bluuebunny/crossref_metadata_2025_split huggingface dataset:
Infection of hepatic cysts following kidney transplantation in polycystic disease
Authors: Bourgeois Nadine , Kinnaert Paul , Vereerstraeten Pierre , Schoutens André , Toussaint Charles 
Published: May 2005

AbstractInfection of hepatic cysts is not considered a classic complication of polycystic liver disease. In the rare cases reported in the literature, diagnosis was always made postmortem. We observed recurrent septicemic episodes due to infected hepatic cysts in a patient with hepatorenal polycystic disease (HRPD) who had been transplanted with a cadaver kidney. Aggressive surgical treatment, intensive antibiotherapy, and interruption of azathioprine treatment were required in order to cure the patient. With increased life expectancy of patients with HRPD because of hemodialysis and kidney transplantation, this complication is likely to occur more often in the future.
Prediction of healing time as an aid to the management of open granulating wounds
Authors: Marks Joseph , Hughes Leslie E. , Harding Keith G. , Campbell Hubert , Ribeiro C. Donald 
Published: May 2005

AbstractThe healing rates of 2 groups of patients were studied. Forty patients had laparotomy wounds that were left open to granulate because of overt or suspected infection, and 29 were from a series of pilonidal sinus excisions left unsutured as a matter of policy. The linear regressions of healing time against wound size were determined, the dimension chosen for wound size being either the breadth or depth, whichever was greater. From the results obtained, it was possible to calculate a “predicted” healing time for each wound corresponding to its size and to see how this differed from the observed time. The deviations found were used for statistical analysis relating to possible etiological factors; for example, the significance of infection as a cause of delayed healing.Prediction of the healing time for individual wounds allows the patient to be given information about the likely duration of wound healing. More importantly, it enables delay in wound healing to be recognized and investigated at an early stage and facilitates analysis of factors having a possible bearing on the process.
Intramuscular pressure changes during and after revascularization of the femoral arteries in humans
Authors: Christenson J. T. , Qvarfordt P. 
Published: May 2005

AbstractIntramuscular pressures in the anterior tibial compartments of the lower extremity were measured by the wick catheter technique in 5 patients undergoing revascularization of the femoral arteries by bifurcation grafting, because of occlusive arteriosclerotic disease. The intramuscular pressure at rest was within a normal range preoperatively (9.1±4.5 mm Hg), but rose significantly to a maximum level 4–6 hours after blood flow was reestablished (22.4±5.0 mm Hg), followed by a gradual decrease over 5 postoperative days, and reached the preoperative value on the 5th postoperative day (8.7±5.1 mm Hg). Changes in calf circumferences reflect the changes in intramuscular pressure. No significant changes in intramuscular pressures were seen when measured at different times during the day. Addition of thoracic epidural anesthesia did not affect the intramuscular pressures as compared to a combination of balanced anesthesia alone.During occlusion of the aorta (clamping), no changes in intramuscular pressures were seen, but the pressure rose significantly immediately after declamping. The intramuscular pressures in the anterior tibial compartment correspond well with the findings on metabolic events seen after declamping, suggesting an incomplete ischemia of the leg muscles with insufficient tissue perfusion.
Combined fluid and corticosteroid therapy in septic shock in puppies
Authors: Connors Robert H. , Coran Arnold G. , Drongowski Robert A. , Wesley John R. 
Published: May 2005

AbstractThe optimal treatment of septic shock remains controversial. In order to evaluate the efficacy of fluid resuscitation and corticosteroid administration, the following experimental study was undertaken. Forty‐five puppies (1.6–5.4 kg) were randomly divided into 9 groups generated by combining 3 different fluid regimens and 3 different timings for steroid administration. Arterial, venous, and pulmonary artery catheterization allowed continuous hemodynamic and metabolic monitoring. Septic shock was achieved by a slow bolus infusion of 109/kgEscherichia coli organisms. Methylprednisolone (30 mg/kg) was administered either 30 min before bacterial infusion, at the time of shock, or 30 min after shock. When cardiac output dropped to less than 50% of control values, 1 of the 3 following fluid resuscitation regimens was begun: 5% albumin in lactated Ringer's (LR) at 35% of the estimated blood volume (EBV), LR at 105% EBV, or 5% albumin in LR at 105% EBV.When all the groups were combined, early steroid treatment was more effective than delayed therapy, yielding respective survival rates of 47% and 7% at 180 min. Similarly, the large‐volume resuscitation groups achieved a 43% survival rate compared to 13% for the smaller fluid protocols. Neither early steroid therapy nor large volume fluid therapy was shown by itself to increase survival, however. Despite steroid pretreatment, none of the puppies given the lower‐volume infusion survived. Also, despite large‐volume fluid resuscitation, there were no survivors when this was combined with steroid treatment that was delayed 30 min. Only by combining early steroid administration with large‐volume fluid therapy was a markedly increased survival rate achieved: 60% with simultaneous steroid treatment, and 70% with steroid pretreatment.A definite increase in animal survival has, therefore, been shown in the acute period of severe septic shock using a combination of high‐volume fluid resuscitation and the early administration of steroids.
Metastasis to the funiculus spermaticus as the first sign of renal cell carcinoma
Authors: Marković Bogoljub , Oprić Miroslav , Prica Vladimir , Čolović Vidosav , Mandić Ratko , Jeremić Aleksandar 
Published: May 2005

AbstractA patient who had renal cell carcinoma metastatic to the funiculus spermaticus is reported. On the basis of the detailed physical, radiological, and laboratory examinations, it was concluded that the tumor in the funiculus spermaticus represented a metastasis of clear cell carcinoma of the left kidney. The patient also had adenoma of the prostate. Surgery was performed in 2 stages. In the first stage, pannephrectomy and ablation of tumor from the funiculus spermaticus were performed. In the second stage, adenomectomy by a retropubic approach was performed 6 months following the first intervention. Histological sections of the renal tumor and of the funiculus spermaticus tumor showed clear cell carcinoma (Carcinoma lucidocellulare), while sections of the prostatic tissue showed adenomyomatosis of the prostate.
Subcutaneous brachial vein arteriovenous fistula for chronic hemodialysis
Authors: Koontz Paul G. , Helling Thomas S. 
Published: May 2005

AbstractWhile the subcutaneous arteriovenous fistula is the ideal method for creating vascular access for chronic hemodialysis, it is not suitable for all patients. Other methods such as polytetrafluoroethylene grafts have proven satisfactory but have been fraught with problems in some cases. In these situations, we have employed the brachial vein arteriovenous fistula as a means of providing continuing vascular access.The brachial vein is dissected free from surrounding structures in the upper arm and anastomosed to the distal brachial artery in end‐to‐side fashion. The arterialized vein is then placed in the subcutaneous position for easy access.We have performed this procedure in 12 patients. All have had previous access problems. Follow‐up has extended from 1 to 34 months. There have been 3 failures and 7 complications. Nine patients have maintained patency of their fistulas through the follow‐up period, until transplanted, or until death.We feel that the brachial vein fistula is a reasonable alternative in patients who have encountered problems with standard wrist arteriovenous fistulas or with prosthetic grafts.
The management of severe hyperthyroidism
Authors: Mieny C. J. , Franz R. C. , Venter I. D. 
Published: May 2005

AbstractEither subtotal thyroidectomy or ablation of the gland with131I will lead to a permanent cure of hyperthyroidism. In choosing between these 2 modalities of treatment, several factors should be taken into account, such as the type of goiter, the severity of hyperthyroidism, the size of the gland, age, fitness, and preference of the patient. It is our practice to perform a subtotal thyroidectomy on the young patient with a large gland and severe hyperthyroidism. In the preparation of these patients, thionamides, beta‐blockade, and Lugol's iodine are used together until the patient is euthyroid. Preparation with beta‐blockade alone led to the only instances of impending storm after surgery in our experience.
Management of symptomatic hypercalcemia and hypocalcemia
Authors: Purnell Don C. , van Heerden Jonathan A. 
Published: May 2005

AbstractSymptomatic hypercalcemia is a medical emergency. Knowledge of the alteration in the factors that control normal calcium homeostasis permits selection of a plan of treatment, which includes general supportive measures along with therapeutic agents directed at the specific alteration in calcium homeostasis. The rationale for the selection of various modes of treatment and treatment schedules and the untoward side effects of the therapeutic agents are reviewed.Acutely developing hypocalcemia often requires emergency treatment. Relief of symptoms can be achieved with intravenous calcium preparations. Knowledge of the underlying cause permits selection of appropriate medications when long‐term treatment is required. When vitamin D is needed, measurement of serum calcium and phosphate at regular intervals is essential. Hypoparathyroidism may be temporary after thyroid or parathyroid surgery, and efforts should be made 6 to 12 months after operation to determine whether the abnormality is permanent.
Management of the patient presenting as an emergency with hypergastrinemia
Authors: Harris Nigel W. S. , Osborne D. Henry , Carter David C. 
Published: May 2005

AbstractThe emergency management of patients presenting with the Zollinger‐Ellison syndrome (ZES) consists of medical measures to control acid‐pepsin hypersecretion; emergency surgery should be confined to urgent complications of ulceration or tumor growth and spread. Operation for ulcer complications should be restricted to conventional surgical procedures with biopsy of suspicious lesions. Emergency total gastrectomy or resection of pancreas and duodenum is contraindicated. Once the emergency has been controlled, the diagnosis of ZES can be confirmed by basal serum gastrin measurements and the secretin provocation test. Other endocrine adenopathies should be excluded. An attempt is then made to localize the tumor(s) and any metastases. With techniques such as selective portal venous sampling, it may be possible to define the small group of patients with lesions amenable to surgical cure. For the remainder, continued control of gastric secretion can be achieved by H2‐receptor antagonists, but elective total gastrectomy or the combination of vagotomy with pharmacological blockade offer valid alternatives in long‐term management. Effective medical or surgical control of the peptic ulcer diathesis means that tumor progression is now the major cause of death in ZES patients, and advances in the fields of chemotherapy and radiotherapy are urgently required to control this aspect of the disease.
The management of the hypoglycemic patient
Authors: Kennedy Terence 
Published: May 2005

AbstractOrganic hypoglycemia may be caused by an insulinoma. This is a rare tumor, multiple in about 10% and malignant in about 10% of cases. Multiplicity is particularly likely when insulinoma occurs as part of the MEN 1 syndrome. When a patient exhibits Whipple's triad, synchronous blood sugar and insulin estimations must be made, and repeated during fasting. Diagnosis depends on the finding of inappropriately high insulin levels in the presence of low blood sugars. Many stimulatory tests are available but none are as reliable as prolonged starvation, and probably should be abandoned.Measurement of proinsulin and C‐peptide are of particular value in the diagnosis and in elimination of factitious hypoglycemia.Preoperative localization is most useful and can be achieved in up to 90% of patients by skillful selective angiography. Percutaneous portal venous sampling has been used and is particularly indicated in patients after a fruitless first exploration.Tumors of the body and tail are usually treated by distal pancreatectomy, those of the head by enucleation. There is a risk of pancreatic fistula, and duct damage can be unmasked by secretin injection. Occult tumors and hyperplasia may require “blind” progressive distal resection with blood sugar monitoring until the hypoglycemia is controlled, but this is something of a desperation measure. In malignant tumors, hypoglycemia may be controlled by diazoxide or somatostatin. Streptozotocin may control the syndrome and lead to prolongation of life. Like other malignant apudomas, these tumors are usually slow growing and relatively benign.
The Radiologist's role in acute endocrine problems
Authors: May Gerald R. , James E. Meredith , Johnson C. Michael 
Published: May 2005

AbstractUltrasound and computed tomography have had an enormous impact on the imaging procedures used in the detection of tumors of the parathyroids, pancreas, and adrenals. Ultrasound is now the examination of choice in localizing parathyroid adenomas in the neck prior to cervical exploration or after unsuccessful exploration. Its role as a screening test in patients without biochemical confirmation of hyperparathyroidism awaits further study. Computed tomography is useful in identifying mediastinal parathyroid adenomas in patients who have had unsuccessful neck explorations and islet‐cell tumors of the pancreas if they are sufficiently large (greater than 2 cm). Angiography remains the most accurate method of localizing insulinomas prior to surgery. Computed tomography scanning has become the procedure of choice in localizing adrenal tumors and has sufficient sensitivity to be used as a screening test in patients without biochemical confirmation of an adrenal abnormality.
The management of the patient with catecholamine excess
Authors: Wheeler Malcolm H. , Chare Michael J. B. , Austin Thomas R. , Lazarus John H. 
Published: May 2005

AbstractThe key to the diagnosis of pheochromocytoma is a high index of suspicion on the part of the clinician. Confirmation of the diagnosis and localization of the tumor have been rendered relatively straightforward by advances in biochemistry, nuclear medicine, and radiology. Close cooperation and team effort between a physician, anesthetist, and surgeon possessing expertise in this field will ensure optimal preoperative, operative, and postoperative care, particularly for the small group of patients seriously ill with “acute” catecholamine excess.
Management of acute hypercortisolism
Authors: Thompson Norman W. , Allo Maria D. 
Published: May 2005

AbstractAn occasional patient with Cushing's syndrome may require urgent management primarily because the chronic ravages of hypercortisolism have caused the patient to be in a precarious metabolic condition. The side effects of prolonged excess corticosteroids increase the risk of operations in such patients and must be considered in overall management. Among the many effects of hypercortisolism to be considered are hypertension, diabetes, ocular hypertension, myopathies, dermatologic changes including skin infection, pancreatitis, osteoporosis, pathological fractures, peptic ulcers, renal calculi, coagulopathies, hypokalemia, poor wound healing, and increased susceptibility to infection. The most effective way to avert these complications is by earlier diagnosis and definitive treatment of Cushing's syndrome. The present report includes a review of the etiology and diagnosis of Cushing's syndrome and the management of problems associated with hypercortisolism.
The management of patients with primary aldosteronism
Authors: Granberg P. ‐O. , Adamson U. , Cohn K. H. , Hamberger B. , Lins P. E. 
Published: May 2005

AbstractThe diagnosis of primary aldosteronism is based upon low plasma renin and elevated unsuppressible aldosterone. Computerized tomography and selective venous sampling are the most accurate methods of localization. In patients with an aldosteronoma, unilateral adrenalectomy is performed preferably via the posterior or flank approach. Patients with bilateral adrenal hyperplasia are treated with spironolactone rather than surgery, although controversy exists regarding the management of patients with macronodular hyperplasia.
Primary hyperparathyroidism in children, adolescents, and young adults
Authors: Allo Maria , Thompson Norman W. , Harness Jay K. , Nishiyama Ronald H. 
Published: May 2005

AbstractPrimary hyperparathyroidism (HPT) is considered a rare disease in children and an uncommon one in adolescents and young adults. Until 1975, only 60 children under the age of 16 years had been reported with proven HPT. Most had symptoms of weakness, irritability, anorexia, and weight loss. Severe hypercalcemia (serum calcium>15 mg/ 100 ml) and radiologic evidence of bone changes were common findings, and suggested delayed diagnoses.This report is based on the clinical and laboratory findings in 53 young patients with proven primary HPT (range: 1–30 years of age) from 1971 to 1980, treated in one hospital. There were 29 male and 24 female patients, 26 of whom developed symptoms before age 18. Common symptoms included hematuria and renal colic (50%), renal calculi (50%), and hypertension with (6%) and without (3%) severe headaches. Although 64.2% of patients had adenomas, only 54% of patients under 18, and as many as 77.8% over 18, had them. The incidence of hyperplasia was markedly increased in the patients under 18 (38%) as compared to the patients over 18 (18.5%) or the group taken as a whole (30.2%). The following associated diseases were identified: MEA I syndrome (4); MEA II syndrome (4); von Recklinghausen's neurofibromatosis; papillary carcinoma of thyroid; craniopharyngioma; and multiple metaphyseal chondromatosis. One child had hereditary neonatal parathyroid hyperplasia.Primary hyperparathyroidism is more common than previously suspected in young people. Symptoms of renal stones, hypertension, persistent headaches, unexplained anorexia, and weight loss should prompt evaluation for primary HPT. If hyperplasia is found, the patient and family should be investigated for associated endocrinopathies.
Parathyroid cysts
Authors: Asfar Sami , Smith George , Krukowski Zygmunt H. 
Published: May 2005

AbstractFrom a review of the world literature, 91 cases of parathyroid cysts have been identified. The majority present as asymptomatic lumps in the lower part of the neck to the right or, more frequently, the left of the midline and are diagnosed as thyroid nodules before surgery. The 4 cases discussed in this article were all derived from the left lower parathyroid gland or left upper pole of the thymus. Three are the largest on record, 2 of which produced pressure symptoms and one, scabbarding of the trachea.
A mechanical suturing method for the gastrointestinal tract: Clinical experience with a new stapling instrument
Authors: Pimenta Amadeu P. A. , Cardoso Valdemar M. B. , Rodrigues Joaquim S. 
Published: May 2005

AbstractThe results obtained clinically with a new circular stapling clamp for end‐to‐end, end‐to‐side, or side‐to‐side anastomosis are described. This clamp is especially indicated for esophagogastric, esophagojejunal, esophagocolonic, or enteroenteral anastomoses. The instrument creates an anastomosis that is held by a double, staggered row of stainless steel wire staples. It is extremely easy to use, saves time and, creates better anastomoses than those achieved with hand suturing.
The role of gastric stasis in the genesis of gastric ulceration following fundoplication
Authors: Maher James W. , Cerda James J. 
Published: May 2005

AbstractGastric ulceration is a cause of significant morbidity in approximately 3% of patients undergoing fundoplication. The etiology of this complication remains unsettled. A patient who presented with gastric ulceration following fundoplication is described. Gastric emptying of solids was markedly delayed (28% retention at 120 minutes; normal range, 3–17%). The integrated gastrin response to 180 g of lean meat (368%) demonstrated marked derangement of the antrat gastrin mechanism (normal, 44±8%). Metoclopramide therapy resulted in normalization of gastric emptying (13% retention at 120 minutes), while the integrated gastrin response showed a decided decrease (257%). This patient clearly implicates gastric stasis and hypergastrinemia secondary to vagal dysfunction as a contributing factor in the etiology of gastric ulceration following fundoplication. The question as to whether this vagal dysfunction is a preexisting condition or the result of operative manipulations remains unresolved.
A simple technique for the treatment of ureteral stenosis after kidney transplantation
Authors: Kinnaert Paul 
Published: May 2005

AbstractAn intraperitoneal approach has been used successfully in 3 patients for surgical correction of ureteral stenosis after kidney transplantation. Although the procedure cannot be used if the kidney has been transplanted in the homolateral iliac fossa, in the majority of cases it avoids the difficult dissection of the renal hilum. Thus, blood loss is minimal and the duration of the surgical procedure is shortened.
Ileal bypass for hyperlipidemia
Authors: Buchwald Henry , Fitch Laurie , Varco Richard L. 
Published: May 2005

AbstractPartial ileal bypass (PIB) is a safe, effective, and lasting therapy for the reduction of lipids and lipoproteins in patients with hyperlipidemia. Following PIB, circulating plasma and low‐density lipoprotein (LDL) cholesterol fall markedly, while high‐density lipoprotein (HDL) cholesterol rises. The average plasma cholesterol lowering is 25% after diet, with a 40% reduction in the LDL‐cholesterol fraction; concurrently, the HDL‐cholesterol rises about 8%. These effects have been demonstrated to be maintained for up to 20 years. Currently, PIB is being used in the Program on the Surgical Control of the Hyperlipidemias (POSCH), a randomized controlled clinical trial designed to assess the effects of lipid reduction on mortality and morbidity in a postmyocardial infarction population with arteriographically demonstrated coronary atherosclerosis.
Small bowel transplantation
Authors: Pritchard Timothy J. , Kirkman Robert L. 
Published: May 2005

AbstractSmall bowel transplantation may offer a future alternative to patients with short bowel syndrome. However, currently available immunosuppressive regimens are not adequate to prevent rejection of small bowel allografts. Recent experimental studies using cyclosporine have provided improved results, especially in rats; but there are relatively few long‐term survivors in large animal models. Graft‐versushost disease may result from lymphoid tissue in the small bowel transplant but is less troublesome than rejection. Seven patients have undergone small bowel transplantation; the longest survivor died at 6 months. Clinical application of small bowel transplantation must await further refinements in immunosuppression.