bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevention and management of hypothyroidism after thyroidectomy for thyrotoxicosis
Authors: Michie W. , Beck J. Swanson , Pollet J. E. 
Published: April 2005

AbstractPostoperative hypothyroidism is the most common complication of thyroidectomy for thyrotoxicosis. Its incidence is inversely related to remnant size. Destructive autoimmunity, as measured by the presence of antithyroid antibodies in the serum, may be another of the factors predisposing to postoperative hypothyroidism, but the extent to which such considerations should influence remnant size is a matter for debate. Experience in Iceland suggests that high iodine ingestion is associated with a low incidence of hypothyroidism and a high rate of recurrent thyrotoxicosis; consequently, smaller remnants are obligatory in Iceland. Therefore, it would seem that environmental factors also play a part, and that a remnant “norm” for each locality should be determined empirically to achieve optimum balance between hypothyroidism and recurrent thyrotoxicosis. With the establishment of a “norm,” prediction of hypothyroidism for a group of patients is reasonably accurate. For the individual patient, postoperative status cannot be predicted and it is not possible to select for alternative methods of treatment patients who might be at risk of postoperative hypothyroidism.Irrespective of large remnant size, approximately 15% of patients will develop postoperative hypothyroidism. These may be the patients described at the turn of the century, before effective treatment became available, in whom the natural course of the disease progressed through euthyroidism to hypothyroidism. It would appear, for some patients at least, that surgery merely accelerates the natural course of the disease and compresses into a matter of weeks events which normally take several months and even years. Fortunately, postoperative hypothyroidism declares itself within 12–15 months and, if clinical scrutiny is sufficiently acute, late onset hypothyroidism is rare. The ethical responsibility remains for a prolonged follow‐up of all postthyroidectomy patients.
Needle aspiration and needle biopsy of the thyroid
Authors: Esselstyn Caldwell B. , Crile George 
Published: April 2005

AbstractA definitive preoperative diagnosis is not readily available for the majority of patients with an enlarging thyroid gland or nodule, but thyroid needle biopsy yields an immediate, safe, and accurate histopathologic diagnosis. In a review of 460 patients having thyroid needle biopsy at the Cleveland Clinic from 1967 to 1976, sufficient biopsy material was available for diagnosis in 410 patients. In 44 patients operations were performed for benign disease for a variety of reasons. In 23 patients operations were performed for thyroid malignancy; in 14 of the latter group the diagnosis was made by needle biopsy and confirmed surgically. Of 9 other patients operated on for thyroid malignancy, 6 had thyroid surgery because needle biopsy showed a follicular neoplasm in which malignancy could not be ruled out, and in the remaining 3, clinical findings and the hypercellular nature of the biopsy prompted operation. In an additional 9 patients thyroid malignancy was diagnosed by needle biopsy, but no operation was performed (1 because of age and prohibitive cardiac risk, 2 because the cancer was metastatic to the thyroid from a separate primary, and 6 because the neoplasms were lymphoma or small cell undifferentiated carcinomas that were treated by radiotherapy). There were 3 complications in 460 biopsies (transient recurrent nerve palsy, hematoma, and local discomfort), all of which were short‐lived and minimal. The true value of needle biopsy was that 393 patients with benign disease were spared unnecessary surgery. After a quarter century of experience with this technique, the authors propose that needle biopsy be used more often to eliminate the mortality, morbidity, and significant cost of unnecessary thyroid surgery, and the uncertainty and expense of less accurate diagnostic methods.
Survival after mastectomy for breast cancer: Predictive value of lymphocyte count and its change after mastectomy in patients with metastases to one to three axillary nodes
Authors: Meyer Kenneth K. 
Published: April 2005

AbstractA low preoperative lymphocyte count that increased after mastectomy was found to be a probably effective predictor of disease‐free survival in women with breast cancer and histologically proven metastases to 1–3 axillary nodes only. Two of 44 patients with < 2,000 lymphocytes/mm3, and 16 of 30 with > 2,000 lymphocytes/mm3 preoperatively developed recurrence within 5 years after mastectomy (p<0.001). Eight patients died and all had preoperative lymphocyte counts of > 2,000/mm3 (p<0.0001). None of 17 patients whose lymphocyte count remained unchanged or rose 1 week postoperatively developed recurrence, while 6 of 14 whose count fell did so (p<0.01). Postmastectomy irradiation was followed by a significant increase in metastases when the preoperative count was <2,000 lymphocytes/mm3 (9 of 28 patients), compared to when the count was > 2,000/mm3 (2 of 44 patients) (p<0.01).Patients with histologically proven metastases to 1–3 axillary nodes whose preoperative total lymphocyte count is < 2,000/mm3 require no adjuvant therapy and seem to be made worse by radiation therapy. Those with > 2,000 lymphocytes/mm3 will probably benefit from adjuvant chemotherapy.
Importance of surgical technique in prevention of retained and recurrent bile duct stones
Authors: Orloff Marshall J. 
Published: April 2005

AbstractApproximately 10% of the 500,000 patients who undergo cholecystectomy for gallstones each year in the U.S.A. have associated choledocholithiasis. Of the patients who have a choledocholithotomy, 10–13% are found to have retained bile duct stones in the immediate postoperative period, and an unknown additional number are found to have biliary calculi subsequently. Residual bile duct calculi come from 3 sources, namely, “retained” stones that were overlooked during the initial operation, “retained” stones that were recognized but could not be removed at the initial operation, and “recurrent” stones that re‐form in the bile ducts in association with highly lithogenic bile. Most retained stones can be prevented by knowing when and how to perform common bile duct exploration. Absolute indications, which have a high yield of calculi, are: (a) palpable stones, (b) obstructive jaundice with cholangitis, (c) demonstration of stones by cholangiography, and (d) dilatation of the common duct beyond a diameter of 12 mm. Relative indications, use of which requires judgment because of a generally low yield of calculi, are: (a) jaundice without cholangitis, (b) biliary‐enteric fistula, (c) small stones in the gallbladder, (d) a single‐faceted gallbladder stone, and (e) pancreatitis.Technical aspects of common duct exploration that are important for prevention of retained bile duct calculi include: (a) routine use of a Kocher maneuver, (b) routine preexploratory operative cholangiography, (c) use of the balloon‐tipped catheter, (d) routine completion cholangiography through a T tube, and (e) operative biliary endoscopy. A large number of retained stones results from inadequate operative cholangiography due to poor radiographic equipment, inattention to details of technique, and insufficient collaboration between radiologist and surgeon.Since approximately 25% of reoperations for residual stones are followed by subsequent recurrence of choledocholithiasis, sphincteroplasty and choledochoduodenostomy play an important role in prevention of recurrent calculi. Use of these adjunctive biliary drainage procedures is indicated: (a) when it is impossible to surgically extract bile duct stones or for impacted ampullary stones, (b) when the biliary tree is “packed” with many stones, (c) when reoperation is required for primary bile duct stones, (d) in third operations for bile duct calculi of any type, and (e) rarely, when bile duct stones are associated with stenosis of the papilla of Vater.
Choledochoscopy and operative fluorocholangiography in the prevention of retained bile duct stones
Authors: Berci George , Shore J. Manny , Morgenstern Leon , Hamlin J. Andrew 
Published: April 2005

AbstractCholedochoscopy has become a clinically accepted adjunct to choledochotomy as a result of recent advances in optics and instrumentation technology. Experience with this diagnostic modality during the past 18 years has led to the development of a compact, right‐angled, rigid, rod‐lens choledochoscope. Because of the excellent image quality and easy manipulation of this new instrument, choledochoscopy can be easily incorporated into routine surgical procedures on the biliary tract. Clinical results of choledochoscopy in a recent series of 120 consecutive choledochotomies are presented. The incidence of retained stones was reduced to 2%. Further advantages were: direct endoscopic removal of calculi, biopsy of biliary tumors, and immediate interpretation of questionable operative cholangiograms. Direct visual diagnosis of the problematic distal duct facilitated appropriate operative management without prolonging operating time. The procedure was carried out without increasing the complication rate beyond that of standard choledochotomy.The standard technique of operative cholangiography, using a portable x‐ray machine, has many disadvantages, including extended operating time, blind exposure of the films, a high incidence of blurred or technically inadequate films, and frequent need to repeat the procedure. A technique of operative fluorocholangiography is described which uses fixed equipment that incorporates modern advances in diagnostic radiology, but is modified to suit the surgical environment. The contrast material inflow is observed by television‐fluoroscopy and the exposures, using indirect radiographic techniques, are made under visual control. The advantages of this new technique are: aimed small format film technique, automatic exposure (brightness, contrast) control, serial films (6–12 instead of 3), reduction of radiation, high quality films, and a significant decrease of time required for a complete examination (5 min). The value of operative fluorocholangiography is emphasized for assessment of sphincter function and duct motility, as well as for the localization of bile duct stones.
Transduodenal endoscopic sphincterotomy and extraction of bile duct stones
Authors: Safrany Laszlo 
Published: April 2005

AbstractRetained and recurrent common bile duct stones have required surgical treatment. Recent advances in endoscopy, however, have made possible endoscopic management of choledocholithiasis. This report describes the method of endoscopic sphincterotomy and the results in 562 patients with choledocholithiasis in whom the procedure was attempted during the past 4 years. Endoscopic sphincterotomy was successfully accomplished in 523 patients (93%). There were 428 patients with retained or recurrent common bile duct stones after cholecystectomy. In 95 high‐risk patients with choledocholithiasis and cholelithiasis, endoscopic sphincterotomy was carried out to relieve jaundice. In 188 patients the stones passed spontaneously after sphincterotomy. In 306 patients, the stones were extracted. Residual stones remained in 29 patients. Complications consisting of bleeding, retroperitoneal perforation, pancreatitis, cholangitis, and stone impaction occurred in 36 patients (6.9%). In 10 patients (1.9%), complications made emergency surgery necessary and resulted in 5 deaths for a mortality rate of 1%. The good results, low morbidity, and low mortality of endoscopic sphincterotomy support the suggestion that this method of treatment has earned a firm place in modern biliary surgery.
The prevention and treatment of recurrent bile duct stones by transduodenal sphincteroplasty
Authors: Jones S. Austin 
Published: April 2005

AbstractSphincteroplasty is a transduodenal method of producing a terminal choledochoduodenostomy as wide as the supraduodenal common duct. The sphincters affecting common and pancreatic ducts are destroyed, making the opening noncontractile and permanent. To achieve this, the common and duodenal walls are divided between clamps and oversewn. The resulting stoma differs anatomically and physiologically from that of sphincterotomy, which leaves functioning sphincter behind. This is demonstrable by postoperative T‐tube pressure and flow studies before and after morphine, and free reflux and stomal permanence after sphincteroplasty. Such an opening prevents trapping of overlooked stones or bile stasis with stone formation.Sphincteroplasty has been performed in a series of 312 patients with a mortality of 0.96% and a morbidity of 4.7%. There have been no deaths in the last 200 patients. There were 211 operations performed for obstructive biliary disease, on the basis of 1 or more indications: multiple common duct stones were present in 187, irremovable hepatic duct calculi in 4, and residual stone in 22 referred patients. In addition, miscellaneous indications for operation included papillary stenosis, strictures, irremovable calculi, and mud and sludge. All 211 patients were relieved of bile duct obstruction and there were no residual stones following sphincteroplasty.It is stressed that sphincteroplasty is one of several ways to achieve free bile duct drainage. These methods should not be considered competitive. The operation selected should be tailored to meet the specific situation at hand.
Clinical and experimental studies of oral 5‐FU emulsion as an adjuvant to the surgical treatment of gastric cancer
Authors: Nishioka Bunzo , Watanabe Shinsuke , Fujita Yoshihiro , Majima Susumu , Takahashi Toshio 
Published: April 2005

AbstractBased on the propensity of fat emulsion to be absorbed mainly into lymphatic capillaries and regional lymph nodes, we studied experimentally and clinically the effectiveness of oral administration of a 5‐fluorouracil (5‐FU) emulsion as an adjuvant to surgery in the treatment of gastric cancer, especially when there were lymph node metastases. Experiments in rats showed that drug concentration in the regional lymph nodes was higher and remained longer after oral administration of 5‐FU emulsion than after oral administration of an aqueous solution of 5‐FU. Furthermore, measurement of the concentration of 5‐FU in the regional lymph nodes of 13 patients with gastric cancer who had been given the 5‐FU emulsion or 5‐FU in water orally 2 hours before surgery showed that the mean 5‐FU level was higher in the patients that received the emulsion than in those who received the aqueous solution. In the past 3 years, we have administered 5‐FU emulsion to 123 patients with gastric cancer for a period of 1–3 weeks before surgery, and examined histologically the effect of this therapy on the met astatic foci in the lymph nodes. A positive change, such as marked necrosis or marked degeneration, was found in 62% of the metastatic lesions. The results suggest that preoperative oral administration of 5‐FU emulsion may be effective as an adjuvant to surgery for gastric cancer, particularly in patients with metastases to lymph nodes.
Late results of perforated duodenal ulcer treated by simple suture
Authors: Skovgaard Søren 
Published: April 2005

AbstractA study was performed of 156 patients who underwent follow‐up evaluations 3 to 23 years (mean 13 years) after simple closure of a perforated duodenal ulcer. Subsequent definitive ulcer surgery was indicated in 111 patients (71%) for severe recurrent dyspepsia. Bleeding, reperforation or pyloric obstruction occurred in 14 patients (9%). Among 33 patients (21%) with an ulcer history of less than 3 months prior to perforation, only 4 (12%) required further surgery while a subsequent operation was indicated in 107 of 123 patients with a longer ulcer history. Immediate definitive surgery is indicated for perforated duodenal ulcer in patients with ulcer symptoms for more than 3 months before perforation. Simple suture of the perforation is sufficient treatment for patients with a shorter ulcer history.
Hypercalcemia and urinary excretion of cyclic AMP in bronchogenic carcinoma
Authors: Francini Guido , Galli Marco 
Published: April 2005

AbstractPlasma calcium and phosphate levels and the cyclic AMP/creatinine ratio in the urine were studied in 23 patients with bronchogenic carcinoma. Hypercalcemia was found in 4 patients (17.4%), confirming the frequency of this abnormality observed by others. However, only one patient had both hypercalcemia and hypophosphatemia. In 4 patients with hypercalcemia and no bone metastases, surgical removal of the tumor was followed by return of the plasma calcium level to normal, suggesting that the hypercalcemia was caused by ectopic secretion of a parathormone‐like substance by the neoplasm. Contrary to what might be expected, the urinary cAMP/Cr ratio was abnormally low in most patients, including 3 of the 4 patients with hypercalcemia. Moreover, the cAMP/Cr ratio in the urine did not decrease after removal of the tumor. This finding suggests another difference between PTH‐like substances of neoplastic origin and natural PTH if, indeed, a PTH‐like substance was responsible for the hypercalcemia.
Use of an external bypass technique in gastrointestinal and biliary surgery
Authors: Zer M. , Mukamel E. , Dintsman M. 
Published: April 2005

AbstractA simple, easily employed method of external bypass in gastrointestinal and biliary surgery is described. This method aims to minimize fluid loss through postoperative leaks, thereby preventing the complications which may ensue, and also is effective in achieving decompression of a viscus without causing diversion of the biliary and gastrointestinal enzymes from the gastrointestinal tract.
Intraluminal techniques for vena caval interruption and pulmonary embolectomy
Authors: Greenfield Lazar J. 
Published: April 2005

AbstractAlthough most patients who sustain thromboembolism can be managed by anticoagulation, a number of them benefit from mechanical protection against further embolism or require embolectomy for survival. Intraluminal approaches have been developed recently as an alternative to major surgical procedures for these aims and show improved effectiveness and reduced morbidity and mortality rates. Clinical results using the Kimray‐Greenfield vena caval filter in 76 patients since 1972 include a mortality rate of 4% within 2 weeks after operation and 17.1% thereafter due to underlying disease. Recurrent thromboembolism was seen in 2.6% and the incidences of thrombophlebitis and extremity edema were comparable to the experience with the Mobin‐Uddin umbrella. In contrast to that experience, migration of the filter has not occurred and the postoperative vena cava patency rate at 11 months by venacavography is 97%. Transvenous pulmonary embolectomy has been performed in 22 patients and the development of a steerable catheter with simultaneous insertion of the vena caval filter reduced the operative mortality rate from 40% to 17%. Emboli were removed in 86% of patients and overall survival has been 14 of 22 patients (64%). Catheter embolectomy under local anesthesia provides a useful alternative to open embolectomy requiring cardiopulmonary bypass.
Disorders of intermediary metabolism: Toxic leukoencephalopathies
Authors: Hörster F. , Surtees R. , Hoffmann G. F. 
Published: April 2005

SummaryMyelination starts in the latter half of gestation. It is initiated by oligodendrocyte progenitor cells. Three sequential steps can be distinguished: (1) initial ensheathment of axons by premyelin sheaths generated by oligodendrocyte progenitor cells; (2) initial insertion of myelin basic protein (MBP) into transitional sheaths; and (3) generation of mature MBP‐rich myelin. Different inborn errors of metabolism can interfere with different stages of these physiological processes, causing white‐matter diseases, i.e. toxic leukoencephalopathies. Some inborn errors of metabolism disturb the formation of myelin by being toxic to oligodendrocytes or by interference with the biosynthesis of cholesterol and lipids, e.g. globoid cell leukodystrophy and phenylketonuria. Remethylation defects, e.g. methylenetetrahydrofolate reductase deficiency, cobalamin C, D, E, F and G defects, interfere with the expression, processing and insertion of MBP. The concept of excitotoxicity, which has been developed in neurons, has recently been modified and has been extended to the oligodendroglial lineage. Mitochondriopathies and cerebral organic acid disorders may cause secondary excitotoxicity resulting in toxic encephalopathies, which may affect both neurons and oligodendrocytes. This review aims to present relevant diseases, summarizing recent knowledge on mechanisms and formulating testable hypotheses of pathophysiology leading to new and improved treatment strategies.
Gamma‐hydroxybutyric aciduria: A biochemist's education from a heritable disorder of GABA metabolism
Authors: Gibson K. M. 
Published: April 2005

SummaryIn keeping with the theme of the 41st Annual Symposium (Metabolic Encephalopathies), the current report provides an overview of a quarter century of research investigating a rare inborn error of GABA metabolism, succinic semialdehyde dehydrogenase (SSADH) deficiency (also referred to as gamma‐hydroxybutyric aciduria). The clinical phenotype, treatment challenges, pathomechanistic concepts, as well as metabolic, enzymatic and molecular characteristics, of the disorder are summarized. In addition, important features of a recently developed murine model are presented, with discussion of how this model has broadened thinking about, and treatment approaches to, the clinical disease. In addition, a brief scientific history of the author is provided, and an account of how serendipitous circumstances brought him together with other colleagues to begin delineating the aetiological mechanisms in SSADH deficiency. The evolution of research on SSADH deficiency re‐establishes the classical approach beginning at clinical characterization, evolving to enzyme and metabolite identification as well as molecular characterization, and eventually to model development and preclinical treatment approaches. This scientific evolution admirably supports the life and ideals of Dr George Komrower, in whose honour this lecture is named.
Microsite variation in light availability and photosynthesis in a cool‐temperate deciduous broadleaf forest in central Japan
Authors: Sakai Toru , Saigusa Nobuko , Yamamoto Susumu , Akiyama Tsuyoshi 
Published: April 2005

AbstractAn empirical light simulation model was applied to estimate stand scale photosynthesis in a deciduous broadleaved forest in central Japan. Based on diurnal courses of photosynthetically active photon flux density (PPFD), we characterized the components of incoming light within the forest canopy, and found that the instantaneous relative PPFD (PPFD under the canopy relative to that above the canopy) under diffuse light condition was a reliable estimator of the intensity and duration of PPFD. We calculated the daily photosynthesis (Aday) for each PPFD class using photosynthesis–light response curves. Model simulated Aday were corroborated with the estimates obtained from the nearby CO2 flux tower. The result demonstrated the potential of the light simulation model. The light use efficiency of two dominant species, Betula ermanii as overstory and Sasa senanensis as understory species, were then evaluated. At the forest understory, PPFD under 50 μmol m−2 s−1 contributed to 77% of the sunshine duration on a completely clear day. Therefore, a higher apparent quantum yield for S. senanensis enhanced the utilization of low PPFD for photosynthesis. On the other hand, at the upper forest canopies, B. ermanii with a higher light‐saturated photosynthetic rate used high PPFD efficiently. Consequently, potential of daily net photosynthesis for both B. ermanii and S. senanensis was high under each light condition. Such interspecific difference in the patterns of light utilization was suggested as one of factors allowing coexistence of the two species in the study forest.