bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical versus medical treatment for calciphylaxis
Authors: Kang A S , McCarthy J T , Rowland C , Farley D R , van Heerden J A 
Published: March 2003

Abstract

Background
Calciphylaxis is a rare, painful, life-threatening problem of cutaneous necrosis and refractory healing seen in patients with uraemia and secondary hyperparathyroidism. The pathogenesis involves abnormalities in calcium and phosphorus metabolism, and acute deposition of calcium in tissues.

Methods
The clinical course of 16 patients diagnosed with calciphylaxis at this institution from 1994 to 1998 was reviewed.

Results
Fourteen women and two men, with a mean age of 56 (range 39–70) years, presented with chronic renal disease of various causes, hyperparathyroidism and characteristic skin lesions. All patients underwent intensive medical therapy, including haemodialysis (n = 16), parathyroidectomy (PTX) (n = 7) and skin debridement of cutaneous lesions (n = 8). Mean preoperative serum values in surgical (PTX) versus non-surgical patients were: calcium 9·9 and 9·3 mg dl−1 (P = 0·25); phosphorus 5·8 and 4·9 mg dl−1 (P = 0·04); calcium–phosphorus product 61·6 and 45·2 (P = 0·03); and parathyroid hormone (PTH) 56·8 and 5·9 pmol l−1 (P = 0·0001) respectively. Mean postoperative values for calcium (8·7 mg dl−1), phosphorus (4·2 mg dl−1), calcium–phosphorus product (30·5) and PTH (4·0 pmol l−1) in surgical patients changed significantly (P &lt; 0·05). Median overall survival was 9·4 months with 15 patients now deceased. Median survival was 14·8 and 6·3 months for PTX versus no PTX (P = 0·22), 14·1 and 6·1 months for skin debridement versus no debridement (P = 0·08), 12·4 and 6·6 months for proximal versus distal skin lesions (P = 0·60), and 6·5 and 13·9 months for diabetic versus non-diabetic patients was (P = 0·11).

Conclusion
Calciphylaxis appears to have a female preponderance with a very dismal prognosis. A multidisciplinary approach using frequent haemodialysis to normalize serum calcium and phosphorus levels, and local debridement of skin lesions seems prudent. PTX cannot be recommended routinely in all such patients unless severe secondary hyperparathyroidism with poorly controlled metabolic disturbance mandates surgery. The exact indications for PTX for calciphylaxis remain unclear.
Late parathyroid function following successful parathyroidectomy guided by intraoperative hormone assay compared with standard bilateral neck exploration
Authors: Carneiro D N , Irvin G L 
Published: March 2003

Abstract

Background
Controversy continues between bilateral neck exploration and limited parathyroidectomy guided by gland hyperfunction. While one approach depends on gland size and histopathology, the other limits excision to hypersecreting glands only. Although both methods claim early operative success, the late recurrence rate with limited exploration is unknown. Late biochemical outcomes from these two operative approaches are reported.

Methods
Some 301 consecutive patients with primary hyperparathyroidism were followed 6–495 months after successful parathyroidectomy; 164 patients had bilateral neck exploration with excision of enlarged glands (group 1) and 137 patients had glands excised based on hypersecretion (group 2). Calcium and intact parathyroid hormone (iPTH) levels were measured yearly. Recurrent parathyroid gland hypersecretion was determined by iPTH levels above the normal range.

Results
In group 1, a single gland was excised in 150 patients (91 per cent); 15 (9 per cent) of 164 had late raised iPTH levels (12 normocalcaemic). In group 2, 133 patients (97 per cent) had a single gland excised and 21 (15 per cent) of 137 had high iPTH levels (19 normocalcaemic). The number of patients with more than one gland excised in group 1 (9 per cent) was three times higher than that in group 2 (3 per cent) (P &lt; 0·04). There was no statistical difference in the incidence of recurrent hyperfunctioning glands between the two operative approaches (χ2 test).

Conclusion
Based on late parathyroid gland function, parathyroidectomy guided by gland hyperfunction yielded comparable results to bilateral neck exploration. Multiple gland excision based on gross appearance alone may result in unnecessary excision of normal glands and possible hypoparathyroidism.
Thyroid surgery with intraoperative neuromonitoring of the recurrent laryngeal nerve: a prospective multicentre study in Germany with 7617 patients
Authors: Thomusch O , Sekulla C , Dralle H 
Published: March 2003

Abstract

Background
Injury to the recurrent laryngeal nerve (RLN) is a frequently noted and serious complication in thyroid surgery. Several studies have established that identification of the RLN may reduce the incidence of RLN palsy. To date, no prospective study has evaluated whether the RLN palsy rate can be further reduced by intraoperative neuromonitoring of the RLN.

Methods
Between 1 January and 31 December 1998, surgery for benign and malignant goitre was performed on 7607 patients in 45 hospitals. Data were collected prospectively by questionnaire. RLN function was evaluated before and after operation in all patients. RLN palsy was defined as permanent when there was no evidence of recovery within 6 months after surgery. The RLN palsy rate was adjusted to nerves at risk in the three groups ‘no identification of the RLN’, ‘intraoperative identification of the RLN without neuromonitoring’ and ‘identification of the RLN with neuromonitoring’. Statistical analysis was by χ2 test.

Results
Mean patient age was 51·8 years; 72·7 per cent were women. Some 7256 patients were treated for benign goitre (multinodular goitre 74·0 per cent, uninodular goitre 16·6 per cent, recurrent goitre 6·1 per cent, Graves' disease 3·3 per cent, Hashimoto and De Quervain thyroiditis less than 0·1 per cent) and 351 patients for thyroid carcinoma, with a negative selection of recurrent goitre and thyroid carcinoma for the two groups with intraoperative RLN identification (P &lt; 0·0001). With respect to the extent of resection, in cases of lobectomy the rate of permanent RLN palsy was 1·5 per cent with intraoperative neuromonitoring which was significantly lower than rate with intraoperative RLN identification without neuromonitoring (2·6 per cent) or no RLN identification (6·3 per cent) (P &lt; 0·0001). Detailed analysis of the complete spectrum of extent of resection and indications for surgery showed a positive trend for intraoperative neuromonitoring in comparison to the group with RLN identification without the use of neuromonitoring, but this trend was not statistically significant because of the small number of permanent RLN palsies.

Conclusion
Intraoperative neuromonitoring of the RLN has a beneficial effect for high-risk patients with recurrent goitre and thyroid carcinoma in whom the RLN is at greatest risk in cases of lobectomy or total thyroidectomy.
Expression of the RET proto-oncogene and the RET/PTC oncogenes in papillary thyroid carcinomas and its correlation to clinical manifestations
Authors: Kjellman P C , Learoyd D L , Larsson C , Wallin G , Messina M , Robinson B G , Zedenius J 
Published: March 2003

Abstract

Background
Papillary thyroid carcinoma (PTC) is the commonest thyroid cancer. It has an excellent prognosis if the patients receive appropriate treatment. However, a subgroup of patients with PTC develop distant metastases and eventually die from the disease. There are considerable difficulties in identifying such patients before operation, and there is a need for better tools to do so. Genetic changes, such as expression of the oncogenic fusion proteins RET/PTC 1–5, have been described but their correlation with the clinical picture and prognosis is unclear.

Methods
Sixty-one PTCs (50 primary and 11 recurrent tumours) from 61 patients were selected and analysed for expression of the RET tyrosine kinase domain (RET-TK) and the oncogenes RET/PTC by reversed transcribed polymerase chain reaction, followed by restriction enzyme digestion and direct sequencing. This expression was then correlated with clinical features of lymph node metastasis, distant metastasis, poor differentiation, tall cell variant, extrathyroidal growth, previous external radiation, recurrent disease and death from disease.

Results
Thirty PTCs (49 per cent) showed expression of RET-TK. Thirteen of them appeared to express wild-type RET, as upstream exons were also expressed. Three were explained by RET/PTC expression: one RET/PTC1, one RET/PTC3 and one with a unique variant of RET/PTC3, previously only described in a patient with PTC from Chernobyl. Poor differentiation, but no other histopathological parameter, was significantly correlated with the expression of wild-type RET. Furthermore, in PTCs from 15 patients with a poor clinical outcome (death from disease or distant metastases) RET-TK expression was found significantly more often.

Conclusion
Half of the PTCs showed expression of RET-TK. Surprisingly, only three of them could be explained by known RET/PTC oncogenes. Probably, some of the PTCs express wild-type RET while others could be explained by new, or not yet identified, RET/PTC rearrangements. Regardless of the mechanism for RET-TK expression, this seems to be correlated with a poor prognosis. If this holds true in a larger sample, RET-TK expression could be used as an additional marker to identify patients with PTC who have a less favourable prognosis, and who may benefit from more extensive treatment.
Role of surgery in mild primary hyperparathyroidism in the elderly
Authors: Roche N A , Young A E 
Published: March 2003

Abstract

Background
The appropriate management of elderly patients with mild hyperparathyroidism is the subject of much debate.

Methods
A Medline literature search was conducted using the keywords ‘hyperparathyroidism’, ‘asymptomatic’ and ‘elderly’. The references of the primary sources were examined for further citations. Personally collected cullings from journals and abstracts from journals were used as an additional source of data.

Results and Conclusion
No prospective randomized controlled trial comparing parathyroidectomy with conservative management for patients with mild or asymptomatic hyperparathyroidism has been published. There are a number of longitudinal studies that attempt to characterize the natural history of hyperparathyroidism, but most do not stratify patients according to age when assessing outcome. None the less, it is clear that elderly patients present with a different spectrum of problems, particularly indistinct neuropsychiatric and musculoskeletal symptoms, and these are likely to be improved by surgery. The evidence allows the conclusion that the truly asymptomatic elderly patient can be successfully managed conservatively; there is a good prospect of benefit from surgery for those with symptomatic disease, and such patients should not be denied an operative option.
Insulin-like growth factor I and truncated keratinocyte growth factor accelerate healing of left-sided colonic anastomoses
Authors: Egger B , Inglin R , Zeeh J , Dirsch O , Huang Y , Büchler M W 
Published: March 2003

Abstract

Background
Human full-length keratinocyte growth factor (KGF) promotes healing of colon anastomoses in rats through mechanisms other than enhancement of collagen synthesis. Since insulin-like growth factor (IGF) I increases matrix synthesis, the aim of this study was to evaluate the effect of systemic truncated KGF (tKGF), IGF-I and combined tKGF–IGF-I administration on the healing of colonic anastomoses in rats.

Methods
Rats underwent laparotomy, division of the left colon, and sigmoidosigmoidostomy. tKGF (1 mg/kg), IGF-I (1 mg/kg), tKGF–IGF-I (both 1 mg/kg) or vehicle was administered intraperitoneally in four groups (n = 18 per group) 12 h before surgical intervention, and then once daily until killing (six animals per group; 2, 4 and 6 days after surgery). Bursting pressure measurements, histological evaluation, morphometric analysis, mucin and collagen staining, and 5-bromo-2′-deoxyuridine (BrdU) immunohistochemistry of the anastomotic site were undertaken.

Results
Administration of tKGF, IGF-I and the combination of both growth factors significantly increased anastomotic bursting pressure at postoperative day 2 (63, 71 and 113 per cent respectively), day 4 (68, 83 and 80 per cent) and day 6 (48, 43 and 43 per cent) compared with the control group. No intergroup differences were found. Histological examination, mucin and BrdU staining, and measurement of colonic crypt depth indicated less inflammation, increased acidic mucin content, a higher crypt cell proliferation rate and thickened mucosal layer in the growth factor-treated animals than in controls. Enhanced collagen staining was observed only in IGF-treated animals.

Conclusion
tKGF and IGF-I markedly accelerate the healing of colonic anastomoses in rats. However, combined administration of the two growth factors does not show additional benefit. Both growth factors may be acting to accelerate host reparative processes as well as to enhance protection of the anastomotic wound bed.
Experimental study of a type 3 phosphodiesterase inhibitor on liver graft function
Authors: Ikegami T , Nishizaki T , Hiroshige S , Ohta R , Yanaga K , Sugimachi K 
Published: March 2003

Abstract

Background
The number of liver transplant recipients is increasing but donor organ shortages have become more severe. The effect of milrinone, a type 3 phosphodiesterase inhibitor (PDEI), on non-heart-beating donor grafts was evaluated using an orthotopic liver transplantation model in rats.

Methods
Type 3 PDEI or normal saline (control group) was given intravenously to the donor animals for 60 min continuously (50 µg kg−1 min−1) before 60 min of warm ischaemia followed by cold preservation and subsequent transplantation. Survival, serum chemistry, bile output, histopathological findings and tissue cyclic 3′,5′-adenosine monophosphate (cAMP) concentrations were then compared.

Results
Five of seven animals in the PDEI group were alive at 7 days, compared with only one of seven rats in the control group (P &lt; 0·01). Serum levels of alanine aminotransferase 2 and 6 h after reperfusion, and hyaluronic acid levels 6 h after reperfusion, were significantly lower in the PDEI group than in the control group. Bile output from the transplanted graft was significantly greater in the PDEI group than in controls 2 h after reperfusion (P &lt; 0·01). The mean necrotic area 6 h after reperfusion was also reduced in the PDEI-treated grafts (P &lt; 0·01). cAMP levels in liver tissue at the end of both warm and cold ischaemia, and 2 and 6 h after reperfusion, were significantly higher in the PDEI group compared with those in the control group.

Conclusion
Type 3 PDEI attenuated the graft injury caused by warm and cold ischaemia and subsequent reperfusion injury via an increase in intracellular cAMP levels. This treatment may be a novel pharmacological intervention for safe and efficient usage of liver grafts from non-heart-beating donors.
Randomized clinical trial of diathermy versus scalpel incision in elective midline laparotomy
Authors: Kearns S R , Connolly E M , McNally S , McNamara D A , Deasy J 
Published: March 2003

Abstract

Background
Electrocautery is used increasingly for tissue dissection, although fears of excessive scarring and poor wound healing have curtailed its widespread use for skin incision. This study compared electrosurgical incision with traditional scalpel incision.

Methods
One hundred patients requiring elective midline laparotomy were randomized prospectively to either scalpel or diathermy incision. Parameters measured included incision time, wound size, wound blood loss, total intraoperative blood loss and postoperative wound pain. All wound complications were recorded.

Results
The two groups did not differ significantly in relation to patient or wound characteristics. Laparotomy incisions using diathermy were significantly quicker than scalpel incisions (mean(s.e.m.) 6·1(0·4) versus 7·5(0·5) s/cm2; P &lt; 0·04). There was significantly less blood loss in the diathermy group compared with the scalpel group (0·8(0·1) versus 1·7(0·3) ml/cm2; P = 0·002). Postoperative pain scores were significantly lower in the diathermy group for the first 48 h after operation (P &lt; 0·05). Morphine requirements were also significantly lower over the first 5 postoperative days in the diathermy incision group (P &lt; 0·04). There was no difference between groups in wound complications before discharge and at the 1-month follow-up.

Conclusion
Electrosurgical midline incision in elective surgery has significant advantages over scalpel use on the basis of incision time, blood loss, early postoperative pain and analgesia requirements.
Detection, treatment and outcome of axillary recurrence after axillary clearance for invasive breast cancer
Authors: de Boer R , Hillen H F P , Roumen R M H , Rutten H J T , van der Sangen M J C , Voogd A C 
Published: March 2003

Abstract

Background
The aim was to gain insight into the diagnosis, treatment and prognosis of axillary recurrence after axillary clearance for invasive breast cancer in a large patient series.

Methods
Between 1984 and 1994, 4669 patients with invasive breast cancer underwent axillary clearance in eight community hospitals in the south-eastern part of the Netherlands. Using follow-up data in a population-based cancer registry, 59 patients with axillary recurrence were identified.

Results
The median interval between treatment of the primary tumour and the diagnosis of axillary recurrence was 2·6 (range 0·3–10·7) years. In 51 patients (86 per cent), axillary recurrence was found by palpation during routine follow-up. Surgery was part of the treatment of recurrence for 41 of 59 patients. Regional control (complete eradication of axillary recurrence) was achieved in 34 patients (58 per cent). The 5-year actuarial survival rate was 39 (95 per cent confidence interval 25–53) per cent. Patients with negative axillary lymph nodes at the time of diagnosis of the primary tumour and complete eradication of axillary recurrence had the best prognosis.

Conclusion
Patients with axillary recurrence had a poor prognosis, except when complete eradication was achieved and axillary lymph nodes were negative at the time of diagnosis of the primary tumour.
Review of current practice to establish success after vasectomy
Authors: Bradshaw H D , Rosario D J , James M J , Boucher N R 
Published: March 2003

Abstract

Background
This study aimed to examine the criteria used by surgeons in a district general hospital to confirm success following vasectomy, to establish the proportion of men undergoing vasectomy in whom the procedure was unsuccessful according to those criteria, and to evaluate their subsequent management.

Methods
All 15 surgeons performing vasectomy indicated that they required two consecutive azoospermic postvasectomy semen specimens before they advised couples that the vasectomy was successful. Results of postvasectomy semen analysis (PVSA) for all 240 primary vasectomies performed over a 12-month interval were analysed. Minimum follow-up was 30 (range 30–42; median 37) months.

Results
At follow-up 72 men (30 per cent) had not returned postvasectomy samples that fulfilled the criteria, including 18 who were azoospermic on the first PVSA 3 months after vasectomy but who failed to produce a second specimen. In 24 men (10 per cent) who failed to comply with the PVSA protocol, there was no documentation of any further action being taken. No pregnancies were reported in the partners of the study group during this interval and only one patient underwent repeat vasectomy.

Conclusion
The results suggest that the strict requirement of two consecutive azoospermic postvasectomy semen specimens may be unjustified, leads to a high level of non-compliance and causes unnecessary delay in confirming success of the procedure.
Somatostatin receptor imaging, therapy and new strategies in patients with neuroendocrine tumours
Authors: Slooter G D , Mearadji A , Breeman W A P , Marquet R L , de Jong M , Krenning E P , van Eijck C H J 
Published: March 2003

Abstract

Background
Somatostatin receptors have been found on a variety of neuroendocrine tumours, such as carcinoids and paragangliomas, as well as on most pancreatic endocrine and breast tumours. Somatostatin receptor scintigraphy with a radionuclide-labelled somatostatin analogue, [111Indium-diethylenetriaminopenta-acetic acid]octreotide, is a sensitive and specific technique for visualizing in vivo the presence of somatostatin receptors on various tumours.

Methods
Material was identified from previous review articles, references cited in original papers and a Medline search of the literature. Additional material was obtained from recently published abstracts of meetings.

Results and conclusion
Somatostatin receptor imaging of neuroendocrine tumours is essential in the diagnostic evaluation of most of these tumours. The expression of somatostatin receptors in vivo not only predicts the outcome of somatostatin analogue treatment but also opens the possibility of new therapeutic strategies. Because better information about spread of the disease can be obtained, more justifiable options for therapy can be proposed.
Tumour necrosis factor inhibitors reduce the acute-phase response in hapten-induced colitis
Authors: Armstrong A M , Foulkes R , Jennings G , Gannon C , Kirk S J , Gardiner K R 
Published: March 2003

Abstract

Background
Tumour necrosis factor (TNF) α has been implicated in the pathogenesis of inflammatory bowel disease. The aim of this study was to assess the contribution of TNF to the pathogenesis of hapten-induced colitis.

Methods
Colitis was induced in Wistar rats using intracolonic instillation of the hapten trinitrobenzenesulphonic acid (TNBS) in ethanol. Animals were treated with monoclonal anti-TNF antibody (cTN3), an idiotype control antibody (CB0006) or pentoxifylline. Colonic and systemic inflammation was assessed quantitatively.

Results
The use of either TNF inhibitor attenuated the acute-phase response in the early stages of colitis. Median (interquartile range (i.q.r.)) α2-macroglobulin levels were reduced in animals pretreated with cTN3 (421 (279–915) μmol/ml) or pentoxifylline (567 (253–1454) μmol/ml) compared with levels in untreated colitic animals (1552 (1406–1998) μmol/ml) (P &lt; 0·001 and P = 0·006, respectively). In established colitis, administration of anti-TNF antibodies resulted in an increase in median (i.q.r.) weight gain (percentage change in body-weight): colitic animals −2·3 (− 5·5 to 9·2) per cent versus cTN3-treated rats 15 (7·5–16·7) per cent; P &lt; 0·05.

Conclusion
The systemic response to TNBS-induced colitis appears to be at least partially dependent on TNF. This study did not provide evidence to support a role for TNF in the pathogenesis of colonic inflammation in this model.