bluuebunny/crossref_metadata_2025_split huggingface dataset:
Primary endoscopic papillotomy (EPT) in patients with stones in the common bile duct and the gallbladder in situ: A 5‐8‐year follow‐up study
Authors: Rosseland Arne R. , Solhaug Jan Helge 
Published: May 2005

AbstractSeventy‐five patients (mean age, 77 years) with common duct stones and the gallbladder in situ were treated with primary endoscopic papillotomy (EPT) during the period 1976–1979. The endoscopic procedure was successful in all patients, but 4 patients had to be operated on since the common duct stone did not pass.The complication rate was 13.3% and 1 patient died. One patient was operated on with cholecystectomy within a week after EPT because of progression of his cholecystitis. Another patient was operated on with drainage for perforated liver abscesses and cholecystectomy; she also died 1 week after operation.In the follow‐up period of 5–8 years, 12 patients were operated on with cholecystectomy: 7 patients because of acute cholecystitis, and 3 patients because of recurrent pain attacks. In 2 patients, the operation was done electively.Thirty patients died, all from other diseases except 1 patient who died from a gallbladder carcinoma 1 1/2 years after EPT. Three patients were treated conservatively for acute cholecystitis.After 5 years, 28 patients were still alive with the gallbladder in situ and none had symptoms from the gallbladder. Altogether, 13 (17.3%) patients were treated for acute cholecystitis during the 5–8‐year follow‐up period.
A Comparison of flexible and rigid endoscopy in evaluating esophageal cancer patients for surgery
Authors: Cheung H. C. , Siu K. F. , Wong J. 
Published: May 2005

AbstractFlexible and rigid esophagoscopy and bronchoscopy were performed in 71 patients with carcinoma of the thoracic esophagus who subsequently underwent surgery; a thoracotomy was performed in 68 patients and the mediastinum examined to assess the extent of disease. Four patients presented with tracheo‐or bronchoesophageal fistulas, 1 of whom also had a thoracotomy. Biopsy confirmation of diagnosis was obtained using flexible esophagoscopy in all patients. In 78% of the patients the fiberscope could negotiate through the tumor and the tumor length was noted, and the distal esophagus, stomach, and duodenum were examined—information otherwise unobtainable using the rigid esophagoscope. The accuracy of flexible and rigid bronchoscopy were comparable in detecting tracheobronchial involvement, but both were insensitive in assessing mediastinal invasion. While other investigations such as computed tomography scan and azygogram may improve the accuracy in evaluating mediastinal disease, whether this would alter the management of patients needs further assessment since, in most patients with bronchoscopic abnormalities, the tumor could still be resected. We conclude that although endoscopy has limitations in the preoperative evaluation of patients with carcinoma of the esophagus, flexible endoscopy is as accurate and, in certain situations, superior to its rigid counterpart and, if available, is the examination of choice.
Preservation of functional aerobic capacity with daily submaximal exercise during intravenous feeding in hospitalized normal man
Authors: Albert James D. , Legaspi Adrian , Horowitz Glenn D. , Kubo Spencer H. , Tracey Kevin J. , Cody Robert J. , Lowry Stephen F. 
Published: May 2005

AbstractWe evaluated the relationship between nutritional status and maximal aerobic capacity in hospitalized normal subjects receiving intravenous nutritional support. In addition, the impact of a daily submaximal exercise regimen on maximal oxygen consumption (VO2 Max) during weight‐stable intravenous feeding (IVF) was quantified. Six normal male volunteers were studied serially in the post‐absorptive state following 3 days of standard enteral feeding, after 10 days of starvation, and after 10 days of intravenous nutritional repletion (group A). Another group of 11 normal subjects were studied post‐absorptively after 3 days of enteral feeding and again after 10 days of weight‐stable IVF (group B). Five of the 11 subjects in group B were randomized to perform 1 hour of daily bicycle exercise at 75 watts during IVF whereas the remaining 6 subjects received IVF without daily exercise.In group A subjects, VO2 Max (ml min−1 kg−1 ±SE) was 36.2±1.5 after enteral feeding and fell to 32.4±2.6 after 10 days of starvation. VO2 Max remained significantly (p<0.05) less than the enteral study even after 10 days of repletion IVF (28.4±2.9). Group B subjects demonstrated a VO2 Max of 34.1±3.0 at admission and, despite 10 days of weight‐stable IVF, the nonexercised subjects experienced a decrease in VO2 Max to 26.4±2.4 (p<0.05). In contrast, those subjects who received daily exercise during IVF demonstrated a nonsignificant decrease in VO2 Max (31.4±4.6) after 10 days of weight‐stable IVF compared to their admission enteral study.The data suggest that loss of cardiovascular functional aerobic capacity as determined by maximal oxygen consumption occurs independently of nutritional status and reflects the relative immobilization of hospital confinement. Moreover, 1 hour of bicycle exercise at 40–50 % of admission VO2 Max during IVF diminishes, but does not totally inhibit, the hospital‐acquired loss of aerobic functional capacity.
DNA analysis and parathyroid pathology
Authors: Shenton Brian K. , Ellis Huw , Johnston Ivan D. A. , Farndon John R. 
Published: May 2005

AbstractThe nuclear DNA content of 85 parathyroid glands (4 carcinomas, 39 adenomas, 21 secondary parathyroid hyperplasias, and 21 normal parathyroid glands) were determined by flow cytometric analysis. All normal parathyroid glands, 85% of the adenomas, and 83.3% of the secondary hyperplastic glands had DNA indices within values of 0.85–1.1. Paraffinembedded fixed glands showed less DNA staining than that found with fresh or normal glands. Glands from patients with carcinoma showed DNA indices outside the normal DNA index range. When the percent of nuclei within the G0/G1 phase of the cell cycle was compared between the study groups, highly significant results were found. While patients with secondary hyperplasia showed a similar distribution to the normal glands studied, only 48% of primary adenomas showed over 80% of cells within the G0/G1 region. A clear subgroup of adenomas was defined with more rapidly cycling tetraploid cells, and showing classical adenoma pathology. This group showed negative correlation with gland weight, plasma calcium, and ionized calcium. These findings suggested that a different etiology of the disease process occurs between secondary hyperplasia and parathyroid adenoma. Such abnormal adenomas may form a group worthy of long‐term follow‐up.
Results of reoperations for persistent or recurrent secondary hyperparathyroidism in hemodialysis patients
Authors: Henry Jean‐Francois R. , Denizot Anne , Audiffret Jean , France Georges 
Published: May 2005

AbstractAmong 258 patients operated on for secondary hyperparathyroidism (HPT II) from 1971 to 1988, a total of 33 had one or more reoperations for persistent or recurrent HPT II. These reoperations did not induce any mortality or significant morbidity.After inadequate parathyroidectomy (25 cases), 15 patients were reoperated. Twelve of these had undergone initial surgery at another institution. Three patients died of causes unrelated to their HPT II. The other 12 patients are disease‐free.After successful subtotal parathyroidectomy (79 cases), 2 patients (2.5%) had a recurrence 5 and 6 years later, respectively. Currently, the 2 patients remain disease‐free.After total parathyroidectomy with autotransplantation (152 cases), 16 patients (10.5%) had reoperations on the grafts. The mean time before reoperation was 2 1/2 years. Hypertrophy of grafted fragments was observed in 4 cases (2.6%), but only 2 of these 4 patients were cured by removal of the grafts. Residual parathyroid tissue or a supernumerary gland in the neck or the mediastinum was suspected in 5 patients, but this could not be confirmed because one had already been reoperated on in the neck without success, another still refuses reoperation, and 3 died. In 6 other patients, the recurrence was debatable and HPT II was not confirmed.In the last 3 patients, the diagnosis was incorrect and aluminium intoxication was proved later.Results of reoperations for persistent or recurrent HPT II depend, first, on a correct diagnosis. After Successful subtotal parathyroidectomy, reoperations are rare and simple. After total parathyroidectomy and transplantation, it must be kept in mind that recurrences can occur on the grafts and/or on residual tissue in the neck or mediastinum.
Hypoglycemia induced by excessive rebound secretion of insulin after removal of pheochromocytoma
Authors: Akiba Masako , Kodama Takaya , Ito Yukio , Obara Takao , Fujimoto Yoshihide 
Published: May 2005

AbstractDuring an 8‐year‐period from 1981 to 1989, a total of 6 of 45 patients with pheochromocytoma developed severe hypoglycemia (plasma glucose, 12–50 mg/dl) 2–4 1/2 hours after removal of the tumor. In order to elucidate the pathogenesis of the hypoglycemic attack, the levels of plasma immunoreactive insulin (IRI) and glucose were sequentially measured at surgery in 10 patients with pheochromocytoma, from the beginning of the operation until usually 5 hours after tumor resection. The same examinations were carried out in 4 patients with primary aldosteronism and 1 patient with Cushing's syndrome as controls. The highest plasma IRI levels observed in the 2 patients with postexcisional hypoglycemia were 174 and 2,081μU/ml and those in the 8 patients without hypoglycemia were 13–222μU/ml (mean, 77), but they were only 14–33μU/ml (mean, 22) in the 5 control patients. The mean of the highest plasma IRI/glucose ratios in the immediate postoperative phase was 1.37±0.87 in the 10 patients with pheochromocytoma but only 0.16±0.04 in the 5 control patients (p<0.01). Review of the clinical data in our series disclosed that patients with higher levels of preoperative urinary epinephrine excretion and those with either diabetes mellitus or impaired glucose tolerance tended to develop postoperative hypoglycemia. These observations suggest that endogeneous insulin secretion is suppressed by increased plasma catecholamines, and that excessive rebound secretion of insulin after removal of a pheochromocytoma is a rather common phenomenon. Intravenous infusion of glucose is necessary and plasma glucose levels should be monitored after resection of a pheochromocytoma.
Long‐term evaluation following resection of apparently benign pheochromocytoma(s)/paraganglioma(s)
Authors: van Heerden Jonathan A. , Roland Christopher F. , Carney J. Aidan , Sheps Sheldon G. , Grant Clive S. 
Published: May 2005

AbstractIn the absence of distant disease, the pathologic diagnosis of malignancy in pheochromocytoma or paraganglioma is impossible. In an effort to establish the true incidence of recurrence in this disease, we have analyzed long‐term follow‐up (average, 15.8 years) of 98 patients who underwent complete resection of localized, noninvasive, histologically‐benign pheochromocytomas and paragangliomas at our institution between 1960 and 1976.Eighty‐eight patients had nonfamilial, sporadic pheochromoctyoma/ paraganglioma. Nine had multiple endocrine neoplasia (MEN) type 2 (2A: 7, 2B: 2), and 1 had familial pheochromocytoma. Seventy‐nine patients had single pheochromocytomas; 10 had single extraadrenal tumors (paragangliomas); and 9 had multicentric or bilateral adrenal tumors.Six patients (6.5%) developed recurrent pheochromocytoma after documentation of normal postoperative urinary catecholamine levels. One of these patients had MEN 2A. The recurrences developed at intervals from 5 to 13 years following initial resection. These were distant in 3 patients, local in 2, and both local and distant in a single patient. None of the recurrences occurred in the 13 patients who, on pathologic rereview, had either local or vascular invasion. No paraganglioma recurred.Life‐long follow‐up of all patients who have had pheochromocytomas or paragangliomas resected is mandatory.
Undescended parathyroid adenoma: An important etiology for failed operations for primary hyperparathyroidism
Authors: Fraker Douglas L. , Doppman John L. , Shawker Thomas H. , Marx Stephen J. , Spiegel Allen M. , Norton Jeffrey A. 
Published: May 2005

AbstractFrom July, 1982 to April, 1989, a total of 145 patients with persistent or recurrent primary hyperparathyroidism (HPT) were explored; 105 patients had an adenoma as the cause of HPT, and in 9 patients (9%), the abnormal gland was located at or superior to the carotid bifurcation (undescended parathyroid gland). These 9 patients had 14 prior explorations for HPT including 4 median sternotomies and 5 thyroidectomies.Each of the 9 patients was symptomatic of HPT, including bone disease in 8 of 9 patients and renal stones in 4 of 9 patients. Seven patients had an undescended parathyroid adenoma correctly localized preoperatively by ultrasound (n=5), angiography (n=5), venous sampling (n=1), or computed tomography scan (n=4). These 7 patients with accurate preoperative localization were explored by an incision anterior to the sternocleidomastoid muscle high in the neck that avoided the previous operative field and allowed rapid resection of the parathyroid adenoma. In the 2 patients who did not have accurate preoperative localization, the undescended adenoma was found after long tedious exploration including median sternotomy in 1 patient. Each patient (n=9) who had an undescended parathyroid adenoma removed was cured of hypercalcemia, and 5 patients required postoperative 1,25‐dihydroxy vitamin D3 for hypocalcemia.We conclude that undescended parathyroid adenomas comprise a significant proportion (9%) of adenomas during reoperations for persistent HPT. The majority of these glands (78%) can be accurately imaged preoperatively and, when imaged, can be easily resected by a rapid, direct, surgical approach.
Stricture and perforation of the esophagus: Overlooked threats in the Zollinger‐Ellison syndrome
Authors: Bondeson Anne‐Greth , Bondeson Lennart , Thompson Norman W. 
Published: May 2005

AbstractThis study was undertaken to assess the frequency of significant esophageal involvement in the Zollinger‐Ellison syndrome (ZES). In a consecutive series of 24 patients with this disease, 9 (37%) showed endoscopic evidence of acid‐induced esophageal lesions ranging from erosive inflammation to ulceration with massive bleeding, severe stricture formation, and perforation. In 3 cases, pronounced esophagitis was known 1–5 years before the underlying disease was diagnosed. Severe esophageal complications developed despite treatment with antisecretory drugs. It is emphasized that the best way to limit such complications is by excision of the underlying gastrin‐secreting tumor(s) when possible.
Surgical treatment of mid‐gut carcinoid tumors
Authors: Makridis Charlie , Öberg Kjell , Juhlin Claes , Rastad Jonas , Johansson Henry , Lörelius Lars Erik , Åkerström Göran 
Published: May 2005

AbstractCoincident with medical antitumor treatment of 138 patients suffering from mid‐gut carcinoid tumors, 51 patients were subjected to surgery with the principal aims of removing primary tumors and debulking mesenteric or liver metastases. Sixteen patients had previously been operated with intestinal resection or, when the tumors had been considered inexcisable, with intestinal bypass or laparotomy alone. Apart from exhibiting symptoms related to the carcinoid syndrome, the majority (approximately 60%) of the 51 patients had generally intermittent, subileus‐like abdominal pain and weight loss. In 18 patients, these symptoms were pronounced and associated with intestinal obstruction or severe malnutrition. Computed tomography and arteriography efficiently demonstrated mesenteric and liver metastases. At laparotomy, the primary intestinal tumors were small, mainly less than 1 cm in diameter, and they were multiple in 39% of the patients. Mesenteric metastases measuring up to 12 cm in diameter were present in 86% of the patients. These metastases were frequently associated with a pronounced mesenteric and retroperitoneal fibrosis causing fixation, angulation, and obstruction of the bowel as well as incipient intestinal gangrene in 8 patients. In all but 6 patients, the primary tumors could be removed by comparatively limited intestinal resections although bulky mesenteric metastases were often dissected from the mesenteric vessels. Liver metastases, found in 49% of the patients, were generally bilateral and multiple, and major hepatic metastases were resected in 6 patients. The results support a role for surgery also in the more compromised patients with mid‐gut carcinoid tumors and that such intervention may be associated with considerable symptomatic relief and substantial periods of survival.
Monoclonal antibodies raised against mid‐gut carcinoid tumor cells
Authors: Juhlin Claes , Papanicolaou Vasilis , Backlin Karin , Klareskog Lars , Wilander Erik , Åkerström Göran , Öberg Kjell , Rastad Jonas 
Published: May 2005

AbstractThree monoclonal IgG 2a antibodies were produced after immunization of mice with dispersed cells from a human mid‐gut carcinoid tumor. Acetone‐fixed cryosections of 57 primary and metastatic mid‐gut carcinoid tumors as well as 2 hind‐gut (rectal) carcinoids showed a conspicuous immunoreaction while a thymic carcinoid was essentially unstained with the antibodies. The 3 antibodies yielded a similar pattern of immunostaining. The immunoreaction comprised more than 95% of the carcinoid tumor cells, and it was more uniform and intense in primary tumors than in mesenteric, hepatic, and ovarian metastases of the mid‐gut carcinoid tumors. Immunofluorescence studies on suspended carcinoid tumor cells showed that the antibodies bound to the surface membrane of the cells. The antibodies immunostained enterocytes of the small and large bowel, intestinal metaplasia of the stomach mucosa as well as colorectal adenocarcinomas. Endocrine pancreatic tumors producing vasoactive intestinal polypeptide, gastrin, somatostatin, and/or pancreatic polypeptide as well as the epithelium of pancreatic ducts were also stained with the antibodies, whereas a large number of other normal and abnormal human tissues, including benign and malignant insulinomas, were unreactive. The findings indicate that the antibodies recognize differentiation antigens on the carcinoid tumor cell surface preserved also on endocrine and nonendocrine cells of the normal bowel mucosa. The restricted tissue reactivity of the antibodies suggests that they may constitute useful tools in the histological characterization of carcinoid tumors. Further studies may reveal if they are applicable for immunolocalization and perhaps even immunotherapy of these neoplasms.
Surgery for benign insulinoma: An international review
Authors: Rothmund Matthias , Angelini Lucio , Brunt L. Michael , Farndon John R. , Geelhoed Glenn , Grama Dimitrie , Herfarth Christian , Kaplan Edwin L. , Largiader Felix , Morino Francesco , Peiper Hans‐Jürgen , Proye Charles , Röher Hans‐Dietrich , Rückert Klaus , Kümmerle Fritz , Thompson Norman W. , van Heerden Jon A. 
Published: May 2005

AbstractIn a multiinstitutional review, data on 396 patients with benign solitary or multiple insulinomas operated on in 15 centers were collected. In these 396 patients, 419 laparotomies (375 primary procedures and 44 reoperations) were performed. The rate of unnecessary laparotomies was 1.7%. Complications occurred after 132 operations (31.5%), requiring 27 reinterventions (6.4%). Ten (2%) patients died within 30 days of surgery. The success rate of first procedures in the centers was 94.9%. After reoperation, all but 2 (99.5%) of these patients were cured. The overall cure rate including those patients who had their primary operations elsewhere was 97.5%.
Scan‐directed unilateral cervical exploration for parathyroid adenoma: A legitimate approach?
Authors: Russell Colin F. J. , Laird James D. , Ferguson W. Rodney 
Published: May 2005

AbstractThallium‐Technetium isotope subtraction scanning was used routinely as a preoperative localization investigation in 90 patients with primary hyperparathyroidism who were submitted to “first‐time” cervical exploration from 1985 to 1988. When the scintigram demonstrated a single focus of activity suggesting the site of a solitary parathyroid adenoma, a scan‐directed exploration was carried out. If the tumor was found at the location suggested by the scan, it was then removed and the ipsilateral normal parathyroid was biopsied. The contralateral side of the neck was not explored in these patients. A total of 48 patients underwent unilateral cervical exploration while the remaining 42 individuals had a standard bilateral neck operation performed.The difference in operating times for patients who had a solitary adenoma and who underwent unilateral and bilateral neck exploration, respectively, was statistically highly significant (71 minutes versus 97 minutes,p<0.001).At mean follow‐up of 16.8 months, no patient who had a unilateral neck exploration performed for solitary parathyroid adenoma demonstrated persistent or recurrent hypercalcemia.
Epidermal growth factor receptors and adenylate cyclase activity in human thyroid tissues
Authors: Duh Quan‐Yang , Siperstein Allan E. , Miller Rebecca A. , Sancho Joan J. , Demeure Michael J. , Clark Orlo H. 
Published: May 2005

AbstractThyroid stimulating hormone (TSH) and epidermal growth factor (EGF) are growth factors for some thyroid cells in cultures. We have previously found more EGF receptors in neoplastic human thyroid tissues than in normal thyroid tissues. We have also found a higher TSH‐stimulated adenylate cyclase (AC) activity in neoplastic human thyroid tissues than in normal thyroid tissues. To clarify the relationship between the effect of EGF and TSH on thyroid tissue, we measured the binding of EGF and TSH and the basal, TSH‐stimulated and forskolin‐stimulated adenylate cyclase activity in 49 normal, hyperplastic and neoplastic human thyroid tissues (5 normal, 2 Hashimoto thyroiditis, 5 Graves' disease, 14 multinodular goiters, 9 follicular adenomas, S follicular carcinomas, 8 papillary carcinomas, and 1 undifferentiated carcinoma). Specific binding of EGF and TSH were measured by radioreceptor assays using competitive inhibition of radio‐labeled ligand by unlabeled ligand. Basal, maximally (300 mU/ml) TSH‐stimulated, and maximally (100 mM) forskolin‐stimulated adenylate cyclase activities were also measured in the same membrane particulate fractions from the thyroid tissues. We found: neoplastic thyroid tissues bind more labeled EGF than nonneoplastic thyroid tissues; follicular adenomas and carcinomas have higher EGF binding than other thyroid tissues; a weak but significant correlation between specific EGF binding and specific TSH binding, and between specific EGF binding and TSH‐stimulated adenylate cyclase activity of the thyroid membrane preparations. These findings are consistent with the hypothesis that TSH stimulates an increase in thyroid EGF receptors by increasing intracellular cAMP. The higher binding of EGF and the higher TSH‐stimulated AC activity may explain why thyroid neoplasms grow to a larger size than normal thyroid tissues.