bluuebunny/crossref_metadata_2025 huggingface dataset:
Pouch versus esophagojejunostomy after total gastrectomy: A randomized clinical trial
Authors: Troidl Hans , Kusche Jürgen , Vestweber Karl ‐Heinz , Eypasch Ernst , Maul Ulla
Published: May 2005

This is an interim report of a randomized clinical trial on esophagojeju‐nostomy (EJ) versus Hunt‐Lawrence‐Rodino (HLR) pouch as reconstruction techniques following total gastrectomy and systematic lymphadenectomy for gastric cancer treatment.

The randomized trial preceded a pilot study comparing the Longmire‐Gütgemann interposition and the HLR. The pilot study included 7 patients, the randomized trial 38 patients (60 planned). The main outcome variables in the pilot study were food resorption, caloric intake, and body weight. Survival probability and general well‐being (quality of life) were measured in the randomized trial. A score was composed of disease‐specific and socio‐personal variables with well‐being ranging from 0 (worst) to 14 (best) points.

Concerning food resorption in the pilot study, no relevant advantage of the duodenal passage was found. The main postoperative disorder was insufficient food intake. Despite a radical operation, a hospital mortality rate of 16%, and a complication rate of 37%, gastric cancer still has a poor prognosis. In the randomized trial only 15 (39%) of 38 patients were alive 1 year after operation, but the survival probability was higher (58%) after HLR than after EJ (24%) (p<0.05). Hunger and appetite were strongly reduced during the first 6 months after operation. Food intake was less than half of the preoperative values, which was reflected by an average decrease in body weight of 7 kg.

Patients dying within the first year after total gastrectomy suffered an irreversible loss of quality of life (scoring 7 points). They had no objective benefit from the operation. Patients surviving this period regained quality of life and exceeded preoperative values, especially after HLR.

We conclude that HLR‐operated patients who have a chance of surviving for at least 1 year benefit from total gastrectomy in regard to quality of life.
The continent ileostomy
Authors: Myrvold Helge E.
Published: May 2005

The object of this article is to evaluate the results with the continent ileostomy and to define its place as a therapeutic alternative after proctocolectomy. In the past, the method has been affected by a high incidence of complications, but technical developments, simplifications, and improvements in surgical techniques have reduced the incidence of early complications from 20–25% to less than 10%, and that of late complications from 45–54% to 10–22%. The mortality rate in several recently published series of 1,142 patients was 0–1% (mean 0.2%), none of the deaths being directly pouch related. Fifteen to 20% of patients develop ileitis, which is usually successfully treated with antibiotics. Eighty‐nine to 97% of the patients never require external ileostomy appliances, indicating perfect continence. No serious adverse effects have been found after 19 years' experience with the method, but a few patients have developed subnormal values of vitamin B12. More than 90% of patients who have previously had a conventional ileostomy claim improvements in social life and sports activities and 68–85% found that the quality of their sexual life had improved. There is no doubt that a well‐functioning continent ileostomy offers the patients a quality of life superior to that with a conventional ileostomy. Despite the increasing popularity of the pelvic reservoir and ileoanal anastomosis, the continent ileostomy remains a therapeutic alternative for proctocolectomized patients undergoing conversional procedures and for patients in whom ileoanal anastomosis with pelvic reservoirs are contraindicated or impossible to construct.
Motor function of the ileal J pouch and its relation to clinical outcome after ileal pouch‐anal anastomosis
Authors: O'Connell P. Ronan , Pemberton John H. , Kelly Keith A.
Published: May 2005

The motor function of the ileal J pouch after ileal pouch‐anal anastomosis has a key role in the clinical outcome. The pouch forms a neorectum that aids in the maintenance of reasonable continence. The maximum capacity of the pouch (mean, 320 ml) is similar to that of the healthy rectum (330 ml). The pouch accommodates to distension, keeping intrapouch pressure low as the pouch gradually fills with stool. The change in pouch volume with each change in pressure (15 ml/mm Hg) approximates that of the healthy rectum (19 ml/mm Hg). When a threshold volume of about 150 ml is reached, large‐amplitude (>25 mm Hg), prolonged (40–60 sec), propulsive waves appear in the pouch. They initiate the call to stool. With continuing distention of the pouch to its functional capacity, which is about 200 ml, reflux of stool into the distal ileum begins, the large pressure waves become more frequent, and the urge for defecation more intense. Defecation is voluntary, spontaneous, and rapid (11 ml/sec), with the pouch and distal ileum emptying concurrently. About 60% of the pouch content, a volume of about 100 ml of stool, is discharged with each bowel movement. The greater the threshold volume and the more complete the evacuation, the fewer the bowel movements per day. After evacuation, the large pressure waves subside, and the next cycle of pouch filling and emptying begins.
Biological effects of a reservoir at the end of the small bowel
Authors: Phillips Sidney F.
Published: May 2005

Substitution of the anorectum by a reservoir fashioned from the distal ileum can achieve the highly desirable goal of enteric continence after proctocolectomy and, not surprisingly, appears to enhance significantly the patient's quality of life. The potential price to be paid for this advance relates largely to uncertainties concerning the absence of the usual barriers to coloileal reflux and the presence of a stagnant, fecal pouch at the end of the small intestine. Moreover, positive experiences with conventional incontinent ileostomies over many years dictate that the Brooke ileostomy still remains the standard against which all other procedures must be judged. In the majority of patients, the presence of an ileal reservoir does not appear to have major adverse consequences; fecal volumes, fat excretion, overall gut function, and general health appear to be well maintained for the 10–15 years that patients with continent ileostomies have been followed. The follow‐up for ileo‐anal anastomoses is somewhat shorter. The pouches develop a fecal flora and mucosal histology is altered but, in most, no adverse sequelae have been noted. Nonspecific inflammation (“pouchitis”) occurs and is sometimes of major clinical significance, especially when also associated with systemic symptoms. The etiology of these conditions is unknown but bacterial overgrowth is suspected since antimicrobial therapy is often curative.
Supravesical urinary diversion via the continent ileal reservoir: Experience in 250 cases
Authors: Skinner Donald G. , Boyd Stuart D. , Lieskovsky Gary
Published: May 2005

From August, 1982, to August, 1985, a total of 250 patients have undergone diversion by means of a continent ileal reservoir. One hundred seventyone were in conjunction with radical cystectomy for the management of invasive bladder cancer; 19 underwent cystectomy and Kock pouch diversion to resolve complications of neurogenic bladder; and 60 patients were converted to a continent ileal reservoir from an unsatisfactory form of conduit, 10 from ureterosigmoidostomy and 2 patients from either a suprapubic tube or cutaneous ureterostomy.

Early complications occurred in 42 patients (16%) resulting in 5 (2%) postoperative deaths. The complication rate was 18% among the 190 undergoing cystectomy with Kock pouch construction and 13% among the 60 undergoing conversion.

Late complications have occurred in 77 (31%) of the 245 patients surviving the operation. Most late complications are due to leakage, parastomal hernia, and/or difficulty with catheterization. During this experience continuing modifications have developed that we feel will reduce the late complication incidence and improve results. These modifications will be discussed in detail.
Coexistence of hyperthyroidism and thyroid cancer
Authors: Wahl Robert A. , Goretzki Peter , Meybier Hinrich , Nitschke Jörg , Linder Malte , Röher Hans ‐Dietrich
Published: May 2005

Among 702 patients who underwent surgery for hyperthyroidism, thyroid cancer was demonstrated histologically in 18 patients (2.6%). A higher incidence of cancer occurred in patients with multinodular toxic goiter (3.3% of 317 patients) and uninodular toxic goiter (2.9% of 207 patients), whereas only 1.1% of 178 patients operated for Graves' disease had coexistent thyroid cancer. In addition, 5 patients who underwent surgery for thyroid cancer were found preoperatively to be hyperthyroid, increasing the total number of patients with coexistent thyroid cancer and hyperthyroidism to 23. Among 554 patients with thyroid cancer operated upon during the same period, 4.2% were hyperthyroid (8.6% of patients with papillary thyroid carcinoma, 4.5% with follicular thyroid carcinoma, and only 0.5% with undifferentiated thyroid carcinoma).

Thyroid cancer was identified within a toxic nodule in 6 patients, in surrounding tissue suppressed by solitary toxic nodules in 4 patients, in cold nodules coexisting with multinodular toxic goiters in 8 patients, and microscopically disseminated in diffuse toxic goiters in 2 patients; 3 patients presented large inoperable and metastatic tumor masses. Although in 8 of the 23 patients (35%) the thyroid cancer was advanced (extrathyroid growth of the primary tumor and/or regional metastases and/or distant metastases), cancer was diagnosed preoperatively in only 5 patients (22%).

This study demonstrates that hyperthyroidism does not prevent thyroid cancer and that patients with nodular toxic goiters in particular must be carefully evaluated with regard to risk factors, history, and clinically suspicious signs. Needle biopsy should not be restricted to cold nodules. Surgery rather than radioactive iodine or antithyroid therapy is the treatment of choice in toxic nodular goiter.
Nodular goiter—Is thyroxine medication of any value?
Authors: Persson C. Peter A. , Johansson Henry , Westermark Kerstin , Karlsson F. Anders
Published: May 2005

In a cohort of 197 patients operated on for non‐toxic nodular goiter, 71 patients had been given preoperative thyroxine. In 31%, the medication afforded some symptomatic relief, but did not reduce the goiter enough to abolish the need for surgery. Postoperatively, 17 of the 197 patients developed supranormal TSH levels and were placed on thyroxine. In addition, 151 patients were placed on thyroxine “prophylaxis,” 121 of whom remained on this medication for the entire follow‐up period. Thirty patients discontinued medication at various times during the follow‐up period and 29 subjects received no medication at all. During a 5‐year follow‐up period, goiter recurred in 11 of the 197 patients, 8 of whom had been on continuous thyroxine medication.

In the second part of this report, results of TRH tests and hormone measurements in a group of 56 consecutive patients with nodular goiter are examined. A “flat” pathological TSH response to TRH was found in 43%. This group of patients exhibited significantly higher thyroid hormone levels and a significantly higher mean age than the group with normal TRH tests.

The results suggest that, apart from being a necessary substitute in postoperative hypothyroidism, the use of thyroxine medication in nodular goiter could be restricted.
Persistent and recurrent pheochromocytoma: The role of surgery
Authors: Brennan Murray F. , Kaiser Harry R.
Published: May 2005

Pheochromocytoma is a rare malignancy. The opportunity to gain experience with persistent and recurrent pheochromocytoma is extremely limited. We have, therefore, reviewed our experience with 8 patients with persistent and recurrent pheochromocytoma treated during the last 6 years. In patients with multiple endocrine neoplasia, the recurrent or persistent adrenal tumor is usually situated in the contralateral adrenal, whereas in other patients the tumor is usually situated in an ectopic position or is due to recognized or unrecognized malignant disease.

Survival from diagnosis ranged from 1.5 to 23 years in these patients. Because long‐term survival may occur following removal of both benign and malignant pheochromocytomas, an aggressive surgical approach is recommended.
Gastric partition for morbid obesity: Greater curvature gastroplasty or gastrogastrostomy
Authors: Buckwalter Joseph A. , Herbst Charles A.
Published: May 2005

Gastric partition is advocated as a better operation than gastric bypass for treatment of morbid obesity (although this is poorly documented) because it is simpler and faster to perform; has a lower complication rate; is more physiologic; and because it is possible to examine the distal stomach by endoscopy and barium contrast studies after operation. It has not been established which of the different gastric partition operations is the best. Greater curvature gastroplasty (GP) was performed upon 47 and gastrogastrostomy (GG) upon 144 patients between May, 1979, and May, 1981, at North Carolina Memorial Hospital. The techniques used in performing the operations are described and illustrated. Postoperative complications occurred in 25.5% of the GP and 10.4% of the GG patients. There were no deaths. Reoperation was required because of stomal obstruction in 14.9% of the GP compared with 1.4% of the GG patients. The percentage of excess weight lost in 12 months following GP was 60.5% and 51.3% after GG, and at 18 months was 68.7% following GP and 53.9% after GG. These differences in weight loss following GP and GG are not statistically significant. Because of the statistically significant lower incidence of stomal obstruction requiring reoperation after GG, although weight loss appeared to be better with GP, GG is currently our preferred operation for the treatment of morbid obesity. The changes in the technique of GG introduced to improve weight loss are discussed and illustrated.
PCV and modified hill procedure as surgical treatment of reflux esophagitis: Results in 108 patients
Authors: Øster Morten J. , Csendes Attila , Funch‐Jensen Peter , Casalnuovo Carlos A. , Sørensen Finn Hanberg , Amdrup Eric
Published: May 2005

Parietal cell vagotomy (PCV) and the Hill antireflux procedure were used in 108 patients with reflux esophagitis. The addition of PCV provides better access to the cardia and ensures that more extensive vagotomy than intended does not occur. Furthermore, a reduction in the basal acid output (BAO) is preferable. In patients still symptomatic after surgery, the BAO was unchanged, while in those without postoperative symptoms a significant decrease in BAO was found (p < 0.01).

Gastroesophageal sphincter pressure was significantly higher postoperatively in all patients. Complications were few; 92% were asymptomatic at 2 months, 88% at 1 year, and 71% at 2 years. A remarkable reduction in pulmonary symptoms after operation indicates a close relationship between chronic pulmonary disease and gastroesophageal reflux in some patients.
Hormonal control of the gastric motor response to feeding: Cross‐perfusion of an isolated stomach using a conscious donor dog
Authors: Pilot Marie ‐Anne , Thomas Paul A. , Gill Richard E. , Knight Matthew A. , Ritchie David H.
Published: May 2005

The purpose of this study was to determine the hormonal response of the gastric motor activity to a meal. A conscious donor dog was used to perfuse an isolated canine stomach placed in a chamber, using a pump‐oxygenator system for recirculation. Strain gauge transducers were used to record the motility of the isolated stomach. The donor dog was fed during the perfusion. An hour after the meal, the fed dog was replaced by a second fasted donor dog. Fasted motor activity in both the proximal and distal stomach was characterized by high‐amplitude contractions occurring in bursts every 10 minutes. After feeding, there was complete abolition of high‐amplitude contractions in the distal stomach in all 7 experiments. The proximal high‐amplitude contractions were abolished in 5 experiments, but were still present in 2, although the contractile pattern was irregular. When the fed dog was replaced by a fasted dog, characteristic fasting motor patterns were resumed in the isolated stomach. There was a delay of up to 17 minutes in the onset of both the postprandial changes in motility and the reappearance of fasted motor patterns. The changes in the motility pattern of the isolated stomach after feeding the donor dog point to a hormonal response.
Intragastric prosthesis for management of obesity
Authors: Miller Jimmy D.
Published: May 2005

During the fall and winter months of 1979–1980, nine dogs were variously studied using an intragastric prosthesis to investigate chronic gastric distention which might lead to reduced food intake and consequent weight loss. The rationale was that large gastric bezoars at times produced weight loss in humans. The prosthesis was a 250‐ml polyethylene bottle introduced at laparotomy, with the intent of subsequent peroral‐esophageal introduction if the initial studies produced weight loss. There was no significant difference between the animals harboring the intragastric prosthesis and the controls. Virtually no ill effects on the stomach itself were attributable to the long‐term residence of the prosthesis.
Anterior and low anterior resection
Authors: Heberer G. , Denecke H. , Pratschke E. , Teichmann R.
Published: May 2005

The various definitions of anterior and low anterior resection are outlined. The operative technique for performance of both and their perioperative management are described. Operative mortality in 157 patients operated on from 1973 to March 31, 1982, was 4.5% (7 of 157 patients) and had decreased to 1.9% (2 of 107 patients) within the last 5 years. The rate of anastomotic leakage also decreased concomitantly. Five‐year survival rates are similar to those reported in the literature; there was no difference between anterior and low anterior resection for tumors of Dukes' stage A‐C.
The use of staplers for anterior anastomoses
Authors: Beart R. W. , Wolff B. G.
Published: May 2005

The EEA stapler is a convenient, well‐designed, and reliable instrument. It will anastomose the bowel with reliability and speed at least equivalent to hand‐sewn techniques, and probably offers a technical advantage in performing very low rectal anastomoses. Unfortunately, intraoperative misadventures are greater with this device than with hand‐sewn techniques, and its use would seem best restricted to those situations in which it has its greatest advantage. Postoperative complications are not increased by its use, but the long‐term incidence of anastomotic stricture and possibly increased rate of local recurrence need to be clarified.
Abdominoperineal excision
Authors: Krause Urban , Påhlman Lars , Thorén Lars
Published: May 2005

The procedure and some problems of abdominoperineal excision are briefly outlined. Despite the advances in surgery and anesthesiology, survival has not improved in the last 30 years, and an overall 5‐year survival of about 30–35% is probably a reasonable estimate. However, the local extent of the tumor has proven to be a very good prognostic index as regards survival frequency, with patients whose tumors are Dukes' stage A having an almost 100% corrected 5‐year survival rate. A relatively high frequency of local recurrence has been noted after local curative operations for rectal cancer, the frequency usually being about 30–60% in unselected patient materials.
Radiation therapy of rectal cancer
Authors: Cohen Alfred M. , Gunderson Leonard L. , Welch Claude E.
Published: May 2005

Potentially curative surgery for cancer of the rectum and rectosigmoid is associated with frequent recurrence of the tumor in the pelvis. Data suggest that perioperative radiation therapy can considerably reduce the local failure rate. Pathological risk factors for local recurrence are described. Preoperative and postoperative adjuvant radiation therapy both appear to be effective. Postoperative radiation allows more accurate case selection based on operative findings and pathological staging. Patients with transmural tumor penetration and/or lymph node metastases appear to benefit from adjuvant radiation.
Palliative and adjunctive measures in rectal cancer
Authors: Fritsch A. , Seidl W. , Walzel C. , Moser K. , Schiessel R.
Published: May 2005

In this review we report our experience and that of others with palliative resection, fulguration, cryosurgery, and chemotherapy in rectal cancer. Since a trial has never been conducted to compare these procedures, it is not possible to give clear recommendations.

In our study of palliative resection in 75 patients, we found an operative mortality of 9.3%. Tumor‐related symptoms were controlled in 88%; the quality of life was good until death in most patients.

Fulguration is reported to have a mortality rate of 0–5%, with control of symptoms in 40–80%, depending on tumor size.

Cryosurgery was used in our series of 219 patients. Control of symptoms was achieved in 85% and the mortality rate was 2.3%. Side effects included unpleasant secretions for many weeks, bleeding, and stenoses.

Chemotherapy has been tested in several studies. Colorectal cancer does not appear to be very sensitive to cytotoxic drugs, although numerous new substances have been tested over the past few years. Remissions have been achieved in 4–31% of patients.
Recurrent cancer and metastases
Authors: Hickey Robert C. , Romsdahl Marvin M. , Johnson Douglas E. , Wallace Sidney , Mavligit Giora M. , Leavens Milam E. , Borgelt Bruce
Published: May 2005

Cancer of the colon and rectum is numerically the most major of visceral cancers in both sexes. A great proportion of colorectal cancer patients die of local problems. This report deals with the various techniques used to manage local recurrence, lung and liver metastases, and the control of pain.
Adverse reactions following T‐tube removal
Authors: Dellinger E. Patchen , Steer Michael , Weinstein Mark , Kirshenbaum Gerald
Published: May 2005

Six of 139 (4.3%) patients experienced adverse reactions following the postoperative removal of a T‐tube. Five (3.6%) were severe enough to require readmission to the hospital or to delay discharge. All had had normal T‐tube cholangiograms and the T‐tube had been clamped without problem prior to tube removal. Signs and symptoms included abdominal pain (6 of 6), chills (3 of 6), tenderness (4 of 6), fever (5 of 6), and increased bilirubin (3 of 4). Symptoms resolved between 4 hours and 8 days following removal without operative intervention. Adverse reaction following T‐tube removal may be related to disruption of the fibrous tract and extravasation of infected bile into the surrounding tissues.
The importance of anti‐lipid A (anti‐endotoxin): Prevention of “shock lung” and acute renal failure
Authors: Wardle E. N.
Published: May 2005

Gram‐negative septicemia or endotoxinemia frequently causes a Shwartzman reaction that results in acute renal failure. Susceptibility to the lipid‐A, which has a common chemical structure in all gram‐negative bacteria, is ascribable to the fact that anti‐lipid A (antitoxin) titers are low in normal persons. This is because exposure is minimal since endotoxins cannot normally cross the bowel mucosa. Even during bacteremia, lipid‐A is a concealed antigen on the surface of bacteria, but it can be liberated by bactericidal antibiotics or by the action of complement in bacteremic shock. The consequences of endotoxinemia are so disastrous that there is a case for active or passive immunization to lipid‐A. Anti‐lipid A is vital as the antitoxin and has great protective potential, but it is nevertheless not the opsonin for phagocytosis of whole bacteria. Thus, antibodies to the innumerable O‐ and R‐antigens of lipopolysaccharides also play a part in resistance to gram‐negative septicemia.
Subcutaneous transposition of the spleen: Pharmacokinetic study of the intrasplenic route
Authors: Noguerales F. , Dapena M. A. , Requena F. , Blanco M. T. , Galeano F. , Dorado J. J. , Garcia‐Sancho L.
Published: May 2005

When the spleen is properly isolated with amniotic membrane and implanted in the extra‐abdominal cellular subcutaneous tissue, it may serve as an excellent route for administering drugs selectively to the liver. We have employed a biological method, the capacity of Adrianiycin®to inhibit the growth of a strain ofBacillus subtilis,in order to evaluate the hepatic concentrations of the drug administered intravenously and intrasplenically. At 60 minutes or more after injection, there was an order of magnitude difference in favor of the intrasplenic route.
Arteriovenous fistulas for dialysis: Blood flow, viscosity, and long‐term patency
Authors: Reilly David T. , Wood Richard F. M. , Bell Peter R. F.
Published: May 2005

A prospective study of the influence of blood flow at the time of operation on subsequent performance of dialysis fistulas is reported. Flow was measured in 33 consecutive arteriovenous fistulas using an electromagnetic flowmeter. During the mean follow‐up time of 7 months (range, 2–12 months), 19 fistulas were used for dialysis, 9 have not yet been used, 4 were never used because of thrombosis or failure to develop adequately, and 1 patient died before using the fistula for hemodialysis. There were 9 complications (thrombosis, stenosis, and failure to develop). Operative blood flow for these 9 fistulas averaged 221 ml/min as compared to 214 ml/min for the group with no subsequent problems. No critical flow rate below which the fistula would not develop could be defined. An analysis of influences on flow rate at the time of operation showed that there was a significant correlation between flow and blood pressure, vessel dimensions, and whole blood viscosity, but it was not possible to predict fistula failure from these data.
Tubo‐ovarian abscess in the postmenopausal woman
Authors: Blumenfeld Zeev , Toledano Chaim , Eitan Arieh , Barzilai Ami , Brandes Joseph M.
Published: May 2005

Tubo‐ovarian abscesses are considered a problem only during the childbearing years because of their rarity in the postmenopausal age group. Three case reports are described, in which pelvic abscesses were diagnosed in elderly women and necessitated surgical intervention. The early recognition and surgical treatment of pelvic abscesses is mandatory in the postmenopausal woman, who often is a poor‐risk patient. Nothing is to be gained by delay of definitive treatment, and the risk of serious deterioration is obvious. Therefore, the gynecologist and surgeon should be alert to this uncommon diagnosis in the elderly woman and be prepared for early surgical intervention.
Treatment of patients with small‐cell lung cancer at the Memorial Sloan‐Kettering Cancer Center, 1974–1979
Authors: Wittes Robert E. , Natale Ronald B. , Sierocki John S. , Hilaris Basil S.
Published: May 2005

Small cell lung cancer (SCLC) has long been recognized as perhaps the most radiosensitive of all carcinomas, but radiotherapy alone is clearly inadequate treatment. The fact that SCLC has a tendency toward early and wide dissemination suggests that chemotherapy might be an important means of tumor control. From July, 1974, to March, 1978, a total of 101 patients were treated at Memorial Sloan‐Kettering Cancer Center on 3 protocols designed for SCLC. The initial regime (COMA) combined vincristine, methotrexate, and high doses of cyclophosphamide. Radiation therapy was employed in most patients with limited disease. Complete response (CR) rate was 17%. BCNU and procarbazine were added to the regimen, and radiation was not part of the primary treatment. Neither the total response rate nor the CR was significantly different from those obtained with the COMA regimen. In the third regimen, DDP and VP‐16 were combined; after 2 such cycles, the patients received CAV for 4 cycles and then were switched back to DDP and VP‐16. Prophylactic cranial irradiation was incorporated into this program. CR rate was 47% and median survival in excess of 18 months. Responses were maximal by the end of the first 6 weeks of treatment. Recent studies include the modifications of abandonment of fixed time intervals for recycling treatment and reintroduction of radiation therapy to the primary complex. Of 43 patients so treated, the CR rate from chemotherapy induction is 62%; after conclusion of radiation, 83% are in CR. However, acute toxicity is significantly greater than that of our previous programs.
Cardiomyotomy associated with antireflux surgery in the treatment of achalasia
Authors: Veiga‐Fernandes F. , Pinheiro M. F. , Didia‐Guerreiro
Published: May 2005

The purpose of this report was to evaluate the efficacy of cardiomyotomy combined with fundoplication in the treatment of achalasia. Results obtained in 15 patients are compared with those collected in 19 asymptomatic patients treated by the classical Heller operation (12 patients), or by cardiomyotomy combined with suture of phrenoesophageal ligament to the underside of the diaphragm (7 patients). The preventive action of fundoplication on reflux esophagitis and especially the effect of surgery on esophageal emptying are particularly examined, using two rigorous isotopic tests. It is demonstrated that even asymptomatic patients have, after cardiomyotomy without antireflux maneuvers, a very high risk of esophagitis. The statistical comparison using the gastroesophageal reflux index between patients treated by Heller cardiomyotomy and normals wasp <0.001 to the classical Heller, and 0.01
0.1), and maintained the improvement of the esophageal emptying.
Submucosal esophagography for esophageal cancer
Authors: Osugi H. , Hamanaka Y. , Sakai K.
Published: May 2005

Submucosal esophagography is examined experimentally in rabbits and clinically to ascertain the cancer invasion to the adventitia of the esophagus before operation.

VX2 carcinomata were implanted into the cervical esophagus of rabbits to produce an experimental model of esophageal cancer. The experimental data suggested that submucosal esophagography would be practicable for ascertaining the extent of cancer invasion. Then submucosal esophagography was performed in 43 patients with esophageal cancer. The submucosal esophagograms obtained were divided into 4 types to ascertain the extent of invasion of carcinoma. Cancer invasion to the adventitia was observed in all except one patient in type III or IV, whereas this could not be seen in type I or II. In the patients who did not have preoperative irradiation, histological invasion of the neighboring structures was found in a majority (4/5 or 80%) of type IV patients. This may be a safe and useful method of detecting cancer invasion of the adventitia before operation and so of determining the best course of therapy.
Minute liver cancer and concomitant esophageal varices: Detection and successful surgical treatment
Authors: Kanematsu Takashi , Sugimachi Keizo , Kohno Hitoshi , Matsumata Takashi , Kobayashi Michio , Inokuchi Kiyoshi
Published: May 2005

Surgical treatment of liver cancer associated with esophageal varices was carried out in 8 cirrhotic patients with evidence of portal hypertension. In 5 patients admitted for elective surgery of esophageal varices, minute hepatomas were detected during the course of preoperative investigation. The remaining 3 patients were referred to our department when esophageal varices plus hepatoma had become evident. Extirpative treatment of the liver tumor followed by selective shunt operations were successfully carried out in 6 patients, and interrupted procedures were used in 2 patients. Treatment of both esophageal varices and liver cancer appears to be effective when the tumor in the liver is detected in an early stage. The most reliable diagnostic tool at the present time seems to be hepatic arteriography. Our experience strongly suggests that arteriographic studies should be seriously considered in cirrhotic patients, particularly when surgery for varices is being contemplated.
A review of 40 cases of benign stricture of the esophagus treated surgically
Authors: Hadjistylianos G. , Spanos H. , Kalogeropoulos B.
Published: May 2005

From 1973 through 1979, we operated on 40 patients presenting with benign stricture of the esophagus, 17 of whom were men. The age varied from 7 to 88 years with an average of 63 years.

The most frequent localization of the stricture was in the lower third (24 patients) and the most common cause for all strictures was gastroesophageal reflux (34 patients). There have been 10 patients with stricture of the middle third, 4 with stricture of the upper third, and 2 with total stricture of the esophagus.
Predisposition of the resected stomach for malignancy
Authors: Rakovec S. , Kovič M.
Published: May 2005

During the 20‐year period from 1959 to 1978, a total of 62 cases of cancer of the gastric stump following gastric resection for benign peptic ulcer were studied in relation to the occurrence of gastric primary carcinoma. This group was compared with the group of patients who were operated on for peptic disease during the same period. Cancer of the gastric stump constituted 4.6% of all gastric carcinomas. The relation between the number of operations for gastric stump carcinomas and the number of gastric resections for benign conditions, performed during the same period, makes the relative frequency 2.6%. The average free interval of 21 years was established to have elapsed from gastric resection to the confirmed diagnosis of malignancy of the stump. The symptoms of anemia, weight loss, and dysphagia were the most frequent presenting complaints. All 62 patients with cancer of the gastric stump were operated on: 20 exploratory, 16 palliative procedures, and 26 curative total gastric resections. The results were poor, mostly due to the late diagnosis. The importance of frequent follow‐up examinations by radiology and endoscopy of the patients having been subjected to gastric resection is emphasized.
Diverticula of the upper gastrointestinal system
Authors: Sechas M. , Karatzas G. , Rigas A. , Homatas J. , Sbokos C. , Pattakos S. , Simopoulos K. , Skalkeas G.
Published: May 2005

Diverticular disease of the alimentary tract presents a challenge to treatment because of the clinical presentation either as incidental asymptomatic findings or as potentially lethal complications.

The purpose of this paper is to describe our experience in the surgical management of diverticular disease of the upper gastrointestinal system.
Cimetidine compared with synthetic secretin in treatment of acute upper gastrointestinal bleeding
Authors: Wagner P. K. , Rothmund M. , Seitz W.
Published: May 2005

In this prospective alternate trial, so far we have tested the effects of either cimetidine or secretin in 26 patients suffering from acute nonarterial bleeding from fresh ulcers or hemorrhagic erosions in the stomach or duodenum.

In all patients, the presence of bleeding was established by endoscopic examination. Secretin was given at a dosage of 0.5 clinical units/kg body weight per hour and cimetidine 1 mg/kg body weight per hour. The test preparations were given as continuous infusions over 48 hours unless premature interruption was necessary.

Additional treatment included rinsing the stomach with ice water through the gastric tube, complete parenteral nutrition, sedative drugs, and blood transfusions as necessary. The criterion for interrupting therapy was persistent or recurrent bleeding. After the initial 48 hours of treatment, patients were given cimetidine, antacids, and parenteral nutrition up to a maximum of 12 days.
Colorectal anastomoses with the EEA stapler
Authors: Detry Roger J. , Kestens Paul J.
Published: May 2005

From March, 1979 to November, 1980, a total of 100 consecutive patients underwent a left colectomy (45 patients) or an anterior sigmoidorectal resection (55 patients) for carcinoma (77 patients), diverticulitis (21 patients), or chronic sigmoid volvulus (2 patients). The colorectal anastomoses were fashioned by means of the EEA stapler. After rectal resections for cancer, the height of the sutures ranged from 11 to 2 cm from the anal margin. Seventeen of these anastomoses would have been difficult, and 7 quite impossible, without the stapling gun. There was no operative mortality and the morbidity was low. Eleven anastomotic leaks occurred, in many cases detected only by the xray controls; there were no significant early or late consequences, except for 1 patient. Clinical and radiological survey confirmed the reliability of the results in most patients. It is concluded from this retrospective analysis that the EEA enables safe sutures and very low colorectal anastomoses to be constructed.
Management of postoperative gastrointestinal fistula
Authors: Fujita H. , Shoji M. , Noto H. , Ueda H. , Kusajima Y. , Isobe Y. , Miyazaki I.
Published: May 2005

Depuis l'usage maintenant largement répandu de la nutrition parentérale les statistiques montrent que la mortalité des fistules gastro‐intestinales post opératoires s'est abaissée et que les cas de fermeture spontanée sont beaucoup plus nombreux. Les résultats du traitement appliqué ne dépendent certes pas seulement de l'alimentation parentérale mais aussi d'autres facteurs tels que le siège de la fistule et la présence d'abcès concommittents. Cependant notre expérience récente nous permet de reconnaitre l'importance du facteur nutritionnel. Nous avons donc étudié l'influence de la nutrition parentérale dans le traitement de ces fistules en les comparant avec les cas où ce support nutritionnel n'était pas utilisé.
Preoperative preparation of the colon
Authors: Lagache G.
Published: May 2005

In a series of 122 patients prepared for colorectal operations, we have compared the efficacy of 4 methods:

Conventional mechanical preparation included a low‐residue diet, paraffin and castor oil, and repeated enemas for 2 days before operation. It was administered to 48 patients, whose gut was judged at operation to be very clean in 29 (60%), fairly clean in 10, and dirty in 9. Despite additional antibiotic prophylaxis, there were complications in 14 (29%) and fistulas in 4.

Whole gut irrigation was administered via a nasogastric tube to 15 patients. Eight to 16 liters of normal saline were perfused in 3 to 5 hours on the day before operation. This resulted in the patients' having fluid retention due to absorption. It resulted in a very clean gut at operation in 13 (87%) and in a dirty gut in 2. Complications occurred in only 1 patient, who also developed a fistula.

Mannitol 5% solution in volumes of 4–5 liters was given by nasogastric tube, in a manner similar to that of the saline in the previous method, to 21 patients. Similar problems of fluid retention were observed and a very clean bowel was produced in only 14 (67%), with a fairly clean bowel in 5, and dirty in 2. Complications occurred in only 2 patients (9%), one of whom developed a fistula.

Mannitol 10% solution, 2–2.5 liters, was given by mouth over a period of 2 to 3 hours to 38 patients on the day before operation. It was well tolerated and produced a very clean bowel in 30 (79%), a fairly clean bowel in 6, and a dirty bowel in only 2. Complications were seen in only 3 patients (8%), one of whom developed a fistula. There was no significant difference in the complication rate whether or not prophylactic antibiotics were given.
The oral or intra‐luminal use of anti‐helminthic drug in bowel anastomosis operations
Authors: Kuczynski L. B.
Published: May 2005

The ascariasis is a cosmopolitan helminthiasis occurring mostly in countries with poor sanitation. It can occur, more rarely, in developed countries due to immigration of the hosts.

Patients can be hosts of ascariasis with a negative faeces examination.

Having had one death due to endotoxic shock, peritonitis and dehiscence of an oesophago‐jejunal anastomosis due toH. lumbricoides in a patient with a negative pre‐operative faeces examination we began to take prophylactic care for the elective and emergency intestinal anastomoses.

We had 15 patients with negative faeces examination submitted to an elective digestive anastomosis who were first given 150 mg of levamisole: six (40%) eliminatedAscaris lumbricoides.

We had 19 patients having emergency operations who had one 150 mg levamisole tablet inserted into the lumen of the gut before completion of the intestinal anastomosis: 15 (78.94%) eliminated A. lumbricoides.
Results of pelvic exenteration
Authors: Mori Takeo , Tominaga Takeshi , Itoh Ichiji
Published: May 2005

Total pelvic exenteration is the most radical and most dangerous operation for advanced malignant tumor widely invading the pelvic cavity. As the result of refinement of the surgical technique, we believe that this operation can now be performed safely. In the last 5 years, we have enlarged the indications for this method to include not only curative excision but also palliation.
Comparison of ileostomists' sexual life before and after conversion to continent ileostomy
Authors: Myrvold H. E. , Nilsson L. O. , Palselius Inger , Kock N. G.
Published: May 2005

To compare ileostomists' sexual life before and after conversion from a conventional spout to a continent pouch ileostomy, questionnaires were sent to 48 ileostomists with experience with both types of ileostomy. Forty‐two patients (88%) returned their questionnaires; 29 were women. In answer to the question about the effect of their ileostomy on their sexual performance, 98% replied that they had sometimes felt embarrassed, uncertain, or inhibited because of the conventional ileostomy, whereas only 24% felt so after conversion to a continent ileostomy. Eighty‐five percent felt that the conventional ileostomy negatively influenced their body image, whereas only 5% considered this to be the case after conversion to continent ileostomy. Eighty‐five percent of the patients claimed that the quality of their sexual life had improved after conversion to continent ileostomy. The results suggest that a conventional ileostomy influences sexual life more than is generally recognized, and that conversion to continent ileostomy can improve the quality of sexual life in such patients.
Iatrogenic strictures of the bile ducts: Our experience with 66 cases
Authors: Castrini Guido , Pappalardo Giuseppe
Published: May 2005

The authors report their experience with 66 patients operated on for iatrogenic strictures of the bile ducts. Among the factors that are considered to predispose to or to cause iatrogenic strictures, all of which have been accurately analyzed, urgent operations for acute cholecystitis have particular importance. The percutaneous transhepatic and duodenoscopic retrograde cholangiographies represent a complementary means for a precise diagnosis of the stricture. Treatment consists of a Roux‐en‐Y hepaticojejunostomy, but in recent years, a biliary‐duodenal interposition utilizing a defunctionalized jejunal limb was preferred. Postoperative morbidity was 22.7%, mortality 3%. Consideration is given to the technique of anastomosis and to the use of transanastomotic drainage. Finally, the results of follow‐up with particular reference to the treatment of strictures of the hepaticojejunostomy, with an incidence of 15.4% in this series of patients, have been analyzed.
A clinical study on an appropriate treatment of acute pancreatitis
Authors: Kinami Y. , Konishi K. , Miyazaki I.
Published: May 2005

One hundred thirty‐nine patients with acute pancreatitis were treated in our clinic during the past 14 years. Seventy‐seven patients had a surgical procedure and 62 patients were managed conservatively. Although 44 patients with edematous pancreatitis were treated with various surgical procedures, 11 patients with the hemorrhagic type had a sump drainage alone. Of the 16 patients with necrotizing pancreatitis, only 2 had a pancreatic resection. The overall operative mortality rate was 18%.

Eighty‐five percent of the patients received antienzymatic drugs: Trasylol® (10–820 × 104), FOY (200–8,600 mg), and others. Dosage of these drugs was determined according to the severity of disease. Of 12 patients who were given 5‐FU, one had mild, 8 had moderate, and 3 had severe acute pancreatitis. Two hundred fifty to 500 mg of 5‐FU was administered daily for 2 to 24 days. Some other antienzymatic drugs were also given in 9 patients, in addition to 5‐FU. Ten patients revealed a beneficial effect from this treatment. Overall, 78% of patients showed a favorable course, 7% developed relapsing acute pancreatitis, and 4% had chronic pancreatitis after discharge from hospital. The mortality rate was 11%. The patients with hemorrhagic or necrotizing type had a higher mortality rate (27–37%) and less therapeutic effect than patients with an edematous type.

These results indicate that early appropriate treatment is important to obtain a favorable therapeutic result.
Surgical therapy of hyperinsulinism
Authors: Hirner A. , Haring R. , Karavias T. , Stallkamp B.
Published: May 2005

Organic hyperinsulinism is rare: the incidence is 1:100,000. In newborns, often of diabetic mothers, there may be islet cell hyperplasia. Rare cases may require partial pancreatectomy. In adults, the condition is always due to an insulinoma.
Pathological anatomy and pathogenesis of acute pancreatitis
Authors: Becker Volker
Published: May 2005

Acute pancreatitis involves autodigestion of the pancreas by its own secretions. The anatomical signal is tryptic necrosis. The so‐called edematous pancreatitis cannot be compared with acute tryptic pancreatitis as it is caused by swelling of the pancreas, with pancreatic juice in the parenchyma, but no necrosis occurs. The severity of acute pancreatitis is determined by the state of preservation of the pancreatic capsule. Three stages may exist: (a) the gland is enlarged with solitary areas of necrosis and the capsule is preserved; (b) confluent necrosis with necrosis of the lipid tissue occurs, but the capsule is preserved; and (c) necrosis extends into surrounding areas, especially into the omental bursa and the retroperitoneum, and the capsule is destroyed. Peritonitis, ileus, and pleural effusion may represent regional extension of acute pancreatitis. Shock is the most dangerous complication and is the most frequent cause of death.
Pancreatic necrosis and acute pancreatitis
Authors: Leger L. , Chiche B. , Louvel A.
Published: May 2005

The surgeon should take pains to section and study himself the operative specimen after excision for acute pancreatitis, in order to understand the true nature of the lesions, which the most attentive and competent pathological examination cannot describe as vividly as direct examination by the operator. Often he will be surprised to find that the lesions, predominant in the capsule, are less profound and less severe than he had thought at first sight. The necrosis, which is sometimes limited to the peripheral and interstitial tissue, sparing the gland itself (its prognosis is less serious and has led many surgeons to perform surgical excision). However the problems encountered postoperatively have given rise to doubts a posteriori as to whether this is legitimate. Reference is made to the decapsulation of the pancreas described by Romanian authors, and a method for future operative diagnosis of glandular necrosis is proposed.