bluuebunny/crossref_metadata_2025_split huggingface dataset:
The effect of intravenous magnesium sulphate on parathyroid function in primary hyperparathyroidism
Authors: Gough Ian R. , Balderson Glenda A. , Lloyd H. Martyn , Galligan John , Willgoss Desley , Fryar Barry G. 
Published: May 2005

AbstractTen patients with primary hyperparathyroidism caused by enlargement of a single parathyroid gland were studied preoperatively. An intravenous bolus of 4 g magnesium sulphate followed by a continuous infusion of 2 g per hour for 3 hours increased serum magnesium from 0.76 to 2.12 mmol/l (median values,p <0.005). Serum C‐terminal parathyroid hormone (PTH) decreased from 94 to 78 pmol/l (p <0.005), and serum intact PTH from 7.0 to 4.8 pmol/l (p <0.008). The PTH changes preceded decreases in serum total calcium from 2.79 to 2.55 mmol/1 (p <0.01), and serum ionized calcium from 1.52 to 1.45 mol/1 (p <0.007). Urinary calcium excretion increased and urinary phosphate excretion decreased. Serum phosphorus, pH, albumin, creatinine, alkaline phosphatase, and urinary cyclic AMP showed no significant changes. The study showed that an intravenous magnesium sulphate infusion which at least doubled the normal serum magnesium concentration significantly suppressed PTH secretion in patients with primary hyperparathyroidism and subsequently reduced the serum calcium concentration.
Psychiatric morbidity in primary hyperparathyroidism
Authors: Joborn Charlotte , Hetta Jerker , Johansson Henry , Rastad Jonas , Ågren Hans , Åkerström Göran , Ljunghall Sverker 
Published: May 2005

AbstractThis report deals with the psychiatric symptomatology in patients with primary hyperparathyroidism (HPT). In a retrospective search of hospital records, psychiatric symptoms were found in 102 (23%) of 441 patients, 78 of whom had depressive and anxiety states. The presence of psychiatric symptoms was not related to the degree of hypercalcemia. Screening for HPT in 101 old patients hospitalized at a psychogeriatric clinic revealed HPT in 5 (5%) patients. Among 13 patients with organic brain syndrome (e.g., senile dementia) and HPT, 8 patients (with a duration of psychiatric illness of less than 2 years) improved mentally after parathyroid surgery, and could return home or to somatic units. The psychiatric symptomatology was prospectively investigated in 59 consecutive patients with primary HPT (mean serum calcium, 2.89±0.30 mmol/l), using the Comprehensive Psychopathological Rating Scale (CPRS). A majority of the patients had considerable psychiatric symptoms (mean CPRS total score, 13.7±9.1) compared with a healthy control group (mean CPRS total score, 4.4±2.0;p <0.001). The most pronounced psychiatric symptoms among the patients were fatiguability, lassitude, failing memory, concentration difficulties, sadness, and inner tension. Analysis of monoamine metabolites in the cerebrospinal fluid in 48 of the patients revealed subnormal values of 5‐hydroxyindoleaceticacid (5‐HIAA) and homovanillic acid (HVA). At follow‐up, 1–1 1/2 years after parathyroid surgery, there was a marked improvement in mental health in the patients (p <0.001), together with a significant rise in the levels of 5‐HIAA and HVA (p <0.05).Our findings demonstrate that psychiatric symptoms are present in a majority of patients with primary HPT, that the symptoms are reversed by parathyroid surgery, and that their severity seems not to be related to the degree of hypercalcemia. The results also indicate that HPT is associated with changes in the central nervous system turnover of monoamines, of possible importance for the symptomatology.
Prognostic value of nuclear DNA content in papillary and follicular thyroid cancer
Authors: Hamming Jaap F. , Schelfhout Lodewijk J. D. M. , Cornelisse Cees J. , van de Velde Cornelis J. H. , Goslings Bernard M. , Hermans Jo , Fleuren Gert Jan 
Published: May 2005

AbstractThe relative importance of prognostic factors in papillary and follicular thyroid cancer was studied in 113 patients using Cox's proportional hazards model. Prognostic factors studied were: histology, tumor grade, extrathyroidal growth, nodal involvement, distant métastases at diagnosis, nuclear DNA content, age at diagnosis, and sex. Nuclear DNA content was measured in primary tumors by flow cytometry. Total thyroidectomy and postoperative131I ablation was the standard treatment. The results showed that nuclear DNA content correlated significantly with histologic type and, in papillary cancer, also with tumor grade. The presence of distant metastases at diagnosis was, by far, the most important prognostic factor. In the patient group without distant metastases (n=91), multiploidy (i.e., presence of 2 or more aberrant stemlines) was the only significant prognostic factor for overall survival. With respect to diseasefree survival, multiploidy was second only to the age factor. In the patient group with distant métastases (n=22), all 6 patients with multiploid tumors died compared to 8 (50%) of 16 of those with other ploidy tumors. However, the small number in this group precluded significant results. The present study demonstrates that nuclear DNA content is a prognostic factor in those patients with papillary and follicular thyroid cancer without distant metastases at diagnosis.
Hashimoto's thyroiditis revisited: The association with thyroid cancer remains obscure
Authors: McLeod Michael K. , East Mary E. , Burney Richard E. , Harness Jay K. , Thompson Norman W. 
Published: May 2005

AbstractHashimoto's thyroiditis (HT) is an autoimmune disease of the thyroid associated with goiter and hypothyroidism. Although there exists a clear association between HT and lymphomas of the thyroid, the association between HT and thyroid cancer remains unclear. To evaluate this further, we retrospectively reviewed the pathology reports for all thyroidectomy specimens as well as the records of patients admitted to the University of Michigan Medical Center, Ann Arbor, Michigan, U.S.A., over a 10‐yearperiod (1975–1985) with the diagnosis of HT or chronic lymphocytic thyroiditis (CLT). Eight hundred and nine pathologic diagnoses were recorded for 816 thyroidectomy specimens from 793 patients. Furthermore, 180 of 228 patient chart records were available for review. Only 128 patients satisfied our criteria for the diagnosis of HT. HT or CLT were diagnosed in 147 (18.2%) of 809 thyroid specimens. HT occurred concurrently with thyroid cancer in 24% of all cases of HT, whereas, HT occurred concurrently with benign thyroid disease in 71% of all cases of HT in all thyroid specimens. Furthermore, HT was associated with 43 (22%) of 195 cases of thyroid cancer. There were 111 (87%) women and 17 (13%) men of 128 patients whose charts were reviewed. The mean age was 49±14 years. Ninety‐eight (77%) of the patients presented with goiters and 57 (45%) presented with dominant thyroid masses, 38 (67%) of which were solitary nodules. One patient (0.8%) presented with a recurrent laryngeal nerve palsy (RLNP) and 12 (9%) presented with tracheal compression. Only 29 (38.2%) of 76 patients measured had positive antithyroglobulin (ATG) titers, whereas 65 (87%) of 75 patients measured had positive antimicrosomal (AM) titers. Seventy (55%) patients were evaluated with either a technetium or131I thyroid scan. There was a heterogeneous pattern to the scan in 75% of these patients. Niney‐one (71%) patients were initially treated with thyroid suppression. However, 27 (21%) required thyroidectomy for initial management. Ultimately, 60% required thyroidectomy and 37% required none. The major indication for surgical intervention was the presence of a dominant mass in 40 (52%) of 77 patients. Only 17 (13%) patients were found to have thyroid cancer concomitant with HT and 3(2%) had lymphoma with HT. The incidence of minimal (occult) cancer in a study of 100 consecutive autopsies at this institution was 13%. We believe that these data suggest that the association of HT with thyroid cancer is relative, at best. It will be necessary to prospectively follow both a large group of patients with HT and a control group of patients without HT for the incidence of thyroid cancer in each before this issue can be appropriately addressed.
Vitamin D deficiency and hyperparathyroidism with severe bone disease
Authors: Ingemansson Stig G. , Hugosson Claes H. , Woodhouse Nicholas J. Y. 
Published: May 2005

AbstractCirculating 25‐hydroxycholecalciferol (25OHD3) levels are low in Saudi Arabia due to a lack of sunlight exposure and a low dietary intake of vitamin D (vit D). Recent studies in animals and man indicate that the half‐life of 25OHD3 is reduced in states of hyperparathyroidism. We, therefore, reviewed the charts of 43 patients with primary hyperparathyroidism (HPT) to establish whether there was coexisting vit D deficiency and osteomalacia. In the 22 patients studied, 25OHD3 levels were below normal in 14 and in the low normal range in 7, and the 1,25‐dihydroxycholecalciferol [1,25(OH)2D3] levels were inappropriately low in 8 of the 9 studied. Three of the 13 patients with classical “parathyroid” bone disease had evidence of osteomalacia with Looser's nodes or rickets.We conclude that patients with primary HPT are likely to develop vit D deficiency in countries in which 25OHD3, stores are low. In selected cases, preoperative treatment with vit D might diminish subsequent bone hunger.
Monoclonal antiparathyroid antibodies revealing defect expression of a calcium receptor mechanism in hyperparathyroidism
Authors: Juhlin C. , Åkerström G. , Klareskog L. , Gylfe E. , Johansson H. , Larsson R. , Ljunghall S. , Nygren P. , Rastad J. 
Published: May 2005

AbstractMonoclonal antibodies were generated with a hybridoma technique after immunization of mice with intact human parathyroid cells. Three antibodies of the IgG type reacted in immunohistochemistry and immunofluorescense with parathyroid epithelial cells and proximal tubule cells of the kidney but not with a large number of other human tissues. Adenomatous and hyperplastic parathyroid glands of patients with hyperparathyroidism (HPT) demonstrated a reduced immunohistochemical reactivity with the antibodies as compared to the intense staining of normal human parathyroid tissue. Experiments with dispersed parathyroid cells from the normal and pathological glands showed that 2 of the antibodies blocked the effects of ambient calcium on cytoplasmic calcium and parathyroid hormone release. This indicates that the antibodies interfere with a newly recognized receptor mechanism of parathyroid cells involved in the sensing and gating of calcium and thereby also in the regulation of parathyroid hormone release. A reduced expression of the putative calcium receptor mechanism of abnormal parathyroid cells may, thus, be principally responsible for the hypercalcemia of HPT by causing a decreased sensitivity to extracellular calcium of the parathyroid hormone release from pathological parathyroid glands. The antibodies should improve the parathyroid histological diagnosis by their ability to identify and to distinguish between normal and abnormal parathyroid tissue.
Immunohistochemical study of medullary thyroid carcinoma: Relationship of clinical features to prognostic factors in 36 patients
Authors: Takami Hiroshi , Bessho Takashi , Kameya Toru , Mimura Takashi , Ito Kunihiko , Abe Osahiko , Hosoda Yasuhiro , Shikata Jun‐ichi 
Published: May 2005

AbstractThis study was designed to identify 11 different antigens including calcitonin (CT), calcitonin gene‐related peptide (CGRP), gastrin‐releasing peptide (GRP), and carcinoembryonic antigen (CEA), in the tumors of 36 patients with medullary thyroid carcinoma (MTC) using immunoperoxidase staining techniques. In addition, clinical features of MTC patients were compared with the immunohistochemical findings to establish factors influencing prognosis. MTC was found to contain various products in many patients and CT and CEA were positive in all patients. CGRP and GRP showed positive staining in 96.6% and 82.9% of MTC patients, respectively, suggesting that CGRP and GRP are novel tumor markers for MTC. In tumor cells, CT, CGRP, and GRP were often revealed in identical cells. Familial patients showed more multiple substances than sporadic patients. In the 2 inoperable patients with extremely aggressive progression, tumors showed undifferentiated histology and poor staining for peptide hormones, suggesting that specific qualities such as neuroendocrine tumor had been lost. These 2 patients particularly revealed an inverse relationship between CT and CEA distribution such that small amounts of CT were present in cells which have homogenous staining for CEA. This study suggests that CGRP and GRP, in addition to CT and CEA, may be a histologically potential tumor marker for MTC. CT and CEA may be possible markers for differentiating patients with high malignancy from those with ordinary malignancy.
The vascular laboratory: Advances in noninvasive techniques
Authors: Bollinger Alfred , Jäger Kurt , Jünger Michael , Seifert Hildegard 
Published: May 2005

AbstractRecent advances in technology have further increased the diagnostic potential of the noninvasive vascular laboratory. They include measurement of transcutaneous oxygen pressure, laser Doppler flowmetry and intravital microscopy with and without the use of fluorescent dyes for analyzing hemodynamics of the skin and microvascular morphology, capillary flow velocity, and transcapillary exchange of solutes. Moreover, duplex scanning opens a way to detect stenoses in previously inaccessible arteries such as the mesenteric and renal trunks. The combination of B‐mode and pulsed Doppler ultrasound is also suited to map and quantify occlusive lesions from the aorta down to the proximal calf arteries with an accuracy similar to arteriography. The clinical implication of these new techniques is discussed in this review article.
Advances in the development of grafts for bypass of small‐caliber arteries
Authors: Sauvage Lester R. 
Published: May 2005

AbstractThe standard for coronary bypass is now clearly the autogenous internal mammary artery (IMA). Complete revascularization of the left ventricle can be attained in most cases using only the IMA's with as many sequential anastomoses as necessary. This advance has freed the saphenous vein (SV) for use below the knee joint.Properly preclotted, noncrimped, externally‐supported Dacron® grafts with an external velour surface merit consideration as the standard for axillofemoral bypass. The limitation of this graft is its dependence on a precise technique of preclotting to transform the Dacron® framework into a biosynthetic complex of dethrombinated fibrin and Dacron®.The autogenous SV is clearly the standard for below‐knee bypass. However, for above‐knee femoropopliteal bypass, the results obtained with polytetrafluoroethylene, umbilical vein, and externally‐supported, noncrimped, knitted Dacron® prostheses are sufficiently competitive with the results obtained with the SV to make their use an acceptable option in the above‐knee location. The saphenous vein is, thus, saved for use in the more demanding below‐knee sites such as a femoropopliteal, femorotibial, or femoroperoneal bypass.
Progress in the treatment of anastomotic aneurysms
Authors: Courbier R. , Aboukhater R. 
Published: May 2005

AbstractOne hundred and twenty‐five patients underwent surgery for 166 anastomotic aneurysms. The most frequent location was the inguinal area. Among the hypotheses advanced to explain this frequency, the role played by the inguinal ligament was underlined. When the prosthesis adheres firmly to this structure, movements in the hip create permanent shear stresses on the distal part of the anastomosis. This can explain why the suture line is often undamaged whereas the arterial wall is ruptured. In operations where the prosthesis is located in front of or below the inguinal ligament (axillofemoral, femoropopliteal bypasses), the incidence of anastomotic aneurysms is lower (p<0.001).Preventive measures have been adopted since 1981. Partial section of the inguinal ligament, enlarging the tunnel in which the prosthesis lies, is combined with free omental wrapping of the entire suture line. No cases of necrosis have been recorded. The comparison between 2 groups of patients operated for aorto‐(or ilio‐) femoral bypass before 1981 (2,602 anastomoses—99 anastomotic aneurysms) and after 1981 (1,409 anastomoses—no anastomotic aneurysms) using this technique shows a highly significant difference:p<0.001.Surgical treatment of anastomotic aneurysms consists of resection and end‐to‐end anastomosis. To avoid injury to the profunda femoral artery in the case of a femoral aneurysm, this vessel should not be dissected but only occluded temporarily.
Aortic‐iliac occlusive disease
Authors: Charlesworth David 
Published: May 2005

AbstractThis article is divided into 4 sections which deal with changes in the management of short stenoses in the iliac arteries, the management of aorto‐iliac disease and the effects of concomitant myocardial ischemia, changes in the design of prostheses, and “multisegmental” disease. Myocardial ischemia may be apparent from clinical or electrocardiogram evidence, or it may be covert. The mortality rate after aortic bifurcation grafting may improve if patients with severe coronary artery disease are either refused operation or have a coronary bypass first. It was postulated over 10 years ago that increased porosity would encourage the formation of a functioning intima on the inner surface of a prosthesis. Since then, the fashion has been to use porous prostheses, and recent developments to offset the loss of blood at implantation are described. Methods of predicting which patients with multisegmental disease will require combined aorto‐iliac and femoropopliteal reconstructions are discussed in the light of the problem of early occlusion of aortobifemoral grafts.
Renal and intestinal artery occlusive disease
Authors: van Dongen René J. A. M. 
Published: May 2005

AbstractSignificant progress has been achieved in the treatment of renal and intestinal artery occlusive diseases during recent years so that surgery can be performed with good results, with survival in over 95% of patients. Vascular surgeons, therefore, have become more aggressive, frequently combining aortic graft replacement with visceral artery repair. Such operations have become progressively safer, and, in centers in which these operations are performed on a regular basis, morbidity and mortality rates are quite low.The improvement in morphologic and functional results is due to proper selection of patients, adequate preoperative preparation, detailed aortographic investigation, and increased technical experience. The use of simplified reconstructive procedures, refinements in anesthesia, and postoperative care have played a large part in reducing the mortality rate even in complex aortic and visceral artery reconstructions.This is a report of surgical procedures and techniques used in over 800 patients with renal and intestinal artery occlusive disease; 182 of these patients underwent combined aortic and visceral artery, or combined renal and intestinal artery repair. Emphasis is placed on the use of autologous vein grafts in reconstructing renal and intestinal arteries, and attention is paid to technical and hemodynamic details of the different procedures to be preferred. Due to recent advances in surgical techniques, the results of surgical treatment have improved, justifying a more aggressive surgical approach.
Percutaneous transluminal angioplasty: The surgeon's role
Authors: Menges H. ‐W. , Jaschke W. , Trede M. 
Published: May 2005

AbstractThe technique of percutaneous transluminal angioplasty (PTA) was developed by radiologists and it is the interventional radiologist who mostly performs these procedures—often with little angiological background. But the latter seems indispensable when it comes to selecting patients for PTA and dealing with its complications.For this reason, PTA has been performed at the Mannheim Surgical Clinic for the past 10 years in close cooperation between surgeons and radiologists; 196 iliac arterial stenoses, 397 femoropopliteal stenoses and occlusions, and 65 renal artery stenoses have been treated with an initial success rate of 100%, 84%, and 96%, respectively. In 79 cases, PTA was used intraoperatively as a complement to reconstructive surgery on ipsilateral or contralateral vessels.Since PTA is not free of complications (2–6%), which may jeopardize limb or organ, indications for its use are restricted to patients who are symptomatic and, therefore, would otherwise require surgery. PTA of asymptomatic stenoses is not recommended.
Extraanatomical bypass procedures
Authors: Blaisdell F. William 
Published: May 2005

AbstractThose extraanatomical bypass procedures which are useful for revascularization of the lower extremities include femorofemoral, axillofemoral, and iliofemoral transobturator bypass. All of these procedures became firmly established during the 1960's, and have added greatly to the armamentarium of the vascular surgeon.The absolute indication for extraanatomical bypass is infection, which precludes the placement of a graft in a conventional location in a patient who requires revascularization to save life or limb. Relative indications for extraanatomical bypass exist when the risk of standard operations is high because of associated disease or anticipated technical problems. The most common indication is to provide revascularization of ischemic extremities in patients who are high‐risk for conventional operations. Utilization of axillofemoral graft to bypass aortic aneurysms is a most controversial indication. Occasionally, there is an extremely high‐risk patient who has symptomatic abdominal aortic disease who may benefit from the potential for staging the operation. Axillofemoral bypass can be done as one procedure and proximal or distal ligation of the aneurysm can be carried out simultaneously or at a later date with less stress on the patient.Important technical requirements of axillofemoral graft which will ensure optimal results are: (a) to place the proximal anastomosis on the first portion of the axillary artery, (b) to tunnel the graft well laterally so that it lies in the plane of flexion of the body, (c) to use an externally supported graft, (d) to ensure optimal outflow by using a femorofemoral graft in conjunction with axillofemoral bypass.The technical problems with the femorofemoral graft are relatively few: (a) the anastomoses should be placed in such a direction so as to avoid kinking, (b) the graft may be placed in a subcutaneous or subfascial position depending on the degree of obesity of the patient and the presence of preexisting scars.Technical aspects necessary for obturator bypass involve using whatever is the most accessible proximal vessel—usually the common iliac. The graft should be carried through the obturator membrane at its anterior medial portion, avoiding injury to the obturator nerve. The distal anastomosis is carried out in the low thigh.The results of axillofemoral graft vary greatly in individual reports. The 1‐year patency for these grafts varies from a low of 50% to a high of 87%, with 5‐year patencies varying from a low of 25% to a high of 76%.Regarding femorofemoral grafts, the literature documents 1‐year patency rates as varying between 82% and 93%, with 5‐year patency rates at approximately 75%, varying from 56% to 86.4%. Results for obturator bypass are not available since no one center has more than a limited experience with these operations.