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At least 199 records · Page 11Linked to original sources

PubMed2006

Unilateral cervical surgical exploration aided by intraoperative parathyroid hormone monitoring in patients with primary hyperparathyroidism and equivocal sestamibi scan results.

HYPOTHESIS: Equivocal parathyroid technetium Tc 99m sestamibi scan results are likely to demonstrate the correct location for parathyroid adenomas. DESIGN: Patients with primary hyperparathyroidism prospectively consented to participate in an institutional review board-approved study. The parathyroid technetium Tc 99m sestamibi scan results were classified as positive, negative, or equivocal. SETTING: A tertiary private hospital in which university faculty practice. PATIENTS: Technetium Tc 99m sestamibi imaging was performed for 464 patients with primary hyperparathyroidism. Eighty-four of these patients had scan results considered equivocal for unilateral adenomas. The algorithm for this group of patients specified that they should receive an injection with technetium Tc 99m sestamibi prior to parathyroidectomy and that an intraoperative parathyroid hormone (iPTH) level decrease of more than 50% be used to define intraoperative success. Seventy-two patients had postoperative calcium levels measured at least 2 weeks after their surgical procedure and defined the study group. The mean follow-up was more than 6 months. INTERVENTION: Parathyroidectomy. MAIN OUTCOME MEASURE: Correlation of equivocal scan interpretation with operative findings and biochemical cure of hyperparathyroidism. RESULTS: Of the 72 patients, 39 underwent unilateral surgical explorations and 33 underwent bilateral surgical explorations; 67 (93%) of the patients were initially cured and 68 (94%) were ultimately cured. In the unilateral group, 38 (97%) of the patients were cured. The 1 failure was associated with a false-positive iPTH level decrease. In the bilateral group, 29 (88%) of the patients were initially cured and 30 (91%) were ultimately cured. Two failures were associated with a false-positive iPTH level decrease and 2 with failure to find the adenoma. Of the 33 patients in the bilateral group, surgical exploration of the opposite side was purely by surgeon choice in 11 cases. Of the other 22 patients, in addition to the 3 failures, 7 had 4-gland hyperplasia, 4 had double adenomas, and 6 had false-negative iPTH level results with iPTH level decreases of less than 50%. CONCLUSION: Overall, between 48 (67%) and 54 (75%) of the 72 patients would have been cured with unilateral surgical exploration alone.

Adenoma↗

PubMed1987

Mandatory vs selective exploration for penetrating neck trauma. A prospective assessment.

To determine the optimal management of patients with penetrating wounds to zone II of the neck, we performed a prospective evaluation of 120 consecutive patients with such injuries, correlating the results of clinical and diagnostic examinations with operative findings. Seven patients presenting with life-threatening hemorrhage from the neck wound were operated on immediately; the remaining 113 patients underwent arteriography, laryngotracheoscopy, esophagoscopy, and esophagography, followed by neck exploration. Forty-eight major injuries were identified in 35 neck explorations. Five patients were identified with clinical and diagnostic findings that were considered normal preoperatively; however, at operation six major injuries were found in these patients. This study indicates that potentially lethal injuries to major vascular and visceral structures in the neck may go undetected if selective exploration criteria are used in the decision to explore penetrating wounds to zone II of the neck.

Adolescent↗

PubMed1979

Exploration of the common bile duct: a comparative study.

The results of a retrospective comparative study of 122 patients who underwent explorations of the common bile duct in a district general hospital over a 5-year period are presented. Seventy-eight patients had a supraduodenal choledochotomy, 32 had a transduodenal spincterotomy and 12 had a combination of both procedures. Particular attention was paid to postoperative complications in relation to the grade of the surgeon performing the operation and also to the age of the patient. A total of 78 (64 per cent) patients had definite stones in the common bile duct. Of these patients, 7 (9 per cent) were subsequently shown to have retained stones, all having been operated on by registrars. Registrars also did more negative explorations than consultants. Nine patients (7.4 per cent) died, all but 1 of them being over the age of 70 and 4 of them having had a combined procedure. We conclude that transduodenal exploration should be avoided in patients over 70, particularly when added to a supraduodenal exploration.

Adult↗

PubMed1982

Primary hyperparathyroidism due to overactive intrathyroid parathyroid glands: a potential cause of failed exploration.

The variable location of the parathyroid glands is a significant factor in unsuccessful cervical exploration for hyperparathyroidism. Particular difficulty may be experienced when an overactive parathyroid is concealed within the substance of the thyroid. Currently available methods of localizing abnormal parathyroid tissue may well fail to indicate an intrathyroid location. The latter possibility should always be considered whenever thorough cervical exploration has failed to reveal a parathyroid tumour as such awareness may obviate re-exploration or an unnecessary sternotomy. This report details the clinical features and operative findings in 6 patients whose primary hyperparathyroidism was due to an overactive intrathyroid parathyroid gland. Successful parathyroid surgery demands a strict routine exploration of the possible sites of overactive glands, virtually all of which are easily accessible through a standard collar incision.

Adenoma↗

PubMed1995

Laparoscopic exploration of the common bile duct: lessons learned from 129 consecutive cases.

Since the introduction of laparoscopic cholecystectomy there has been widespread debate about the best way to manage common bile duct (CBD) calculi. Between August 1991 and July 1994, 129 patients underwent laparoscopic exploration of the CBD. Fifteen patients of median age 52 years were managed by glucagon-induced relaxation of the sphincter of Oddi and saline flushing of the bile duct through a cholangiogram catheter. This had a success rate of 73 per cent and took a median of 90 min including cholecystectomy. The technique has now been replaced by Dormia basket exploration of the CBD. Transcystic common duct exploration using a Dormia basket was used in 79 patients of median age 47 years. Duct clearance was achieved in 96 per cent of cases with a median operating time of 55 min. Thirty-five patients of median age 52 years were managed by choledochotomy and T tube placement, with a 91 per cent duct clearance rate and a median operating time of 120 min. Overall duct clearance was achieved in 92 per cent of patients with an operative morbidity rate of 5.4 per cent. Duct clearance using either a Dormia basket or choledochotomy and T tube placement was obtained in 95 per cent of patients. Laparoscopic exploration of the CBD is an important alternative in the management of common duct calculi.

Adult↗

PubMed2006

Gaining knowledge from previously unexplained spectra-application of the PTM-Explorer software to detect PTM in HUPO BPP MS/MS data.

A novel software tool named PTM-Explorer has been applied to LC-MS/MS datasets acquired within the Human Proteome Organisation (HUPO) Brain Proteome Project (BPP). PTM-Explorer enables automatic identification of peptide MS/MS spectra that were not explained in typical sequence database searches. The main focus was detection of PTMs, but PTM-Explorer detects also unspecific peptide cleavage, mass measurement errors, experimental modifications, amino acid substitutions, transpeptidation products and unknown mass shifts. To avoid a combinatorial problem the search is restricted to a set of selected protein sequences, which stem from previous protein identifications using a common sequence database search. Prior to application to the HUPO BPP data, PTM-Explorer was evaluated on excellently manually characterized and evaluated LC-MS/MS data sets from Alpha-A-Crystallin gel spots obtained from mouse eye lens. Besides various PTMs including phosphorylation, a wealth of experimental modifications and unspecific cleavage products were successfully detected, completing the primary structure information of the measured proteins. Our results indicate that a large amount of MS/MS spectra that currently remain unidentified in standard database searches contain valuable information that can only be elucidated using suitable software tools.

Amino Acid Sequence↗

PubMed2002

The role of personality, parents and peers in adolescents career exploration.

The role of individual characteristics, parental behaviours and peers for occupational exploration was examined in a sample of 192 German ninth graders (80 girls, 112 boys) from middle-track schools. The adolescents completed questionnaires at two points of measurement which were 6 months apart. The results showed that individual characteristics which reflected an active and constructive approach to developmental demands were correlated with more intense occupational exploration. Child-centred parental behaviours were also correlated positively with information-seeking behaviours. Moreover, parental behaviours predicted change in exploration over the observed time period. Concerning the role of peers which was often neglected in career development theory, the results showed that frequent talks with peers about career-related issues were significantly associated with the intensity of information-seeking behaviours and, at the same time, predicted an intensification of occupational exploration during the following 6-month period. The findings suggest that it would be fruitful to consider more thoroughly the role of peers in future research on adolescents' career development.

Adolescent↗

PubMed1976

Stereo-electroencephalographic exploration and epilepsia partialis continua.

Somatomotor status epilepticus in infatnts consisting of continous repetitive clonic jerks as a sequel of involvment of the sensorimotor area cortex has rarely been explored by multiple depth electrodes. The authors report 3 cases, which were examined stereo-electroencephalographically. Two girls, a 5 year old and a 3 year old showed sustained jerks of one foot with intermittent Jacksonian seizures. Both had a primary epileptogenic focus in the medial prerolandic and postrolandic cortex. The third case, an 8 year old girls, was a borderline case of Kozevnikov epilepsy. All 3 patients were operated on following the stereo-electroencephalographic exploration and the focus was removed. The study shows that it is possible to explore children with depth electrodes and that this exploration is the safest way to localize a focus and, consequently to cure the patient by surgery.

Brain Mapping↗

PubMed1987

The effects of repeated doses of ethanol on exploration and its habituation.

The effects of ethanol (0.8-2.4 g/kg) on exploratory behavior and its habituation were investigated by testing DBA/2 mice in a holeboard apparatus. Mice familiar with the holeboard had lower levels of exploration than animals with no previous experience in the apparatus. If the animals received ethanol during their first exposure to the holeboard they did not show the same degree of habituation. Ethanol (0.8 g/kg) increased the exploration of animals naive to the holeboard, but failed significantly to increase the exploration of animals familiar with the apparatus. An increase in locomotor activity was observed following treatment with ethanol (2.4 g/kg). This was potentiated if animals received a single treatment with ethanol 3 days earlier, but only if they were tested in the apparatus following the initial treatment. These results have important implications for the design of experiments investigating tolerance and sensitization to ethanol's effects on locomotor activity and exploration.

Animals↗

PubMed1975

Effects of low doses of catecholamine receptor agonists on exploration in mice.

Female mice were given 0.025--0.8 mg/kg of the dopamine and noradrenaline receptor agonists apomorphine and clonidine, respectively, and the effect on explorative behaviour of these drugs was tested in a Y-shaped runway for three minutes. Saline-treated controls displayed a stable exploratory behaviour, declining during the time period measured. The decline probably reflects adaptation to the new environment. Apomorphine depressed the activity, but the configuration of the time curve was the same as in controls. Clonidine also depressed the exploratory activity and further appeared to break the pattern of adaptation, the activity in clonidine-treated mice being low from the beginning. The higher doses of the drugs, alone or in combination, caused a pronounced suppression of the exploration. These mice were observed for ten minutes, under which period their exploration of the runway was not increased, as compared with the first three minutes. The smaller doses used are not known to cause functionally measureable activation of postsynaptic catecholamine receptors. On the other hand these doses are known as cause inhibition of firing in the respective presynaptic neurons and also inhibition of synthesis of the respective transmitter. Thus the present findings are interpreted to be due to presynaptic inhibition of the respective neurons. Clonidine caused a more pronounced inhibition of the exploration than apomorphine, suggesting nordrenaline to be of particular importance for exploratory behaviour.

Animals↗

PubMed1994

Interactions of Ro15-4513, Ro15-1788 (flumazenil) and ethanol on measures of exploration and locomotion in rats.

The present study investigated the role of the GABAA-benzodiazepine (BDZ) receptor complex in mediating ethanol (ETOH)-induced increases in exploration (head-dipping) and locomotion of rats in a holeboard test. Male Sprague-Dawley rats were selected based on low basal exploratory rates to increase the likelihood that ETOH would increase these behaviors. The effects of the BDZ partial inverse agonist, Ro15-4513 (2.5 mg/kg), and the BDZ receptor antagonist, Ro15-1788 (flumazenil) (8.0 mg/kg), alone, and in combination with ETOH (0.25, 0.50 and 0.75 g/kg, IP) were investigated. The 0.25 and 0.50 g/kg doses of ETOH markedly increased both exploration and locomotion in low exploratory rats. The ETOH-induced increases were prevented by Ro15-4513 on both measures at a dose that produced no observable intrinsic action; however, this apparent lack of intrinsic activity on exploration may have been related to the low basal rates of responding in the subjects. The BDZ antagonist, flumazenil, completely reversed the antagonistic action produced by Ro15-4513 of the ETOH-induced stimulant effects on locomotion, however, flumazenil exerted only a marginal statistically significant effect on Ro15-4513's actions on head-dipping. When flumazenil was given alone, it increased head-dipping, but was without effect on locomotion. Flumazenil did not affect ETOH-induced increases in locomotion; however, ETOH and flumazenil appeared to show agonistic effects on exploration. The different effects exerted by flumazenil alone, and in combination with ETOH on head-dipping and locomotion suggest that the actions of flumazenil on these behaviors are mediated through separate mechanisms. The research further suggests that both the anxiolytic and locomotor activational effects of ETOH are mediated through the GABAA-BDZ receptor complex.

Animals↗

PubMed1992

Do autoreceptors mediate dopamine agonist--induced yawning and suppression of exploration? A critical review.

The hypothesis that stimulation of dopamine autoreceptors is the mechanism by which dopamine agonists induce yawning and suppression of exploration is critically examined. It is shown that the relation between reduced extracellular dopamine levels, assessed by microdialysis, and behavioural effects of dopamine agonists, a dopamine synthesis inhibitor and a granule storage blocker is highly inconsistent. The time-course and duration of the behavioural effects of dopamine agonists differ from the reduction of extracellular dopamine. Amphetamine cotreatment is shown to increase dopamine levels, while yawning and suppression of exploration can still be induced. The data strongly indicate that autoreceptors are not the mediators of these behavioural effects. It is proposed that postsynaptic receptors mediate dopamine agonist induced yawning and suppression of exploration. Evidence is also presented showing that yawning and suppression of exploration are not functionally equivalent.

Animals↗

PubMed1996

[Morbidity in concomitant interventions in neck exploration for primary hyperparathyroidism. Results of a prospective study].

A prospective follow-up study was undertaken in patients undergoing surgical therapy for primary hyperparathyroidism to establish the frequency of concomitant surgical procedures and their influence on the morbidity of cervical exploration. From 1 August 1987 to October 1995, 231 patients underwent cervical exploration for primary hyperparathyroidism. In 16 patients 18 (7.8%) concomitant abdominal and thoracic surgical procedures as well as surgical interventions for soft-tissue tumors were performed. A total of 133 patients (57.6%) underwent thyroid resections of varying extent; 4.8% had carcinoma of the thyroid. Catamnestic data were obtained on the basis of a standardized follow-up in 94.4% of all patients (1-9 follow-up examinations in 216 patients). Hematoma occurred after adrenalectomy in a patient undergoing a concomitant extracervical procedure. In patients with a first manifestation of primary hyperparathyroidism due to a solitary parathyroid adenoma (n = 189), an increase in the morbidity of parathyroid surgery performed in combination with a thyroid resection was observed. Furthermore, a relationship was established between the number of intraoperatively identified parathyroid glands and the incidence of permanent hypoparathyroidism (permanent hypoparathyroidism: initial cervical intervention with parathyroid exploration alone, 2.2%; with concomitant thyroid resection, 6.5%; after secondary thyroid resection and parathyroid exploration alone, 0%; after concomitant thyroid resection, 28.6%; four parathyroid glands identified intraoperatively, 3.1%; fewer than four parathyroid glands identified, 8.2%). The increase in the morbidity of parathyroid surgery in combination with thyroid resection is justifiable, because unsuspected thyroid carcinomas can potentially be treated curatively.

Abdominal Neoplasms↗

PubMed1999

Laparoscopic common bile duct exploration.

Since the introduction of laparoscopic cholecystectomy, the management of common bile duct (CBD) stones has undergone significant change. Preoperative endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy is now routinely done in cases where the diagnosis of choledocholithiasis is suspected preoperatively, with clearance of the bile ducts before laparoscopic cholecystectomy. Intraoperative discovery of CBD stones by cholangiography represents a challenge to the surgeon, who must make a decision about when to perform laparoscopic CBD exploration, convert to open surgery, or send the patient for ERCP during the postoperative period. Because ERCP has a definite failure rate, laparoscopic CBD exploration can be a treatment option. Among 2500 laparoscopic cholecystectomies done by our group from January 1991 to June 1997, 50 patients (2%) underwent laparoscopic CBD exploration, 13 by the transcystic technique and 37 by choledocotomy, with a conversion rate of 8% and a hospital stay of 4.3 days. One patient died from complicated pancreatitis following ERCP and unsuccessful extraction of a CBD stone. We obtained our goal of a CBD free of stones in 92% of the cases. We conclude that laparoscopic CBD exploration is an effective method for treating choledocolithiasis that allows management of this pathology in one stage, although it requires advanced laparoscopic skills and adequate equipment.

Adult↗

PubMed2006

The outcome of cervical exploration for asymptomatic and symptomatic patients with primary hyperparathyroidism.

This study examined the success and safety of cervical exploration in patients with primary hyperparathyroidism (HPT). The presentation, pathologic findings, and outcome of patients with asymptomatic primary HPT were compared with those with symptomatic disease. Records of patients undergoing cervical exploration for primary HPT from January 1993 until December 31, 2003, were reviewed. Information collected consisted of preoperative symptoms, calcium and parathormone (PTH) levels, imaging studies, operative findings, pathology, and outcome of the patients. The groups with asymptomatic and symptomatic primary HPT were compared. In all, 139 patients were studied; 31 (22.3%) were asymptomatic (group I), and 108 (77.7%) had symptoms (group II). The two groups were also comparable regarding mean age, sex, and the yield of the imaging studies. The mean preoperative serum calcium level was comparable in the two groups (11.1 mg/dl versus 11.3 mg/dl). However, PTH levels were significantly lower in group I than in group II (142 pg/dl versus 283 pg/dl, P = 0.01). The weight of the adenoma was also significantly less in group I than in group II (1082 mg versus 1679 mg P = 0.079). The outcome of the surgical exploration was comparable in the two groups with an immediate success rate close to 98% and a long-term success rate of 95.4%. Cervical exploration and parathyroidectomy in patients with primary HPT is a safe procedure with a high success rate and favorable outcome.

Adenoma↗

PubMed2006

Early scrotal exploration in all cases is the investigation and intervention of choice in the acute paediatric scrotum.

The acute scrotum in the paediatric population is a clinical dilemma where a definitive diagnosis can only truly be made at surgical exploration. We postulate that surgical exploration in all cases allows truly accurate diagnoses, treats the torted appendage testes and enables the validity of clinical signs associated with scrotal pathology to be assessed. We retrospectively reviewed all boys less than 15 years old who presented to our institution with scrotal pain over a 2 year period. A total of 121 patients attended of whom 113 had exploratory surgery, 31 (27%) had testicular torsion, 64 (57%) had a torted appendage testis, 12 (11%) had epididymitis, 1 (1%) had fat necrosis and 5 (4%) had no abnormality detected. On exploration 9 (29%) of the torted testis were unsalvageable and thus required excision. The initial clinical impression was frequently demonstrated to be flawed. Two patients with testicular torsion presented with a painless swelling and two further patients had necrotic testes despite a history of pain for less than 4 h. A normal cremasteric reflex and a visible blue dot were detected in boys with testicular torsion. Doppler ultrasound scans were not reliable with 50% sensitivity to clearly differentiate between torsion of the testis and that of the appendage testis. Absolute dependence on clinical features can lead to a misdiagnosis of testicular torsion. The surgical treatment of torted appendage testis is safe, allowing accurate diagnosis and pain relief with minimal morbidity. Early scrotal exploration of all cases with testicular pain ensures maximal testicular salvage.

Acute Disease↗

PubMed2002

Laparoscopic common bile duct exploration.

In recent years, laparoscopic common bile duct exploration has become the procedure of choice in the management of choledocholithiasis in several laparoscopic centers. The increasing interest for this laparoscopic approach is due to the development of instrumentation and technique, allowing the procedure to be performed safely, and it is also the result of the revised role of endoscopic retrograde cholangiopancreatography, which has been questioned because of its cost, risk of complications and effectiveness. Many surgeons, however, are still not familiar with this technique. In this article we discuss the technique and results of laparoscopic common bile duct exploration. Both the laparoscopic transcystic approach and choledochotomy are discussed, together with the results given in the literature. When one considers the costs, morbidity, mortality and the time required before the patient can return to work, it would appear that laparoscopic cholecystectomy with common bile duct exploration is more favorable than open surgery or laparoscopic cholecystectomy with preoperative or postoperative endoscopic sphincterotomy. However, the technique requires advanced laparoscopic skills, including suturing, knot tying, the use of a choledochoscope, guidewire, dilators and balloon stone extractor. Although laparoscopic common bile duct exploration appears to be the most cost-effective method to treat common bile duct stones, it should be emphasized that this procedure is very challenging, and it should be performed by well-trained laparoscopic surgeons with experience in biliary surgery.

Biliary Tract Surgical Procedures↗

PubMed2000

A new technique for laparoscopic exploration to find contralateral patent processus vaginalis.

BACKGROUND: Contralateral inguinal exploration in an infant with a symptomatic unilateral hernia is controversial. A patent processus vaginalis (PPV) may be found in up to 60% of term infants, and even in a greater number of preterm infants. However, only 10% to 30% of children will subsequently develop a contralateral hernia when only the symptomatic side is repaired. Standard contralateral laparoscopic inguinal exploration (CLIE) usually is performed through the ipsilateral groin with an angled scope or through the umbilicus with a 0 degrees scope. A significant number of children have a peritoneal veil shrouding the internal ring. To enhance the accuracy of contralateral groin exploration, we have used a laparoscopic technique of directly visualizing the internal ring through a lateral abdominal approach. METHODS: From January 1993 through June 1997, we performed 141 CLIE on infants younger than 1 year of age with symptomatic unilateral inguinal hernia. After routine dissection on the symptomatic side, the sac was used to insufflate the abdominal cavity. A needle catheter was inserted on the contralateral abdominal wall and used to introduce a 1.2-mm scope. If a PPV was identified, the potential hernia was repaired using standard techniques. RESULTS: Of the 141 CLIEs performed on patients younger than 1 year of age, 39 (27.6%) were positive. There were no false-positives. In all, 42 CLIEs (29.7%) were performed on infants born at less than 36 weeks gestation, and 14 of these infants (33.3%) had a positive exploration. The patients were followed for 3 to 57 months. No complications resulted from the technique. One patient had a recurrence on the repaired side. No patients who had a negative CLIE subsequently developed a contralateral hernia. CONCLUSIONS: The lateral abdominal approach for laparoscopic evaluation of the contralateral groin is safe and accurate, requiring no additional incisions. Longer follow-up is necessary to determine the true false-negative rate.

Female↗