Recurrent hyperparathyroidism caused by benign neoplastic seeding: two cases of parathyromatosis and a review of the literature.

Background: Parathyromatosis is defined as small nodules of hyperfunctioning parathyroid tissue scattered in the soft tissues of the neck and/or mediastinum. Parathyromatosis may be primary, it may be aimed for when autotransplanting parathyroid tissue in secondary hyperparathyroidism, and it may occur after surgery for primary hyperparathyroidism (pHPT). In the latter cases parathyromatosis poses a diagnostic and therapeutic challenge.

The ileo neo rectal anastomosis: long-term results of surgical innovation in patients after ulcerative colitis and familial adenomatous polyposis.

Purpose: Restorative proctocolectomy with ileo neo rectal anastomosis (INRA) combines cure of ulcerative colitis (UC) or familial adenomatous polyposis (FAP) with restoration of intestinal continuity. Evaluation of long-term results was needed to determine if there is a place for INRA in the armamentarium of a surgeon besides the ileal pouch anal anastomosis (IPAA).

Methods: All patients with INRA were included in the analysis.

Shifting incidence of solitary adenomas in the era of minimally invasive parathyroidectomy. A multi-institutional study.

Background: Previously, when a conventional neck exploration (CNE) without preceding diagnostic imaging was the surgical treatment for patients with primary hyperparathyroidism (pHPT) solitary adenomas were observed in 69-88% of patients. The advent of minimally invasive parathyroidectomy (MIP), aiming at a preoperatively identified parathyroid abnormality may be associated with a different incidence of solitary and multiglandular parathyroid disease.

Materials And Methods: In a cohort of 467 patients with sporadic pHPT who preferentially underwent MIP in four hospitals in the same geographical region, the incidence of solitary adenomas, multiple adenomas, and multiglandular hyperplasia (MGD) was evaluated.

Surgical treatment of large contaminated abdominal wall defects.

Background: Repair of a large, severely contaminated abdominal wall defect is a challenging problem. Most patients are currently treated with a multistaged procedure, which is time consuming, carries a high complication rate, and is often not finalized.

Study Design: In this study, our experience with a one-stage repair of contaminated abdominal wall defects using the Components Separation Method was evaluated with respect to morbidity and recurrence.

[Surgical treatment of primary hyperparathyroidism: how high do we place the crossbar?].

Minimally-invasive parathyroidectomy has improved to a level that has made it the operation of first choice in the treatment of primary hyperparathyroidism. A gamma probe should be used when the radio-guided technique is performed and quick intra-operative parathormone testing should be used with all other minimally-invasive techniques. This not only serves as an instrument for quality control but also improves the expertise necessary to consistently obtain good results.

The ileo neo rectal anastomosis (INRA) in patients with familial adenomatous polyposis: clinical results at two years.

Background: Ileo neo rectal anastomosis (INRA) is a promising alternative for patients with familial adenomatous polyposis (FAP) to restorative proctocolectomy with its morbidity and unpredictable functional outcome to colectomy with ileo rectal anastomosis (IRA) with the continuing risk of rectal cancer. The aims of the present study were to evaluate the function of the neorectum, to assess the morbidity and complications of the operation and to determine the incidence of neorectal polyps.

Methods: Data of all patients having INRA, including bowel function and complications, were prospectively recorded.

Ileo-neorectal anastomosis: medium- and long-term follow-up of 37 patients.

Background: Ileo-neorectal anastomosis (INRA), an alternative restorative procedure, was developed to reduce the pouch-related complication rate with an (at least) equal functional result.

Methods: For this surgical outcome, data of all INRA patients, including bowel function and complications, were prospectively recorded. The reservoir capacity was determined repeatedly by physiologic tests.

Angiostatin inhibits experimental liver fibrosis in mice.

Background And Aims: Liver fibrosis is a response to chronic hepatic damage, which ultimately leads to liver failure and necessitates liver transplantation. A characteristic of fibrosis is pathological vessel growth. This type of angiogenesis may contribute to the disturbance of hepatocyte perfusion dynamics and lead to aggravation of disease.

Early malignant progression of hereditary medullary thyroid cancer.

Background: An age-related progression from C-cell hyperplasia to medullary thyroid carcinoma is associated with various germ-line mutations in the rearranged during transfection (RET) proto-oncogene that could be used to identify the optimal time for prophylactic surgery.

Methods: In this European multicenter study conducted from July 1993 to February 2001, we enrolled patients who had a RET point mutation in the germ line, were 20 years of age or younger, were asymptomatic, and had undergone total thyroidectomy after confirmation of the RET mutation. Exclusion criteria were medullary thyroid carcinomas of more than 10 mm in greatest dimension and distant metastasis.

The ileo neorectal anastomosis: an experimental study on development of the surgical technique and theoretical background.

Objective: The keystones of surgical treatment of ulcerative colitis and familial adenomatous polyposis are resection of the diseased colon with either an ileostomy or restoration of oro-anal continuity with an ileo-anal pouch. The ileo pouch anal anastomosis however, has a 15-35% pouch-related complication rate, 10% failure rate and is accompanied by an unpredictable functional outcome. In order to reduce these unfavourable rates and to improve functional results an alternative surgical technique, the ileo neorectal anastomosis (INRA), was developed experimentally.

Recurrences after conventional anterior and laparoscopic inguinal hernia repair: a randomized comparison.

Objective: To study the long-term recurrence rate and other complications after conventional and laparoscopic inguinal hernia repair.

Summary Background Data: Reliable long-term follow-up of patients with inguinal hernias treated by laparoscopic repair techniques is lacking.

Methods: The authors performed a randomized, multicenter trial in which 487 patients with inguinal hernia were treated by totally extraperitoneal laparoscopic repair and 507 patients were treated by conventional anterior hernia repair.

Liver regeneration is an angiogenesis- associated phenomenon.

Objective: To investigate whether liver regeneration is an angiogenesis-associated phenomenon.

Summary Background Data: Angiogenesis is predominantly known for its pivotal role in tumor growth. However, angiogenesis could also play a role in physiologic processes involving tissue repair, such as liver regeneration.

[Surgical treatment of primary hyperparathyroidism: minimally invasive if possible, conventional neck exploration if necessary].

Objective: To determine the results of surgical treatment of patients with primary hyperparathyroidism by means of a protocol consisting of preoperative imaging, perioperative parathormone (PTH) measurement, and a minimally invasive approach in the case of a solitary parathyroid adenoma being unequivocally identified and a conventional neck exploration in all other cases.

Design: Prospective and descriptive.

Methods: A total of 100 consecutive patients with primary hyperparathyroidism underwent neck imaging (ultrasound, CT) according to a fixed protocol.

Robot-assisted surgical systems: a new era in laparoscopic surgery.

The introduction of laparoscopic surgery offers clear advantages to patients; to surgeons, it presents the challenge of learning new remote operating techniques quite different from traditional operating. Telemanipulation, introduced in the late 1990s, was a major advance in overcoming the reduced dexterity introduced by laparoscopic techniques. This paper reviews the development of robotic systems in surgery and their role in the operating room of the future.

Diagnosing non-palpable breast disease: short-term impact on quality of life of large-core needle biopsy versus open breast biopsy.

Background: One of the alleged advantages of stereotactic large-core needle biopsy of non-palpable breast lesions is that it entails less inconvenience for the patient. In this prospective study, the quality of life of patients undergoing large-core needle biopsy was compared with that of patients undergoing open breast biopsy prior to learning the definitive diagnosis.

Methods: Thirty patients with non-palpable breast lesions underwent stereotactic large-core needle biopsy as initial diagnostic procedure (needle biopsy group).

Feasibility of robot-assisted laparoscopic surgery: an evaluation of 35 robot-assisted laparoscopic cholecystectomies.

Laparoscopic surgery offers patients distinct benefits but is not without its disadvantages to surgeons in terms of maneuverability and visualization. Robotic telemanipulation systems were introduced with the objective of providing a solution to the problems in this field of surgery. The feasibility of robot-assisted surgery was assessed by performing 35 laparoscopic cholecystectomies with the da Vinci robotic system.

Management of common bile duct stones: selective endoscopic retrograde cholangiography and endoscopic sphincterotomy: short- and long-term results.

Background: Common bile duct stones are still a frequent problem. Although new diagnostic and therapeutic techniques are continually being development, they remain poorly defined. Therefore, we decided to evaluate our standard method of diagnosing and treating common bile duct stones.

[Gluteal abscess complicated by sepsis as the expression of Crohn's disease].

Two young women, aged 19 and 25 years, suffered from persistent perianal sepsis after local drainage of unusual gluteal abscesses. Preoperative CT scanning showed unrecognised and inadequately treated abscesses and signs of inflammatory bowel disease. Both patients underwent a reoperation: affected bowel segments were removed, stomas were created and abscesses were drained.

[Lump in the neck: 4 patients with a medullary thyroid carcinoma].

In a 25-year-old man, medullary thyroid carcinoma (probably a solitary sporadic form) was diagnosed following investigation of a small lump in the patient's neck. This was removed and followed up with further treatment. In a 27-year-old man, episodes of headache, palpitations and excessive perspiration (due to a pheochromocytoma) and a positive family history of thyroid problems led to further investigations and the subsequent diagnosis of multiple endocrine neoplasia (MEN) type 2A.

Angiostatin inhibits pathological but not physiological retinal angiogenesis.

Purpose: Antiangiogenic treatment is a promising new therapy for angiogenesis-dependent diseases. In the current study, the biologic effects on pathologic and physiological angiogenesis in the retina of angiostatin, a very potent angiogenesis inhibitor were determined. In addition, the effects of angiostatin on the growth and development of newborn mice were examined.

Risk factors for cancellation of stereotactic large core needle biopsy on a prone biopsy table.

Among patients undergoing stereotactic needle biopsy of the breast on a prone biopsy table, a substantial proportion of planned procedures are terminated prematurely. This study was undertaken to identify risk factors for cancellation of these procedures and to derive a clinical rule for predicting cancellation. Risk factors for cancellation were assessed in a group of 476 consecutive patients with non-palpable lesions planned for large core needle biopsy.

Minimally invasive surgery for solitary parathyroid adenomas in patients with primary hyperparathyroidism: role of US with supplemental CT.

Purpose: To determine the role of ultrasonography (US) with supplemental computed tomography (CT) in patients with primary hyperparathyroidism who undergo minimally invasive surgery instead of conventional neck exploration.

Materials And Methods: US and CT were performed in 61 consecutive patients with primary hyperparathyroidism (part 1) to identify and localize solitary adenomas for resection by means of minimally invasive surgery and to provide a surgical road map. In part 2, involving 33 consecutive patients, CT was performed only when no solitary adenoma was identified with US or for road map information.

Peroperative measurement of PTH in the management of primary hyperparathyroidism.

Unlabelled: This study was performed to prospectively evaluate the efficacy of a newly developed, non-expensive and non-commercial perioperative PTH-assay as indicator of successful surgery in minimally invasive adenomectomy (MIA) for primary hyperparathyroidism (pHPT).

Methods: A chemoluminescence-based PTH-assay was modified to significantly shorten the incubation time, producing results in a total of 45-60 minutes. Its reliability was tested in 19 patients undergoing MIA for pHPT.

Impact of stereotactic large-core needle biopsy on diagnosis and surgical treatment of nonpalpable breast cancer.

Introduction: Stereotactic large-core needle biopsy is increasingly replacing needle-localized breast biopsy for the diagnosis of nonpalpable breast disease. In this prospective study, the impact of the introduction of this technique on diagnosis and surgical treatment of nonpalpable breast cancer was assessed in two hospitals in The Netherlands.

Patients And Methods: A total of 84 patients with nonpalpable breast cancer, diagnosed by means of stereotactic large-core needle biopsy (needle biopsy group) were compared with 80 patients diagnosed with nonpalpable breast cancer before the introduction of large-core needle biopsy.

Functional results and visceral perception after ileo neo-rectal anastomosis in patients: a pilot study.

Introduction: To reduce pouch related complications after restorative proctocolectomy, an alternative procedure was developed, the ileo neo-rectal anastomosis (INRA). This technique consists of rectal mucosa replacement by ileal mucosa and straight ileorectal anastomosis. Our study provides a detailed description of the functional results after INRA.