bluuebunny/crossref_metadata_2025 huggingface dataset:
New aspects of craniofacial surgery
Authors: Marchac Daniel , Renier Dominique
Published: May 2005

The concept of craniofacial surgery, introduced by a French plastic surgeon named Paul Tessier, has completely transformed the treatment of facial deformities affecting the skeleton. Two of the more spectacular operations are correction of teleorbitism by orbital mobilization, and correction of facial retrusion by facial or fronto‐facial advancement. These operations have evolved with the bipartition principle and the monobloc and splitting techniques. Craniofacial techniques applied in infancy for correction of craniosynostosis have proved very successful in most cases. The increasing use of miniplate fixation and utilization of cranial bone grafts are mentioned, as well as advances made in genetic and fetal diagnosis.
Functional reconstruction after facial paralysis: A survey
Authors: Berger Alfred , Bargmann Hans J. G.
Published: May 2005

The attempt to achieve symmetrical harmonious facial expression represents a complex surgical challenge, necessitating an individualized approach. Clinical investigations and laboratory experiments have demonstrated how to better reconstruct a “smile.” In long‐standing deformities, ipsilateral or crossfacial nerve grafting followed by functional muscle transfer in a 2‐stage procedure seems to give the most acceptable results; however, hypoglossal‐facial anastomosis and dynamic muscle techniques such as temporal muscle transposition and others can result in adequate functional reconstruction. The development of these techniques with special emphasis on those made during the last 10 years is discussed and compared with our own experiences.
Progress in free tissue transfer
Authors: McC O'Brien Bernard , Vinod Kumar P. A.
Published: May 2005

The development of microsurgical techniques has supplied plastic surgery with a new chance to transfer tissue to nearly any recipient site of the body. Classical methods still have their value but also their limits in many circumstances. Free tissue transfer has proved its advantages, especially in covering defects in the lower extremity; but microsurgical flaps also gain ground in reconstructive surgery of the head and neck, the female breast, the abdominal wall, and the hands.

This article will survey well‐classified microsurgical flaps, their indications, and their limits. In addition to a description of skin, fasciocutaneous, septocutaneous, and musculocutaneous flaps, we also include the latest detailed knowledge of free transfer of muscles, vascularized tendons, nerves, bones, and even joints, digits, and jejunal transfer. An outlook toward new perspectives with so‐called prefabricated flaps will also be discussed.
Progress in limb and digital replantation: Part B
Authors: Berger Alfred , Brenner Peter , Flory Peter , Schaller Eberhard , Schneider Wolfgang
Published: May 2005

Progress in micro‐ or macroreplantation has resulted in higher survival rates of formerly amputated parts. Progress has been made as a result of intensive laboratory training and considerable experience due to the popular application of microsurgical techniques. More amputated digits or limbs may survive because the time of ischemia can be exceeded in using cold storage or perfusion. Homo‐ or heterodigital vessel transposition, expanded indications for vein graft interposition, as well as heterotopic transplantation allow for extremity preservation even in crush injuries, and in disastrous multiple amputations combined with contusion or avulsion. Nowadays, microvascular digital replantation with vessel anastomosis distal to the distal interphalangeal joint in adults is technically feasible. Finger amputations in children are a prime indication for replantation. Maintenance of extremity length is possible in applying external fixation. Emergency free flaps or compound tissue transfer under the “Urgence differée” condition may provide reliable soft tissue coverage. Secondary reconstruction with regard to bone defects, tendon repair, and eventual nerve grafting have to be aspired, finally leading to an improvement of functional results in daily and leisure activities as well as in early professional readaptation.
Progress in burn treatment and the use of artificial skin
Authors: Tompkins Ronald G. , Burke John F.
Published: May 2005

Recently improved survival from thermal injuries has been demonstrated both in children and adults. This increase in burn injury survival rates is the result of multiple changes in treatment; probably the most important changes are, first, a more aggressive management of the wound with prompt excision of devitalized tissues and immediate closure of the wound, and, second, a better understanding and management of metabolic, immunologic, and nutritional aspects of the injuried patient. Artificial skin is a very important additional treatment modality that has more recently become available and promises to contribute significantly to improvements in wound management and survival rates by its ability to physiologically close a burn wound immediately after its excision.
Premature death in patients operated on for primary hyperparathyroidism
Authors: Hedbäck Gunilla , Tisell Lars‐Erik , Bengtsson Bengt‐åke , Hedman Ingmar , Oden Anders
Published: May 2005

To investigate long‐term survival after operation for primary hyperparathyroidism, a follow‐up study was performed on 896 consecutive patients in whom this diagnosis had been clinically and microscopically verified. These patients were operated on in the years 1953–1982. Their mean age at operation was 57.3 years [standard deviation (SD) 13.1], overall cure rate was 97.0%, and postoperative mortality was 0.89%. Follow‐up was 99.8% complete by the end of 1986. Mean follow‐up time was 12.9 years (SD: 6.1). Two‐hundred ninety‐four patients were deceased, which was 118 more than in a control group (p<0.001). The latter was based on Swedish population statistics, matched for age, sex, and calendar year. Each year, the control group was the same size as the hyperparathyroid population. The risk of premature death remained increased (p<0.001) even after exclusion of poor‐risk patients having their hyperparathyroidism diagnosed when being treated or followed because of other serious diseases. The main causes of premature death for the hyperparathyroid patients were cardiovascular and malignant diseases. Both occurred more often than in the control group (p<0.001). The results demonstrate that primary hyperparathyroidism causes damage that is not reversed by surgery.
Papillary thyroid carcinoma: The new, age‐related TNM classification system in a retrospective analysis of 199 patients
Authors: Kukkonen Seppo T. , Haapiainen Reijo K. , Franssila Kaarle O. , Sivula Arto H.
Published: May 2005

The new, age‐related TNM classification system of papillary thyroid carcinoma was applied in a retrospective analysis of 199 patients operated on during the 24‐year period from 1956 through 1979 at the Second Department of Surgery, Helsinki University Central Hospital. According to the new staging system, 103 patients (under 45 years of age) and 96 T1 patients (45 years of age and older) were categorized into stage I. The incidence of carcinoma‐positive cervical lymph nodes was highest among patients under 30 years of age at primary surgery. During the follow‐up period of 6–29 years, cervical lymph node involvement was verified at reoperation in 20 patients (10%). Distant metastases (bone or lung) developed in 11 patients (5.5%). thirty‐one patients (16%) died from carcinoma. The prognostic value of stage grouping, in terms of metastatic tendency and cancer mortality, was clearly demonstrated in the present material, suggesting the suitability of this simplified, new, age‐related staging system in clinical practice.
Deep leg veins as femoropopliteal bypass grafts
Authors: Schulman Martin L. , Schulman Lee G.
Published: May 2005

Conclusion

Our extensive experience indicates that resection of normal superficial femoral and popliteal veins is free of significant late morbidity. Adequate evidence to the contrary has never been presented. Our 5‐year patency rates using deep leg veins equal or surpass the best results ever reported with saphenous veins. Erroneous presentation of our work, as exemplified by the comments of Bergan and associates, tends to delay the acceptance of a major arterial graft source. Deep leg vein grafts represent an important advance in arterial reconstructive surgery, and we are confident that future reports by other groups will confirm the high patency rates and lack of significant late morbidity in our reports [36, 37, 43] and that of Noppeney [1].
The pathology of chronic pancreatitis
Authors: Singh Surjait M. , Reber Howard A.
Published: May 2005

We describe the current concepts of the pathology of alcoholic and obstructive chronic pancreatitis (CP). These 2 types of CP possess distinct pathological features. Alcoholic CP is associated with a lobular distribution of the lesions, with both obstruction (from protein plugs) and dilatation of the canalicular and intercalated ducts. In alcoholics, the concentration of protein in the pancreatic juice is increased, making the precipitation of proteinaceous plugs likely. Obstructive CP, on the other hand, is rarely associated with intraductal precipitates; the small ducts are often normal in appearance, but exocrine damage is much more widespread.

The complications of CP are varied. Jaundice, while usually transient, may occasionally be permanent. This results from the compression of the distal common bile duct by fibrotic changes in the pancreatic head. Transient or permanent obstruction of the duodenum and/or colon may also occur. Nearby vessels may be involved, leading to thrombosis and/or hemorrhage from veins or arteries. Electron microscopic changes recently described in the pancreatic nerves may play a role in the etiopathogenesis of the severe pain so common in patients with CP.
Observations and surgical management of chronic pancreatitis in the British Isles: A review of the twentieth century
Authors: MacLaren Ian F.
Published: May 2005

Chronic pancreatitis was a recognized clinical entity in the British Isles at the beginning of the twentieth century, but until little more than 30 years ago, it was considered to be a rare condition and received scant attention from British surgeons. During the second half of the twentieth century, the incidence of the disease in the British Isles has increased significantly and alcohol abuse has become, by far, the most important etiological factor. Per capita consumption of alcohol in the British Isles has increased very markedly in the past 30 years and alcohol abuse is becoming a major social problem, but, although chronic pancreatitis is more common now than it was 30 years ago, the increase in its incidence is a good deal less than might be expected. British surgeons are agreed that intractable pain is the cardinal indication for surgical intervention in chronic pancreatitis and success depends on selection of the operative procedure most appropriate to the pathological state of the pancreas and, in particular, of its ductal system. In recent years, British surgeons in highly specialized units have become more radical in their approach to the treatment of chronic pancreatitis with total pancreatectomy in selected patients currently being advised more frequently than in previous decades.
Chronic pancreatitis in China: Etiology and management
Authors: Gu Zhuo‐yun , Zhang Kou‐hua
Published: May 2005

The incidence of chronic pancreatitis in China is unknown. Endoscopic retrograde cholangiopancreatography (ERCP), surgery, and autopsy demonstrated that chronic pancreatitis in China is mainly secondary to cholelithiasis and other diseases of the bile ducts. Stones in the common bile duct, both intra‐ and extrahepatic, are extremely frequent in China. Such patients may have scores, even hundreds, of stones filling the common bile duct and its radicles. Biliary tract disease constitutes the etiology of chronic pancreatitis in 40–50% of our patients. The prolongation of necrosis, abscess, or pseudocyst after acute pancreatitis may also lead to chronic inflammation of the pancreas, as may a diverticulum at the second part of the duodenum.

The pancreatitis observed in China is apt to be of the chronicrelapsingtype. Pancreatic ductal stones and ascaris lumbricoides may sometimes be associated with chronic inflammation of the pancreas; however, the cause of chronic pancreatitis is obscure in a large segment of the patients.

Beside the ordinary clinical manifestation of chronic pancreatitis, such as abdominal pain, fever, jaundice, and steatorrhea, regional (splenic) portal hypertension may be observed. ERCP has been useful in diagnosis, and the major changes found in the pancreatic duct are discussed.

Since the symptoms and signs of chronic pancreatitis in China are usually mild or moderate, the patient with intractable pain is uncommon, most being treated with medication. Most surgical procedures utilized to treat chronic pancreatitis are related to the biliary system, such as cholecystectomy with internal or external drainage of the choledochus. Internal drainage of a pancreatic pseudocyst, partial pancreatectomy, and pancreaticojejunostomy are also performed, as indicated, but are less frequent.
Observations and surgical management of tropical pancreatitis in Kerala and Southern India
Authors: Thomas P. G. , Augustine P. , Ramesh H. , Rangabashyam N.
Published: May 2005

This article describes the surgery of tropical pancreatitis as practiced in a region of high incidence, based on the experience at 2 centers: the Department of Surgical Gastroenterology and Proctology, Government General Hospital, Madras, Tamilnadu (a tertiary‐care referral unit) where 52 patients were diagnosed and 40 were operated on between 1982 and 1987; and the Department of Gastroenterology, Deva Matha Hospital, Koothattukulam (a specialized center located in the main endemic area of Kerala), where 116 patients were diagnosed and 33 operated on between 1983 and 1988. The latter series is described in detail with emphasis on the preoperative imaging, operative findings, surgical procedures, complications, and results of surgery.

The experience of other centers in southern India is summarized and discussed. The disease is obviously different from chronic pancreatitis in the West. Special problems of tropical pancreatitis, particularly the management of diabetes and the association of pancreatic carcinoma at a young age, are discussed.
Pancreatitis in Northern Newfoundland and Labrador: A 20‐year review of the Grenfell Regional Health Services experience
Authors: Fitzgerald G. William N. , Thomas Gordon W.
Published: May 2005

A retrospective review of the Grenfell Regional Health Services experience with pancreatitis over a 20‐year period (1968–1987) has been presented. The small number of cases in this series precludes meaningful statistical analysis, however, in general, one can state that native peoples are represented in this study in roughly the same proportion as they are represented in the population served. We have demonstrated that pancreatitis in its chronic form does occur in the Inuit of Northern Labrador. Given the prominent role that alcohol abuse plays in the social and behavioral ills of Labrador's native peoples as reflected in the high incidence of family violence, accidental deaths, and suicides, one might anticipate a disproportionately high incidence of pancreatitis and its chronic sequelae among the Inuit [1, 2]. The answer to this seeming paradox may be found through future study of the nature of the alcohol consumed, its pattern of consumption or of genetically‐determined differences in the metabolism of alcohol and its toxic effects within the body, of differences in the composition of pancreatic secretions, or of environmental and dietary factors [3, 4].
Surgery for chronic pancreatitis in Zaria, Nigeria
Authors: Mabogunje Oluatope A. , Lawrie James H.
Published: May 2005

Fifteen children and 23 adults with complications of chronic pancreatitis were managed in Zaria, Nigeria from 1971 to 1987. They comprised 26 patients with chronic pseudocysts, 9 with chronic abdominal pain, and 3 with obstructive jaundice. Internal drainage was performed for 22 (85%) of the pseudocysts, with resection and external drainage, respectively, in 2 each. A longitudinal pancreaticojejunostomy was performed in a child with juvenile tropical pancreatitis syndrome and biliary bypass was performed in the jaundiced patients. The cause of chronic pancreatitis was known only in 8 (31%) of the patients.
Management of chronic relapsing pancreatitis in adolescents
Authors: Trapnell John E.
Published: May 2005

Chronic relapsing pancreatitis in adolescence is a most uncommon clinical problem and has received minimal separate recognition in the literature. Adolescence is an age when the causes of the disease, which may operate from birth, overlap with the major etiological factors in the generality of pancreatitis in adult life. A personal series of 32 patients with pancreatitis, aged 11–20 years, is reported. Twenty‐four followed a chronic relapsing course. There was, therefore, a marked reversal of the normal preponderance of acute over chronic relapsing cases. Those with underlying biliary disease, and the group in whom no etiological factors could be identified, ran an unexpectedly severe and troublesome course. This, coupled with the reversal of the acute versus chronic disease ratio, raises the question as to whether adolescent pancreatitis is a distinct subgroup in the overall spectrum of this disease.
Chronic pancreatitis: Results of operations for relief of pain
Authors: Ihse Ingemar , Borch Kurt , Larsson Jörgen
Published: May 2005

Pancreaticojejunostomy is the method of choice for surgical treatment of pain in chronic pancreatitis in the case of ductal dilation. The operative risk is small and all remaining glandular tissue preserved. At 5 years postoperatively, about two‐thirds of the patients still experience pain relief.

In the absence of dilated ducts, the surgical options are somewhat more controversial. Parenchyma‐saving alternatives such as nerve‐cutting procedures have not met expectations. Instead, percutaneous blockage of the celiac plexus using alcohol and phenol have been more commonly used for short‐term pain relief. The relatively great number of different resective procedures probably reflects the dissatisfaction with the effect of each one of them. Neither left resection nor total pancreatectomy is, today, an attractive alternative due to the relatively high mortality and morbidity (short‐ and long‐term) risks, especially when evaluated against the backdrop of the limited pain reduction in many patients. The Whipple procedure is still the best alternative, although it should be used with critical selection by both the patient and the surgeon.

As for the new operations presented during the 1980's, it is too early to foresee their possible future role. We feel, however, that we still have to await the operation which fulfills the criteria of an ideal operation for pain in chronic pancreatitis.
Treatment of chronic pancreatitis complicated by obstruction of the common bile duct or duodenum
Authors: Frey Charles F. , Suzuki Mamoru , Isaji Shuji
Published: May 2005

In patients with chronic pancreatitis, common bile duct obstruction is reported in 3.2–45.6% of patients; however, only 5–10% of all patients with chronic pancreatitis require operative decompression of the bile duct. The cause of the intrapancreatic stricture of the common bile duct may be either a fibrotic inflammatory restriction, or compression by a pseudocyst. Obstruction of the duodenum is much less common than common bile duct obstruction in chronic pancreatitis occurring in less than 1‐2% of patients with chronic pancreatitis. Colonic obstruction secondary to pancreatitis is very infrequent.

The intrapancreatic strictures of chronic pancreatitis are characteristically smooth and tapering on endoscopic retrograde cholangiopancreatography (ERCP), but in some patients, they may have a sharp cut‐off and closely resemble the appearance of carcinoma of the pancreas invading the bile duct. The natural history of these intrapancreatic strictures is variable. They may progress and be associated with cholangitis, biliary cirrhosis, common duct stones, or may remain stable for years or regress. Prior pancreaticojejunostomy is not protective against the development of intrapancreatic biliary strictures which may follow in 5–30% of patients, with most authors reporting an incidence of less than 10%. Evaluation of alkaline phosphatase, bilirubin, the presence of jaundice, or the appearance of an intrapancreatic stricture on ERCP is not predictive of whether cholangitis or biliary cirrhosis may or may not develop. The incidence of cholangitis and biliary cirrhosis in patients with intrapancreatic stricture is 9.4% and 7.3%, respectively. Laennec's cirrhosis occurs in a similar number of patients.

Operation is indicated in patients with intrapancreatic strictures of the common bile duct in association with chronic pancreatitis in patients developing cholangitis, biliary cirrhosis, common duct stones, progression of the stricture, persistent high elevations of alkaline phosphatase and/or bilirubin for over a month or inability to rule out cancer of the pancreas or periampullary region. The operation of choice is choledochoduodenostomy or Roux‐en‐Y choledochojejunostomy to bypass the obstructed intrapancreatic portion of the common bile duct. Persistentduodenalobstruction for over 3 or 4 weeks is an indication for gastrojejunostomy.

Pain is not a feature of common bile duct obstruction in the absence of cholangitis. In the presence of pain associated with chronic pancreatitis, longitudinal pancreaticojejunostomy is the operation of choice combined with Roux‐en‐Y choledochojejunostomy. Some of the newer operations, e.g., the Beger and Frey procedures, may make the necessity of a separate operation for biliary decompression superfluous.
Long‐term results of side‐to‐side pancreaticojejunostomy
Authors: Greenlee Herbert B. , Prinz Richard A. , Aranha Gerard V.
Published: May 2005

Chronic alcoholism is the etiologic factor initiating most instances of chronic pancreatitis and its complications in the United States of America. The goal of operative intervention is to relieve incapacitating abdominal and back pain, while preserving as much endocrine and exocrine function as possible. Ultrasound and computed tomography scans are helpful for the identification of gross anatomical changes in the pancreas, but endoscopic retrograde cholangiopancreatography is critical for the precise delineation of pancreatic ductal anatomy. In patients who exhibit dilation of the pancreatic duct secondary to single or multiple sites of obstruction, pancreatic ductal drainage will provide complete or significant relief of pain in greater than 80% of patients. Side‐to‐side pancreaticojejunostomy has evolved as the operation which permits the widest drainage of the entire pancreatic ductal system. Although, initially, it was hoped that pancreatic exocrine and endocrine function would improve or stabilize after pancreatic ductal drainage, follow‐up studies show that the destructive process in the pancreatic islets and acinar cells initiated by chronic alcoholism continues during the years after operation with an increasing incidence of diabetes and steatorrhea. Late mortality is primarily related to continued alcoholism and death secondary to alcohol‐(and smoking‐) associated diseases. Correction of coexistent complications secondary to chronic pancreatitis including pseudocyst and biliary and/or duodenal obstruction should be considered at the time of pancreatic ductal drainage.
Pancreaticoduodenectomy (Whipple resection) in the treatment of chronic pancreatitis
Authors: Howard John M. , Zhang Zhaoda
Published: May 2005

The armamentarium of the pancreatic surgeon must include multiple operative techniques, to be adapted to the clinical and anatomical findings in the patient with chronic pancreatitis. Pancreaticoduodenectomy is an essential component of this armamentarium. Its indications and limitations require continued refinement.

Pancreaticoduodenectomy (Whipple operation) provides excellent results in the relief of the pain of chronic pancreatitis. The incidence of reoperation for control of pain after this procedure is less than after drainage procedures. The postoperative mortality rate in recent reports is less than 2%. Whereas resection of pancreatic tissue diminishes pancreatic function, the metabolic deficits are partially compensated by the better nutritional status resulting from pain relief and discontinuation of narcotics.

In experienced hands, pancreaticoduodenectomy would appear to be the procedure of choice in patients with small pancreatic ducts. In selected patients, it appears to be a good procedure and, possibly, the operation of choice when the disease is predominantly present in the head of the pancreas and/or the uncinate process, especially when strictures involve the common bile duct and duodenum. The authors prefer the procedure when a hard, chronically‐inflamed mass is present in the head of the pancreas.

In our experience, if the suspicion of malignancy of the head of the pancreas persists at operation, pancreaticoduodenectomy is the procedure of choice. Before undertaking resection, the individual surgeon must assess his/her own experience; a low risk is essential.

The continuing alcoholic is not a candidate for pancreaticoduodenectomy. Those who will not stop drinking should seldom be accepted for resection. The same limitation exists for the narcotic addict, but few such patients are encountered today.

In the authors' experience, the operation is excellent for the relief of pain. It is the lifestyle of the continuing alcoholic that poses the more significant problem.
Duodenum‐preserving resection of the head of the pancreas in chronic pancreatitis with inflammatory mass in the head
Authors: Beger Hans G. , Büchler Markus
Published: May 2005

In 141 patients with chronic pancreatitis and an inflammatory enlargement of the head of the pancreas, a duodenum‐preserving resection of the head of the pancreas was performed within a 16‐year period. The hospital mortality was 0.7%; the late mortality was 5%. Seventy‐seven percent of the patients were completely free of abdominal pain; 67% returned to their former occupation. After a follow‐up period of 3.6 years, glucose metabolism was unchanged in 81.7% of the patients, in 10.1% it deteriorated, and in 8.3% it improved permanently.

In patients with severe chronic pancreatitis and an inflammatory mass in the head of the pancreas, a duodenum‐preserving resection of the head of the pancreas is an alternative procedure to the Whipple operation. The surgical technique of the duodenum‐preserving resection includes 2 major steps: first, subtotal resection of the head of the pancreas conserving the duodenum; second, restitution of the exocrine pancreatic secretory flow from the body and tail of the pancreas by using the first jejunal loop as an interposition. In comparison to the Whipple procedure, the duodenumpreserving resection of the head of the pancreas in chronic pancreatitis spares the patient a gastric resection, a duodenectomy, and a common bile duct resection. With respect to long‐lasting pain relief and preservation of the endocrine function of the pancreas, duodenum‐preserving resection of the head is a highly effective surgical procedure with a low early and late morbidity and mortality due to the limited surgical resection.
Assessment of insertion techniques and complication rates of dual lumen central venous catheters in patients with hematological malignancies
Authors: Jansen Ruud F. M. , Wiggers Theo , van Geel Bert N. , van Putten Wim L. J.
Published: May 2005

One hundred and twenty‐three dual lumen silicone rubber central venous catheters were inserted into 101 patients with hematological malignancies undergoing intensive treatment. There was a perioperative complication rate of 13%. Open and closed techniques for inserting the catheter were compared. The operating time needed for introducing the catheter by the closed technique (average, 51 minutes) was significantly shorter (p< 0.001) than the time needed for the open technique (70 minutes), whereas complication rates were equal in both techniques. On average, the catheters functioned for 149 days. Complications leading to removal were observed in 29.3% of patients, most of which were catheter‐related infections (20.4%). Thromboembolic complications leading to removal were less frequent (4.1%) and appeared significantly earlier (p<0.001). These data indicate that introduction of the catheter by direct puncture of the subclavian vein is a quick and safe technique, and that this type of catheter is suitable for long‐term use, both for infusion and for blood sampling.
Early hemodynamic changes following selective distal splenorenal shunt for portal hypertension: Comparison of surgical techniques
Authors: Spina Gian Paolo , Santambrogio Roberto , Opocher Enrico , Gattoni Filippo , Baldini Umberto , Cucchiaro Giovanni , Uslenghi Carlo , Pezzuoli Giuseppe
Published: May 2005

Ninety patients with cirrhosis undergoing elective distal splenorenal shunt (DSRS) for variceal bleeding between January, 1977 and September, 1988 comprised the study group. In 63 cases, the original technique of Warren was used and, in 15, the modified Britton procedure was employed. Twelve patients had a DSRS plus splenopancreatic disconnection. Thirtyfour had alcoholic cirrhosis and 56 had nonalcoholic cirrhosis. Intraoperative portal pressure remained high after the shunt (29.4 cm H2O)even if its initial value was probably decreased by the loss of the splenic flow. Splenic pressure was reduced to 21 cm H2O. The hepatic artery diameter enlarged even after selective shunt (from 6.5 to 7.1 mm). The persistence of a high portal pressure allowed for the preservation of hepatopedal portal flow in 87% of cases. Disconnection between the high‐pressure mesenteric area and the low‐pressure splenic area seemed to be ideal in only 17% of cases. Fifty‐five percent of cases had the early development of minimal or moderate portomesenteric gastrosplenic (PM‐GS) collateral pathways. In 33%, the PM‐GS collaterals were generally abundant and often allowed visualization of the splenic and caval veins during the venous phase of the superior mesenteric arteriograms. In this group, portal flow was generally highly reduced and even abolished. The incidence of portal thrombosis was 11%. Early angiographic checks after DSRS did not show a different hemodynamic behavior between alcoholics and nonalcoholics. Splenopancreatic disconnection seems to prevent the development of collaterals and the loss of portal perfusion after shunt surgery.
Can hepatic failure after surgery for hepatocellular carcinoma in cirrhotic patients be prevented?
Authors: Takenaka Kenji , Kanematsu Takashi , Fukuzawa Kengo , Sugimachi Keizo
Published: May 2005

To study the causes of postoperative hepatic failure in cirrhotic patients undergoing resection for hepatocellular carcinoma, we evaluated data on 126 cirrhotic patients surgically treated from 1977 to 1987. The records of 102 patients with a good postoperative course (survival group) and 24 patients who developed hepatic failure and died (hepatic failure group) were reviewed. No difference in preoperative liver function was apparent between the 2 groups. Histologically, moderate to severe inflammatory activity in the liver was present in 20 (83%) of 24 patients in the hepatic failure group. Major hepatic resections (lobectomy and extended lobectomy) were more frequent in the hepatic failure group. Mean perioperative blood loss was 1,945 g and 4,322 g in the survival and hepatic failure groups, respectively, with a significant difference (p< 0.01). Major postoperative complications occurred in 22 (22%) of 102 patients in the survival group and major complications followed by hepatic failure occurred in 21 (88%) of 24 patients in the hepatic failure group, with a significant difference (p< 0.001).

In light of these data, we propose that: (a) histological examination should be done before the resection, (b) perioperative blood loss should be less than 2,000 g, and (c) intensive care is needed postoperatively to prevent complications which might lead to hepatic failure.
Necrosis of intraabdominal esophagus and proximal third of the stomach after proximal gastric vagotomy and fundoplication
Authors: Ackermann Christoph , Müller Claude , Harder Felix
Published: May 2005

Lesser curve necrosis is a rare but known complication of proximal gastric vagotomy (PGV). Incidence seems to increase when PGV is combined with fundoplication. In reports of this complication, the necrosis was of various sizes, but generally limited to the lesser curve. We report a 54‐year‐old patient with hiatus hernia, severe peptic esophagitis, and increased acid output who developed necrosis of the whole intraabdominal esophagus, cardia, and proximal third of the stomach after PGV and fundoplication with division of several short gastric vessels. A proximal gastric resection with intrathoracic esophagogastric anastomosis had to be performed. After drainage of a subphrenic abscess, the patient made a complete recovery.

When combining PGV with a fundoplication, an increased risk of necrosis of the stomach must be considered. Division of the short gastric arteries should be avoided and the original Nissen fundoplication is preferred.
Quantitative approaches to the evaluation of screening programs
Authors: Day N. E.
Published: May 2005

The evaluation of screening programs for cancer is considered. Initial evaluation has to be in terms of mortality, but increasing importance should be attached to measures which evaluate the interaction of early detection with the disease process. These include the degree to which diagnosis is advanced, both in time and in stage of disease, and the ability of the screening test to identify presymptomatic lesions. Randomized trials are of major importance in establishing—in quantitative terms—the benefits of screening; in their absence, case‐control methods can be adapted for this purpose, but cannot provide evidence of the same rigor. Currently, only screening for breast cancer and cervical cancer have been fully demonstrated to be effective.
The biology and natural history of breast cancer from the screening perspective
Authors: Holmberg L. , Pontén J. , Adami H. ‐O.
Published: May 2005

A review of the tumor biology of breast cancer from the screening perspective reveals important research issues. It is not known if the induction phase includes any detectable preneoplastic lesions. Evidence for the existence of preneoplasias is conflicting. The effect of removal of such lesions on the incidence of breast cancer has not yet been studied. The mechanisms that govern progression of in situ lesions—or even small preclinical invasive cancers—are not fully understood. It is not clear to what extent progression into cancers with metastatic behavior occurs. Current predictors for progression are weak.

One major benefit of the scientific evaluation of the screening programs is that we can learn more about the natural history of the disease. Mammographic screening detects tumors that are smaller in size than those detected by clinical examination only. There is an inverse relationship between tumor size and the probability that the patient has acquired axillary metastases. These facts, taken together, indicate that the mortality reduction seen in screening is a result of a real impact on the natural history. Calculations of the lead time gained in randomized screening projects give empirical proof that a third of the cancers progress from a localized stage to a disseminated disease relatively late in the preclinical phase of the tumor. Analyses of interval cancers in screening have pointed to the conclusion that the net growth rate of the primary tumor does not directly parallel metastatic ability, and that the tumors grow faster in younger women.
Screening for colorectal cancer: A critical review
Authors: Hardcastle Jack D. , Pye Geoffrey
Published: May 2005

This article discusses the place of symptom detection, endoscopy, and fecal occult blood testing in population screening for colorectal cancer. There is now considerable evidence that screening the population over the age of 50 years for occult blood in the feces will result in an increased yield of tumors localized to the bowel at the time of surgical treatment. These tumors also have other favorable prognostic features and it is likely that the prognosis of this group will be better than the prognosis of patients presenting with symptoms in the usual way. Because of the biases that result from the selection and detection of tumors in screening studies, the mortality results of the control trials now underway must be awaited until it is known whether population screening is of real value.

In chemical fecal occult blood screening tests, a compromise has to be made between sensitivity and specificity. The fecal occult blood test most widely used and the one that has been subjected to the most evaluation in screening studies is the guaiac‐based slide test, Hemoccult. The predictive value of a positive test for invasive cancer is 11–17%, and for adenomas, 36–41%. This specificity is achieved at a loss of sensitivity, the interval cancer rate reported in screening studies being over 20%. Newly developed immunological techniques appear to be more sensitive and specific, but require further evaluation in population screening studies.
Progress and problems in screening for carcinoma of the prostate
Authors: Chodak Gerald W. , Schoenberg Harry W.
Published: May 2005

Carcinoma of the prostate is the second most common cause of cancerrelated deaths in American men. This is due, in part, to the low percentage of cases that are diagnosed when the tumor is still curable. To improve early detection, routine screening has been performed using one or a combination of tests that included open prostate biopsy, serum acid phosphatase, the digital rectal exam, and transrectal sonography. These studies have been critically reviewed and the problems associated with prostate cancer screening have been discussed. No study has proven that routine screening reduces the mortality from prostate cancer. Furthermore, the positive predictive value and the sensitivity of each of these tests are too low for any of them to be useful for screening at the present time. To determine the value of screening, new studies are needed which should include a control group and an assessment of the disadvantages of screening as well as the potential benefits. Based on published reports, however, routine screening for prostate cancer using any test should be considered investigational at the present time.
Screening for carcinoma of the prostate: Efficacy of available screening tests
Authors: Thompson Ian M. , Fair William R.
Published: May 2005

Despite the high prevalence and mortality from carcinoma of the prostate, very few prospective, controlled, population‐based studies are available to assess the impact of early diagnosis programs. Three screening modalities have been suggested for this tumor : rectal examination, serum tumor markers, and transrectal ultrasound. Prostatic acid phosphatase and prostatic specific antigen have proven to be insensitive and nonspecific in large trials and generally, when elevated, allow diagnosis of metastatic disease. Transrectal ultrasound also suffers from poor specificity. Rectal examination, although insensitive to small tumors (less than 1 ml in volume), has the advantage of possibly detecting tumors of a higher biologic activity. An improved survival has been demonstrated in populations undergoing routine rectal examinations. Further prospective, population‐based trials comparing early detection techniques are necessary before mass screening for carcinoma of the prostate can be recommended.
Screening for cancer of the cervix uteri
Authors: Lynge Elsebeth
Published: May 2005

Cervical cancer is the second most common cancer in women worldwide. The majority of cervical cancers are squamous cell carcinomas. Pap smears for early detection of precursor lesions of cervical cancer have been availáblé for 40 years. A clinical trial to evaluate Pap smears was never undertaken; however, evidence gradually accumulated from time trend analyses and from cohort and case‐control studies showed the incidence and mortality of cervical cancer to be reduced by organized screening programs. The risk of cervical cancer following different screening histories was estimated in a recent study of the International Agency for Research on Cáncer. Screening with 1‐year and 3‐year intervals was estimated to reduce the incidence of squamous cervical cancer by 94% and 91%, respectively. Cervical cancer is rare in young women, and little was estimated to be gained from including women below the age of 25 years in organized screening programs. The age distribution of cervical cancer has changed; a substantial proportion of cases now occur in the older generations of women, who have never been offered organized screening. Computerized pathology registration systems may serve as a tool for integration of the total smear‐taking activity and, thus, ensure that a high percentage of women are screened regularly at minimized costs. The planning of a screening program should include both the smear‐taking activity and the treatment.
Screening for cancer: State of the art and prospects for the future
Authors: Miller Anthony B.
Published: May 2005

Effectiveness of screening has been established for two cancer sites: breast and cervix uteri. Only for these, therefore, are national policies applicable. The degree of effectiveness of such programs will depend on the coverage of the eligible population; organized programs are, therefore, essential. For cancer of the cervix, nearly maximal efficacy will be obtained by screening sexually active women from 25 to 60 years of age every 3 years. For cancer of the breast, current evidence only justifies screening from 50 years of age; most programs will stop at 70 years of age. Mammography every 2 years will provide nearly maximal efficacy. The place of breast self‐examination and physical examination of the breasts is under investigation. In Japan, screening for stomach cancer is justifiable, although strict evidence of effectiveness is lacking. Screening for other cancers must still be regarded as experimental, including the use of sigmoidoscopy and fecal occult blood tests for colorectal cancer, and visual examination of the mouth for oral cancer. Because of organizational and other difficulties, screening seems unlikely to make a major contribution to reduction in overall cancer mortality by the year 2000. However, if organizational problems can be overcome, screening has the potential to control invasive cancer of the cervix, and to make a major contribution to reduction in breast cancer mortality.
Colonic involvement in acute necrotizing pancreatitis: Results of surgical treatment
Authors: Bouillot J. L. , Alexandre J. H. , Vuong N. P.
Published: May 2005

In this series of 15 personal cases, the authors emphasize the unusual colonic complications which occur during acute necrotizing pancreatitis. These lesions always indicate a particularly severe pancreatitis and depend on 2 factors: extension of pancreatic necrosis into the mesocolon with encasing pericolic tumoral fibrosis, and parietal ischemic necrosis secondary to shock and thrombosis with infection. Laparotomy followed by colectomy is indicated in these severely ill patients. Prognosis is poor (8 deaths of 15 patients), sometimes in spite of extensive pancreatic excision. The existence of colonic complications gives evidence of the particular severity of certain forms of pancreatitis.
Appraisal of distal splenorenal shunt in the treatment of esophageal varices: An analysis of prophylactic, emergency, and elective shunts
Authors: Nagasue Naofumi , Kohno Hitoshi , Ogawa Yuichiro , Yukaya Hirofumi , Tamada Ryuichiro , Sasaki Yukiharu , Chang Yu‐Chung , Nakamura Teruhisa
Published: May 2005

From June, 1969 to February, 1987, distal splenorenal shunt was carried out on 78 patients with esophagogastric varices. The operations were urgent in 9, elective in 40, and prophylactic in 29 patients. There were 52 males and 26 females. Age ranged from 16 to 76 years with an average of 53 years. Thirty‐seven patients were alcoholics. Hepatitis B surface antigen was positive in only 15.5%. The causes of portal hypertension were cirrhosis of the liver in 67, chronic hepatitis in 5, idiopathic portal hypertension in 4, primary biliary cirrhosis in 1, and fatty liver in 1 patient. Fifty‐two patients were in Child's class A, 18 in class B, and 8 in class C. Emergency shunts were performed only when conservative therapy had failed to stop variceal bleeding. Prophylactic operations were done in patients having Child's class A or class B liver disease and risky varices, in varices larger than 5 mm in diameter and/or varices with red color signs such as cherry red spots. Forty‐two patients underwent the original Warren shunt, but the remaining 36 had modified distal splenorenal shunt with expanded polytetrafluoroethylene interposition. The operative mortality rates were 11.1% in the emergency group, 2.5% in the elective group, and 3.4% in the prophylactic group. The overall operative and hospital death rates were 3.8% and 7.7%, respectively. The patency rate was 94.1% and the incidence of rebleeding from esophageal varices was 3.8%. Hepatic encephalopathy, although mild to moderate in degree, was observed in 14.7% of 75 patients excluding 3 operative deaths. The 1‐, 2‐, and 3‐year survival rates of the emergency group were all 77.8%. The 1‐, 2‐, 3‐, 5‐, and 10‐year survival rates of the elective patients were 86.9%, 75.1%, 71.3%, 55.2%, and 29.4%, respectively. The 5‐, 10‐, and 15‐year survival rates of the prophylactic group were all 85.5%. The long‐term prognosis was significantly worse in patients in Child's class C and alcoholics as compared with otherwise.

In the light of this retrospective evaluation, it can be concluded that distal splenorenal shunt is a reliable operative method in the treatment of esophagogastric varices associated with portal hypertension and that it can be performed safely in emergency, elective, and prophylactic situations.
Proximal stenosis of the bile ducts: Results with a new surgical endoprosthesis
Authors: Sezeur Alain , Kracht Matthias , Fagniez Pierre‐Louis , Rey Pierre , Leandri Jeanine , Julien Michel , Malafosse Michel
Published: May 2005

A new endoprothesis designed for surgical intubation of neoplastic strictures of the proximal biliary tract has been developed. The technical aspects of intubation by this endoprothesis are discussed, and the results in the first 25 patients are given. The results suggest that this device was well tolerated. Mortality and morbidity related to the endoprothesis were low in comparison to the results given in the literature for intrahepatic cholangioenteric anastomosis. The authors conclude that this procedure could favorably replace intrahepatic cholangioenteric anastomosis as currently used for selected cases of malignant biliary stricture.