bluuebunny/crossref_metadata_2025_split huggingface dataset:
Recurrent adhesive small bowel obstruction
Authors: Jones Peter F. , Munro Alexander 
Published: May 2005

AbstractAdhesive obstruction of the small bowel complicates about 5% of laparotomies; of these, 5–10% have recurrent attacks. The etiology of adhesions is incompletely understood and attempts to prevent their formation are of unproven value. Patients with recurrent acute obstruction that threatens strangulation, or that fails to subside, require laparotomy. If numerous adhesions have to be divided, it is worth considering a procedure to encourage fresh adhesions to form in a favorable pattern. Suture plication of the bowel by Noble's technique has a high incidence of complications and recurrent obstruction, and transmesenteric plication cannot be used in the presence of sepsis. Splinting of the entire small bowel by intraoperative passage of a long tube, which is left indwelling for 2–3 weeks, appears to be effective and safe. We have used this method in 140 patients without associated complications; of these, 17 had recurrent intestinal obstruction after 1–5 previous laparotomies for adhesions. A meticulous adhesiolysis followed by transluminal splinting through a jejunostomy has been followed by freedom from recurrence during 103 patient‐years of follow‐up.
Small bowel fistulas
Authors: Sansoni Baldasarre , Irving Miles 
Published: May 2005

AbstractMost external small bowel fistulas follow surgical operation, but a few develop spontaneously. Seventy percent will close with conservative treatment including vigorous nutritional support and elimination of sepsis. Internal fistulas involving the small bowel always result from extension of disease in the bowel or in adjacent viscera, and they virtually never close spontaneously. Our 11‐year experience of 71 Crohn's fistulas confirms 2 types. Type 1 (n=49) results from spontaneous extension of active bowel disease, while type 2 (n=22) follows leakage of an anastomosis. The former virtually always requires surgical closure, which can usually be achieved without mortality and with minimal complications. Most type 2 fistulas will close with parenteral nutrition, but staged surgery with exteriorization of bowel ends may be required. Our 4 deaths were all among type 2 cases. High‐output fistulas with severe associated sepsis should be managed in specialized intestinal failure units. In just under 4 years, 51 patients with complicated intestinal fistulas have been treated in this department, with a 23.5% mortality rate.
The management of duodenal and other small intestinal trama
Authors: Donohue John H. , Crass Richard A. , Trunkey Donald D. 
Published: May 2005

AbstractOne hundred sixty‐three patients were treated for blunt and penetrating trauma of the duodenum and small bowel over a 41/2‐year period at a major trauma center. Blunt injuries, mostly a result of vehicular trauma, comprised 17% of the cases, while stabbing and firearm injuries made up the remainder. Laboratory data, including white blood cell count, amylase, and abdominal x‐rays, were unreliable in predicting the presence of intestinal injury. Although only obtained in a few patients following blunt injury, computerized tomography (CT scan) of the abdomen was sensitive to intraperitoneal findings suggestive of or diagnostic for gastrointestinal injury. Speedy operative management is of the utmost importance; 63% of these patients were operated on in less than 2 hours from the initiation of medical treatment. The majority of intestinal damage can be repaired by simple closure or resection. Because of anatomic and physiologic considerations, complex operative procedures are required for the correction of some duodenal lesions. Our treatment of these injuries included frequent utilization of pyloric exclusion, as well as occasional diverticulization of the duodenum and pancreaticoduodenectomy. Delay in treatment and the magnitude and number of associated injuries contributed to increased morbidity and mortality, which was much higher in blunt trauma (21% versus 4% for penetrating injuries), especially when the duodenum was involved (36% mortality). Complications were also more common in the patients following blunt trauma and with multiple injuries. Infectious complications were the most frequent, with postoperative ileus or obstruction, hemorrhage, and iatrogenic complications occurring less often. In the majority of small bowel injuries, the management is straightforward and consists of operative repair as soon as possible. A high index of suspicion and reliance on diagnostic aids, such as CT scan, will speed the diagnosis of occult blunt intestinal injuries. Sound surgical judgment and facility with a variety of repairs is needed in the treatment of complex duodenal injuries.
Enteric adenoma and adenocarcinoma
Authors: Cooper M. J. , Williamson R. C. N. 
Published: May 2005

AbstractThe small bowel comprises 75% of the length of the gastrointestinal tract but is a rare site of neoplasia. An unselected retrospective review of Bristol patients between 1969 and 1983 revealed only 25 small bowel carcinomas: an incidence of 1 per 450,000 of population per annum. Distribution was 10 duodenal, 6 jejunal, and 9 ileal carcinomas; 5 patients had other associated diseases. Twenty‐one of the 25 patients underwent a surgical resection, of whom 17 survived (operative mortality 19%). Survival was 60% at 1 year and 40% at 2 years; no patient has survived 5 years although 3 remain alive and well.A further 5 patients were found to have benign adenomas in the absence of malignancy: 3 duodenal and 2 jejunal. Duodenal lesions were treated endoscopically while the jejunal adenomas were removed by enterotomy. There were no complications of treatment.
Fine‐needle biopsy of the pancreas: Results of 204 routinely performed biopsies in 190 patients
Authors: Søreide Odd , Skaarland Elsa , Pedersen Ole M. , Larssen Trond B. , Arnesjø Bo 
Published: May 2005

AbstractTwo‐hundred and four fine‐needle aspiration biopsies of the pancreas have been performed in 190 patients during a 12‐year period. Sixty‐one of these were performed percutaneously guided by endoscopic retrograde cholangio‐pancreatography, percutaneous transhepatic cholangiography, angiography, or ultrasonography; and 143 were taken intraoperatively. In 77 (67%) out of 115 patients with pancreatic cancer, a correct cytological diagnosis was obtained. Two biopsies were reported as malignant in 1 patient who ultimately was found to have chronic pancreatitis (false positives). The frequency of “not representative” biopsies varied from 20.8% in patients with suspected cancer biopsied intraoperatively to 48.4% in patients biopsied preoperatively. A correct cytological diagnosis of malignancy was obtained preoperatively in 54.6% of patients with cancer, in 60.0% of patients evaluated without later operation, and in 71.1% of patients biopsied during laparotomy for suspected pancreatic cancer. The overall false‐negative rate was 9.8%. The predictive value of a positive test was almost 100%, whereas the predictive value of a negative test was only 69.6% (total material). Analyses may indicate that a more aggressive approach with multiple punctures may lower the not representative biopsy rate and increase the diagnostic accuracy in patients with pancreatic cancer.
Long‐term surgical results of carcinoma of the gastric remnant: A statistical analysis of 613 patients from 98 institutions
Authors: Kidokoro Tsutomu , Hayashida Yaso , Urabe Motomichi 
Published: May 2005

AbstractBased on a survey questionnaire sent to the 98 member institutions of the Japanese Research Society for Gastric Cancer, 613 cases of cancer of the gastric remnant, after resection for a variety of benign and malignant conditions, were collected and reviewed. This study includes both recurrences and newly developed cancers, although only cases with an accurate diagnosis and careful follow‐up were selected. An analysis of the time intervals between initial gastrectomy for cancer and second operation suggests that recurrences usually occur within 10 years of the first procedure, while those cancers developing after 10 years are likely to represent new lesions. The cumulative 5‐year survival rates of 48.7% after subtotal and 28.9% after resection for carcinoma of the gastric remnant are no worse than those for cancer resections in the stomach previously untreated surgically. An active approach based on early detection and aggressive surgical therapy of these lesions is recommended.
Results of surgical treatment of necrotizing pancreatitis
Authors: Beger Hans G. , Krautzberger Wolfgang , Bittner Reinhard , Block Sylvia , Büchler Markus 
Published: May 2005

AbstractIn 205 patients with necrotizing pancreatitis, surgery was carried out following failure of medical treatment. Intraoperatively, according to the size of the necrotic area and the weight of the surgically removed necrotic tissue, 79 patients showed a limited pancreatic necrosis, and 126 patients an extended necrotizing process. In 40.4% of 138 patients with bacteriological reports, a bacterial contamination of the pancreatic necrosis was found. The main objective of surgical management was the removal of the necrotic tissue. This was performed with 2‐way drainage and postoperative continuous peritoneal and/or local lavage, in a smaller group of patients with inner drainage of the necrosis cavity, and in a few patients with drainage alone. The overall hospital mortality rate was 24.4%. The lowest mortality was achieved in patients treated with necrosectomy and postoperative continuous local lavage (6.0%). In patients with necrosis of approximately 30% of the pancreas, mortality was lower (7.6%) than in patients with a 50% necrosis (24.0%) or in patients with a subtotal/total necrosis (51.0%) (p<0.0001). Formation of extrapancreatic necrosis resulted in a significantly increased mortality rate (p<0.02). In patients with bacterially contaminated necrosis, a mortality rate of 32.1% was found, whereas in patients with a sterile necrosis, mortality was down to 9.8% (p<0.01). Based on the results of this study, we conclude that the clinical course of necrotizing pancreatitis depends essentially on the extent of the necrosis in the pancreas itself, the development of extrapancreatic necrosis, and the bacteriological status of the necrotic area. Adequate surgical management leads to a considerably increased survival rate of patients with necrotizing pancreatitis.
Histochemical demonstration of thyroxine, triiodothyronine, and thyroglobulin in the primary lesion of thyroid carcinoma, and its predictability for radioiodine uptake by metastatic lesions
Authors: Kodama Takaya , Fujimoto Yoshihide , Obara Takao , Ito Yukio , Kusakabe Kiyoko , Hirayama Akira 
Published: May 2005

AbstractAlthough a total thyroidectomy followed by131I therapy is widely adopted for hematogenous metastatic lesions of thyroid carcinoma, they do not always take up enough131I for treatment. This work was undertaken to elucidate the predictive value of histochemical demonstration of thyroid hormones in the primary lesion for131I uptake by the metastatic lesions. A total of 27 patients with thyroid carcinoma underwent the above treatment during a 19‐year period (1966–1984). Metastases in either the lung, the bone, or both were found in 12, 9, and 6 patients, respectively. Five patients died of thyroid cancer 2, 4, 10, 10, and 20 years after the initial surgery. Five patients demonstrated negative131I uptake in the lung metastases, but one of them had simultaneous bone metastasis, which was positive for131I uptake. Sectioned specimens were stained by the peroxidase antiperoxidase method for thyroxine, triiodothyronine, and thyroglobulin, the presence of which was demonstrated in 15, 9, and 26 cases, respectively. All of the thyroxine‐ or triiodothyronine‐positive patients showed the ability to take up131I.131I uptake was not shown in 4 of 12 thyroxine‐negative or in 4 of 18 triiodothyronine‐negative cases. From these results, it may be concluded that131I uptake by metastatic lesions is predictable when thyroxine or triiodothyronine is demonstrated immunohistochemically in the primary lesion. In the absence of thyroxine or triiodothyronine, however, no prediction can be made.
The use of intercavernous sinuses phlebography in the diagnosis of ACTH‐secreting microadenomas
Authors: Merola B. , Lombardi G. , Lupoli G. , De Chiara G. , Colao A. M. , Finelli L. , Marzano L. A. , Iaccarino V. , Zarrilli L. 
Published: May 2005

AbstractThe use of intercavernous sinus phlebography in the diagnosis of pituitary adenomas has enabled the collection of selective venous samplings of the inferior petrosal sinuses (IPS), where pituitary hormones can be measured before becoming excessively diluted in the systemic circulation. This approach has been particularly useful in patients affected by ACTH‐secreting microadenomas, whose diagnosis and preoperative localization can be very difficult. Five female patients, 30–53 years old, suffering from hyperadrenocorticism have been studied. The basal and dynamic hormonal assessment indicated an ACTH‐dependent hyperadrenocorticism, although the computed tomography of the sella turcica, performed in all the patients, was negative in 3 patients and doubtful in 2. The perihypophyseal phlebography showed a small left‐sided intrasellar expansive process in patient no. 1 and a right‐sided intrasellar mass in patients no. 2 and 3. The analysis of ACTH concentrations in the IPS and in the peripheral circulation showed the presence of a concentration gradient between the side of presumed adenoma and the contralateral side (2.7 times;p<0.01) and between the side of the presumed adenoma and the periphery (3.4 times;p<0.01). No significant difference was found between the ACTH concentration in the contralateral IPS and that of the periphery. Surgery confirmed the presumed diagnosis in all cases.
Studies on in vivo and in vitro release of intact parathyroid hormone using a new two‐site immunochemiluminometric assay
Authors: Aston J. Paul , Wheeler Malcolm H. , Brown Richard C. , Curley Ian R. , Woodhead J. Stuart 
Published: May 2005

AbstractBasal parathyroid hormone (PTH) levels measured by a chemiluminescent immunoassay for intact PTH showed good discrimination between normal, n=82 (1.2–9.4 pmol/l), and hyperparathyroid subjects, n=55 (9–200 pmol/l). In malignant hypercalcemia, all PTH levels were within the normal range or suppressed (0.8–5.2 pmol/l). Dynamic studies of PTH release in response to intramuscular salmon calcitonin (100 u) showed no significant rise out of the normal range in controls, but adenoma patients demonstrated a mean rise at 120, 180, and 240 minutes of 22%, 22%, and 35%, respectively, and hyperplasia patients a mean rise of 44%, 63%, and 46%, respectively. The mean absolute rise in PTH concentration was 10.6±7.2 pmol/g parathyroid adenoma and 26.6±19.2 pmol/g hyperplastic parathyroid tissue; this difference being significant (p <0.01). In vitro studies were performed in which dispersed cells prepared from both parathyroid adenomas and hyperplastic tissue were exposed to low (0.5 mM) and high (2.5 mM) extracellular calcium. Intact PTH secretion was measured under these conditions and compared with the results obtained by a mid‐region (44–68) specific immunoassay for PTH. There was parallel secretion of intact and mid‐region hormone under all conditions, the secretion rate of hyperplastic cells being greater than that of adenomas. Suppressibility of PTH release by high extracellular calcium was significantly greater in hyperplasia than in adenomas. These differences in the behavior of adenomatous and hyperplastic tissues both in vivo, in response to calcitonin, and in vitro, in response to changes in extracellular calcium concentration, suggest that the underlying pathogenesis of hyperparathyroidism may be heterogenous at the cellular level.
Duplex scan‐derived thyroid blood flow in euthyroid and hyperthyroid patients
Authors: Hodgson Kim J. , Lazarus John H. , Wheeler Malcolm H. , Woodcock John P. , Owen Glynn M. , McGregor Alan M. , Hall Reginald 
Published: May 2005

AbstractUsing a high‐resolution real‐time scanner to locate the superior thyroid artery (STA), the absolute blood flow has been measured with a pulsed Doppler flow meter. The diameter of the vessel and the angle of inclination of the ultrasound beam to the axis of the vessel were measured from the real‐time image and the blood flow then computed in the on‐board computer. Vessel diameter measurements were performed by the computer to 1/10 mm and all examinations were performed under identical conditions.In 24 randomly selected, clinically and biochemically euthyroid, preoperative, general surgical patients on no drugs (12 males, 12 females; age range, 18–65) the STA was located and blood flow measured in 46 arteries (96%). Mean blood flow was 18.3 ml/min ± 6.0 SD (range, 5.8–29.2). Bilateral measurements were made in 20 of 22 (5 males, 17 females; range 27–80 years) hyperthyroid patients. Mean blood volume flow was 73.0 ml/min±34.3 SD (range, 30–140), significantly higher (p < 0.01) than in the euthyroid group. No sex differences were seen. For euthyroid and thyrotoxic patients together, thyroid blood flow correlated with FT4 (r = 0.77,p <0.001), and, in the thyrotoxics, blood flow was significantly correlated with FT3 (r = 0.51,p <0.05), 4‐hr123I uptake (r =0.60,p <0.01), and 48‐hr123I uptake (r =0.63,p < 0.01), but not with FT4 (r = 0.40). The within artery coefficient of variation for volume flow was 17.4% for euthyroid subjects and 24.4% for hyperthyroid subjects. However, the mean comparable coefficient of variations for time‐averaged velocity were 9.2% and 13.8%, respectively.It is concluded that this noninvasive Duplex scanning method for measuring thyroid blood flow is accurate, reproducible, suitable for examining this parameter in relation to thyroid disease and drug effects, and may have a role to play in the management of patients with hyperthyroidism.
Flow cytometric DNA measurements in benign and malignant Hürthle cell tumors of the thyroid
Authors: Ryan John J. , Hay Ian D. , Grant Clive S. , Rainwater Leslie M. , Farrow George M. , Goellner John R. 
Published: May 2005

AbstractThe prediction of outcome in the rare Hürthle cell tumor of the thyroid continues to present a problem to surgeons and pathologists. To better clarify the distinctions between benign and malignant tumors, we have measured DNA content by flow cytometry on isolated cell nuclei derived from archival paraffin‐embedded tissue blocks of 125 Hürthle cell tumors operated from 1943 to 1985 at the Mayo Clinic, Rochester, Minnesota, U.S.A. Nuclear DNA ploidy patterns were divided into 3 groups. A DNA normal (diploid) pattern was found in 55% of 75 Hürthle cell adenomas and in 26% of 50 Hürthle cell cancers; a DNA tetraploid/polyploid pattern was found in 11% of benign, and 14% of malignant tumors. An abnormal DNA stemline was detected in 34% of benign and 60% of malignant tumors. Hürthle cell cancer was the histologic diagnosis in 24% of the DNA normal, 47% of the DNA tetraploid/polyploid, and 54% of the DNA aneuploid tumors. None of the patients with adenomas developed tumor recurrence. However, 20% of the euploid and 40% of the aneuploid tumors developed local or distant recurrences. Survival to thyroid cancer death was significantly correlated with DNA ploidy status (p=0.02) but did not correlate with either tumor size or histologic grade. To date, deaths from thyroid cancer have been confined to patients whose tumors were DNA aneuploid. We would conclude that determination of DNA ploidy status may not aid the surgical pathologist in the diagnosis of Hürthle cell cancer. However, when a patient's Hürthle cell cancer is DNA aneuploid, there is significant risk of death from thyroid cancer.
Benign Hürthle cell tumors of the thyroid: A diagnosis to be trusted?
Authors: Grant Clive S. , Barr Darlene , Goellner John R. , Hay Ian D. 
Published: May 2005

AbstractThe ability to differentiate benign from malignant Hürthle cell thyroid neoplasms has provoked considerable controversy. This has significant therapeutic implications, since some have advocated total thyroidectomy for all of these lesions. The principal objectives of this study were: (a) to determine whether the histologic diagnosis of Hürthle cell adenoma could be reliably made, (b) to quantitate the risk of inappropriately labelling a Hürthle cell cancer as an adenoma, and (c) to ascertain whether the type of operative procedure affected the clinical course.We reviewed 272 patients who had undergone thyroid resection for benign Hürthle cell neoplasms at the Mayo Clinic from 1960 to 1980. All pathologic sections were rereviewed. Postoperative follow‐up was available on 233 patients (86%), with a mean of 8.9 years. A minimum of 5 years of follow‐up was obtained on 10% of the patients. Nodules ranged in size from 0.3 to 11 cm; 195 (55%) were 2 cm or larger. Surgical resection was limited to one side in 137 (50%) patients and involved both sides in 135 patients. No total thyroidectomies were performed. Evidence of malignancy—a local recurrence—developed in only 1 patient, and she died of unrelated causes. None of the 272 patients died of thyroid cancer, and none showed evidence of metastases. Our data is in agreement with most published reports, with only 6 (0.9%) of 642 reported patients being diagnosed incorrectly. These tumors can be accurately separated into benign and malignant. Routine total thyroidectomy for Hürthle cell adenomas is not justified.
Improved differential diagnosis of hypercalcemia by hypocalcemic stimulation of parathyroid hormone secretion
Authors: Ljunghall Sverker , Benson Lars , Wide Leif , Åkerström Göran , Rastad Jonas 
Published: May 2005

AbstractIn vitro experiments have indicated that in primary hyperparathyroidism (HPT) the hyperfunctioning glands have a set point error, i.e., they are not autonomous but regulate serum calcium around a hypercalcémie value. In contrast, parathyroid function is suppressed in patients with hypercalcemia of causes other than HPT (e.g., malignancy or sarcoidosis). The basal measurements of serum parathyroid hormone (PTH) levels, however, cannot, alone, separate with precision HPT from other causes of hypercalcemia.Lowering of calcium, in order to stimulate secretion of PTH, was, therefore, achieved by either infusion of Na2 EDTA (24 mg/kg per hr) for 1 hour, or intramuscular injection of 100 IU salmon calcitonin.All 35 patients with primary HPT displayed a significant increase of serum PTH concentrations, evaluated by a midregion/intact hormone assay, during the EDTA infusion, which lowered plasma ionized calcium by an average of 0.16 mmol/l. The injection with calcitonin reduced the calcium concentrations by 0.10 mmol/l after 8 hours and caused a rise in PTH in 80% of HPT patients. With both tests, the secretory response by PTH to the reduction of plasma calcium was generally evident while the patients were still hypercalcemic.In 32 patients with other causes for hypercalcemia, primarily malignancy and sarcoidosis, similar reductions of plasma ionized calcium were obtained. In contrast to the HPT patients, none of them raised their serum PTH values during the test. Thus, stimulation of PTH secretion by a moderate reduction of serum calcium considerably improves the differential diagnosis of hypercalcemia since a significant secretory response appears to be exclusive for HPT.