were compared in 2 groups, each including 30 patients, with benign esophageal strictures. Four additional patients with tight and tortuous cervical esophageal strictures were initially managed by balloon dilatation followed by Savary‐Gilliard dilatation. These patients could not be dilated by each of the methods alone. Sixty patients [35 males and 25 females with a mean age of 52 years (range, 4–91)] underwent 165 esophageal dilatations. The etiologies of strictures included reflux esophagitis (65%), caustic damage (18.3%), and postoperative (anastomotic, or post‐Nissen operation) in 16.7%. Dysphagia improved in all patients; however, 2 patients (1 from each group) with hard postoperative anastomotic stricture eventually underwent surgical resection of stricture. There were no major complications or mortality related to the dilatations. Both methods were highly effective and well tolerated, yet Savary‐Gilliard dilators were slightly more effective and simpler to use than balloons. Nevertheless, tortuous cervical strictures and multiple closely‐placed strictures were more effectively managed by initial use of balloon followed by Savary dilators.
Bilateral breast carcinoma: 28 years' experience
Authors: Gülay Hüseyin , Hamaloglu Erhan , Bulut Orhan , Göksel Hüsnü Aziz 
Published: May 2005

AbstractFrom 1959 to 1987, a total of 1,182 histologically proven breast cancer patients were followed. Of these, 48 (4.06%) with bilateral breast carcinoma were reviewed. Eight patients (0.68%) had simultaneous breast carcinomas and the remaining 40 (3.38%) had nonsimultaneous breast carcinomas. The period between the development of the first and second primary carcinoma ranged from 17 to 200 months (mean, 86 months). The second primary carcinoma was found symetrically located with the first primary carcinoma in only 34.5% of the cases. No significant differences were observed between the bilateral carcinoma patients and the unilateral carcinoma patients with respect to pregnancy, delivery, family history, and the size and localization of the carcinomas. Axillary metastasis was seen in a higher percentage of the second primary carcinomas (48% versus 37.5%). It was observed that the shorter the time interval between the presentation of the carcinomas, the shorter the survival.