bluuebunny/crossref_metadata_2025_split huggingface dataset:
Relation between changes in clinical and histopathological features of primary hyperparathyroidism
Authors: Åkerström Göran , Bergström Reinhold , Grimelius Lars , Johansson Henry , Ljunghall Sverker , Lundström Bertil , Palmér Mats , Rastad Jonas , Rudberg Claes 
Published: May 2005

AbstractA material consisting of 609 patients with primary hyperparathyroidism (HPT) operated on from 1955 to 1984 was examined retrospectively. The number of patients operated on for HPT increased until 1970 but remained fairly constant thereafter. The increase was due to HPT being diagnosed and treated more often in older women without symptoms or with vague neuromuscular or psychiatric impairment. A renal stone disorder was mainly found in young males and, to a gradually decreasing extent, in females. During the last years, when the number of operations remained constant, approximately 25% of the females had either neuromuscular or psychiatric symptoms, renal stones, or were asymptomatic. Among the male patients, 65% had renal stones while 10% had either neuromuscular or psychiatric symptoms or were asymptomatic. Patients with parathyroid chief cell hyperplasia had lower serum calcium values than patients with adenomas. Before 1979, mostly younger patients with renal stones were subjected to operation in spite of low serum calcium values, and parathyroid chief cell hyperplasia was then mainly found in these individuals. After this date, a more liberal attitude toward surgery was also adopted in older patients with vague symptoms and a slight hypercalcemia and then the proportion of chief cell hyperplasia increased also among these patients. A recurrent parathyroid disease was encountered among patients previously operated on for hyperplasia but was also observed in a few adenoma cases, but only after a long postoperative period of time. The findings seem to indicate that parathyroid chief cell hyperplasia may represent an early form of primary HPT not related to any specific symptoms, but mainly seen in patients with a mild hypercalcemia. A recommendation that parathyroid surgery should be undertaken more generally in patients with low serum calcium values should take into account the greater difficulties associated with this type of surgery. The glands are often small and sometimes asymmetrically enlarged due to a nodular chief cell hyperplasia, which makes the extent of the necessary surgical resection difficult to decide.
Current approach to the management of tumoral process in patients with gastrinoma
Authors: Mignon M. , Ruszniewski P. , Haffar S. , Rigaud D. , Rene E. , Bonfils S. 
Published: May 2005

AbstractOne hundred forty‐four consecutive patients with Zollinger‐Ellison syndrome (ZES) were reviewed at Bichat Hospital in 1985. The population included 117 patients with a demonstrated tumoral process, 10 with islet‐cell hyperplasia, and 17 in whom no anatomical findings had yet been demonstrated. Patients in the 2 latter categories had clinical and biological features of ZES. Thirty‐five patients had multiple endocrine neoplasia type I (MEN I). Hyperparathyroidism was the most frequently associated endocrine disorder and required neck surgery in 65% of the patients. Pancreatic surgery failed in 61% of these individuals. Preoperative imaging techniques allowed a correct topographic diagnosis in only 1 out of every 2 patients. In 27 patients with negative preoperative imagery, pathological findings were revealed at surgery.Since 1974, major gastric antisecretory agents were used systematically in practically every patient which recommended either no surgical intervention (18 patients) or in most cases elective abdominal surgery. H2‐blockers have, in this series, clearly induced a reduction of the classical surgery combining total gastrectomy with gastrinoma removal and fostered gastrinoma surgery alone. The best chance of getting an apparently complete cure is offered to patients with ectopic gastrinomas, particularly those with duodenal wall tumors, and to a lesser degree, removable pancreatic tumors.Malignancy is frequent: 36 patients had hepatic metastases, which adversely and considerably influenced the probability of survival in ZES patients. Chemotherapy was used in 14 individuals with encouraging results.
Intraoperative scintigraphy in surgical treatment of thyroid carcinoma: Evaluation of a new technique
Authors: Lennquist Sten , Persliden Jan , Smeds Staffan 
Published: May 2005

AbstractEven when thyroidectomy with lymphadenectomy for thyroid carcinoma is macroscopic‐ally radical, postoperative scintigraphy sometimes reveals iodine uptake in residual or ectopic thyroid tissue or lymph nodes, necessitating radioiodine ablation. In order to detect such tissue during the operation, a technique for intraoperative scintigraphy was devised. It was tested in 20 patients undergoing total thyroidectomy for highly differentiated thyroid carcinoma. The patients received 20 mBq125I intravenously 24 hours before the operation. After removal of all macroscopically visible thyroid tissue and metastatic growth, the operative field was examined with a cadmium‐telluride detector placed in a sterile tube of stainless steel. By using this technique, iodine uptake was found in 16 of the 20 patients. All of this tissue was removed in 11 patients, leading to a negative postoperative scintiscan in 9 patients. In 2 patients, the perioperative scanning identified minimal residual uptake in a minute remnant of thyroid tissue adjoining the nerve entrance and not requiring postoperative radioiodine ablation. Scintigraphy was repeated in all patients 6 weeks after thyroidectomy. Recordings over different‐sized tissue fragments showed the detector to have a very high sensitivity, with capacity to detect tissue fragments weighing less than 2 mg. The results indicate that intraoperative scintigraphy, according to this technique, increases the possibilities to perform a complete removal of thyroid and tumor tissue and significantly reduces the need of postoperative radioiodine ablation.
Decrease in serum uric acid level following parathyroidectomy in patients with primary hyperparathyroidism
Authors: Duh Quan ‐Yang , Morris R. Curtis , Arnaud Claude D. , Clark Orlo H. 
Published: May 2005

AbstractSerum uric acid levels in 101 patients with surgically treated hyperparathyroidism were studied retrospectively. Twenty‐five patients had preoperative hyperuricemia and 8 patients had a history of gout. Preoperatively the serum uric acid level correlated positively with the blood urea nitrogen and serum creatinine levels, but not with serum immunoreactive parathyroid hormone or calcium levels. Following parathyroidectomy the serum uric acid level decreased from a preoperative level of 6.55±0.18 mg/100 ml (mean±S.E.) to 6.05±0.21 mg/100 ml at 1 week to 1 month postoperatively, and the uric acid level remained decreased at 6–18 months postoperatively (5.22±0.31 mg/100 ml). Patients with the highest serum uric acid level seemed to improve most.
Microsurgical free fibular bone transfer: A technique for reconstruction of large skeletal defects following resection of high‐grade malignant tumors
Authors: Schuind F. , Burny F. , Lejeune F. J. 
Published: May 2005

AbstractIn selected patients with localized malignant bone tumors, radical en bloc resection with adjuvant chemotherapy is now performed. Vascularized bone autografts can be used for secondary reconstruction of the bone defect. These grafts have the advantages of the nonvascularized ones, as well as the advantages of preserved viability. The fibula is usually the most suitable donor bone. Our surgical technique and the advantages and limitations of vascularized bone grafts are discussed.
Limb salvage in sarcomas in children
Authors: van der Eijken Jan W. 
Published: May 2005

AbstractLimb‐saving surgery plays an increasingly important role in the treatment of malignant tumors of the extremities. This type of surgery may pose special problems in children when one or two epiphyses have to be sacrificed. An unacceptable leg‐length discrepancy may occur, especially in the very young child, at the end of growth after reconstructive procedures. The different possibilities of reconstruction after a tumor resection and their repercussions in growth are discussed. The role of reconstruction by means of a rotation plasty versus other methods of reconstruction is especially considered.
Upper and lower limb disarticulation in soft tissue and bone sarcomas
Authors: Lienard D. , Lejeune F. J. 
Published: May 2005

AbstractThe authors have reviewed 23 patients with proximal disarticulations with the aim of assessing the therapeutic value in sarcoma, taking into account previous radio‐ and chemotherapy. The following criteria were especially examined: recurrences, survival, and quality of life. There were 14 soft tissue sarcomas, and 9 bone sarcomas. In 11 cases, the tumor was primary and treated for the first time while, in 12 cases, it was recurrent. Eighteen patients had been previously treated by nonradical surgery, 11 by radiotherapy, and 10 by chemotherapy. For upper limb tumors, 6 patients underwent an interscapulothoracic disarticulation, and 3 an interscapulothoracic resection according to Tikhoff‐Linberg. For lower limb tumors, 8 patients were submitted to interilioabdominal disarticulation, 3 to coxofemoral disarticulation, and 1 to internal hemipelvectomy according to Eilber. The mean disease‐free interval has been 34 months, and the mean survival, 38.5 months. Three (15%) of 20 evaluable patients recurred locally, although most of them benefited from second surgery. Quality of life has been excellent, in general, despite the fact that only 8 patients accepted to wear a prosthesis. The Karnofsky index ranged from 60 to 100%. No significant difference was seen, whether or not previous radio‐ and/or chemotherapy had been administered.
Hyperthermic isolation perfusion of the limbs with cytostatics after surgical excision of sarcomas
Authors: Lejeune F. J. , Lienard D. , Ewalenko P. 
Published: May 2005

AbstractIn order to prevent recurrence, isolation perfusion was applied in 15 patients after resection of sarcomas of the limbs. There were 6 liposarcomas, 4 synoviosarcomas, 2 malignant fibrohistiocytomas, 1 malignant mesenchynoma, 1 Kaposi, and 1 osteosarcoma (the only bone sarcoma). Eight sarcomas were recurrent after narrow surgery and/or radiotherapy.The treatment schedule was conducted in 2 steps: (a) removal of the tumor with safety margins at least outside the tumor capsule, followed 3–8 weeks later by (b) isolation perfusion with melphalan with or without actinomycin D under moderate hyperthermia at 39–41°C for 1 hour.Median follow‐up time has been 30 months. Four of the 8 recurrent sarcomas recurred again and developed distal metastases. In contrast, none of the previously untreated patients recurred and 1 disseminated in the form of multicentric liposarcoma. Eleven are still alive with survival ranging from 8 to 103 months.It is concluded that isolation perfusion with melphalan with or without actinomycin D may be considered as an adjunct to surgery.
Two cases of gastric carcinoids: Diagnostic and therapeutic aspects
Authors: Ahlman Håkan , Dahlström Annica , Enerbäck Lennart , Granérus Göran , Nilsson Ola , Persson Stellan , Tisell Lars ‐Erik 
Published: May 2005

AbstractTwo cases of gastric carcinoid tumors with the foregut carcinoid syndrome are presented. Due to elevated urinary levels of 5‐hydroxyindoleacetic acid (5‐HIAA), primary tumors of midgut origin were suspected. Provocation with pentagastrin (PG) elicited atypical flushing and severe bronchoconstriction, most probably caused by the release of histamine. Excessive excretion of the main histamine metabolite, tele‐methylimidazole acetic acid (MeImAA), in urine of both patients was demonstrated. Both patients had good symptomatic relief with prednisolone and blockade of histamine receptors. One of the patients had excessive secretion of serotonin (5‐HT) as well as of histamine. Peripheral blockade of 5‐HT2receptors was therefore added to the medical treatment. This patient had a subjective and biochemical response to cytotoxic treatment with streptozotocin and later responded well to a somatostatin analogue.On clinical suspicion of a foregut carcinoid tumor, or in patients with carcinoid tumors without anatomical localization, PG provocation should not be used until the excretion of MeImAA has been determined.
Cefotaxime i.v. versus oral neomycin‐erythromycin for prophylaxis of infections after colorectal operations
Authors: Raahave Dennis , Hesselfeldt Peter , Pedersen Torben B. 
Published: May 2005

AbstractOne hundred patients undergoing colorectal operations were randomly assigned to a parenteral prophylactic regimen with 2 g cefotaxime i.v. (3 doses) or to our present oral prophylaxis with neomycin‐erythromycin. Wound infection occurred in 2 patients who received cefotaxime (4%) compared with 6 patients (12%) who received neomycin‐erythromycin, a nonsignificant difference. Nor was there any significant difference between the anastomotic leakage rates, 12.5% and 6.1%. Predominant pathogens wereEscherichia coli andBacteroides fragilis. The results show that a 12‐hour cover with cefotaxime has a low rate of infectious complications and is as effective a prophylaxis as neomycin‐erythromycin orally.
Results of gastric resection for carcinoma of the stomach: The European experience
Authors: Heberer G. , Teichmann R. K. , Krämling H. ‐J. , Günther B. 
Published: May 2005

AbstractA European state of the art in the treatment of gastric cancer is presented from the results of a questionnaire. Data were obtained from 62 centers, 60% of which were from abroad and 40% of which were from Germany, reporting a total of 16,594 patients. A feature was a low portion (8.8%) of early cancer. The operation preferred was total gastrectomy. Only in the case of antral carcinoma of the intestinal type, according to Laurén, would the majority perform subtotal gastrectomy. Staging of lymph nodes was performed by 84% of these centers; however, systematic radical dissection was carried out only by 27%. The preferred type of reconstruction after total gastrectomy was Roux‐en‐Y esophagojejunostomy; 16% of the European centers used some type of pouch in addition. Splenectomy was carried out depending on location of the tumor.The median in‐hospital mortality for early cancer was 0; for carcinoma of the antrum, 6.7%; corpus, 9.6%; and gastroesophageal junction, 11.7%. The median 5‐year survival rate in patients with early cancer was 82.5%; for advanced cancer of the antrum, 30.7%; corpus, 24%; and gastroesophageal junction, 15.5%. Ten‐year survival was 6–10% less.It is concluded that in Europe there is a high rate of advanced gastric cancer affecting the results. Improved results may be expected if gastric cancer can be detected earlier and if there is radical lymph node dissection. Generally, prospective randomized studies presented by standardized documentation and statistics are urgently needed.
Effect of proximal gastric vagotomy on human gastric blood flow evaluated by endoscopic laser doppler flowmetry
Authors: Lunde Ole ‐Christian , Kvernebo Knut , Liavåg Ivar 
Published: May 2005

AbstractThe effect of proximal gastric vagotomy (PGV) on gastric blood flow has been evaluated endoscopically by laser Doppler flowmetry (LDF) in 12 patients with duodenal ulcer. The gastric wall circulation was examined at 7 defined positions in all subjects prior to surgery, 1 week postoperatively, and after 3 months. For comparison, 21 healthy volunteers were also examined by LDF.In all the investigated areas of the stomach, the blood flow values were lower in the unoperated duodenal ulcer patients than in the controls. In both groups, the blood circulation was significantly lower at the lesser curvature than at the greater curvature.Seven days after PGV, the blood flow was reduced 30% in the devascularized part of the lesser curvature. After 3 months, the flow values were similar to the preoperative ones. The gastric acid secretion was significantly reduced at 3 months.Postoperatively, one patient developed a gastric ulcer in the dissected area of the lesser curvature. This patient had lower flow values along the lesser curvature than the other patients after 7 days.The results of this study show that PGV leads to a temporary reduction of blood flow at the lesser curvature. This regional decrease in blood flow is probably not an important factor for the reduced acid secretion measured after PGV.
Effect of pancreatitis on moxalactam excretion in pancreatic fluids of dogs and man
Authors: Rubinstein Ethan , Meissel Doron , Klein Ehud , Samra Yehezkel , Schwartzkopf Renata , Ben‐Ari Gur 
Published: May 2005

AbstractPancreatic excretion of moxalactam was evaluated in a patient with mild pancreatitis and pancreatic fistula, in normal dogs, and in dogs with induced pancreatitis. In the patient, moxalactam was not excreted in the pancreatic fluid, despite adequate blood levels. Similarly, no moxalactam activity was present in the pancreatic fluids of normal animals and animals with experimentally induced pancreatitis. The data suggest that moxalactam does not penetrate into pancreatic fluid in detectable concentrations in the presence or absence of pancreatic inflammation.These results suggest the need for further study of the use of moxalactam in the treatment of bacterial infections of the pancreas.
Surgical management of large paraesophageal hernia with complete intrathoracic stomach
Authors: Menguy René 
Published: May 2005

AbstractBetween 1971 and 1986, the author operated on 30 patients, 23 women and 7 men, with large paraesophageal (PE) hernias and complete intrathoracic stomach. The average age of the patients was 70 years. Thirteen patients required urgent repair because of incarceration causing complete obstruction, bleeding, and, in one instance, perforation. Only 2 patients had a prior history of esophageal reflux. Surgery, always transabdominal, included excision of the sac, closure of the defect with pledgetted sutures, and anterior gastropexy. Four extremely poor‐risk patients underwent anterior gastropexy alone under local anesthesia. Two other patients underwent anterior gastropexy alone for different reasons. There were no deaths or major complications and no recurrences. The author's experience suggests that: (a) an abdominal approach is preferable to a transthoracic repair; (b) ancillary antireflux surgery, such as fundoplication, should be used only when indicated on the basis of a prior history of reflux esophagitis, which was the case in only 2 of our patients; (c) because the symptoms and complications of PE hernias result from the gastric volvulus rather than from the hernia per se, formal repair of the defect is not always necessary. Thus, patients whose general condition does not permit a major abdominal operation under general anesthesia can be completely relieved of their symptoms by an anterior gastropexy done under local anesthesia; (d) a PE hernia is a life‐threatening condition and elective repair should be recommended once the diagnosis is made.
Training for laparoscopic surgery
Authors: Zucker Karl A. , Bailey Robert W. , Graham Scott M. , Scovil William , Imbembo Anthony L. 
Published: May 2005

AbstractLaparoscopic cholecystectomy has rapidly become the procedure of choice for most patients with symptomatic gallbladder disease. Laparoscopic surgery, however, has not been a required component of most general surgery training programs. The demonstrated efficacy of laparoscopic surgery dictates that this discipline be rapidly incorporated into residency programs. Laparoscopic cholecystectomy and other surgical endoscopic procedures have been an integral part of the training program at the University of Maryland since 1989. Currently, residents who are completing their training have performed on average 50 to 75 laparoscopic procedures as the primary surgeon and 25 to 30 as the first assistant. In addition to training future community and academic physicians, those surgeons currently in practice must receive appropriate instruction in laparoscopic surgery. Most practicing surgeons attend a 2‐ to 3‐day intensive course offering both didactic and hands‐on experience. Additional exposure to clinical cases is achieved by working with other surgeons with laparoscopic expertise. Full credentialing in laparoscopic cholecystectomy generally requires proctoring by a surgeon from the local community. Since 1990 faculty from the University of Maryland have been active in the local community serving as proctors to surgeons in 14 hospitals.
Elective and emergent laparoscopy
Authors: Berci George 
Published: May 2005

AbstractAlthough laparoscopy has been received enthusiastically by gastroenterologists, mainly in Europe, over the past four decades, its usefulness in surgery has been ill‐defined or neglected. Gynecologists recognized the value and included laparoscopy as one of the most important diagnostic and therapeutic tools for pelvic pathology. After the introduction of laparoscopic cholecystectomy, several thousand surgeons were trained in laparoscopic techniques. Laparoscopy allows direct visualization of abdominal organs and the parietal peritoneum. It permits a safe target biopsy under precise visual control. The practical value of laparoscopy is the observation of lesions that would not be discovered by other investigations and the ability to assess the dissemination of malignant disease and its operability. Hence many unnecessary explorations are avoided. Diagnostic laparoscopy has a high overall diagnostic yield, has an excellent safety record in the hands of a well trained operator, and is cost‐effective. Minilaparoscopy in the emergent (blunt abdominal) trauma case gives the surgeon a much larger latitude for decision making than does diagnostic peritoneal lavage. Emergency minilaparoscopy has been performed in 150 trauma patients and has accurately predicted the need for laparotomy in all but one patient (0.7%). No major complications have occurred as a result of minilaparoscopy in this setting. A large number of emergency laparotomies in the multiorgan‐injured or high‐risk case can be avoided. Minilaparoscopy may be useful also in the elderly patient with an equivocal abdominal examination but suspicion of visceral injury.
Laparoscopic appendectomy
Authors: Pier Arnold , Götz Friedrich , Bacher Christoph , Ibald Rudolf 
Published: May 2005

AbstractAppendectomy was performed using a laparoscopic approach in 915 patients. The collected data show that the technique is as feasible, rapid, and safe as open surgery. Few wound infections, minimal pain, and rapid postoperative mobilization are the main arguments in favor of laparoscopic appendectomy. The most important potential benefit, a lower incidence of long‐term complications such as adhesive intestinal obstruction, remains to be confirmed by prolonged follow‐up of our patients.
Laparoscopic vagotomy for chronic duodenal ulcer disease
Authors: Mouiel J. , Katkhouda N. 
Published: May 2005

AbstractTwo laparoscopic procedures for treatment of chronic duodenal ulcer are described: bilateral truncal vagotomy with balloon pyloric dilatation and posterior truncal vagotomy with anterior lesser curve seromyotomy. The first procedure is simple to perform and easily reproducible, but the latter is preferred because it respects the physiology of the stomach. Thirty‐six patients were operated on over a period of 18 months with good results comparable to those with open surgery. The indications for surgery were intractable chronic duodenal ulcers resistant to optimal medical therapy. There was no perioperative morbidity or mortality, and recurrent ulcers have not been demonstrated during early postoperative follow‐up. The proper role of laparoscopic surgery in the arsenal of treatment of duodenal ulcers is unclear. The method of laparoscopic vagotomy requires rigorous experimental evaluation in specialized centers before widespread clinical application. Future multicentric prospective studies with long‐term follow‐up are necessary to assess the results of this innovative therapy of acid‐peptic disease.