bluuebunny/crossref_metadata_2025 huggingface dataset:
Analysis of 242 cases of gastric carcinoma
Authors: Ribeiro Manuel Moutinho , SimÕes Manuel A. Sobrinho , Bastos Joaquim
Published: May 2005

Clinical and pathological features of 242 patients with gastric cancer seen consecutively at the Department of Surgery (Cirurgia 4) of the Hospital de S. JoÃo in Porto, Portugal from 1970 to 1977 were analyzed. There were 140 men and 102 women and their mean age was 57.7 years. The overall 5‐year survival rate was 16.1%, and that of patients undergoing a curative resection was 42.6%. Duration of symptoms and tumor site did not influence survival rate. The expanding‐type of cancer was more frequent than the infiltrative‐type in a ratio of 2.8 to 1 and gave a significantly higher 3‐year survival rate. This better prognosis of the expanding‐type did not depend on sex, age, duration of symptoms, tumor site, or pattern of nodal metastases, reinforcing the prognostic significance of this classification. The high 5‐year survival rate may reflect the relatively high frequency of gastric carcinoma of the expanding‐type of northern Portugal. A relationship between this high frequency and the recent increase in the mortality rate of gastric cancer in Portugal is suggested.
Comparison of extended deep femoral angioplasty and femoropopliteal bypass graft in severe ischemia of the leg
Authors: Meyer Eugene , Adar Raphael
Published: May 2005

Extended deep femoral angioplasty (EDFA) as a single procedure in 33 patients for revascularization of the severely ischemic lower extremity was compared with femoropopliteal bypass graft (FPBG) in 34 patients in a nonrandomized study. Severity of ischemia, incidence of diabetes, and frequency of cardiovascular diseases were comparable in the 2 groups. The pathology of the occlusive disease as delineated by angiographic criteria was worse in patients in the EDFA group, who had more severe disease in the profunda and in the outflow tract. Life table analysis to 3 years showed better overall results for FPBG than for EDFA. This difference was mainly attributed to the fact that FPBG was performed more often in patients with better outflow tracts. Significant angiographic correlates of success in EDFA were: (a) a good quality distal popliteal segment, (b) 2 or 3 vessel outflow tract below the knee, and (c) a patent and normal profunda femoral artery or a profunda femoral lesion limited to the proximal few centimeters of the artery.

On the basis of our results we prefer FPGB in the presence of ischemic ulcer or gangrene if anatomic conditions offer a reasonable chance of success. In patients with severe claudication or rest pain, the choice between EDFA and FPBG is made on the basis of the above mentioned angiographic criteria that are weighted against other clinical considerations.
Medical and surgical indications for treatment of morbid obesity
Authors: Diaz S. Garcia , Fernandez S. Garcia
Published: May 2005

Indications for operative intervention for morbid obesity are well established for most of the cases: overweight of 35–50 kg or twice or more the ideal body weight; the type of obesity; age between 20 and 55 years; no existence of metabolic or endocrine diseases causing obesity; and no hepatic dysfunction. We consider it absolutely essential to limit surgery to cases of hyperplastic and mixed obesity, excluding patients with hypertrophic obesity. Relative indications, especially orthopedic problems, as well as social and psychological situations, modify patient selection, including certain peculiarities of the Latin patient.
Surgical treatment of massive obesity: Our experience with jejunoileal bypass
Authors: Montorsi W. , Doldi S. B.
Published: May 2005

The authors relate their experience with surgery for massive obesity, reporting the results obtained in 76 severely obese patients submitted to jejunoileal bypass. The average body‐weight of the 76 operated patients is 151 kg. With a maximum follow‐up of 8 years, 88% of bypassed patients have returned to a normal body weight, their occupation, and a full social life.

The most severe complication of jejunoileal bypass was hepatic failure, requiring the reestablishment of bowel continuity in 3 patients. The adoption of the end‐to‐side jejunoileal bypass, as well as greater clinical experience, contributed to an improvement in results, with a mortality rate of zero.
Management of morbid obesity by jejunoileal bypass
Authors: Schwartz Marshall Z. , Rucker Richard D. , Schneider Philip D. , Coyle John J. , Guzman Ignacio J. , Varco Richard L. , Buchwald Henry
Published: May 2005

Jejunoileal bypass has been the subject of over 350 reports in the literature. The initial enthusiasm for massive intestinal bypass seems to be declining because of its association with numerous and occasionally severe or fatal complications. In the past 9 years, there have been 800 jejunoileal bypass procedures performed at the University of Minnesota. A specific protocol for preoperative, intraoperative, and postoperative care has been, devised to minimize the perioperative and long‐term morbidity and mortality. The most frequent complications in the immediate postoperative period were urinary tract infection (11.9%), wound infection (6%), and thrombophlebitis (2.9%). There were 2 deaths which occurred in the early postoperative period.

In our patient series, 80.5% sustained a weight loss in excess of 30 kg by 1 year. This weight loss has been associated with many beneficial effects including reduction in serum lipid levels, blood pressure, and blood sugar in the diabetic patients. There has also been a marked improvement in self‐esteem and socialization.

The severe adverse sequelae of jejunoileal bypass have occurred in approximately 8%–10% of our patients. Many of the electrolyte and liver dysfunction problems have been minimized by close and frequent follow‐up. Fatigue (8%), cholelithiasis (4%), urolithiasis (9%), and bypass enteritis (10%) have been other adverse results of massive intestinal bypass. There were 5 additional deaths (total mortality rate of 1%) in our series related to sepsis and/or hepatic failure.

The reanastomosis rate has been under 2% in our series to date.
Gastric bypass for morbid obesity
Authors: Griffen Ward O. , Bivins Brack A. , Bell Richard M. , Jackson Kathleen A.
Published: May 2005

This is a report on 402 consecutive gastric bypass operations performed for morbid obesity. The operation involves the construction of a small (30–60 ml) upper gastric pouch connected to a Roux‐en‐Y jejunal limb by an anastomosis no larger than 1.2 cm in diameter. Concomitant patient ailments included hypertension, gallbladder disease, arthritis, and diabetes. Three patients died postoperatively, and the overall immediate morbidity was 4.2%. Ninety percent of the patients have achieved and maintained a satisfactory weight reduction. However, residual problems include anastomotic leaks, inadequate weight reduction, and few but significant difficulties such as anemia, kidney stones, and marginal ulcer. All of the obesity‐associated diseases responded favorably, either disappearing or being greatly ameliorated.
Gastroplasty in morbid obesity: A progress report
Authors: Gomez Cesar A.
Published: May 2005

The lower mortality and morbidity rates of the gastric partitioning operations seem to be the primary reason for their increasing popularity among surgeons everywhere. Two hundred patients in our series underwent gastroplasty for morbid obesity. A measured 60‐ml proximal gastric pouch is formed as the TA‐90 is doubly applied across the upper stomach, just distal to the esophagogastric junction. The egress channel is located on the greater curvature, supported by a continued seromuscular inverting layer using 2‐0 polypropylene suture and a second interrupted inverting layer using 4‐0 Dacron® sutures. There were 154 females and 46 males in the series. The mean age was 34.2 years and the mean kg overweight, 67.4. The early postoperative complication rate was 19%, including 1 cardiac death, for a 0.5% mortality rate. Twelve percent revision rate included 15 staple line disruptions, 3 enlarged channels, 4 channel stenoses, and 2 enlarged pouches. Staple line dehiscence continues to be of concern with stapling in continuity. Liquid or pureed diet restriction for the first 12 postoperative weeks decreases the incidence of this complication. The second application of TA‐90 and the preservation of adequate blood supply to the pouch are important factors in the preservation of the integrity of the staple line. Ninety percent of total weight loss occurred at 12 months. Weight loss was maintained at 18 and 24 months.
Treatment of morbid obesity by gastric partitioning
Authors: Carey Larry C. , Martin Edward W.
Published: May 2005

The surgical treatment of morbid obesity by partitioning the gastric reservoir was designed to reduce caloric intake while avoiding alteration of the normal digestive process. Use of a single row of staples with a TA‐90 apparatus followed by a solid diet provided disappointing weight loss after 12 months, despite early gratifying results. Restricting patients to a liquid diet for 8 weeks postoperatively improved the efficacy of the procedure, but after the superior integrity of a double staple application was proven in the laboratory, that technique has been adopted. Without exception, patients are limited to liquids for 8 weeks postoperatively. Essential to a successful outcome of this procedure is continuing, understanding, skilled support by the nurse and the dietitian, who with the surgeon, comprise the team dedicated to the care of these patients.
Lower esophageal sphincter and the gastroesophageal antireflux mechanism
Authors: Laitinen Seppo T. , Larmi Teuvo K. I.
Published: May 2005

Various factors involved in the structure and functional control of the gastroesophageal antireflux mechanism were investigated experimentally in dogs and in a clinical series, with special attention to manometric examination of the lower esophageal sphincter (LES). The prevention of the compressive action of extrinsic paraesophageal structures did not lead to changes either in LES pressure or in LES response to increases in abdominal pressure. The mechanism intrinsic to the gastroesophageal junction, the LES, seems to be primarily responsible for the maintenance of gastroesophageal competence. Also, the LES response to increased ultra‐abdominal pressure appears to be a property of the LES itself. Vagotomy performed at different levels did not produce a change in LES pressure, whereas LES response was significantly attenuated after each type of vagotomy. The vagus nerves apparently have no important role in the maintenance of LES pressure, whereas LES response seems to be mediated by a vagal reflex. Intragastric bile instillation caused a significant rise in LES pressure, but chronic intragastric bile contamination did not lead to changes in gastroesophageal competence. This suggests that intragastric bile contamination does not have a deleterious effect on LES competence and does not seem to predispose to gastroesophageal reflux. Of the drugs generally used in premedication for or induction of anesthesia, atropine decreased LES pressure significantly. Metoclopramide, in turn, produced a significant rise in LES pressure and, when administered before atropine, was capable of preventing the depressant effect of atropine on LES pressure. Thus, routine use of metoclopramide in premedication for or induction of anesthesia to prevent the depressant effect of atropine on LES pressure and the possible consequent gastroesophageal reflux, pulmonary aspiration, and postoperative pulmonary complications should be considered. The mean LES pressure after surgery for reflux esophagitis was significantly greater in patients with an objectively good operative result than in those with an objectively poor result. However, some overlapping occurred in LES pressure values between these two groups. The correlation between LES manometry and other examination methods in the evaluation of the operative result of reflux esophagitis seems to be rather good.
Hemangiopericytoma: A clinicopathologic and ultrastructure study
Authors: Bose Bireswar
Published: May 2005

Hemangiopericytoma is a rare mesenchymal tumor arising from special cells known as “pericytes,” present on the outer walls of the capillaries. This neoplasm, first described by Stout in 1942, can occur in any part of the body but the majority are confined to the trunk and lower limbs. It can affect both sexes equally and all age groups, but occurs principally in adults in the 4th decade of life. Occasionally, the spectrum of variations in its histologic features lead to misinterpretation; such errors can be avoided by the use of electron microscopy. Approximately 50% are malignant and certain criteria are used to differentiate the benign from its malignant counterpart.

This paper is based on a study of 6 patients seen in a special referral center during a 10‐year period; in 2 patients electron microscopic studies were undertaken to confirm the diagnosis. Four patients (66%) died within 5 years, and the remaining 2 are alive without recurrence at 6 years and 32 months, respectively. The literature on hemangiopericytoma is briefly reviewed from a surgeon's viewpoint, with special reference to the place of preoperative tumor embolization and recent advances made in the field of adjuvant radiotherapy and chemotherapy.
Medical management of ulcerative colitis and indications for colectomy
Authors: Truelove Sidney C.
Published: May 2005

Contemporary medical management of ulcerative colitis is surveyed. The most valuable drugs are corticosteroids, which may be administered orally, by injection, or topically (as enemas); and sulphasalazine (Azulfidine®) for oral or topical use. Other agents such as immunosuppressive drugs and disodium cromoglycate may also have a small role in management. In addition, in very ill patients, intravenous fluid and electrolyte replacement, blood transfusion, or parenteral nutrition may be required.

Suitable regimens of medical treatment for mild, moderate, and severe attacks of colitis are outlined as well as the indications for surgery. The best choice of medication for maintenance therapy is also considered.

The risk of malignant change in long‐standing colitis is discussed with particular reference to the method of containing this risk during continued conservative management by regular proctoscopic and colonoscopic biopsies to detect the premalignant condition of severe epithelial dysplasia.
Complications and function of the continent ileostomy at the Cleveland clinic
Authors: Fazio Victor W. , Church James M.
Published: May 2005

We have reviewed the results of continent ileostomy management in 168 patients treated from 1977 to 1985: 83 men and 85 women ranging from 16 to 69 years of age (median, 35 yr). One hundred fifty patients were diagnosed as having ulcerative colitis originally (14 later manifested Crohn's disease), 7 had familial polyposis coli, 1 Crohn's disease, and 10 continent urostomies. Twenty‐four patients were referred with pouches made elsewhere. A total of 252 operations were undertaken to construct or reconstruct the ileostomies, with a postoperative mortality rate of 0.04% (1 case). Postoperative complications following pouch construction or revision included bowel obstruction (5.2%), hemorrhage (2.8%), and sepsis (4.8%), while valve necrosis occurred in 4 patients and there were 5 fistulas. Twenty‐nine percent of patients developed pouchitis, all treated medically. Valve extrusion occurred in 17% of cases, late fistulas in 7.1%, valve prolapse in 3%, and peristomal sepsis in 11%. Reoperation rates were 42.5% in the first 3 years of the series, 38.5% in the next 5 years, and 6.5% in the last year. The use of Marlex® mesh in pouch construction was effective in stabilizing the valve, but led to a prohibitively high incidence of late complications and was abandoned in 1984. Ten pouches have been excised (8 of 15 done for Crohn's disease) and a total of 6 patients have died. Of the 152 patients alive with a pouch, 91% were continent. Results are encouraging and support the use of the continent ileostomy in patients unsuited for ileoanal pouch procedures.
Total colectomy and ileorectal anastomosis for ulcerative colitis
Authors: Mann C. V.
Published: May 2005

The pros and cons of total colectomy and ileorectal anastomosis for ulcerative colitis are discussed based on the author's experience and on the collective results with this operation at St. Mark's Hospital, London, over a 20‐year period. Its chief merits are that it is easy to perform, carries a low operative mortality and morbidity, and, when it works well, usually affords excellent anorectal function. It has 2 main disadvantages: in a proportion of cases it proves unable to control the disease because of continuous or recurrent activity of the residual proctitis, and occasionally a carcinoma may develop in the rectal stump. But patients who have failed with it can easily be salvaged, as a rule, by proceeding to a proctectomy and ileoanal anastomosis (or ileostomy). As for the risk of cancer arising in the rectum, fortunately, this can now be largely contained by regular follow‐up attendances, at which rectal biopsies are taken to look for evidence of the premalignant change of severe epithelial dysplasia, a precaution that is absolutely essential after this operation.

Important points in the technique of ileorectal anastomosis are emphasized, and the suitability of the operation for colitis in various clinical settings is examined.
Proctocolectomy and ileoanal anastomosis
Authors: Beart Robert W.
Published: May 2005

An account is given of the evolution of proctocolectomy with construction of a pelvic ileal pouch and an ileoanal anastomosis, which has probably become the most popular elective operation at the present time for ulcerative colitis. The technique favored by the author for this procedure is described and the results obtained in 422 cases at the Mayo Clinic are analyzed, with 188 of them analyzed in detail. Outstanding issues regarding technical methods and outcome are discussed.
Proctocolectomy and ileoanal anastomosis with J‐shaped or S‐shaped ileal pouch
Authors: Cohen Zane , McLeod Robin S.
Published: May 2005

This article reports an experience of 150 ileoanal anastomoses with pelvic ileal pouches performed between January, 1982 and March, 1986. The pouches were J‐shaped in 70 patients, and S‐shaped in 80 (with an exit conduit not longer than 2.5 cm). In most of the former group, a long cuff of rectal muscle coat (10 cm from the pectinate line) was preserved, while only a short cuff (2 cm from the pectinate line) was retained in some of the former group and all of the latter group, a modification which had considerable technical advantages and seemed to carry no detriment to subsequent function.

An attempt was made to assess the influence of these variations in operative technique on the quality of the functional result by a special study of 82 patients: 39 with a J pouch and long rectal cuff, 2 with an S pouch and long rectal cuff, 28 with a J pouch and short cuff, and 13 with an S pouch and short cuff. At an initial survey, the patients with J pouches reported more urgency and frequency of defecation and more frequent disturbances at night than did those with S pouches. Almost all these differences disappeared 8 months later. At this stage, 94% of the patients were very pleased with the outcome of their surgery and glad to have avoided an ileostomy, but, even so, most of them continued to have some bowel complaints.
Emergency surgery for ulcerative colitis
Authors: Hawley P. R.
Published: May 2005

In this article, the role of emergency surgery for severe acute phases of ulcerative colitis is examined. Consideration is given to the diagnosis of the urgent condition, the assessment of the severity of the attack, and the timing of the decision to abandon intensive medical treatment for operation. The form that this emergency intervention should take is then discussed, the author's preference being an ileostomy and subtotal colectomy, and described, in detail, is the operative technique employed in these acute cases. The results obtained from this and other emergency procedures at St. Mark's Hospital, London, and elsewhere are analyzed.
Medical management: Its accomplishments in Crohn's disease and indications for surgery
Authors: Allan R. N.
Published: May 2005

While the etiology of Crohn's disease remains unknown, the optimal treatment of patients with this complaint must include integrated medical and surgical management.

Crohn's disease is, in practice, not a single disorder but comprises a wide variety of disorders masquerading under the one name, so that each patient requires careful individual evaluation, including a review of previous resections and a clear definition of the site and extent of macroscopic disease. Any anemia and fluid or electrolyte depletion must be detected and rectified. Local complications such as stricture, abscess, or enterocutaneous fistula must be identified, and secondary complications such as renal stones, gallstones, or peptic ulcer considered. Symptomatic relief of diarrhea with codeine phosphate, Lomotil®, or loperamide may be appropriate. In symptomatic patients with nonobstructing Crohn's disease, “specific therapy” using sulphasalazine, metronidazole, corticosteroids, or immunosuppressive therapy may play a useful shortterm role. In a few patients, dietary manipulation and enteral or parenteral feeding may be of value. Several controlled trials have shown that “specific” medical treatment is not of any benefit either for patients with quiescent disease or for asymptomatic patients after resection of their lesions.

Crohn's disease complicated by the occurrence of a stricture, an intraabdominal abscess, or an enterocutaneous fistula lies essentially within the province of the surgeon.

Many patients with Crohn's colitis respond initially to specific medical treatment, but relapses are common, so that resection is appropriate in those patients with chronic ill health; there is a negligible mortality in experienced hands. The risk of recurrent disease should not delay surgical treatment, which can restore the chronically ill patient to good health, often for a considerable time. Furthermore, recurrent disease is commonly localized to the site of previous resection; if symptoms persist, a further resection can be undertaken with minimal morbidity.
Surgical treatment of Crohn's disease of the small bowel or ileocecum
Authors: Hultén Leif
Published: May 2005

Standard surgical treatment for most cases of Crohn's disease of the small bowel or ileocecal region consists of resection, which, however, suffers 3 major disadvantages: (a) It often causes a fair amount of operative morbidity and mortality, especially when performed in the presence of septic complications. To reduce these immediate hazards, a strong case can certainly be made for an earlier resort to surgery before the onset of such complications; (b) It is followed by a high incidence of recurrence of the disease, amounting to about 50% by 10 years. Claims that the risk of recurrence can be reduced by using a more radical type of resection have not been substantiated. Fortunately, recurrences can usually be excised with no increased likelihood of further recurrence, and, by a combination of resection and reresection as required, many patients can be afforded prolonged periods of symptomatic relief; (c) Normal intestinal absorption is impaired, especially after major or repeated resections of the small bowel. The consequences are diarrhea and possible hematological and nutritional disturbances and a predisposition to the formation of biliary and urinary calculi. But, even a loss of up to 50% of the entire small intestine is often compatible with a reasonably good state of general health, particularly if most of the colon has been preserved. Fortunately, such extensive intestinal losses are rare, even after 2 or 3 resections.

For short stenosing Crohn's lesions of the small bowel, the alternative operation of stricturoplasty has recently become available. Although the initial results have been encouraging, more prolonged study is required for a valid appraisal.
Surgical treatment of Crohn's disease affecting mainly or entirely the large bowel
Authors: Goligher J. C.
Published: May 2005

The measures available for the elective or emergency surgical treatment of Crohn's disease confined mainly or entirely to the large intestine are surveyed in the light of the author's personal experience in the management of 250 cases, followed up since operation for a mean period of 5 years (range, 7–25 yr).
Management of perianal Crohn's disease
Authors: Allan Arthur , Keighley Michael R. B.
Published: May 2005

Most patients with perianal Crohn's disease are asymptomatic and perianal disease may resolve given adequate medical treatment for the underlying intestinal lesion. This will consist principally of sulphasalazine and prednisolone, both of which are known to be effective in the treatment of Crohn's disease. Should the local perianal disease become more severe, a trial of oral metronidazole may be worthwhile. The development of an ischiorectal or perianal abscess is an indication for the simplest surgical drainage procedure, and rectal strictures resulting from the healing of perianal fissures may be gently dilated. Further progression of disease may be treated by diversion of the fecal stream, but this will stand a greater chance of success in patients without florid rectal Crohn's disease. Fecal diversion is also indicated as a preliminary to the repair of rectovaginal fistulas. Patients with florid perianal Crohn's disease and severe anorectal disease will probably come to proctocolectomy, but initial defunctioning of the colon will make the operative procedure easier, may facilitate perineal healing, and some patients may actually avoid proctectomy with its high risk of a persistent perineal sinus.
Management of conventional ileostomies
Authors: Pemberton John H.
Published: May 2005

With few exceptions, proctocolectomy is the treatment of choice for patients with chronic ulcerative colitis. The method by which patients are offered control of bowel function postoperatively, however, is more controversial. Traditionally, proctocolectomy is accompanied by a conventional Brooke ileostomy and control of enteric effluent provided by an external appliance. Today, several alternatives are available, such as Kock's continent ileostomy and the ileoanal anastomosis. The results of both are generally good. The functional outcome of these procedures is, however, not always uniform and not all patients are candidates for such alternatives. Conventional ileostomy, therefore, remains the standard surgical approach; Brooke ileostomy is the one procedure which is applicable to any patient regardless of age, body habitus, type of disease, or other medical problems. It is the aim of this article to summarize important principles of surgical technique and of stomal care, to detail the functional results and physiologic consequences of standard ileostomy, and to document the impact of ileostomy on quality of life. Finally, the current and future role of ileostomy in the era of surgical alternatives will be discussed.
Estimation of serum complement and its role in management of trauma
Authors: Kapur M. M. , Gidh M.
Published: May 2005

Serum samples of traumatized (16) and operated (31) patients were analyzed to determine C3 levels and activation. It was found that in the immediate postinjury and postoperative periods, serum C3 activation occurred with a fall in C3 levels. The degree of serum C3 depletion was directly related to the severity of injury, as assessed by the injury severity score (ISS), and to the extent of surgical procedure performed, as assessed by the total duration of surgery and total blood loss. The mean ISS of patients with activated complement was 20.3, in comparison with the ISS of those in whom complement was not activated (mean ISS, 6.6;p<0.01). The mean serum C3 level of patients with ISS≥12 was 80.3 mg% in comparison with the mean C3 level (110.2 mg%) of those with ISS<12(p <0.01).

Serial assay for serum C3 levels at 24‐hour intervals in uncomplicated cases revealed a gradual return of the levels to near normal values over a period of several days. Failure to return to normal levels at the expected time invariably indicated complications and, in all such patients, an occult septic focus was either discovered or it revealed itself during the subsequent period of observation. Resolution of septic complication by therapeutic intervention led to a prompt return of the levels to normal. One patient ultimately succumbed to sepsis and had persistently low C3 levels until death.

Serial serum C3 estimation is recommended here as a simple, effective, and inexpensive parameter for feedback information in the management of traumatized and operated patients.
Recurrence rate after highly selective vagotomy
Authors: Busman Dick C. , Volovics Alexander , Munting Jaap D. K.
Published: May 2005

Several ways of analyzing recurrence figures are presented in order to demonstrate the difficult interpretation of recurrence rate with highly selective vagotomy (HSV) in 262 patients operated on for duodenal ulcer with an almost complete follow‐up. Actuarial recurrence risks and cumulative recurrence hazards are calculated and compared with several studies on the same subject.

We conclude that: (a) There is no such entity as a fixed or definitive recurrence percentage (usually indicated in clinical reports as “recurrence rate”) after HSV or other operations for duodenal ulcer; (b) The risk of any patient developing a recurrence at any time after HSV is constant in the immediate future and is as high 6 years after operation as it is after 1 year; and (c) There is no permanent cure after HSV; cure can only be expressed as a certain probability of freedom from recurrence in a similar way to that of oncological or vascular surgery.
Dynamic Visick grading after highly selective vagotomy
Authors: Busman Dick C. , Munting Jaap D. K.
Published: May 2005

A continuous way of assessing the results after highly selective vagotomy (HSV) is presented, as applied in 262 patients operated on for duodenal ulcer. Regrading of all patients who showed recurrences at any time is permitted according to their actual condition at each grading moment. The dynamic Visick grading shows the same percentage of success at each assessment in spite of an ever increasing percentage of recurrences— many defined failures appear to be temporary failures—which is accounted for in this type of presentation.

The conclusion is that HSV appears to favorably change the natural history of duodenal ulcer disease in 94% of patients at any time of assessment and that 3% of patients in the present series are graded as permanent failures.
Effects of thyroxine on cell proliferation in human multinodular goiter: A study on growth of thyroid tissue transplanted to nude mice
Authors: Smeds Staffan , Peter Hans J. , Gerber Hans , Jörtsö Erik , Lennquist Sten , Studer Hugo
Published: May 2005

To analyze the inhibitory effect of thyroxine (T4) on thyroid growth, freshly obtained biopsies of human nontoxic multinodular goiter tissue from 9 patients were transplanted to nude mice. After the implantation period, thyroid growth was stimulated by either hemithyroidectomy (HT) or by administration of the goitrogen propylthiouracil (PTU), with or without simultaneous administration of T4. During the latter period,3H‐thymidine was continuously administered by osmotic minipumps to label replicating cells. After processing of the tissue for autoradiography, the fraction of labeled cells (LI) was calculated.

Following HT, the fraction of labeled cells in nontoxic multinodular goiter tissue was 4.8%. T4 significantly reduced the LI to 1.0%. The goitrogen induced transplant growth, the LI varying between 28% and 61% in the different specimens. Administration of T4 resulted in lower LI in all transplants: in 5 specimens the LI was similar to control transplants. In transplants from 3 goiter specimens, however, significantly higher LI were found.

The present results show that administration of T4 significantly inhibits growth of human thyroid tissue. The effect seems, however, to vary in different specimens of nontoxic goiter, indicating a varying degree of autonomous replicating activity.
Esophageal carcinoma: Patient selection for transhiatal esophagectomy. A prospective analysis of 50 consecutive cases
Authors: Barbier Peter A. , Becker Christoph D. , Wagner Hans E.
Published: May 2005

Fifty patients underwent transhiatal esophagectomy (THE) without thoracotomy with gastric interposition for esophageal carcinoma. Resection was considered curative in 15 patients with stage I or II, and palliative in 35 patients classified as stage III or IV. Postoperative morbidity was 42%. The frequency of complications was significantly higher following palliative surgery than after curative surgery. The mortality rate was 2%. On the basis of the clinical, diagnostic, surgical, and histologic data for all patients, criteria for patient selection are defined. Patients with tumors of the pretreatment T3 category and those with systemic metastases were excluded from the study. Differentiation between the pretreatment T1 and T2 categories was without importance in determining the suitability for THE.

In advanced tumors of the upper thoracic esophagus, involvement of the tracheobronchial system may preclude complete removal of the tumor. Sharp dissection, which is often required in these cases, increases the risk of THE. Because such involvement can be recognized accurately on computed tomographic (CT) examination of the mediastinum, tumors of the upper thoracic esophagus should only be treated by THE if there are no signs of involvement of the tracheobronchial system on preoperative CT.

Respiratory impairment rarely constitutes a contraindication, and THE is well tolerated even by geriatric patients. THE is a safe procedure for both curative and palliative resection of esophageal carcinoma provided that candidates for this operation are selected properly.
Increased ulcer relapse rate after PCV in smokers
Authors: Graffner Hans , Lindell Gert
Published: May 2005

There is epidemiological evidence of an association between cigarette smoking and peptic ulcer disease. Patients who are smokers and treated with H2‐receptor antagonists have a higher recurrence rate than equally treated nonsmokers. To study whether this is also a fact among surgically treated patients, we investigated 306 patients operated on with parietal cell vagotomy (PCV) from 1971 to 1980. Sixty‐two percent were cigarette smokers and among these, 16% were female compared to 33% in the nonsmoking group (p<0.01). An ulcer recurrence rate of 24% was found among smokers with a primarily duodenal ulcer disease compared to 7% in nonsmokers (p<0.01). In the group of patients with pyloric/prepyloric ulcer disease, a 34% ulcer recurrence rate was reported in the smoking group compared to a 5% ulcer recurrence rate among nonsmokers (p<0.01). Before surgery, basal and pentagastrin‐stimulated acid output were significantly higher in the smoking group, but, postoperatively, no significant differences were seen. This implies that factors other than gastric acid secretion must be the cause of the higher ulcer recurrence rate in smokers.
Hepatic hemobilia of traumatic or iatrogenic origin: Recent advances in diagnosis and therapy, review of the literature from 1976 to 1981
Authors: Curet Philippe , Baumer Richard , Roche Alain , Grellet Jacques , Mercadier Maurice
Published: May 2005

A rare lesion, macroscopic hemobilia involving the liver, is usually of traumatic or iatrogenic origin. A review of the international literature published between 1976 and 1981 demonstrated 73 such cases, including 50 of an iatrogenic nature. Among the diagnostic investigations employed, duodenal fibroscopy gave negative results in 50% of cases. Ultrasonography and computed tomography are now replacing scintigraphy with99mtechnetium as a diagnostic procedure for intrahepatic fluid collections. The most reliable method is arteriography, this alone providing both diagnostic and topographic data. The fact that treatment by endovascular route was successful in 24 of the 28 patients suggests that the need for surgery requires reconsideration, particularly in cases of iatrogenic origin.
Hepatolithiasis: Present status
Authors: Nakayama Fumio , Koga Akitoshi
Published: May 2005

In contrast to ordinary cholesterol cholelithiasis, hepatolithiasis or intrahepatic calculi pose serious health problems not only in Japan but also in China, Taiwan, Korea, the Philippines, Malaya, Singapore, and Indonesia. Soft brown calcium bilirubinate stones are present in the grossly dilated intrahepatic bile duct distal to a stricture. Liver lobes involved become fibrous and contain large cysts filled with stones. The classification of hepatolithiasis based on prevailing pathological findings is presented. Two main factors, bile stasis and bacterial infection, are thought to be responsible for the formation of intrahepatic calculi (calcium bilirubinate stones). Β‐glucuronidase from bacteria such asEscherichia colipresent in intrahepatic ducts hydrolyzes bilirubin diglucuronide to bilirubin. The bilirubin combines with the calcium in bile to form calcium bilirubinate which leads to the formation of intrahepatic calculi. The presence of bile stasis, due to bile stricture, aids growth of intrahepatic calculi and aggravates bacterial infection in situ. The clinical picture and the diagnosis and treatment of hepatolithiasis are discussed with emphasis on the recently introduced diagnostic imaging techniques of the hepatobiliary system. Also the principle and practice of operative procedures employed by hepatolithiasis are presented.
Strictures of the intrahepatic bile ducts
Authors: Mercadier M. , Fingerhut A.
Published: May 2005

Strictures of the intrahepatic bile ducts are rare. Frequently, the condition passes unrecognized by both the internist and the surgeon, and is too often discovered only at autopsy. The strictures are related either to an inflammatory process, which is rare, or to a tumor which is more common. Benign or malignant stenosis may involve an intraparenchymatous hepatic duct or one of its segmental afferents. It results in proximal stasis, infection, lithiasis, and biliary cirrhosis. In fact, the prognosis and treatment of the lesion are dominated by the inflammatory or malignant origin of the stricture.
Papillomatosis of the intrahepatic bile ducts
Authors: Mercadier M. , Bodard M. , Fingerhut A. , Chigot J. P.
Published: May 2005

Intrahepatic biliary papillomatosis is most often the initial stage of diffuse biliary papillomatosis. Without any specific clinical expression, the disease may mimic the symptomatology of biliary lithiasis. It is usually discovered either during surgery or postoperatively by the presence of mucus discharge via the drainage system of the biliary tract. Its course is unfavorable because of its tendency to extend to the entire biliary tree and even to the pancreatic ductal system. Papillomatosis may degenerate, as recent publications have shown. Numerous therapeutic approaches have been proposed, including transcanalicular extraction, drainage, and hepatic excision. Most often, these measures are only palliative because of the unrelenting extensive character of the disease. Prognosis is bleak. Perhaps some hope may be provided by hepatic transplantation.
Hepatic hemobilia: Hemorrhage from the intrahepatic biliary tract, a review
Authors: Sandblom Philip , Saegesser Frédéric , Mirkovitch Velimir
Published: May 2005

Hepatic hemobilia is defined as hemorrhage arising from pathological changes in the intrahepatic biliary tract. The main causes are iatrogenic trauma, cholangitis, tumors, and coagulopathy. The salient features of the hemobilia syndrome are described and their causes explained. The treatment, when necessitated by hemorrhage or clot formation, is either resection of the liver or occlusion of the responsible artery by ligature or embolization. The iatrogenic trauma may be operative, resulting from instrumental lesion of the bile ducts, needle biopsy, transhepatic cholangiography, biliary tract prosthesis, or inlaying hepatic artery catheters. Among the inflammatory etiologies, special attention is given to nematodes in the ducts, “the tropical hemobilia.” Spontaneous hemobilia may, just as nose bleeds or hematuria, result from treatment with anticoagulants.
Liver transplantation for biliary atresia
Authors: Iwatsuki Shunzaburo , Shaw Byers W. , Starzl Thomas E.
Published: May 2005

Orthotopic liver transplantation was performed 15 months to 20 years ago in 126 recipients, all of whom were under 18 years of age. Eighty‐six of these pediatric recipients were treated before 1980 with azathioprine (or eyclophosphamide) and prednisone, to which antilymphocyte globulin (ALG) usually was added. One‐year patient survival was 40%. In the last 40 cases, the new drug cyclosporine has been given with low doses of steroids. The one‐year patient survival increased to 65%. Both in the pre‐cyclosporine era and more recently, the survival of patients with biliary atresia has been lower than in the next largest category of patients, namely, those with liver‐based inborn metabolic errors. The difficulty of operation in patients with biliary atresia has been greater than in recipients with other diagnoses, partly because of previous operations such as portoenterostomy (Kasai procedure). Hepatic portoenterostomy, worthwhile as it is, has posed technical difficulties for eventual liver transplantation, particularly when complicated Roux limb techniques or venting procedures have been applied. In our total experience the longest survival after liver replacement in a child whose original diagnosis was biliary atresia is 132/3 years.
Hepatic transplantation and biliary atresia: Early experience in eight patients
Authors: Ascher Nancy L. , Najarian John S.
Published: May 2005

Recent improved results have raised interest in hepatic transplantation. Transplantation experience in patients with biliary atresia at the University of Minnesota is reported. These patients are frequently first seen when very small; rigorous metabolic support is used to optimize hepatic function and enhance weight gain while a donor is found. Preoperative exchange transfusion is performed as dictated by coagulation parameters; this minimizes operative blood loss. The operative procedure is performed as described by Starzl using a cholecystojejunostomy and aorto‐aortic anastomosis. Immunosuppression is achieved with cyclosporine and low‐dose prednisone. Weekly percutaneous biopsies provide an early indication of rejection which occurs frequently in these patients. Rejection is treated with bolus steroids and/or antilymphoblast globulin. Five of eight children with biliary atresia have returned to health after liver transplantation. Two deaths were related to difficulties with the donor hepatectomy and the last child died after erosion of a central venous catheter with cardiac tamponade. In this small series, early success after liver transplantation (>24 hours), predicted longterm survival.
Arterial surgery in Scandinavia
Authors: Bergqvist David , Myhre Hans O.
Published: May 2005

With help of a questionnaire with a 96% response rate, the exact number of arterial operations in Scandinavia has been established. In Sweden in 1980 it was 470 per million inhabitants and in Norway in 1981 it was 553 per million inhabitants, but regional differences within the countries were great. In only 14% of the hospitals were more than 100 arterial operations performed per year. The development of arterial surgery during a 10‐year period in the cities of Malmö and Oslo, with active vascular centers, is also given. The increase in the two cities is similar and above 300%. Percutaneous transluminal angioplasty comprised 11% of the total number of arterial interventions in 1981.
Repair of bile duct injuries
Authors: Saber Khairy , El‐Manialawi M.
Published: May 2005

Twenty‐two patients with surgical injury to the common hepatic duct or common bile duct were evaluated. In 20 patients the injury occurred during cholecystectomy and resulted from mistaken identification of the common duct for the cystic duct. Roux‐en‐Y hepaticojejunostomy was performed in 21 patients. Three of the anastomoses were end‐to‐side, while 18 were side‐to‐side. Choledochoduodenostomy was performed in 1 patient.

There were no operative deaths in the 22 patients. Four (18%) patients developed wound infections and in 2 (9%) patients there was a transient bile leak. Two patients died of liver failure due to irreversible biliary cirrhosis 2 and 3 years after the initial injury. All patients in whom side‐to‐side Roux‐en‐Y hepaticojejunostomy was performed as a first procedure (14 cases) had a successful long‐term result with no signs of cholangitis or anastomotic stenosis. The 3 patients with end‐to‐side hepaticojejunostomy developed anastomotic stricture with repeated attacks of cholangitis and required secondary operations. The patient treated by choledochoduodenostomy had a satisfactory result. Patients with iatrogenic bile duct injury can be managed with a high degree of success if referred early and treated appropriately.
Quality of life with the continent ileostomy
Authors: McLeod Robin S. , Fazio Victor W.
Published: May 2005

A survey of 71 patients with continent ileostomies was undertaken to determine their life‐style. Comparison of life‐style in patients with a conventional ileostomy compared to those with a continent ileostomy was possible because 40 of the 71 patients previously had conventional ileostomies. Approximately 50% of them had been restricted in work, hobbies, and travel, and 90% were restricted in clothing selection and athletic activities. About 10% of the patients with continent ileostomies experienced limitations in one of these parameters. With either ileostomy, dietary restrictions were encountered by 54%. The mean cost of supplies was $200 with the continent ileostomy compared with $475 with the conventional ileostomy. Following conversion from a conventional to a continent ileostomy, 68% of the patients noted an improved sex life and 80% noted an improved body image. All would choose retrospectively to have a continent ileostomy and 96% found the result to be as good as or better than their preoperative expectations. If complications were to arise, 97% of patients would undergo revisional surgery rather than have removal of the continent ileostomy. We conclude that patient satisfaction with the continent ileostomy is high. Fewer limitations are encountered with the continent ileostomy than with the conventional ileostomy.
A clinical evaluation of radiation‐induced hyperparathyroidism based on 148 surgically treated patients
Authors: Hedman Ingmar , Hansson Göran , Lundberg Len‐Marie , Tisell Lars‐Erik
Published: May 2005

During a 29‐year period ending in 1981, there were 839 patients treated surgically for hyperparathyroidism (HPT). One hundred and forty‐eight (17.6%) of these patients had a history of previous radiation to the neck region. Latency time between irradiation and diagnosis was inversely correlated to age at irradiation and showed a mean of 35 years. Hyperparathyroidism (HPT) following neck radiotherapy (r‐HPT) had the same clinical presentation as spontaneous primary HPT (p‐HPT); however, the r‐HPT patients traced by follow‐up had milder disease. In patients with r‐HPT or p‐HPT, kidney stones were more common in men, while mental and skeletal changes were more common in women. The percentage distribution of adenoma and chief‐cell hyperplasia did not differ between the two groups. There were no cases of water clear‐cell hyperplasia or parathyroid carcinoma among r‐HPT patients. Location of a parathyroid adenoma in an upper gland was significantly more common (p<0.001) in patients with r‐HPT compared to patients with p‐HPT. This distribution of adenomas could be correlated with the radiation treatment field. Concomitant thyroid abnormalities were diagnosed in 84% of patients with r‐HPT and in 49% of patients with p‐HPT. Thyroid carcinoma occurred 9 times more often in r‐HPT patients strengthening the indication for surgery in irradiated subjects.