bluuebunny/crossref_metadata_2025 huggingface dataset:
Outcome of microscopically nonradical, subtotal pancreaticoduodenectomy (Whipple's resection) for treatment of pancreatic head tumors
Authors: Reinders Marcel E. , Allema Jan H. , van Gulik Thomas M. , Karsten Tom M. , de Wit Laurens Th. , Verbeek Paul C.M. , Rauws Erik J. , Gouma Dirk J.
Published: October 2004

From 1983 to 1992 a total of 240 patients with a pancreatic head tumor underwent laparotomy to assess the resectability of the tumor. In 44 patients the tumor was not resected because of distant metastases (n=20) or major vascular involvement or local tumor infiltration (n=24) not detected during the preoperative workup. A palliative biliary and gastric bypass was performed in these patients. All other patients underwent a subtotal (Whipple's resection, n=164) or total (n=32) pancreaticoduodenectomy. However, in 56 cases after Whipple's resection, microscopic examination of the specimen showed tumor invasion in the dissection margins. For this reason, these resections were considered palliative. We compared hospital mortality, morbidity, and long‐term survival of patients who had undergone a biliary and gastric bypass for a locally advanced tumor (group A, n=24) with a matched group of patients who had undergone a macroscopically radical Whipple's resection that on microscopic examination proved to be nonradical (group B, n=36). Both groups were comparable with regard to age (mean 61 years in both groups), duration of symptoms (8 weeks in group A and 10 weeks in group B), and tumor size (mean 4.25 cm in group A and 4.30 cm in group B). Median postoperative hospital stay was 18 days in group A and 25 days in group B. Postoperative complications (intraabdominal abscess, gastrointestinal hemorrhage, anastomotic leakage, delayed gastric emptying) occurred in 33% of patients in group A and in 44% of patients in group B. Hospital mortality was 0% and 3% in group A and group B, respectively. Survival in group B was significantly longer than in group A (p<0.03). Survivals after 1 and 2 years were 22% and 2% in group A versus 44% and 24% in group B, respectively. These results support our view that when a macroscopically radical resection seems feasible, a Whipple's resection should be carried out. In case of microscopic, residual tumor, the Whipple procedure offers acceptable palliation.
Simple, effective procedure with few complications for esophageal varices
Authors: Lin Pin‐Wen , Tsai Hong‐Ming , Lin Ching‐Yin , Chiu Nan‐Tsing
Published: October 2004

The surgical morbidity, mortality, and effectiveness of a modified nonshunting operation that includes splenic artery division instead of splenectomy, devascularization, and esophageal transection (SAD group) were evaluated. Eighteen cirrhotic patients with varices who underwent this modified procedure were compared with 54 patients treated with a conventional nonshunting operation (splenectomy group). Results show that immediate effects on portal pressure and preservation of portal perfusion between the two groups were similar. The operative time is shorter (p<0.05), and the bleeding amount is less (p<0.005) in the SAD group than in the splenectomy group. No surgical mortality and no major complications were noted in the SAD group. A surgical mortality of 2.3% and 30% was noted for the elective and emergency operations of the splenectomy group, respectively. There was no encephalopathy in the SAD group but one in the splenectomy group. Recurrent bleeding occurred in three patients of the splenectomy group 1 year after surgery but none in the SAD group. These data indicate that this modified procedure is a simple and effective operation with few complications for esophageal varices.
A balancing condition for weak limits of families of minimal surfaces
Authors: Traizet Martin
Published: October 2004

We prove a balancing condition for weak limits of families of embedded minimal surfaces of finite total curvature. We use it to prove compactness theorems for certain families of minimal surfaces.
Difféomorphismes holomorphes Anosov
Authors: Cantat Serge
Published: October 2004

We classify the holomorphic diffeomorphisms of complex projective varieties with an Anosov dynamics and holomorphic stable and unstable foliations: The variety is finitely covered by a compact complex torus and the diffeomorphism corresponds to a linear transformation of this torus.
Rigid resolutions and big Betti numbers
Authors: Conca Aldo , Herzog Jürgen , Hibi Takayuki
Published: October 2004

The Betti-numbers of a graded ideal I in a polynomial ring and the Betti-numbers of its generic initial ideal Gin(I) are compared. In characteristic zero it is shown that if these Betti-numbers coincide in some homological degree, then they coincide in all higher homological degrees. We also compare the Betti-numbers of componentwise linear ideals which are contained in each other and have the same Hilbert polynomial.
Topological finite-determinacy of functions with non-isolated singularities
Authors: Fernández de Bobadilla Javier
Published: October 2004

We introduce the concept of topological finite-determinacy for germs of analytic functions within a fixed ideal I, which provides a notion of topological finite-determinacy of functions with non-isolated singularities. We prove the following statement which generalizes classical results of Thom and Varchenko: let A be the complement in the ideal I of the space of germs whose topological type remains unchanged under a deformation within the ideal that only modifies sufficiently large order terms of the Taylor expansion. Then A has infinite codimension in I in a suitable sense. We also prove the existence of generic topological types of families of germs of I parametrized by an irreducible analytic set.
Sur les puissances de l' idéal fondamental de l' anneau de Witt
Authors: Morel Fabien
Published: October 2004

Nous reformulons un résultat récent de Arason et Elman en donnant une présentation très simple des puissances de l' idéal fondamental de l' anneau de Witt d' un corps de caractéristique pas égal à 2. We reformulate a recent result of Arason and Elman by giving a very simple presentation of the powers of the fundamental ideal of the Witt ring of a field of characteristic other than 2.
Abundance of stable ergodicity
Authors: Bonatti Christian , Matheus Carlos , Viana Marcelo , Wilkinson Amie
Published: October 2004

We consider the set

\mathcal{PH}_\omega(M)

of volume preserving partially hyperbolic diffeomorphisms on a compact manifold having 1-dimensional center bundle. We show that the volume measure is ergodic, and even Bernoulli, for any

C^2

diffeomorphism in an open and dense subset of

\mathcal{PH}_\omega(M)

. This solves a conjecture of Pugh and Shub, in this setting.
Long‐term Survival of Patients with Unresectable Colorectal Liver Metastases treated by Percutaneous Interstitial Laser Thermotherapy
Authors: Christophi Christopher , Nikfarjam Mehrdad , Malcontenti‐Wilson Caterina , Muralidharan Vijayaragavan
Published: October 2004

In situ ablation of colorectal cancer (CRC) liver metastases is an accepted form of treatment for selected patients. It is associated with low morbidity and mortality and increases the number of patients who may benefit from therapy compared to resection alone. This study assesses the impact of interstitial laser thermotherapy (ILT) on local tumor control and long‐term survival in patients with unresectable CRC liver metastases. Percutaneous ILT was performed in patients with unresectable CRC liver metastases between January 1992 and December 1999 using a bare‐tip quartz fiber connected to an Nd:YAG laser source. This was prior to the routine use of a diffusing fiber for ablative therapy. Treatment was monitored with real‐time ultrasonography. Tumors were considered unresectable based on their anatomic location or the extent of liver involvement. Patients with extrahepatic disease, more than five liver metastases, or tumors larger than 10 cm in diameter were excluded from this study. Local tumor control was assessed by dynamic computed tomography (CT) 6 months after therapy. Long‐term follow‐up was undertaken, and the impact of various factors on survival was analyzed. Eighty patients with a mean age of 63.8 years were suitable for ILT. In total, 168 liver tumors with a median diameter of 5 cm (range 1–10 cm) were so treated. There were no procedure‐related deaths. The overall complication rate was 16%, with all cases managed conservatively. Bradycardia (n = 5), pneumothorax (n = 3), and persistent pyrexia (n = 3) were the most common complications. Complete tumor ablation was noted in 67% of patients assessed by CT 6 months following the initial therapy. Median follow‐up was 35 months (range 4–96 months), with 10 patients alive at the end of this period. Altogether there were 67 deaths, which were related to hepatic disease in 55 cases and to extrahepatic disease in 9; they were unrelated to malignancy in 3 others. Three patients were excluded from follow‐up after ILT down‐staging of tumors that allowed complete surgical resection. The median disease‐free survival of patients treated by ILT was 24.6 months, with a 5‐year survival of 3.8%. Poor tumor differentiation and the presence of more than two hepatic metastases were associated with lower overall survival (p < 0.01). Fourteen patients treated by ILT for postoperative hepatic recurrences had the best outcome, with a median overall survival of 36.3 months and a 5‐year survival of 17.2%. Percutaneous ILT is a minimally invasive, safe, effective technique that appears to improve overall survival in specific patients with unresectable CRC liver metastases, compared to the natural history of untreated disease reported in the literature.
Effect of Chemoradiotherapy with Gemcitabine and Cisplatin on Locoregional Control in Patients with Primary Inoperable Pancreatic Cancer
Authors: Wilkowski Ralf , Thoma Martin , Schauer Rolf , Wagner Andreas , Heinemann Volker
Published: October 2004

Gemcitabine sensitizes tumor cells to radiation and cisplatin and thereby enhances the cytotoxic effect of gemcitabine. Here we report the efficacy and toxicity of concurrent chemoradiation with gemcitabine and cisplatin in the treatment of patients with locally advanced, unresectable pancreatic cancer. A total of 47 patients (29 men, 18 women; median age 61 years) with histologically proven advanced pancreatic carcinoma were included in the study. They underwent chemotherapy with gemcitabine 300 mg/m2 and cisplatin 30 mg/m2 on days 1, 8, 22, and 29; concurrent radiation (45—50 Gy) was applied to the tumor and regional lymph nodes (1.8—2.0 Gy/fraction 5 days per week). Subsequent to chemoradiotherapy, treatment was continued with more two cycles of gemcitabine (1000 mg/m2) and cisplatin (50 mg/m2) applied on days 1 and 15 of a 4‐week cycle. After completion of chemoradiotherapy, 9 patients (19.1%) achieved a complete response and 23 patients (48.9%) a partial response, for an overall response rate of 68%. The lesions were considered resectable in 27 patients, and 25 of the 27 patients underwent laparotomy. The other 20 patients underwent a definitive pancreatic resection. Altogether, 13 patients had negative surgical margins. With a median follow‐up of 25.7 months (range 12.7—38.7 months) after completion of chemoradiation, distant metastasis had occurred in 23 patients and local recurrence in only 4 of 44 patients (8.5%). the median progression‐free survival was 7.8 months (range 6.2—9.4 months). The median survival amounted to 10.7 months (range 8.4—13.0 months) for all patients, whereas it was prolonged to 24.2 months (range 6.8—41.7 months) for those undergoing R0 resection. The main toxicities associated with chemoradiation included grade 3/4 leukopenia (68% of patients) and thrombocytopenia (61%). Episodes of cholangitis were observed in 11 patients. We concluded that gemcitabine and cisplatin can safely be combined with external beam radiation. This preoperative treatment approach is highly effective and appears to improve survival in patients whose tumors are rendered completely resectable.
Risk Factors for Postoperative Delirium after Liver Resection for Hepatocellular Carcinoma
Authors: Yoshimura Yasuko , Kubo Shoji , Shirata Kumiko , Hirohashi Kazuhiro , Tanaka Hiromu , Shuto Taichi , Takemura Shigekazu , Kinoshita Hiroaki
Published: October 2004

We investigated risk factors for delirium in 100 patients who underwent liver resection for hepatocellular carcinoma. Postoperative delirium developed in 17 (17%). Univariate analysis revealed that advanced age (especially = 70 years old), a history of smoking, a decreased serum albumin concentration (especially < 3.8 g/dl), advanced cancer stage (II–IV), major hepatectomy, prolonged operating time, and large intraoperative blood loss were possible risk factors for postoperative delirium. When patients’ preoperative condition and laboratory test results were subjected to multivariate analysis, only advanced age [odds ratio (OR) 1.201; confidence interval (CI) 1.063–1.357] and a decreased serum albumin concentration (OR 0.151; CI 0.025–0.900) were independent risk factors for the delirium. The percentages of patients with high aspartate and alanine aminotransferase activities, a high indocyanine green retention rate at 15 minutes, a low platelet count, and advanced cancer stage (II–IV) were higher in patients with a low (< 3.8 g/dl), rather than high (= 3.8 g/dl) serum albumin concentration. These findings indicate that multiple factors, including advanced age, impaired liver function, and advanced cancer stage, affect the development of postoperative delirium after liver resection for hepatocellular carcinoma.
Altered Serum Transforming Growth Factor‐ß1 and Monocyte Chemoattractant Protein‐1 Levels in Obstructive Jaundice
Authors: Sheen‐Chen Shyr‐Ming , Eng Hock‐Liew , Hung Kuo‐Sheng
Published: October 2004

Impaired immune function has long been documented in patients with obstructive jaundice, and those with jaundice due to extrahepatic biliary obstruction still experience a high rate of postoperative complications and death. Transforming growth factor‐ß1 (TGFß1) appears to be an important regulator of both normal and pathologic conditions in the liver. Monocyte chemoattractant protein‐1 (MCP‐1) is an important mediator of monocyte recruitment to inflammatory sites. We hypothesize that obstructive jaundice may alter serum TGFß1 and MCP‐1 expressions in the rat and that oral bile acid or glutamine (or both) can restore the altered serum TGFß1 and MCP‐1 expression in rats with obstructive jaundice. Male Sprague‐Dawley rats weighing 250 to 300 g were randomized to four groups (n = 10 in each group). Group 1 underwent a sham operation with oral normal saline administration. Group 2 underwent common bile duct ligation (CBDL) with oral normal saline administration. Group 3 underwent CBDL with oral bile acid replacement. Group 4 underwent CBDL with oral glutamine administration. Animals were sacrificed after 3 days (n = 5) and 7 days (n = 5), and blood samples were collected. Serum was obtained after centrifugation for measurement of TGFß1 and MCP‐1 levels by an enzyme‐linked immunosorbent assay. The serum TGFß1 level was significantly elevated (p = 0.006) 3 days after CBDL. Oral glutamine administration prevented this elevation, but oral bile acid replacement did not. The serum MCP‐1 level showed similar changes. After 3 days of obstructive jaundice, the TGFß1 and MCP‐1 levels were altered in the rat. Oral glutamine administration, not oral bile acid replacement, was able to prevent these alterations.
Decreased Identification Rate of Sentinel Lymph Node after Neoadjuvant Chemotherapy
Authors: Kang Seok Hyung , Kim Seok‐Ki , Kwon Youngmee , Kang Han‐Sung , Kang Jae Hee , Ro Jungsil , Lee Eun Sook
Published: October 2004

We prospectively studied the feasibility of sentinel lymph node biopsy (SLNB) after neoadjuvant chemotherapy by comparing the identification rate and the false‐negative rate (FNR) with the results obtained from the patients without chemotherapy. From October 2001 to March 2003, a total of 284 consecutive patients who underwent SLNB and axillary lymph node dissection (ALND) at the Center for Breast Cancer, National Cancer Center were enrolled. Of the 284 patients, 54 underwent neoadjuvant chemotherapy prior to operation. The sentinel lymph node (SLN) was mapped by radioactive colloid alone or in combination with blue dye. All SLNs were evaluated by 2 mm serial sections after hematoxylin‐eosin staining. The overall SLN identification rate was 91.9% (261/284): 72.2% (39/54) of the patients after chemotherapy and 96.5% (222/230) of the patients without chemotherapy. These results suggest that preoperative chemotherapy significantly affects lymphatic mapping (p< 0.001). Among the patients with chemotherapy, there were 3 false negatives in 39 successfully mapped tumors, yielding an FNR of 11.1% (3/27), a negative prediction value (NPV) of 80.0% (12/15), and an accuracy of 92.3% (36/39). There were 10 false negatives among 222 successfully detected patients without chemotherapy, yielding an FNR of 9.9% (10/101), an NPV of 92.4% (121/131), and an accuracy of 95.5% (212/222). These results were not statistically different when compared (p > 0.05). Although the SLN identification rate significantly decreased after neoadjuvant chemotherapy, SLNB could accurately predict axillary status. Thus SLNB can be an alternative to ALND even after neoadjuvant chemotherapy in cases of successful identification of the SLN.
Patterns and Clinical Outcomes Associated with Routine Intravenous Sodium and Fluid Administration after Colorectal Resection
Authors: Tambyraja Andrew L. , Sengupta Fergus , MacGregor Alasdair B. , Bartolo David C.C. , Fearon Kenneth C.H.
Published: October 2004

Excess intravenous water and sodium may be associated with postoperative complications and an adverse outcome. However, the effect of the magnitude of the surgery on such a relation has not been studied. This study assesses current practice in intravenous fluid and sodium administration after colonic and rectal resection and its relation to the postoperative outcome. A series of 100 consecutive patients undergoing elective colonic (n = 44) or rectal resection (n = 56) were included in a retrospective case‐cohort study. The volumes of water and sodium from intravenous fluid and antibiotic administration on the day of surgery and the next 5 days were recorded together with the clinical outcome. The mean ± SEM fluid and sodium administration on the day of operation was greater after rectal than colonic resection (4.6 ± 0.2 vs. 3.6 ± 0.2 liters and 507 ± 34 vs. 389 ± 22 mmol, respectively (p < 0.05). The mean ± SEM rate of daily fluid and sodium administration for the 5 subsequent days was greater following rectal than colonic resection (2.1 ± 0.1 vs. 1.8 ± 0.1 L/day and 155 ± 8.7 vs. 128 ± 8.0 mmol/day; p < 0.05). For all resections, there were no differences in fluid and sodium administration on the day of surgery in patients with or without postoperative complications. During the subsequent 5days, patients with complications after colonic resection had a higher postoperative mean rate of intravenous sodium administration than those who did not (149 ± 12 vs. 115 ± 10 mmol; p < 0.05). A similar pattern was not observed following rectal resection. Current postoperative intravenous fluid prescription delivers approximately 2 liters of fluid and 140 mmol of sodium per day. Complications after colonic, but not rectal, resection are associated with more early postoperative daily intravenous sodium administration. Because colonic resection poses less of a physiologic insult than rectal resection, the overall outcome in the former group may be more sensitive to the interplay between fluid and sodium overload and patient co‐morbidity.
Serum Hyaluronate Level for Predicting Subclinical Liver Dysfunction after Hepatectomy
Authors: Mizuguchi Toru , Katsuramaki Tadashi , Nobuoka Takayuki , Kawamoto Masaki , Oshima Hideki , Kawasaki Hiroyuki , Kikuchi Hitoshi , Shibata Chihiro , Hirata Koichi
Published: October 2004

The serum hyaluronate (HA) level reflects sinusoidal endothelial cell function correlated with liver function. We have reviewed multiple liver function indicators from 37 patients who underwent hepatectomy for various liver diseases. The serum HA level was well correlated with the indocyanine green retention rate at 15 minutes (ICGR15), lectin‐cholesterol (LCAT), hepatocyte growth factor (HGF), liver uptake ratio of technetium‐99m galactosyl human serum albumin (99mTc‐GSA) at 15 minutes (HH15), prealbumin, and hepatic uptake ratio of 99mTc‐GSA at 15 minutes (LHL15). In addition, the model for end‐stage liver disease (MELD) score at 7 days after operation was well correlated with serum HA, ICGR15, HH15, and LHL15. In patients who showed serum an HA level of = 100 ng/ml before hepatectomy, the MELD score had significantly deteriorated by 7 days after hepatectomy. Of the 20 patients who showed a serum HA level < 100 ng/ml before hepatectomy, 11 had high serum HA after hepatectomy. The bilirubin level 7 days after operation in this group was much higher than that for patients who maintained a serum HA level < 100 ng/ml after hepatectomy. In addition, the serum HGF level before hepatectomy in this group was significantly lower. We concluded that the serum HA level is a reliable indicator when evaluating liver function and predicting liver dysfunction after hepatectomy. Furthermore, patients with a significantly low HGF level who have a normal HA level are susceptible to liver dysfunction after hepatectomy.
Changes in Splenic Volume during Liver Regeneration
Authors: Ando Hideya , Nagino Masato , Arai Toshiyuki , Nishio Hideki , Nimura Yuji
Published: October 2004

Little is known about the relation between liver regeneration and splenic size. We monitored serial changes in liver and spleen volumes using computed tomography in 24 patients with biliary cancer who underwent right hepatectomy or more extensive liver resection following portal vein embolization (PVE). Nonembolized hepatic segments increased in volume from 316 ± 97 cm3 (34% ± 8% of total liver volume) before PVE to 410 ± 115 cm3 (44% ± 8%) after PVE. The volume of nonembolized hepatic segments (i.e., remnant liver) increased to 617 ± 111 cm3 (59% ± 10% of total liver volume before PVE) 14 days after hepatectomy and then increased slowly to reach 795 ± 231 cm3 (76% ± 16%) 1 year after hepatectomy. Splenic volume increased from 87 ± 29 cm3 before PVE to 104 ± 38 cm3 (119% ± 17% of original volume) after PVE. Splenic volume increased to 137 ± 65 cm3 (155% ± 40%) by 14 days after hepatectomy and to 155 ± 67 cm3 (179% ± 41%) by 28 days after hepatectomy, with no further change at 1 year after hepatectomy (153 ± 92 cm3; 174% ± 79%). The rate of increase in splenic volume within the first 14 days after hepatectomy was 2.7 ± 3.6 cm3/day, correlating well with increases in remnant liver volume (r = 0.64, p = 0.0006). These data indicate that the spleen is enlarged during liver regeneration, suggesting that the liver and spleen share certain common growth regulatory mechanisms.
Resection of the Colon Simultaneously with Pancreaticoduodenectomy for Tumors of the Pancreas and Periampullary Region: Short‐term and Long‐term Results
Authors: Suzuki Yasuyuki , Fujino Yasuhiro , Tanioka Yasuki , Sakai Tetsuya , Ajiki Tetsuo , Ueda Takashi , Tominaga Masahiro , Kuroda Yoshikazu
Published: October 2004

Simultaneous resection of the colon with pancreaticoduodenectomy (PD) is occasionally inevitable to accomplish curative resection in instances when a periampullary tumor involves the mesentery of the colon. However, there is little information regarding short‐ and long‐term outcomes of this aggressive surgery. Among 95 consecutive patients who underwent PD for periampullary malignant tumors, 12 had simultaneous resection of the right colon (group 1) and 83 underwent PD alone (group 2). Intraoperative variables, postoperative morbidity and mortality, and the length of the hospital stay were comparatively analyzed. Survival was also compared between the groups in a subset of 36 pancreatic adenocarcinoma patients. Group 1 included more patients with pancreatic cancer, and portal vein resection was more frequently performed, which seemed to be associated with a significantly longer operating time (640 vs. 510 minutes) and increased total blood loss (1965 vs. 1220 ml). However, morbidity and mortality rates did not differ between the groups (50,0% and 0%, respectively, in group 1; 44.6% and 1.2%, respectively, in group 2). The median hospital stays were 67 and 48 days in groups 1 and 2, respectively. In a subset of 36 pancreatic adenocarcinoma patients, the median progression‐free survivals were 6 months in both groups 1 and 2; the median overall survivals were 14 months in group 1 and 12 months in group 2. There was no statistically significant difference in survival between the groups. Simultaneous right hemicolectomy with curative intent at the time of PD could thus be performed safely and may offer a survival benefit even for individuals who have advanced pancreatic cancers with involvement of the transverse mesocolon.
Immunohistochemical Study of DPC4 and p53 Proteins in Gallbladder and Bile Duct Cancers
Authors: Chuang Shih‐Chang , Lee King‐Teh , Tsai Kun‐Bow , Sheen Pai‐Ching , Nagai Eishi , Mizumoto Kazuhiro , Tanaka Masao
Published: October 2004

Gallbladder and bile duct carcinomas belong to the family of biliary tract tumors, but they demonstrate different clinical behavior. We evaluated a series of biliary tract carcinomas to determine whether they also had genotypic differences by analysis of the tumor suppressor genes DPC4 and p53. Twenty‐one gallbladder cancers, 20 intrahepatic bile duct carcinomas, and 10 extrahepatic bile duct carcinomas were retrieved from the surgical pathology files of Kaohsiung Medical University Hospital. Sections were immunostained with monoclonal antibodies to the DPC4 and P53 proteins. Statistical differences between gallbladder cancer and bile duct carcinomas were determined using ?2 analysis or the Fisher’s exact test, when appropriate. Two of the 21 gallbladder cancers (9.5%), 7 of the 20 intrahepatic bile duct carcinomas (35%), and five of the 10 extrahepatic bile duct carcinomas (50%) were negatively labeled for DPC4. The differences were significant between gallbladder carcinoma and both intrahepatic bile duct carcinomas (p = 0.023) and extrahepatic bile duct carcinomas (p = 0.012). A higher frequency of P53 overexpression was found in gallbladder cancers (61.9%) than in intrahepatic bile duct carcinomas (26.3%) (p = 0.024). This study suggests that the DPC4 gene may play a limited role in gallbladder carcinoma; however, p53 gene mutation is more frequently found in gallbladder cancers. In contrast, DPC4 deletion may be more common in bile duct carcinomas, especially in those arising from the extrahepatic bile duct. These findings support the concept that gallbladder and bile duct carcinomas are different tumors with differing etiologies and tumorigenesis.
Selective Venous Sampling in Recurrent and Persistent Hyperparathyroidism: Indication, Technique, and Results
Authors: Chaffanjon Philippe C.J. , Voirin David , Vasdev Ashok , Chabre Olivier , Kenyon Norman M. , Brichon Pierre Yves
Published: October 2004

Between 1992 and 2002, 542 patients underwent a surgical treatment for hyperparathyroidism in our department. Twenty‐three selective venous sampling procedures (SVS) were performed because of the failure of the other methods of diagnosis. These patients have recurrent or persistent hyperparathyroidism. Noninvasive methods of topographical diagnosis have failed or they have given contradictory results. In our experience, the surgeon needs a precise localization of the pathological glands in these difficult cases. In our series of SVS, specificity was 85.7% and sensitivity was 94.7%. Our results show that a high postoperative gradient of parathyroid hormone in the internal thoracic veins indicates an ectopic pathological gland in the thymus. A high gradient in a vertebral vein indicates a pathological superior parathyroid gland, usually in a retro‐esophageal position.
Cytoreductive Surgery and Intraperitoneal Chemohyperthermia for Recurrent Peritoneal Carcinomatosis from Ovarian Cancer
Authors: Zanon Claudio , Clara Renzo , Chiappino Isabella , Bortolini Massimiliano , Cornaglia Silvia , Simone Paolo , Bruno Francesco , De Riu Leonarda , Airoldi Mario , Pedani Fulvia
Published: October 2004

Aggressive surgical cytoreduction has been shown to have a positive impact on survival of patients with ovarian cancer. After first‐line chemotherapy, 47% of patients relapse within 5 years, and median survival after second line chemotherapy is 10—15 months. Adding intraperitoneal chemohyperthermia (IPCH) to surgical cytoreduction could further control ceolomic spread of disease. The aim of this study was to determine morbidity and mortality, regional relapse‐free survival and, preliminarily, overall survival after combining cytoreductive surgery with IPCH for the treatment of peritoneal carcinomatosis from ovarian epithelial cancer relapsed after prior chemotherapy. Thirty women affected with such a relapse were included. Patients underwent extensive cytoreductive surgery including tumor resections and peritonectomy, followed by intraoperative IPCH with cisplatin. Complete surgical cytoreduction down to nodules less than 2.5 mm (CC0—CC1) was obtained in 23 patients (77%). One patient died postoperatively from a pulmonary embolism. Major postoperative morbidity was 5/30 (16.7%). We registered one case of anastomotic leakage, a spontaneous ileum perforation, a postoperative cholecystitis, a hydrothorax, and one patient with bone marrow toxicity. Kaplan‐Meier estimates of median locoregional relapse‐free survival and median overall survival were 17.1 months and 28.1 months, respectively. Patients with CC0—CC1 had locoregional relapse‐free and overall survival rates of 24.4 and 37.8 months, whereas the remainder had survival rates of 4.1 and 11.0 months. We concluded that cytoreductive surgery combined with IPCH is feasible with acceptable morbidity and mortality and seems to promise good results in selected patients affected with peritoneal carcinomatosis from ovarian cancer.
Edoardo Bassini and the Wound That Inspires
Authors: Thomas Andrew D. , Rogers Ann
Published: October 2004

Edoardo Bassini, an Italian surgeon active at the turn of the 19th century, made a lasting contribution to surgery with his elucidation of the cure for inguinal hernia. The magnitude of this contribution in contrast to centuries of frustration in attempting surgical repair of hernia is described, as are Bassini’s personal experiences, which may have played a role in his successful search for a cure.
Coronary Bypass before Simultaneous Pancreas‐Kidney Transplants for Type 1 Diabetics in Renal Failure
Authors: Molina J. Ernesto , Sutherland David E.R. , Wang Yang , Gruessner Angelika C. , Bland Barbara J.
Published: October 2004

Our study examined the results of coronary artery bypass (CAB) before simultaneous pancreas‐kidney (SPK) transplant in type 1 diabetics in renal failure. Of 588 pancreas transplant patients from 1992 to 2002, 77 (24 females, 53 males) were candidates for SPK transplant. All 77 had coronary evaluation and were referred for pretransplant CAB. Among the 77 CAB patients, the mean age was 42 years (range: 30– 63 years), and the duration of diabetes was 28.52 years (range: 9–51 years). All had neuropathy, retinopathy, and nephropathy; 12.9% (n = 10) had angina; and 76% (n = 59) were on dialysis at the time of CAB. The creatinine level of the 18 nondialysis patients was 3.7 mg%; 42.8% (n = 33) had suffered myocardial infarction. The left ventricular ejection fraction (LVEF) was 49% (30‐65%). At CAB surgery, 88% (n = 68) triple, 9% (n = 7) double, and 2.5% (n = 2) single arterial grafts were implanted. All 77 CAB patients had severe coronary artery disease (CAD); some vessels could not be bypassed in 9.8%. At surgery, 3.4 grafts/patient were implanted (range: 1–6 grafts). All 59 dialysis patients continued dialysis after CAB; 6 nondialysis patients required dialysis after CAB. The intensive care stay averaged 1.86 days (range: 1–10 days); the hospital stay averaged 10.5 days (range 6–28 days). There was no operative mortality. Eventually, 68 patients underwent SPK transplant; 9 await organs. The waiting period for 68 CAB patients who had SPK was 2 years, 5 months (range: 2 months to 10 years). The SPK operative mortality was 3.9% (n = 3). Significant CAD exists in patients > 30 years of age with type 1 diabetes and renal failure. Pretransplant CAB can be done safely and may reduce posttransplant mortality associated with cardiac events.
Efficacy of Pre‐incisional Bupivacaine Infiltration on Postoperative Pain Relief after Appendectomy: Prospective Double‐blind Randomized Trial
Authors: Lohsiriwat Varut , Lert‐akyamanee Narong , Rushatamukayanunt Winchai
Published: October 2004

Pain is the most undesirable and threatening experience for surgical patients. This study aims to determine the efficacy of pre‐incisional analgesic bupivacaine infiltration (preemptive analgesia) on postoperative pain relief after appendectomy. A prospective randomized double‐blinded study was conducted on 123 patients aged 13–45 years with a preoperative and‐postoperative diagnosis of acute appendicitis admitted to Siriraj Hospital, Bangkok, from January to May 2002. They were randomly set into two groups: the control (61 patients) and the preemptive (62 patients). In the preemptive group, bupivacaine (Marcaine) was infiltrated into the skin and subcutaneous tissue along the proposed wound line before gridiron incision, and also into the muscle layer after incision. The control group received no injection. Routine appendectomy was done. Pain score was assessed by the patients in the first 48 hr while they were lying supine and as they moved to a sitting position at 24 and 48 hr after operation. Morphine injection was given on patients’ request with pain score = 5 every 4 hr in the first 48 hr or until analgesic paracetamol could be taken orally. The pain score during the first 6, 12, 24, and 48 hr, including the score while sitting up, were all significantly lower (p < 0.001) in the preemptive group. So were the total number of morphine injections and the amount of morphine used postoperatively. The pain reduction could be due to interruption of inflammatory or pain mediator cascades that normally occur during an operation. This study showed that pre‐incisional bupivacaine infiltration is an effective and simple method of reducing postoperative pain for patients undergoing appendectomy.
Extended Thymectomy in Patients with Myasthenia Gravis with High Thoracic Epidural Anesthesia Alone
Authors: Tsunezuka Yoshio , Oda Makoto , Matsumoto Isao , Tamura Masaya , Watanabe Go
Published: October 2004

Successful extended thymectomy was performed in three patients with myasthenia gravis under only high thoracic epidural anesthesia with voluntary breathing. It was not necessary to intubate a tracheal tube during operation for any of the patients. Neither muscle relaxants nor volatile anesthetic agents were required. The mean operating time was 2.0 ± 0.5 hours. The drainage tubes were removed the day after operation in all patients. In two patients the arterial oxygen saturation (SaO2) and the arterial partial pressure of carbon dioxide (PaCO2) and oxygen (PaO2) were stable; in the third patient the SaO2 was temporarily decreased to 92 mmHg when bilateral mediastinal pleura were opened. The right pleural defect was then covered with a large wet towel, which was pressed on the defect, and thoracic drainage was performed. The left pleural defect was repaired with 3‐0 Vicryl after suctioning the air in the pleural space, after which the SaO2 recovered. All patients were able to drink water and walk within 1 hour after the operation. This procedure is advantageous in that the use of muscle relaxants and volatile anesthetic agents prevented the laryngeal injury that results from translaryngeal intubation; in turn we avoided causing postoperative respiratory insufficiency. This may be suitable for the operation of some patients with MG, but further studies are required to define the indication.
Spiegel’s Lobe Bile Ducts Often Drain into the Right Hepatic Duct or Its Branches: Study Using Drip‐Infusion Cholangiography‐Computed Tomography in 179 Consecutive Patients
Authors: Kitami Masahiro , Murakami Gen , Ko Saiho , Takase Kei , Tuboi Masahiro , Saito Haruo , Nakajima Yoshiyuki , Takahashi Shoki
Published: October 2004

Using drip‐infusion cholangiography‐computed tomography (DIC‐CT), we successfully identified the bile ducts draining the caudate lobe in 138 of 179 consecutive patients with extrahepatic cholelithiasis (179 ducts from Spiegel’s lobe and 154 from the paracaval portion; 1–5 ducts per patient). The dorsal subsegmental duct of S8 (B8c) was often identified and could be discriminated from the paracaval caudate ducts, thus acting as a landmark for the right margin of the caudate lobe. Notably, in more than one‐third of the 138 patients, at least one of the Spiegel’s lobe ducts drained into the right hepatic duct or its branches (30.2% of the 179 ducts overall; all ducts joined branches of the right lobe in 25 patients). Similarly, 34.4% of the 154 paracaval caudate lobe ducts drained into the left hepatic duct or its branches. These “anatomical left/right dissociations” between the drainage territory and route were much more frequent than previously reported. Our results confirm the effectiveness of DIC‐CT as a classical, noninvasive method for presurgical evaluation of the biliary system, but they also suggest that anatomical partial resection of the dorsal liver in patients with hilar cholangioma is often impossible because of contralateral biliary drainage.
Improved Health‐related Quality of Life after Coronary Artery Bypass Grafting Is Unrelated to Use of Cardiopulmonary Bypass
Authors: Järvinen Otso , Saarinen Timo , Julkunen Juhani , Laurikka Jari , Huhtala Heini , Tarkka Matti R.
Published: October 2004

This prospective study was instituted to assess whether the use of the on‐pump method or the off‐pump method affects changes in health‐related quality of life (QOL) as evaluated a year after coronary artery bypass graft (CABG) surgery. Data including preoperative risk factors and postoperative morbidity up to discharge were collected from 508 CABG patients operated in the Heart Center of a university hospital and further treated in secondary referral hospitals. Four hundred and fifty‐two (89.0%) patients underwent operation with the on‐pump method and 56 (11.0%) with the off‐pump method, i.e., without cardiopulmonary bypass (CPB). The RAND‐36 Health Survey (RAND‐36) was used as indicator of QOL. The primary outcome measure was a change in the physical component summary (PCS) and mental component summary (MCS) from the RAND‐36. Symptomatic status was estimated according to New York Heart Association (NYHA) class. Assessments were made preoperatively and repeated 12 months later. The majority of patients operated on‐pump (85.6%) and off‐pump (92.9%) had a favorable outcome without major complications (p = 0.136). The present data showed significant improvement (p < 0.001) in all eight domains of QOL following on‐pump CABG. Likewise, off‐pump patients improved in all eight aspects, and the change was statistically significant in six dimensions. A highly significant (p < 0.001) pattern of change was seen in the RAND‐36 MCS and PCS scores in both operative groups. Differences between the groups were nonsignificant. We conclude that most patients experience significant improvement in health‐related QOL during the first year after CABG, and that cardiopulmonary bypass has no effect on patients’ subsequent health‐related QOL, but its use depends on specific indications.
Penetrating Cardiac Wounds: Principles for Surgical Management
Authors: Gao Jin‐mou , Gao Yun‐han , Wei Gong‐bin , Liu Guo‐long , Tian Xian‐yang , Hu Ping , Li Chang‐hua
Published: October 2004

Stab wounds are the main type of penetrating cardiac injury in China and they have a fairly good prognosis when the patient receives expeditious and appropriate management. The objective of this study is to present the experience of managing the patients with penetrating cardiac injuries. A retrospective study involving 82 cases with penetrating wounds of the heart in the past 16 years was carried out. Stab wounds accounted for 86.58% of this series (71 of 82 patients). All 82 cases were treated operatively. The amount of preoperative infusion as fluid resuscitation for shock was less than 1,000 ml in 65.85% of the present study. Only in three patients was preoperative pericardiocentesis performed, yielding a false‐negative result in one. Six patients sustaining cardiac arrest soon after arrival were subjected to emergency room thoracotomy (ERT), and five of them surviced. The overall survival rate was 96.34%. One patient died of exsanguination due to injury of multiple chambers; of the remaining 2 deaths after operation 1 was associated with abdominal injuries and the other with failure of cerebral resuscitation. From the experience reported in this study, early establishment of diagnosis and prompt thoracotomy against time are the fundamental factors affecting the outcome of penetrating cardiac injuries. Preoperative massive transfusion and pericardiocentesis are not advocated.
Laparoscopic Cholecystectomy: Is It a Conscious Preference among Turkish Patients with Symptomatic Gallstones? — Prospective Study
Authors: Cingi Asım , Düşünceli Fikret , Güllüoğlu Bahadır M. , Yeğen Cumhur , Aktan A. ızdemir , Yalın Rıfat
Published: October 2004

Laparoscopic cholecystectomy (LC) has the advantages of early return to full daily activity, early return to work, and better cosmetic result, as well as quickly resolving pain. Yet how this information about the procedure influences a patient’s attitude toward laparocopy is not known. In this study we analyzed the factors that play role in the decision‐making process of patients who choose laparoscopic surgery, and we also evaluated patients’ knowledge of laparoscopy and their expectations. A questionnaire was used in evaluating 98 patients suffering from symptomatic cholelithiasis scheduled for elective laparoscopic cholecystectomy between January 2001 and January 2002. Females constituted 81% of the study population. Most of the patients (56%) were housewives. While 45% of the patients had an educational status of primary school degree only, 14% had graduated from a university. Forty‐three patients described their level of knowledge about laparoscopy as “low” (had only heard about laparoscopy). In 61% of the patients the surgeon was the sole decision maker about the type of the operation. Almost none of the patients had a preference for the time of discharge from the hospital after surgery, and only three of the actively working patients offered a time interval for return to work. From this study we concluded that most patients have inadequate information about laparoscopic surgery, that the type of operation is dictated mostly by the surgeon, and that early discharge and early return to work are not important for many patients.
Molecular Mechanism of c‐jun Antisense Gene Transfection in Alleviating Injury of Cardiomyocytes Treated with Burn Serum and Hypoxia
Authors: Huang Yuesheng , Hu Angeng
Published: October 2004

To explore the molecular mechanism of c‐jun antisense gene transfection in alleviating injury of cardiomyocytes treated with burn serum and hypoxia, burn serum was collected from Wistar rats inflicted with 30% third‐degree burn of the total body surface area. The cardiomyocytes of neonatal Wistar rats were cultured and then treated with burn serum and hypoxia (a gas mixture containing 1% O2). The constructed c‐jun antisense gene recombinant was transfected into the cardiomyocytes of neonatal Wistar rats. TdT‐mediated d‐utp nick end labeling (TUNEL) was adopted to examine cardiomyocyte apoptosis. Morphological changes of cardiomyocytes were observed under an optic‐microscope and an electron‐microscope. Expression of troponin T and ß‐tubulin protein, c‐jun protein, protein kinase Ca (PKCa), and c‐jun N‐terminal kinase (JNK) were assayed with Western blot in the transfected and non‐transfected groups. The morphology of cardiomyocytes in the non‐transfected group changed explicitly, but the change was not so obvious in the transfected cardiomyocytes. The expression of ß‐tubulin and troponin increased significantly in the transfected group as compared with the non‐transfected group. In the non‐transfected group, numbers of apoptotic cardiomyocytes were significantly higher than in the transfected group. The c‐jun protein, PKCa, and JNK were significantly expressed in the non‐transfected group, and they reached a maximum at the 24th hour after cardiomyocytes were treated with burn serum and hypoxia. In the transfected group, however, expressions of c‐jun protein, PKCa, and JNK decreased significantly compared with the non‐transfected group. The c‐jun antisense gene recombinant transfection alleviates injury to cardiomyocytes treated with burn serum and hypoxia, probably through low expression of PKCa and JNK.
Medicine’s Greatest Gifts to Surgery
Authors: Perrier Nancy D. , Boger Michael S.
Published: October 2004

Dr. Robert Graves and Dr. Henry Plummer are immortalized by the thyroid diseases bearing their names. Dr. Graves’ clinical lectures and Dr. Plummer’s “goiter lunches” were considered medical masterpieces; they introduced novel concepts in physical diagnosis that helped surgeons determine when to operate on patients with thyrotoxicosis. Dr. Plummer’s observations with perioperative iodine administration helped lower the mortality associated with thyroidectomy—at that time a treacherous operation—to make it one of the safest operations in history. Their fascinating discoveries laid foundations for thyroid surgery today. They truly are among medicine’s greatest gifts to surgery.
Jan Mikulicz‐Radecki (1850–1905): Pioneer of Endoscopy and Surgery of the Sinuses, Throat, and Digestive Tract
Authors: Kuczkowski Jerzy , Stankiewicz Czeslaw , Kopacz Andrzej , Narozny Waldemar , Mikaszewski Boguslaw , Drucis Kamil
Published: October 2004

The authors described the medical achievements of Jan Antoni Mikulicz‐Radecki—–a famous surgeon and laryngologist of Polish origin, belonging to the Viennese surgical school of Prof. Theodor Billroth at the turn of the 20th century. His scientific and clinical activity in Vienna, Cracow, Königsberg, and Wroclaw resulted in 232 publications and several new surgical methods. He changed the opinion on scleroma and described benign lymphoepithelial lesions. He was one of the authors of modern aseptics, antisepsis in surgery, and is regarded as a pioneer of endoscopic procedures. He was interested mainly in thoracic surgery, surgery of the abdomen, orthopedics, and laryngology. Mikulicz was the first to describe the method of surgical treatment of the maxillary sinus, osteoplastic surgery of the nose, esophagoscopy, and lateral pharyngotomy in tonsil carcinoma. Prof. Mikulicz was the first to perform thoracic surgery; he performed the first pyloroplasty, the first partial esophagectomy and gave rise to antiseptic procedures and general surgical management. He described many modifications of surgical operations and he constructed the esophagoscope, scoliozymeter, and many other useful surgical devices.