bluuebunny/crossref_metadata_2025_split huggingface dataset:
Endoscopic intervention for enteral access
Authors: Stellato Thomas A. 
Published: August 2005

AbstractContrary to total parenteral nutrition with its relatively recent introduction into modern clinical medicine, enteral nutrition has a long and colorful history. Prior to development of fiberoptic endoscopy, physicians attempting to feed patients who could not or would not eat were limited to the blind placement of intestinal tubes or radiologically assisted placement of these devices. Previous to these modern attempts, the use of nutrient enemas was attempted for which there was evidence of occasional success. With the introduction of fiberoptic flexible endoscopy, guidance of tubes into the upper intestinal tract under direct vision became feasible. The manner in which tubes were positioned, advanced, or manipulated are myriad and attest to the ingenuity of clinicians. A revolution in endoscopic intervention occurred with the introduction of the percutaneous endoscopic gastrostomy in 1980. This provided secure access to the stomach without a laparotomy. This technique was also modified to allow decompression of the stomach with feeding distally into the small intestine and also direct puncture and placement of tubes into the small intestine. The most recent advance in enteral nutrition is taking place at the present time with the introduction of laparoscopic techniques in the creation of gastrostomies and jejunostomies.
Therapeutic colonoscopy
Authors: Forde Kenneth A. 
Published: August 2005

AbstractTherapeutic colonoscopy has replaced or lessened to a significant degree the need or extent of traditional open surgical procedures. The common uses of therapeutic colonoscopy are hemostasis, resection and ablation of benign and malignant disease, decompression and recanalization of obstructed or dilated bowel, as well as foreign body extraction. Bleeding from arteriovenous and other vascular abnormalities can be controlled with 40% to 80% success rates using endoscopically delivered, monopolar, bipolar, or laser coagulation. The palliation of bleeding recurrent or inoperable colorectal cancer is achieved in up to 90% of patients. Virtually all pedunculated adenomas and most sessile adenomas are regularly removed colonoscopically, while large and recurrent villous adenomas in high risk individuals can be successfully managed by endoscopically delivered laser ablation techniques. Emergency colonoscopic reduction of sigmoid volvulus is performed pre‐operatively and decompression of the dilated colon of non‐obstructive colonic ileus is now regularly achieved. Colonic strictures have been dilated with a variety of techniques ranging from divulsion with through‐the‐scope balloon dilators to laser recanalization. Pre‐operative endoscopic laser relief of tumor obstruction is employed to avoid preliminary or decompressing colostomy. Endoscopic laser debulking and recanalization of recurrent or inoperable cancer has been achieved with up to 80% success and various foreign bodies may be extracted from the colon with a number of endoscopic techniques. The morbidity of therapeutic colonoscopy has ranged from 1% to 2% for polypectomy to 11% for laser palliation of bleeding from advanced cancer, often with obstruction.
Endoscopic therapy for biliary obstruction
Authors: Soehendra Nib , Binmoeller Kenneth F. , Grimm Horst 
Published: August 2005

AbstractEndoscopic management of biliary obstruction is feasible in most patients and has emerged as standard treatment. Aside from the removal of bile duct stones, placement of a biliary stent is the most commonly employed modality of management. In experienced hands, this is successful in over 90% of patients. Lower procedure‐related complications and the relative non‐invasive nature of endoscopic treatment has relegated surgical manement to a subsidiary role. Hospitalization time rarely exceeds 1–2 days. In most patients with advanced malignant disease and short life expectancy, stenting affords effective palliation. For the majority of patients endoscopic management is preferable to the percutaneous transphepatic approach due to lower overall mortality and morbidity. Stent occlusion necessitating replacement remains a problem, but improvements in this area can be expected. New plastic stent designs are undergoing investigation. Expandable metallic stents are promising but controlled comparative trials with conventional plastic prostheses are needed. Use of expandable stents should be judicious since these cannot be removed. In the future we can look forward to advances in peroral cholangioscopic technology which may permit targeted treatment of intraductal biliary malignancies.
Gastrointestinal motility of patients with Roux‐en‐Y reconstruction
Authors: Coelho Julio C. U. , Clemente Luiz , Matias Jorge E. F. , Campos Antonio C. L. , Wiederkehr Julio C. 
Published: August 2005

AbstractThe electromyographic activity of the gastrointestinal tract was studied in 28 patients undergoing gastric, biliary, and pancreatic operations with reconstruction of the gastrointestinal tract with a Roux‐en‐Y limb. The Roux‐en‐Y limb was constructed 1 to 5 years before the study in 8 patients (chronic Roux‐en‐Y) and at the operation in which the electrodes were implanted in 20 patients (recent Roux‐en‐Y). All four phases of the migrating motor complex (MMC) were identified in the gastrointestinal tract, including in the Roux‐en‐Y limb. The duration of the MMC was 82.4 ± 22.3 min in the patients with chronic Roux‐en‐Y and 89.0 ± 25.1 min in the patients with recent Roux‐en‐Y. Food ingestion converted the MMC to the fed pattern in the entire gastrointestinal tract, including the Roux‐en‐Y limb in 16 (76.2%) of 21 recordings of the patients with chronic Roux‐en‐Y and in 27 (84.4%) of 32 recordings of the patients with recent Roux‐en‐Y. The duration of the fed pattern was 170 ± 34 min in the patients with chronic Roux‐en‐Y and 154 ± 26 min in the patients with recent Roux‐en‐Y. The findings of this study indicate that the electromyographic activity of the Roux‐en‐Y limb is normal during both fasting and fed states, even many years after the construction of the Roux‐en‐Y.
Optimization of isolated hyperthermic limb perfusion
Authors: Omlor G. , Gross G. , Ecker K. W. , Burger I. , Feifel G. 
Published: August 2005

AbstractDuring isolated limb perfusion, we studied the impact of limb temperature on the concentration of cytostatic drugs in the tissue to identify a possible selective absorption of cytostatic agents by the various tissues. Ten consecutive patients with malignant melanoma were randomly divided into two different groups and perfused with 1 mg cisplatin per kg body weight. In one group the cytostatic agents were injected under hyperthermic conditions (39.5°C) and in the other group under normothermic conditions (37°C). The platinum concentration in the melanoma was twice as high in the hyperthermic group as in the group under normothermic conditions. In the tumor‐free tissue the platinum concentration decreased with temperature while it remained constant in the musculature. This selective concentration of cisplatin in the tumor under hyperthermic conditions is accompanied by fewer side effects. Follow‐up will show whether the oncological results will be improved in the hyperthermic conditions as one might expect.
Prostacyclin release from the human saphenous vein in diabetics is lower than in nondiabetics
Authors: Brunkwall Jan S. , Bergqvist David 
Published: August 2005

AbstractThe balance between prostacyclin and thromboxane has been suggested to be of great importance for the maintenance of patency in veins. In order to investigate prostacyclin and thromboxane release, segments from the human saphenous veins were investigated in 53 patients. Twenty‐seven patients (10 males, 17 females) underwent surgery for varicose veins. Twenty‐six patients (14 nondiabetics, 12 diabetics) underwent surgery for lower limb ischemia (rest pain or gangrene) with use of the saphenous vein as arterial conduit. Vein segments were gently excised and perfusedex vivo for five 15 minute periods, with a balanced salt solution and determination of the stable degradation products 6‐keto‐PGF1α and TxB2. Saphenous veins from patients with varicose veins had an initial prostacyclin release of 61 ± 13 pg/mm2/15 min declining to 4 ± 1 pg/mm2/15 min after 60 min (p<0.001) and increasing after addition to arachidonic acid to 37 ± 7 pg/mm2/15 min (p<0.001). Segments from nondiabetic patients with lower limb ischemia did not differ from those of varicectomy patients, but diabetic segments had a significantly lower prostacyclin release than both these groups, 34 ± 11 pg/mm2/15 min, 1 ± 1 pg/mm2/15 min, and 7 ± 5 pg/mm2/15 min, respectively (p<0.05). The addition of arachidonic acid failed to increase the prostacyclin release in diabetics. Three patients from each group were studied regarding thromboxane release and there was almost no detectable thromboxane in any group. These findings suggest that diabetics have a lowered prostacyclin release from the saphenous vein and that the deficiency is at the cyclo‐oxygenase level. The results could be of importance in thrombogenesis.
Mutational activation of RAS and GSP oncogenes in differentiated thyroid cancer and their biological implications
Authors: Goretzki Peter E. , Lyons John , Stacy‐Phipps Sandrina , Rosenau Werner , Demeure Michael , Clark Orlo H. , McCormick Frank , Röher Hans‐Dietrich , Bourne Henry R. 
Published: August 2005

AbstractActivating mutations of ras‐genes (Kirsten‐ras, Harvey‐ras, N‐ras) and genes encoding for the alpha subunit of G‐proteins (Gs, Gi2, Gi3, Go, Gz) were assessed in 32 differentiated thyroid cancer (DTC) tissues from German (n=22) and American (n=10) patients. Gs‐protein (GSP) and/or ras mutations were found in 69% of all tissues with a heterogeneous distribution pattern. An increased prevalence could be demonstrated in metastatic (8 of 9 mutation positive) when compared to localized disease (13 of 23 mutation positive) (p<0.001) and in patients >50 years of age (16 of 18 mutation positive), when compared to younger patients (6 of 14 mutation positive) (p<0.001). No activating mutations were found on H‐ras and K‐ras genes nor on genes encoding for the alpha subunits of Gi2, Gi3, Go, and Gz. Differentiated thyroid cancer tissue from German patients revealed a higher prevalence for GSP mutations (73%) than did DTC from American patients (20%) (p<0.001). We demonstrated a high frequency of ras and GSP mutations in DTC and suggest that these mutations may contribute to our basic understanding of this disease and might initiate a new search for more rational and individualized therapeutic approaches in patients with DTC.
Pancreatic tumors in multiple endocrine neoplasia type 1: Clinical presentation and surgical treatment
Authors: Grama D. , Skogseid B. , Wilander E. , Eriksson B. , Mårtensson H. , Cedermark B. , Ahrén B. , Kristofferson A. , Öberg K. , Rastad J. , Åkerström G. 
Published: August 2005

AbstractAmong 33 patients with endocrine pancreatic tumors due to multiple endocrine neoplasia type 1 (MEN‐1), 19 (58%) patients had hypergastrinemia, 7 (21%) patients had hyperinsulinism, and 7 (21%) patients had clinically non‐functioning lesions. At least one gross tumor was found in all patients undergoing pancreatic surgery, including those with negative localization studies prior to operation. The patients also had additional macroscopic tumors as well as numerous microadenomas, and the lesions frequently were positive for immunostaining with multiple hormones, mainly pancreatic polypeptide, insulin, glucagon, and somatostatin. Duodenal endocrine lesions were found in 4 of 5 investigated patients and stained with gastrin and somatostatin antibodies. Distal, mainly subtotal pancreatic resection, was performed in 18 patients, eventually combined with caput tumor enucleation or duodenotomy, while a few patients underwent only tumor enucleation or a Whipple procedure. The long‐erm outcome of operation was most favorable in patients with hyperinsulinism; only 1 patient had clinical recurrence. Patients with hypergastrinemia experienced only transitory lowering of serum gastrin values after pancreatic surgery and 47% of them had or developed metastases. Such tumor spread was seen in 57% of the patients with non‐functioning lesions. Nine patients died from progressive tumor disease during follow‐up. Consistent with previous studies, we found that surgery is indicated in MEN‐1 patients with hyperinsulinism even if a lesion is not visualized by radiology. In addition, these indications should be extended to also include patients with only biochemical markers of disease, including elevations of gastrin, as these indicate the presence of gross tumors. This strategy should be applied especially in patients with aggressive family histories to possibly reduce the risk of malignant tumor progression.
Clinical course and thyroid stimulating hormone (TSH) receptor antibodies during surgical treatment of Graves' disease
Authors: Mori Yoko , Matoba Naoya , Miura Shunji , Sakai Nobumitsu , Taira Yukio 
Published: August 2005

AbstractThis study assessed the results of surgical treatment for Graves' disease in our hospital and examined the relationship between the values of thyroid stimulating hormone (TSH) receptor antibodies and postoperative thyroid function. From 1983 to 1988, subtotal thyroidectomy was performed in 313 patients with Graves' disease. The follow‐up rate was 89.1% (278 of 313 patients). Thirteen (4.2%) patients required methimazole postoperatively for hyperthyroidism and 23 (7.3%) patients required L‐thyroxine postoperatively for hypothyroidism. The relationship between the postoperative thyroid function and TSH receptor antibodies was examined.The pre‐operative thyrotropin binding inhibitory immunoglobulin (TBII) value had no relationship to postoperative thyroid function. Only in the patients who were hyperthyroid postoperatively did the TBII value remain elevated, but the value decreased gradually in patients who were not hyperthyroid postoperatively. In 43 of 94 patients whose pre‐operative TBII values were high, the postoperative TBII value normalized. The higher the preoperative TBII value, the longer time was required for it to normalize postoperatively. The postoperative thyroid stimulating antibody (TSAb) values were higher in patients who remained hyperthyroid than in the patients who were not hyperthyroid. In the patients who remained hyperthyroid postoperatively, there was a significant correlation between the postoperative TBII value and the TSAb value. In the patients who were hypothyroid postoperatively, the TSBAb values were negative.In patients undergoing surgical treatment of Graves' disease, the postoperative TBII and TSAb values were related to postoperative hyperthyroidism. The TSBAb value had no relationship to postoperative hypothyroidism.
Unilateral neck exploration for primary hyperparathyroidism: Analysis of a controversy using a mathematical model
Authors: Duh Quan‐Yang , Udén Per , Clark Orlo H. 
Published: August 2005

AbstractMost endocrine surgeons explore both sides of the neck and identify all parathyroid glands when operating on patients with primary hyperparathyroidism. Others, however, advocate the unilateral approach, i.e., if an adenoma and a normal gland are identified, the contralateral side is not explored. We analyzed the strategy of the unilateral approach using a mathematical model to determine the variables that influence the probability of missing a tumor on the unexplored side of the neck. Assuming the frequency of single adenoma is 80%, hyperplasia 14%, double adenomas 4%, triple adenomas 1%, and carcinoma 1%, and the probability of missing a tumor on the explored side is 5%, we found that: 1. Only 41% of the patients treated by the unilateral approach undergo unilateral exploration. This is increased to 62% when a localization study with a sensitivity of 80% is used pre‐operatively. 2. The probability of missing a tumor on the unexplored side of the neck parallels the prevalence of multiple adenomas. Half of the patients with triple adenomas and two‐thirds of the patients with double adenomas will have a missed tumor when treated by the unilateral approach. 3. Patients who undergo unilateral exploration have an additional 7% to 8% probability of missing a tumor that would have been found if bilateral exploration is performed. This risk is lowered to 2% by a pre‐operative localization study that is 80% sensitive. 4. A prospective study will require 684 patients, randomized to the unilateral or bilateral approach, to have an 80% statistical power (α=0.05, β=0.20) of detecting a difference between a 5% and a 10% risk of missing a tumor.
Urodynamics in patients with pheochromocytoma: A peri‐operative study of 10 cases
Authors: Carnaille B. M. , Rigot J. M. , Bailleul J. P. , Quievreux J. L. , Wemeau J. L. , Proye C. A. 
Published: August 2005

AbstractAlpha receptors have been demonstrated in the bladder neck, and urinary retention may be the presenting symptom in an occasional pheochromocytoma patient. This prompted us to definie the urodynamic profile in pheochromocytoma patients. Ten patients were studied. Except for 2 patients, all tumors secreted norepinephrine either alone (n=4) or mixed (n=4). Urodynamic studies (uroflowmetry, cystometry, profilometry, response to alpha‐adrenergic agents) were performed with Urodyn 5000 chain (DANTEC) connected to a water perfused Bohler's catheter. Profilometry was done according to the Brown and Wickham technique. Normal values were those of the International Continence Society. Alpha blocker test was done by intravenous injection of thymoxamine (0.5 mg/kg) and was considered as positive if urethral closure pressure (UCP) decrease was >30% after 10 minutes. Ten patients had a pre‐operative study, omitting alpha‐blocker test in 1 patient; 5 patients consented a postoperative study. Pre‐operatively we could demonstrate: 1) Increased UCP in 8 of 10 patients, regardless of the secretory pattern; 2) Response to alpha‐adrenolytic agents in 7 of 9 patients; and postoperatively: 3) Good correlation between a positive alpha‐blocker test and a decrease in urethral pressure in 3 of 5 patients. Urodynamics in pheochromocytoma patients show a typical alpha‐adrenergic pattern and may explain bladder dysfunction as a presenting symptom.
Adrenalectomy in primary aldosteronism: A long‐term follow‐up study in 52 patients
Authors: Favia Gennaro , Lumachi Franco , Scarpa Vincenza , D'Amico Davide F. 
Published: August 2005

AbstractFrom 1975 to 1989, 52 patients with primary adolsteronism underwent adrenalectomy. There were 16 men and 36 women. The average age was 42.5 years, ranging from 28 years to 70 years. They were all hypertensive, with average pre‐operative diastolic pressures varying from 105 to 140 mm Hg (median 117 mm Hg). The subjective symptoms most frequently reported were headache (71%) and asthenia (53%). In all patients except two, serum potassium concentration was 3.3 mEq/L (median 2.7 mEq/L) at the time of diagnosis. Plasma aldosterone concentration was elevated in all patients, 48±5.3 ng/mL in the recumbent position and 52.6±6.0 ng/mL in the upright position. The operations carried out were 50 unilateral and 2 bilateral adrenalectomies. In 4 patients a transperitoneal approach was employed and in the remaining 48 patients an extraperitoneal flank incision was used. The histological findings were 47 adenomas (with dimension ranging from 1 to 4.5 cm), unilateral macronodular hyperplasia in 2 patients, an adenoma plus controlateral hyperplasia in 1 patient, bilateral hyperplasia in 1 patient, and unilateral hyperplasia in 1 patient. After long‐term follow‐up (median 77 months, range 13 to 189 months), 15 patients remained hypertensive (diastolic blood pressure up to 100 mm Hg). In 9 of these patients the hypertensive illness had been present for more than 5 years prior to operation. In the remaining 37 (71%) patients, the arterial pressure returned to normal and in almost half of the patients this result was evident one or two days after operation.
The role of epinephrine, norepinephrine, and dopamine in blood pressure disturbances in patients with pheochromocytoma
Authors: Ito Yukio , Fuimoto Yoshihide , Obara Takao 
Published: August 2005

AbstractFifty‐six patients with pheochromocytoma underwent surgery during the 9‐year period from 1981 to 1990. These patients were divided into two groups according to whether the dominant plasma concentration was of epinephrine or norepinephrine. Plasma levels of the catecholamines were stratified into three grades at 5 and 10 times the normal upper limit. Pre‐operative disturbances of blood pressure, sustained or paroxysmal, and normal blood pressure were highly correlated with the dominantly secreted catecholamine and its plasma concentration. Thirteen patients with high plasma norepinephrine levels (≥10 times normal) had sustained hypertension while 18 patients with moderate to high plasma epinephrine levels (≥5 times normal) had paroxysmal hypertension. In the majority of normotensive patients (12 of 14), plasma catecholamine levels were <10 times the upper normal limit. Urinary excretion of dopamine and size of the tumor were analyzed according to these patient groups. In the norepinephrine dominant group, urinary dopamine excretion tended to be proportional to the plasma epinephrine levels and when the patients were normotensive, urinary dopamine excretion decreased. In norepinephrine‐secreting patients, urinary dopamine tended to be inversely correlated with the plasma norepinephrine level; however dopamine did not prevent the hypertensive action of norepinephrine. Tumor size showed no correlation with the plasma levels of catecholamine in the moderate to high plasma catecholamine groups. We conclude that the plasma catecholamine type and its level are the most important factors in determining the patterns of blood pressure disturbances of patients with pheochromocytoma.
Surgery for hyperthyroidism: Hemithyroidectomy plus contralateral resection or bilateral resection? A prospective randomized study of postoperative complications and long‐term results
Authors: Andåker L. , Johansson K. , Smeds S. , Lennquist S. 
Published: August 2005

AbstractFifty consecutive patients undergoing surgical treatment for hyperthyroidism were randomized to have either bilateral subtotal resection (n=23) or hemithyroidectomy plus contralateral resection (n=27). No significant differences in operating time or intra‐operative bleeding were found. No postoperative bleeding and no temporary or persistent recurrent laryngeal nerve paralysis occurred. Four patients who underwent bilateral resection and 2 patients who had hemithyroidectomy resection needed temporary calcium supplementation, and the serum calcium concentrations were slightly lower during the first few postoperative days in the patient undergoing hemithyroidectomy/resection. No persistent hypocalcemia occurred in either of the groups. At follow‐up 3–4 years (mean 3.6 years) postoperatively, 1 patient in the bilateral resection group developed recurrent hyperthyroidism; no patients in the hemithyroidectomy/resection group developed recurrent hyperthyroidism. Twelve (44%) patients in the hemithyroidectomy/resection group and 8 (35%) patients in the bilateral resection group needed thyroxine supplementation because of a rise in thyroid stimulating hormone concentration combined with clinical signs of hypothyroidism that developed during follow‐up. Hyperthyroidism can be treated by hemithyroidectomy plus contralateral resection without increasing the risk of complications. The results also suggest that when using this method, a slightly larger thyroid remnant should be left to avoid an increase in the incidence of hypothyroidism postoperatively.