bluuebunny/crossref_metadata_2025_split huggingface dataset:
The systematic use of operative ultrasound for detection of liver metastases during colorectal surgery
Authors: Boldrini Giuseppe , de Gaetano Anna Maria , Giovannini Ivo , Castagneto Marco , Colagrande Corrado , Castiglioni Giancarlo 
Published: May 2005

AbstractIntraoperative ultrasonography of the liver was routinely performed during 86 elective surgical procedures for the treatment of primary colorectal malignancies, in search of intrahepatic metastatic deposits. Results were compared to preoperative diagnostic procedures and to direct evaluation of the liver at laparotomy. Different diagnostic modalities showed a definite scatter in the number of reported space‐occupying hepatic lesions.Solitary liver metastases were visualized in 6 patients by preoperative hepatic ultrasonography and in 5 patients by abdominal computed tomographic (CT) scan and by the operating surgeon at laparotomy; intraoperative ultrasonography disclosed solitary lesions in 8 patients. Multiple metastases were visualized in 10 patients by preoperative ultrasonography, in 11 by CT scan, and in 13 at laparotomy; intraoperative ultrasonography disclosed multiple lesions in 13 patients. Furthermore, operative hepatic sonography allowed the detection of an increased number of non‐neoplastic intraparenchymal lesions, promptly recognizing their solid or liquid nature.As a result of the systematic use of operative sonography for liver scanning during colorectal surgery, previously undetected neoplastic nodules as well as lesions escaping even the most accurate direct examination at surgery, were easily visualized.
The use of intraoperative sonography in endocrine tumors of the pancreas
Authors: Klotter H. J. , Rückert K. , Kümmerle F. , Rothmund M. 
Published: May 2005

AbstractIntraoperative ultrasound (IOUS) was performed in 21 patients with 22 endocrine tumors of the pancreas. Seventeen patients suffered from an organic hyperinsulinism, 4 had Zollinger‐EUison syndrome. One patient with an insulinoma had a pancreatic‐polypeptide‐producing adenoma (PPoma) as a second tumor. Fifteen of the insulinomas investigated by IOUS were visible and palpable. In 2 patients no tumor was found during initial operation. At reoperation 1 tumor was detected by IOUS only, the reoperation in the other patient is planned. The PPoma was an incidental finding during IOUS.In 4 patients with Zollinger‐Ellison Syndrome, 1 gastrinoma was localized in the pancreas and 2 in the duodenal wall by palpation. In 1 patient we found no gastrinoma by either surgical exploration or by IOUS. In 1 of the positive cases the tumor was demonstrable by IOUS. In the other patient it was too small for imaging. Two of these patients had liver metastases, which could be demonstrated by IOUS only. We conclude that IOUS should be performed routinely in operations for pancreatic APUDomas.
The ultrasonic detection of insulinomas during surgical exploration of the pancreas
Authors: Angelini Licinio , Bezzi Mario , Tucci Gianfranco , Lirici Marco M. , Candiani Francesco , Rubaltelli Leopoldo , Tremolada Carlo , Tamburrano Guido , Fegiz Gianfranco 
Published: May 2005

AbstractThe sensitivity of preoperative imaging was evaluated for the localization of insulinomas in 2 series of 54 and 17 patients, respectively. In the first series, diagnosis was obtained with ultrasonography (US) in 14.8%, with computed tomographic (CT) scan in 60%, and with arteriography and/or angio CT scan in 75% of patients. In the second series, US, CT scan, and arteriography were performed preoperatively showing a sensitivity of 53% of one or more of the imaging techniques. The last 17 patients all underwent intraoperative pancreatosonography, and the insulinoma was localized in each.Considering the high reliability of intraoperative ultrasonography, and the high costs and low benefits of other current diagnostic techniques, a new management plan is suggested for patients with a definite laboratory diagnosis of insulinoma.
The use of high‐resolution intraoperative ultrasound to localize gastrinomas: An initial report of a prospective study
Authors: Cromack Douglas T. , Norton Jeffrey A. , Sigel Bernard , Shawker Thomas H. , Doppman John L. , Maton Paul N. , Jensen Robert T. 
Published: May 2005

AbstractWe evaluated the use of high‐resolution, real‐time, B‐mode, intraoperative ultrasound (IOUS) compared to simple manual palpation to localize gastrinomas during laparotomies in 10 consecutive patients with Zollinger‐Ellison syndrome (ZES). All patients had clear biochemical evidence of ZES, and patients with metastatic gastrinoma identified preoperatively were excluded. Preoperative localization studies including ultrasound, computed tomography, and selective arteriography localized gastrinoma in 3 patients. Transhepatic portal venous sampling (PVS) for gastrin localized gastrin gradients to the pancreatic head region in 8 patients, and found no significant gastrin gradient in 2 patients. Gastrinomas were found at laparotomy and proven pathologically in 6 patients. Four patients had gastrinomas in the pancreatic head area as predicted by PVS; however, one patient had a tumor in the pancreatic tail and another in the jejunal wall. Palpation was the most sensitive intraoperative method to localize a gastrinoma (100% sensitivity). IOUS correctly imaged 3 gastrinomas (50% sensitivity). Palpation had 1 false‐positive finding (80% specificity) and IOUS had 2 false‐positive findings (60% specificity). All palpable masses that were also sonolucent on IOUS proved to be gastrinomas (3 patients). Thus, a combined positive finding raised the specificity and positive predictive value to 100%. We conclude that IOUS has utility in explorations for gastrinomas. Although not as sensitive or specific as palpation, IOUS can confirm, noninvasively, a suspicious palpable nodule. If IOUS fails to image a palpable nodule, our results suggest that the surgeon should still attempt to resect the nodule.
The use of operative sonography in carcinoma of the pancreas
Authors: Plainfosse M. C. , Bouillot J. L. , Rivaton F. , Vaucamps P. , Hernigou A. , Alexandre J. H. 
Published: May 2005

AbstractWe studied 22 patients who underwent surgery for suspected pancreatic carcinoma. One individual was found to have a normal pancreas and one mass was finally diagnosed as chronic pancreatitis. Accurate diagnoses were made preoperatively in 63% of our patients. All masses were palpated intraoperatively. Operative ultrasonography confirmed these findings and the absence of a mass in the patient with a normal pancreas. Operative sonography (OS) revealed 2 previously undetected lesions and permitted 2 biopsies of lesions under its guidance. It was helpful in diagnosing 18% of lesions. In evaluating the spread of pancreatic carcinoma, OS was very helpful in 32% of our patients and moderately helpful in 18%. OS thus helped to direct surgical management in 50% of our patients, by providing information that limited dissection in patients with unresectable spread or permitted resection to proceed in the absence of evidence of unresectability.
The use of ultrasound during surgery for complications of pancreatitis
Authors: Sigel Bernard , Machi Junji , Kikuchi Toshiyuki , Anderson Kenneth W. , Horrow Mindy , Zaren Howard A. 
Published: May 2005

AbstractUltrasound imaging is a useful diagnostic procedure during operations for complications of pancreatitis. The most common of such procedures are for drainage of pancreatic pseudocysts, abscesses, and obstructed pancreatic ducts. Operative ultrasound proved to be helpful in 71.7% of these operations. In addition to diagnosing and better defining abnormalities for drainage, operative ultrasound is able to detect previously unsuspected associated pathological conditions such as a second pseudoeyst. Knowledge of such associated lesions may permit their management at the primary operation.
The detection of gastric and esophageal tumor extension by high‐resolution ultrasound during surgery
Authors: Machi Junji , Takeda Jinryo , Kakegawa Teruo , Yamana Hideaki , Fujita Hiromasa , Kurohiji Toshihiko , Yamashita Yuichi 
Published: May 2005

AbstractHigh‐resolution ultrasound with 7.5‐MHz instruments was employed to detect tumor extension during 30 gastric and 25 esophageal cancer operations. With 5 echo layers, which corresponded to histologie structures of the stomach wall, operative ultrasound diagnosed intramural tumor spread more accurately than operative palpation. Thirteen of 14 early gastric cancers including 8 nonpalpable cancers were precisely localized by operative ultrasonography. In addition, lateral extension of tumor along the stomach wall was correctly diagnosed by operative ultrasound in 26 of 30 cancers, while palpation was correct in 14 of 30 cancers. For esophageal cancer, extramural local invasion, particularly to vessels, was accurately detected by operative ultrasound. Three of 25 esophageal cancers had histological invasion of the aorta. Preoperative imaging methods showed 1 false‐negative and 2 false‐positive results in determining the aortic invasion. Operative ultrasound had no false results. Lymph nodes that were unrecognized at preoperative studies, nodes that were nonpalpable prior to tissue dissection, and nodes as small as 3 mm in size could be depicted by ultrasonography during gastroesophageal operations. The present results indicate that high‐resolution operative ultrasound may be a valuable technique for the detection of gastric and esophageal cancer extension during surgery.
Adenosine: A new antihypertensive agent during pheochromocytoma removal
Authors: Gröndal Staffan , Bindslev Lars , Sollevi Alf , Hamberger Bertil 
Published: May 2005

AbstractSevere hypertension and cardiac arrhythmias are well known problems during surgical removal of pheochromocytoma. This is due to extremely high circulating catecholamines during tumor manipulation. In this study, peroperative blood pressure control was obtained by the infusion of adenosine, which antagonized cardiovascular effects of catecholamines. During operation of 10 patients, none had systolic blood pressure exceeding 200 mm Hg or any cardiac arrhythmias despite extremely high plasma catecholamine levels. A mean blood pressure of 120–150 mm Hg was maintained in all patients. Peroperative use of adenosine seems to be a most effective compound for hemodynamic control during pheochromocytoma surgery.
The effect of subtotal thyroidectomy on Graves' ophthalmopathy
Authors: Levitt Michael D. , Edis Anthony J. , Agnello Ross , McCormick Clement C. 
Published: May 2005

AbstractNineteen unselected patients undergoing subtotal thyroidectomy (STT) for Graves' disease were submitted to thorough ophthalmologic assessment before and after (mean, 10 mo) thyroid surgery. All clinical examinations were performed by the same observer and findings were scored according to the American Thyroid Association (“NOSPECS”) classification. Orbital computed tomography (CT) scans were performed in all patients prior to surgery and again at follow‐up if the initial scan was abnormal or if there was evidence of clinical deterioration; all CT scans were viewed by the same individual. There was evidence of infiltrative ophthalmopathy at some stage in the course of observation in 17 (89%) of the 19 patients.No predictable ocular response to STT was apparent. Ophthalmic status was noted to improve in 6 patients, to remain unchanged in 7 patients, and to progressively deteriorate in 6 patients. This unpredictable pattern was seen irrespective of the severity of preexisting ocular involvement. The absence of any consistent or predictable ocular response to STT strongly suggests that thyroidectomy does not influence the natural course of Graves' ophthalmopathy. We believe that the presence of evolving or stable ophthalmopathy, even if severe, should not be regarded as a contraindication to STT in Graves' disease.
Changing concepts of islet cell dysplasia in neonatal and infantile hyperinsulinism
Authors: Thomas C. G. , Cuenca R. E. , Azizkhan R. G. , Underwood L. E. , Carney C. N. 
Published: May 2005

AbstractNeonatal and infantile hypoglycemia due to insulin excess has been associated with a spectrum of anatomic changes, i.e., nesidioblastosis, endocrine cell dysplasia, islet cell hyperplasia, and adenomatosis. The mechanism of hyperinsulinemia in these patients has been attributed to: (a) an increase in islet cell mass, (b) abnormal islet cell architecture with alternation in paracrine function, (c) imbalance of alpha, beta, and delta cell secretion, and (d) a regulatory defect of insulin secretion. Morphometric, immunocytochemical, and electron microscopy studies have not substantiated an increase in endocrine cell mass in many patients. Nesidioblastosis is believed to be a normal phase of fetal development of the pancreas rather than a pathologic entity. A regulatory defect in insulin storage and release is the best explanation of hyperinsulinism in these patients.We report experience with 165 neonates and infants including 6 of our own collected during the last decade. Subtotal pancreatectomy (79–90%) was carried out as the initial operative procedure in 76% of patients. Twenty‐eight percent required a second operation of near‐total to total pancreatectomy. Eleven percent required a third procedure. A near‐total pancreatectomy (95–98%) was performed as the initial operation in 24% of the patients. Five percent of these patients required a second operation.There is a clear advantage of performing an extensive pancreatectomy (95–98%) at the initial operative procedure. In the 40 patients so treated, the incidence of mental retardation was 12.5% and seizures, 2.5%. Ten percent required diazoxide for further management, and 7.5% required insulin on a long‐term basis. Mortality was 2.5%. In our report, covering experience from 1934 to 1971, the mortality was 8.3% and mental retardation, 52%.
Epidermal growth factor receptor on human thyroid neoplasms
Authors: Masuda Hiroyuki , Sugenoya Akira , Kobayashi Shinya , Kasuga Yoshio , Iida Futoshi 
Published: May 2005

AbstractMorphological observation of epidermal growth factor receptor (EGF‐R) was attempted for human thyroid neoplasms, and the results were evaluated compared with the various histological types.Thirty‐four malignant tumors, 24 benign tumors, 7 adenomatous goiters, and 7 normal thyroid tissues obtained at surgery were subjected to this study. They were fixed in 10% formalin solution, embedded in paraffin. After sectioning at 4μm, immunohistochemical staining by avidin‐biotin‐peroxidase complex technique was performed employing anti‐human EGF‐R monoclonal antibody.Both normal thyroid tissues and benign adenomas showed no apparent immunoreactive staining. The majority of the malignant tumors, however, demonstrated dark brown reaction products indicating location of EGF‐R on the cell surface, cytoplasm, and nuclear envelope. Medullary and anaplastic carcinomas were stained more intensively than papillary and follicular carcinomas. In adenomatous goiter, the immunoreactive products were occasionally observed on the follicular cells of some limited areas, whereas its staining pattern was different from the malignant neoplasms.The correlative study between UICC classification of thyroid tumors and EGF‐R staining in the papillary carcinoma revealed a higher frequency of positive staining in cases of multifocal metastasis.
Deaths due to differentiated thyroid cancer: A 46‐year perspective
Authors: Harness Jay K. , McLeod Michael K. , Thompson Norman W. , Noble Walter C. , Burney Richard E. 
Published: May 2005

AbstractFrom 1940 to 1986, a total of 798 patients were treated for differentiated thyroid carcinoma. One hundred and seventy‐two patients died during the follow‐up period: 42 (24.4%) patients from thyroid cancer, 14 (8.1%) from other causes with extensive thyroid cancer present, 75 (43.6%) with no thyroid cancer, and 41 (23.8%) with an unknown status of thyroid cancer.Of the 42 patients dying due to thyroid cancer, 15 were male and 27, female. Mean age at diagnosis was 48.3±17.7 years with one‐third of patients age 45 or younger at the time of the initial diagnosis. The primary tumors were large (>4 cm) and 59.5% of the patients had local invasion and/or cervical metastasis. Distant metastases were present in 9 (21.4%) patients at the time of diagnosis.Surgical therapy included total thyroidectomy (72.1%) and limited or radical neck dissection (69.4%). Radioactive iodine (131I) was used to treat residual cancer and/or distant metastasis in 73.8% of the patients. External radiation therapy was used to treat locally advanced or recurrent disease in 52.3% of the patients.Distant metastases and local recurrence were identified earlier in patients with follicular thyroid cancer whose survival time and disease‐free interval were significantly shorter (p<0.001) than that of patients with papillary neoplasms. However, the survival and disease‐free intervals were often very long in both papillary and follicular thyroid cancer deaths.Onset of differentiated thyroid cancer before the age of 40 years does not preclude serious sequelae and death. Since no known histopathologic features can consistently predict outcome, we continue to advocate aggressive treatment of all patients with differentiated thyroid cancer.
Ionized calcium in monitoring effective parathyroidectomy: A preliminary report
Authors: Rosen Irving B. , Pollard Alan 
Published: May 2005

AbstractThis study set out to determine the validity of a laboratory technique that might provide the surgeon with an indication of effective parathyroidectomy before the patient leaves the operating room. Seventeen patients with a firm diagnosis of primary hyperparathyroidism established by conventional criteria (11 adenoma and 6 hyperplasia) came to operative treatment. During operation, interval blood sampling was carried out for duplicate determination of ionized calcium using the Radiometer ICA 1 Analyzer, which also measures pH and corrects ionized calcium to a pH of 7.4. Samples, usually 6 in number or more, were collected about every 20 minutes throughout operation. The times of parathyroid sampling or excision were noted and correlated with ionized calcium levels.Twelve of the 17 patients showed a marked decline in ionized calcium levels 40–120 minutes following presumptive effective parathyroidectomy. If measured on site, these results would have been available before the patient's departure from the operating room. All these patients achieved eucalcemia. In 5 patients, there was no significant decline in ionized calcium. Four of these patients became eucalcemic, the fifth patient showed a marked decrease in total serum calcium, but not to normal levels. Three control patients showed no evidence of alteration in ionized calcium.This study should be construed as preliminary, but does provide a basis for continued investigation. While it is apparent that a lack of decline of intraoperative ionized calcium does not exclude cure, the occurrence of such a decline provides strong evidence of curative parathyroidectomy. This technique, if confirmed by further work, permits a rapid, reliable, simple measure which would be available to most hospitals.
Pancreatic endocrine functions in long‐term survivors after pancreatoduodenectomy: Special reference to reversibility of insulin and glucagon secretion
Authors: Miyata Masahiko , Yamamoto Takayoshi , Hamaji Masayasu , Izukura Masaaki , Nakamura Masahiro , Taketani Hiroshi , Nakao Kazuyasu , Kawashima Yasunaru 
Published: May 2005

AbstractThe number of long‐term survivors of pancreatectomy for cancer is increasing. This study was conducted in patients with periampullary cancer to elucidate the serial change in the pancreatic endocrine functions before and after resection of the head of the pancreas. The pancreatic A and B cell functions were determined by the responses of plasma glucagon and insulin to arginine infusion. For serial comparison, the maximum response and integrated increment of plasma glucagon and insulin were calculated in each patient. There were no significant differences in these parameters between the patients (n=36) before the operation and normal controls (n=18). Early after pancreatoduodenectomy (mean, 6.4 weeks), each parameter was significantly less than its corresponding preoperative value and also less than the value in the normal controls. In the long‐term survivors (mean, 20.1 months after the surgery; n=12) among these 36 patients, these parameters showed no significant changes compared with the early postoperative values and were still significantly less than both the preoperative values and the normal control values. We, thus, conclude that pancreatic A and B cell functions are preserved long‐term after pancreatoduodenectomy in patients with periampullary cancer.
Emergency department thoracotomy following injury: Critical determinants for patient salvage
Authors: Timothy Baxter B. , Moore Ernest E. , Moore John B. , Cleveland Henry C. , McCroskey Brian L. , Moore Frederick A. 
Published: May 2005

AbstractThe role of emergency department (ED) thoracotomy in resuscitation of the moribund trauma patient remains ill‐defined. The purpose of this article is to analyze our experience during the past decade in order to elucidate prognostic features enabling a more cost‐effective application of this heroic measure.Injury mechanism in the 632 ED thoracotomies performed in our trauma consortium consisted of blunt (BLT) in 50%, gunshot wounds (GSW) in 35%, and stab wounds (SW) in 15%. Mean patient age was 31 years, and 76% were men. Twenty‐nine (5%) of the patients were ultimately discharged alive from the hospital. Outcome was analyzed on the basis of physiologic status at presentation to the ED: group I, n=481 (76%), presented without signs of life (SL); group II, n=38 (6%), presented with SL (pupillary response), but without vital signs (VS); and group III, n=113 (18%), presented with VS. Survival without SL was 10% of SW, 1% of GSW, and 1% of BLT. When VS were present, patient salvage was 32% following SW, 15% following GSW, and 5% after blunt trauma. Five of 15 survivors without SL had irreversible cerebral damage; whereas, 13 of the 14 survivors with VS had no permanent neurologic sequelae.This experience underscores the rationale for selective application of ED thoracotomy done for postinjury resuscitation; functional salvage of the blunt trauma victim arriving lifeless is nil while nearly one‐third of patients in extremis from a thoracic SW can be returned to their preinjury state.
Preoperative imaging versus intraoperative localization of tumors in adult surgical patients with hyperinsulinemia: A multicenter study of 338 patients
Authors: Proye C. , Boissel P. 
Published: May 2005

AbstractThree hundred thirty‐eight patients with organic hypoglycemia were referred to French‐speaking surgeons during an 18‐year period (1965–1983). Two hundred sixty‐eight (79%) of these patients proved to have benign tumors (12 multiple), 37 (11%) had carcinoma, and 11 (3%) had “hyperplasia.” Of the remaining 22 patients, 9 (2%) were not operated, 12 (4%) underwent negative pancreatic explorations, and 1 (0.3%) was misdiagnosed.The use of preoperative localization studies (computed tomographic scan, arteriography, ultrasound, and transhepatic portal sampling) were successful in 195 (62%) of 315 patients.Intraoperative diagnostic studies (blood sugar and insulin assays) in peripheral and portal blood, and intraoperative ultrasound were positive in 86% (265/305) of patients.
Percutaneous transhepatic gallstone removal by nephroscopic technique in a case of cholelithogenous liver abscess
Authors: Janetschek Günther , Aufschnaiter Martin , Bodner Ernst 
Published: May 2005

AbstractIn a patient with intrahepatic bile duct obstruction in the right lobe due to a retained stone, we succeeded in removing the calculus with a nephroscope through a percutaneous transhepatic puncture after a failed surgical attempt to extract the stone.