bluuebunny/crossref_metadata_2025 huggingface dataset:
Lymphadenectomy for gastric cancer in clinical trials: Update
Authors: Roder J. D. , Bonenkamp J. J. , Craven J. , van de Velde C. J. H. , Sasako M. , Böttcher K. , Stein H. J.
Published: October 2004

The controversy over the value of extended lymph node dissection for treatment of gastric cancer is fiercely debated. Whereas Japanese surgeons claim that the superior survival rates in their series are due to extensive resection (D2 resection), many Western authorities believe that their results only reflect differences in the prevalence of prognostic factors, inconsistencies between Japanese and Western staging systems, and the phenomenon of “stage migration,” which occurs with extensive resection. Two small randomized prospective trials from Hong Kong and Cape Town showed a tendency toward high morbidity with extensive lymph node dissection but no survival benefit. In contrast, the recently completed prospective German Gastric Carcinoma Study demonstrated a clear survival advantage with D2 resection for tumor stages II and IIIa with no increase in perioperative morbidity or mortality. The long‐term results of the still ongoing randomized MRC and Dutch trials are therefore eagerly awaited.
Reconstruction after gastrectomy and quality of life
Authors: Buhl Klaus , Lehnert Thomas , Schlag Peter , Herfarth Christian
Published: October 2004

To evaluate quality of life and functional results following surgery for gastric cancer we studied 104 patients with no evidence of disease at a minimum of 12 months postoperatively. Patients were treated with total gastrectomy and jejunal pouch reconstruction according to Hunt‐Lawrence‐Rodino (n=59) or simple esophagojejunostomy (n=24) and distal subtotal gastrectomy (n=21). No significant differences were found between total gastrectomy with pouch reconstruction and distal gastric resection with respect to dumping or heartburn, whereas patients with total gastrectomy and restoration with esophagojejunostomy suffered from both. The latter group of patients also had reduced nutritional status. Although there is a lack of a proper definition of quality of life, all instruments applied to its measurement indicated improved results for patients with pouch reconstruction and those after distal gastrectomy, but we could not state any significant differences. We conclude that in terms of postoperative functional results as well as quality of life distal gastric resection has no advantage over total gastrectomy with pouch reconstruction; hence a reduction of surgical radicality in an attempt to improve postoperative results is not justified. Pouch reconstruction should be considered the treatment of choice for reconstruction after total gastrectomy.
Intrahepatic absorbable fine mesh packing of hepatic injuries: Preliminary clinical report
Authors: Frame Scott B. , Enderson Blaine L. , Schmidt Ulf , Maull Kimball I.
Published: October 2004

A previous report from the authors' institution reported the effectiveness of hepatic packing with absorbable fine mesh (AFMP) for the control of hemorrhage in an animal model with an otherwise lethal hepatic injury. The technique has subsequently been applied to 12 abdominal trauma patients with hemodynamic instability and actively hemorrhaging hepatic injuries. Two patients expired in the operating room owing to uncontrolled hemorrhage from hepatic and associated injuries for a mortality of 16.7%. AFMP was successful in controlling hemorrhage in the remaining 10 patients. Hepatic injuries ranged from grade II to grade V, and all were actively hemorrhaging at the time of exploration. None of the surviving 10 patients experienced early or late recurrent bleeding attributable to the hepatic injuries, and there were no intraabdominal abscesses or late deaths. Liver function studies returned to normal prior to discharge in all surviving patients. Follow‐up included serial computed tomographic scans, which demonstrated fibrosis incorporating the mesh packing. Complete resolution of injury and mesh appears to proceed over approximately a 6‐month period. AFMP is a safe, effective method for controlling hepatic hemorrhage. It is easy to perform in the operating room, offers an excellent matrix for hemostasis, provides tamponade of bleeding sites, and does not require reoperation for removal of packing material, as is necessary with conventional, nonabsorbable packing techniques.
Arterial ketone body ratio as a parameter of hepatic mitochondrial redox state during and after hemorrhagic shock
Authors: Nakatani Toshio , Spolter Leonard , Kobayashi Kunio
Published: October 2004

This study was aimed at clarifying the usefulness of the arterial ketone body ratio (AKBR), which reflects hepatic mitochondrial redox state and closely correlates with hepatic energy production, for understanding the degree of hepatic mitochondrial damage and the extent of the deterioration in hepatic energy metabolism during of shortly after hemorrhagic shock. Changes in the AKBR of 33 trauma victims who were admitted to our institute in hemorrhagic shock with a systolic pressure lower than 70 mmHg were measured until the patient recovered with the restoration of AKBR to the normal range (≥ 1.0) or until the patient died. During hemorrhagic shock the AKBRs were highly decreased, indicating deteriorated hepatic function. With successive fluid resuscitation the AKBR quickly recovered in 15 surviving patients from an initial value of 0.26±0.03 toward normal within hours, indicating that hepatic mitochondria are functioning normally. The AKBR recovered to a normal value of 1.10±0.06 on day 2 (p<0.001). In 18 expired patients, AKBR did not recover to normal range, even though some of the patients recovered from the shock state. On the other hand, AST, ALT, LDH, and prothrombin time on day 2 were not significantly different from the values on admission, and the changes during the interval were not unidirectional even in the surviving patients, providing no information on the current functional state of the liver. Measurement of AKBR during and shortly after hemorrhagic shock provides timely and accurate information about liver function.
Calcium/phosphate/vitamin D homeostasis and bone mass in patients after gastrectomy, vagotomy, and cholecystectomy
Authors: Marcinowska‐Suchowierska Ewa B. , Talalaj Marek J. , kłodarczyk Andrzej W. , Bielecki Krzysztof , Zawadzki Jakub J. , Brzozowski Ryszard
Published: October 2004

Sixty‐two outpatients were assessed and divided into the following groups: 20 patients who had had partial gastrectomy (PG group), 22 patients who had had truncal vagotomy and pyloroplasty (TV group) or high selective vagotomy (HSV group), and 20 patients who had had cholecystectomy (CH group). The patients' age ranged from 35 to 64 years (mean 45 years), and the average postoperative period was 9 years. None of the patients evidenced clinical or biochemical symptoms of malnutrition or malabsorption or of diseases affecting vitamin D metabolism. The function of the kidneys and the liver was normal. An age‐matched group of volunteers served as a control group. The calcium dietary intake was determined using a standardized questionnaire; and the levels of serum calcium (Cas), phosphate (Ps), alkaline phosphatase (AP), and 25‐hydroxyvitamin D [25(OH)D] and the excretion of Ca in a sample of fasting urine corrected for concurrent creatine excretion (FuCa/cr) were assessed by means of standard laboratory techniques. The bone mineral density (BMD) of the lumbar spine (L2–4) and femoral neck (neck‐L) was determined by means of dual energy x‐ray absorptiometry (DXA). The daily Ca dietary intake was lower than recommended (RDA) in 80% of the patients, with most of them ingesting less than 300 mg daily. The mean values of Ca2, P2, AP, and FuCa/cr did not differ from these in the controls. Significantly reduced 25(OH) D levels were observed in the PG group (7.0 ng/ml) (p<0.001) and CH group (12.5 ng/ml) (p<0.01) compared with the values in the control group (20.0 ng/ml). The serum 25 (OH)D concentration was correlated with the Cas level and postoperative period. The BMD of L2–4 was decreased in all postoperative patients compared to that in the control group (in the PG group the BMD was 80±2%; in the CH group 95±2%; and in the TV or HSV group 94 ±1%) (p<0.05). In both L2–4 and three sites of the femoral neck in was lowest in the PG group (neck 94±1%; Ward's triangle 93±3%; trochanter 95±2%) compared with the CH group (neck 98±1%; Ward's triangle 100±1%; trochanter 98±1%) and with TV or HVS group (100±1%; 100±1%; 98±1%, respectively) (p<0.05). In the postgastrectomy group BMD showed a significant negative correlation with the interval following gastrectomy and Ca excretion in urine but a significant positive correlation with the Ca level and serum 25 (OH)D concentration. The BMD in the CH group showed a positive correlation only with the serum 25(OH)D concentration. Gastrectomy and cholecystectomy without postoperative supplementation of Ca and vitamin D led to insidious disturbances in the calcium‐vitamin D homeostasis and osteopenia. Therefore we suggest that immediate supplementation of calcium and vitamin D be initiated as a routine postoperative procedure, particularly in countries where routine fortification of food with Ca and vitamin D is not carried out.
Prognostic implications of the response of arterial ketone body ratio and insulin secretion to glucose load in major hepatectomy
Authors: Kagawa Ryuzaburo , Mori Keiichiro , Yamamoto Yuzo , Fujii Tsunco , Shimabukuro Takashi , Morimoto Taisuke , Yamaoka Yoshio
Published: October 2004

Impaired glucose tolerance is a serious obstacle to major hepatic resection. To assess the predictability of surgical risk in major hepatectomy for patients with chronic liver diseases from the viewpoint of glucose metabolism, we evaluated the insulinogenic index (II) and redox tolerance index (RTI) in 48 patients who underwent major hepatectomy at our university hospital due to hepatocellular carcinoma. Patients with low II and low RTI fell into the high risk group. Based on this finding, the Z score was developed as an index of patient risk for major hepatectomy: Z =3.11×[II]+1.43×[RTI]‐2.27. When the Z score was negative, mortality reached 33.3%, but when it was positive the mortality was only 3.2%. Intraportal insulin supplementation after hepatectomy to patients with a negative Z score could reduce mortality. Preoperative evaluation of surgical risk by Z score seems to be useful for predicting patient prognosis after hepatectomy.
Survival until 6 years after cholecystectomy: Female population of Denmark, 1977–1983
Authors: Andersen Tavs Folmer , Brønnum‐Hansen Henrik , Jørgensen Torben , Roepstorff Christian , Loft Anne , Madsen Mette
Published: October 2004

It has been a prevailing assumption that cholecystectomy patients by and large follow a pattern of survival similar to that of the normal population. This paper presents a population‐based study of the long‐term survival after cholecystectomy in order to reassess this assumption. Based on data available in the Danish National Hospital Register the records of all Danish women who were operated between 1977 and 1981 were examined and studied up to 6 years subsequent to surgery. Cholecystectomy patients who were free of diagnosed cancer and who had no major co‐surgery (n=11,123) were compared to both hysterectomy patients and a sample of the female population. Adjusting for age and other covariates, patients with psychiatric hospital admissions prior to surgery experienced a threefold risk of dying within 6 years after surgery. Patients with prior somatic admissions and patient with acute admissions had a relative risk (RR) of about 1.5. Cholecystectomy patients had a significantly increased mortality when compared to hysterectomy patients, RR=1.3 (1.1–1.6), and to the population sample. Heart diseases and cancer occurred significantly more often as causes of death among cholecystectomy patients when compared to hysterectomy patients, but our data suggest that the occurrence of many other causes of death may be increased among cholecystectomy patients as well. The authors concluded that cholecystectomy patients are subject to relatively higher levels of mortality than previously assumed in parts of the literature. Furthermore, the increase seems to be attributable to a multitude of causes of death. The most likely explanation of the excess mortality among cholecystectomy patients is that gallbladder patients are relatively fragile. Indeed, with this vulnerable group of patients the potential trauma of the surgical intervention itself needs careful consideration.
Optimal dose of garlic to inhibit dimethylhydrazine‐induced colon cancer
Authors: Cheng Jhy‐Young , Meng Ching‐Liang , Tzeng Ching‐Cherng , Lin Jih‐Chang
Published: October 2004

This study was designed to investigate the optimal dose of garlic during long‐term feeding and its preventive and therapeutic effects on colon cancer in rats induced by 1,2‐dimethylhydrazine (DMH). A total of 240 male Sprague‐Dawley rats were grouped and fed with either a basal or a garlic diet of different concentration, and some groups were subcutaneously injected with DMH 20 mg/kg once a week for 20 weeks. The incidence of colon tumor was significantly decreased in the groups fed with 2.5%, 5%, and 10% garlic diets (p<0.001). There was no distinct difference among these concentrations (p>0.05). Therefore the minimal optimal dose of garlic to inhibit colon cancer was 2.5%. The equivalent dose of this concentration in humans is 4.76 g/m2 body surface/day. In a therapeutic study, the tumor‐inducing interval in nude mice subcutaneously injected with colon cancer cells (CC‐M2) was prolonged by a 2.5% garlic diet (p<0.01). Thus smaller tumor volume and longer survival time were found in the garlic group than in the controls (p<0.01). However, the growth rate of tumors was not markedly inhibited by garlic. All rats finally died within 18 weeks. This study suggested that a 2.5% garlic dose may be used mainly as an inhibitor to prevent colon cancers and improve survival time.
Twelve‐year experience with the long intestinal tube
Authors: Rodriguez‐Ruesga Roberto , Meagher Alan P. , Wolff Bruce G.
Published: October 2004

A number of surgical methods, including use of the long intestinal tube, have been designed to decrease the incidence of recurrent small bowel obstruction. The aim of the present study was to review the indications, morbidity, and long‐term results of the long intestinal tube at the Mayo Clinic. During the 12‐year period 1981–1992, 47 patients had such tubes placed. The patients formed a complex surgical group: 46 patients had previously undergone at least one laparotomy (median 4, range 1–10); 41 patients had been hospitalized at least once for small bowel obstruction (median 3, range 1–15); and all 41 of these patients had undergone at least one previous laparotomy for obstruction (median 2, range 1–7). Eleven patients had a history of inflammatory bowel disease, and eight had a history of irradiation. In addition to dense adhesions in 46 patients, operative findings included large bowel tumors in six patients, intraperitoneal carcinomatosis in four, intraabdominal abscess in four, and small bowel stricture in three. Twenty patients required either a small bowel or large bowel resection, and three had a stoma fashioned. Only one case of morbidity (tube retraction) was related to tube placement. Among the 36 patients with complete follow‐up, nine patients developed episodes of recurrent adhesional small bowel obstruction after a mean follow‐up of 48 months, although only one required laparotomy. Of the remaining 11 patients it is known that two developed small bowel obstruction, one of whom required laparotomy. Use of the long intestinal tube has generally been reserved for surgically complex cases. In light of the diverse and complicated nature of the patients in this series, the long‐term reoperation rate for adhesional small bowel obstruction appears to be low.
Technical aspects and complications of end‐ileostomies
Authors: Carlsen Erik , Bergan Anstein
Published: October 2004

During a period of 10 years (1980–1990) we constructed or reconstructed 358 end‐ileostomies: 224 were primary constructions, 96 were reconstructed by laparotomy, and 38 were local reconstruction. Only 2 ileostomies were primarily located on the left side. The mean length was 5 cm. We had 11.6% reoperations after primary stomy and 7.3% and 7.9% reoperations after reconstruction by laparotomy and local approach, respectively. There were 12.9% and 8.7% reoperations after emergency and elective primary operations, respectively. Closing the lateral gutter or number of ileum to the rectus fascia did not influence significantly the number of reoperations. Postoperative discolored stomy did not indicate more dysfunction of the ileostomy. Stenosis of the ileostomy, peristomal fistulas, and peristomal dermatitis were seen in 23 (10.3%), 21 (9.4%), and 18 (8%) of the patients after primary ileostomies, respectively. Patients with Crohn's disease had significantly more of these problems than patients with ulcerative colitis. Only a few patients had retraction of the ilcostomy (2.7%), stomal prolapse (1.8%), or parastomal herniation (1.8%). Women had significantly more parastomal herniation than men; otherwise there were no differences between the sexes.
Aggressive surgery for pancreatic duct cell cancer: Feasibility, validity, limitations
Authors: Takahashi Shin , Ogata Yoshiro , Miyazaki Hiroshi , Maeda Dai , Murai Shinji , Yamataka Koichi , Tsuzuki Toshiharu
Published: October 2004

Pancreatic duct cell cancer is characterized by a low resectability rate and a low long‐term survival rate. Between September 1974 and December 1992 in our institution, 149 (59%) of the 253 patients with this cancer underwent resection. The operative procedures were pancreatoduodenectomy in 105 patients, total pancreatectomy in 36, and distal pancreatectomy in 8. The tumor was extirpated with extensive dissection of the lymph nodes and excision of the nerve plexus in the retroperitoneum. Of the 149 patients, 79 (53%) underwent combined resection of the pancreas and the portal vein; 16 of the 79 patients also underwent resection of the adjacent arteries. Three patients died within 30 days after surgery, and 17 other patients succumbed within 2 to 7 months. The mortality among patients undergoing pancreatectomy and resection of the portal vein (9.5%) was similar to that of patients with pancreatectomy alone (10%). Curative resection was necessary for long‐term survival. The 5‐year survival rate in 61 patients with the curative resection was 15%. Ten patients lived more than 5 years. Even patients with lymph node metastases and cancer invasion of the portal vein had a prolonged survival. Intraoperative irradiation was carried out in 35 patients to improve the survival rate, but without success. Infusion chemotherapy with 5‐fluorouracil via the portal vein was tried in 25 patients, resulting in a decrease in liver metastasis. We have made some progress in the first step toward improving treatment, although we are far from the goal and it is necessary to conduct additional trials.
Male breast cancer: Austrian experience
Authors: Stierer Michael , Rosen Harald , Weitensfelder Wolfgang , Hausmaninger Hubert , Teleky Bela , Jakesz Raimund , Fruhwirth Hannes , Dünser Martina , Beller Siegfried , Haid Anton , Tüchler Heinz
Published: October 2004

Data were collected on 169 men treated for breast cancer at 36 surgical departments in Austria between 1970 and 1991. We report here several of their clinical features and assess the importance of established prognostic factors. After a median observation period of 51 months 60 patients (35%) suffered a recurrence. The estimated 5‐year recurrence‐free survival for the entire group was 55%, and the estimated 5‐year overall survival was 62%. Although stage‐adjusted data are comparable to those for female breast cancer, the outcome in this series may be attributed to a relatively high frequency of advanced tumor stages. Tumor size (recurrence‐free survivalp=0.00001; overall survivalp=0.03) and axillary lymph node status (recurrence‐free survivalp=0.0001; overall survivalp=0.0001) proved to have a prognostic impact. Using a multivariate analysis, axillary lymph node status (recurrence‐free survivalp=0.001; overall survivalp=0.01) still had prognostic influence. The various procedures used had no effect on local recurrence.
Hepatitis C virus infection among Japanese general surgical patients
Authors: Yanaga Katsuhiko , Wakiyama Shigeki , Soejima Yuji , Yoshizumi Tomoharu , Nishizaki Takashi , Sugimachi Keizo
Published: October 2004

The incidence of hepatitis C virus (HCV) antibody positivity is unknown. The purpose of this study was to clarify the prevalence of HCV infection among surgical patients and to identify high risk surgical patients. HCV antibody tests were performed in 789 surgical patients between April 1991 and March 1992. Of these patients, 129 (16.3%) tested positive, which was much higher than the positivity of the ordinary Japanese. Hepatobiliary diseases and portal hypertension were associated with a higher positivity than other disease categories (94 of 206, 45.6% versus 35 of 583, 6%; p<0.0001). Patients above 50 years of age had a higher positivity than their younger counterparts (118 of 578, 20.4% versus 11 of 211, 5.3%; p<0.0001). The HCV positivity was as high as 54.1% (119 of 220) among surgical patients with known risk factors for hepatitis, in contrast to only 1.9% (10 of 569) among those without such risk factors. We conclude that surgical patients have a high incidence of HCV infection, for whom medical professionals should pay special attention to avoid disease transmission.
Reconstruction of the food passage after total gastrectomy: Randomized trial
Authors: Fuchs Karl‐Hermann , Thiede Arnulf , Engemann Rainer , Deltz Eberhard , Stremme Ortrud , Hamelmann Horst
Published: October 2004

Controversial results have been reported regarding the importance of the duodenal food passage after total gastrectomy. There are a number of experimental and clinical studies showing an advantage for the jejunal interposition between esophagus and duodenum. Others favor the Roux‐en‐Y reconstruction, as it is technically less demanding. The purpose of this study was the randomized comparison between two major reconstruction principles after total gastrectomy for gastric cancer (i.e., jejunal interposition with pouch versus Roux‐en‐Y pouch reconstruction). A group of 120 patients with gastric cancer were randomized and operated on during a 5‐year period according to standardized operative protocols, using either a jejunal interposition with pouch (JIP) or the Roux‐en‐Y reconstruction with pouch (RYP). Endpoints of this study were operation time, intra‐and postoperative problems and complications, patients' body weight, functional assessment, and quality of life. Of the 120 patients, 14 had to be withdrawn during the operation because only the Roux‐en‐Y reconstruction was technically possible. Finally, 53 patients with JIP were compared with 53 patients with RYP for the perioperative course. There were no significant differences between the two procedures (RYP and JIP) regarding complications (24.5% and 26.4%, respectively), mortality (3.8% and 1.9%, respectively), and operation time (4.35 hours and 4.40 hours, respectively). For long‐term functional comparison 46 (RYP, n=26; JIP, n=20) patients were without recurrence after 3 years of survival. Comparison of body weight, Visick scoring, and the Spitzer Index also did not reveal any significant difference between the two operation methods. In conclusion, patients with gastric cancer after total gastrectomy do not benefit from reconstructing the duodenal food passage by a jejunal interposition with pouch regarding their postoperative quality of life when compared to the widely used and technically less demanding Roux‐en‐Y reconstruction with pouch. Differences between the two reconstruction principles, documented by sophisticated functional assessment, may well exist, but the have no major clinical importance.
Symptomatic duodenal diverticulum
Authors: Jang Lee Chan , Kim Sun Whe , Park Yong Hyun , Kim Jin‐Pok
Published: October 2004

To determine management guidelines for symptomatic duodenal diverticulum, we reviewed medical records of 26 patients. Complicated duodenal diverticulum was the only possible cause of symptoms‐abdominal pain, fever and chills, melena, vomiting‐in 18 patients. Ten patients improved with conservative management, and eight patients underwent diverticulectomy with or without various other procedures. Among the eight patients, one patient who had duodenal fistula died of respiratory complications on the second postoperative day. Symptoms recurred in two patients: One had a distal common bile duct (CBD) stricture and underwent choledochojejunostomy. In the other patient a CBD stone developed 3 years later, and choledocholithotomy and choledochojejunostomy were performed. Eight patients had associated gallstone disease as well as the diverticulum. Five of the eight had a history of operation for gallstone disease; four improved with conservative treatment, and one underwent choledochojejunostomy. Two patients were thought to have an innocent diverticulum and underwent cholecystectomy and choledocholithotomy only. One patient underwent diverticulectomy and sphincteroplasty for a CBD stone and pervaterian diverticulum. In conclusion, operations for duodenal diverticulum should be reserved for seriously complicated diverticula, and the surgeon should be aware that pervaterian diverticulum can be a cause of choledocholithiasis.
Meckel's diverticulum in Amsterdam: Experience in 136 patients
Authors: Bemelman Willem A. , Hugenholtz Elise , Heij Hugo A. , Wiersma Piet H. , Obertop Hugh
Published: October 2004

The object of this study was to establish the relation of symptomatic diverticula to the age and gender of the patients and to the presence of ectopic tissue. A total of 136 patients with surgically treated diverticula were collected from the medical charts of five Amsterdam hospitals; 51 had undergone resection because of diverticulum‐related symptoms and 85 during laparotomy for other causes. Obstruction was the predominant symptom (39%) in the 51 symptomatic patients. Hemorrhage, perforation, diverticulitis, and intussusception were the other symptoms (12–14% each). Obstruction occurred mainly in patients under age 10 years and perforation in patients 10 to 30 years old. All symptoms, hemorrhage excepted, occurred two to four times more in men. Hemorrhage and perforation were associated with the presence of ectopic gastric tissue. We concluded that symptoms caused by Meckel's diverticula are mainly due to the presence of bands or ectopic gastric tissue. The symptoms manifest at an early age (77% in those under age 30) and predominantly in males. Diverticula found incidentally in patients younger than 30 years should be resected. In the older patients, resection is indicated if ectopic gastric tissue is suspected. Diverticular bands can simply be cut.
Antioxidative vitamin treatment: Effect on lipid peroxidation and limb swelling after revascularization operations
Authors: Rabl H. , Khoschsorur G. , Petek W.
Published: October 2004

The objective of this study was to evaluate the antioxidative properties of the multivitamin cocktail Omnibionta® (α‐tocopherol, ascorbic acid, retinol, vitamin B complex) in terms of diminishing lipid peroxidation with improvement of leg edema performance after limb revascularization operations in humans. Fifty‐one subjects were selected; the control group contained 27 patients and the treatment group 24 patients, who received the vitamin cocktail intravenously before the start of reperfusion. All patients suffered from acute or chronic arterial occlusive disease, except two subjects with arterial trauma. MDA‐TBARS in plasma, quantified by HPLC, taken as a measure of lipid peroxidation was significantly increased (p<0.001) in the control group 1 hour after reperfusion onset and decreased to its baseline value within the following 2 hours (0.73±0.26, 1.21±0.48, 0.99±0.48, 0.73±0.33 nmol/ml). In contrast, in the treatment group MDA‐TBARS did not exceed the baseline value during the reperfusion period (0.93±0.30, 0.70±0.29, 0.65±0.23, 0.70±0.37 nmol/ml). Leg edema, expressed by extremity circumference, was significantly (p<0.008) elevated in the control group (30.7±4.04 cm versus 35.35±4.12 cm) compared to a lack of increase in the treatment group (29.25±5.13 cm versus 29.76±5.70 cm). These results suggest that antioxidative vitamin treatment might be valuable in preventing lipid peroxidation and decreasing extremity edema.
Coelioscopic cholecystectomy: Experience with 2006 cases
Authors: Dubois François , Berthelot Gérard , Levard Hughes
Published: October 2004

2006 laparoscopic cholecystectomies (LC) were performed from April 1988 to December 1992 by three senior surgeons using the French technique and selective intraoperative cholangiography (IOC). Obesity was present in 318 patients (15.8%), respiratory insufficiency in 75 (3.7%), inflammation in 251 (12.5%), and common bile duct (CBD) stones in 83 (4.1%). The presence of these additional ailments is a good indication for L.C. Conversion to laparotomy occurred in 43 cases (2.1%). The rate of complications was 2%; 25 (1.25%) were nonbiliary complications and 15 (0.7%) were biliary‐related; there was one death. IOC is not effective in preventing biliary complications, as those observed in this study would not have been recognized or avoided by it. IOC is carried out only selectively to locate unsuspected stones in patients with risk factors of CBD lithiasis. Laparoscopic treatment of CBD stones is still controversial.
Outcome of 49 repairs of bile duct injuries after laparoscopic cholecystectomy
Authors: Schol Francois P. G. , Go Peter M. N. Y. H. , Gouma Dirk J.
Published: October 2004

Treatment of bile duct injuries after laparoscopic cholecystectomy is still under discussion. The aim of this study was to evaluate the results of end‐to‐end or biliodigestive anastomosis for various types of bile duct injury. Patient charts of 49 (0.81%) classified bile duct injuries from a national survey of 6076 laparoscopic cholecystectomies in The Netherlands were analyzed. The median follow‐up after repair was 183 days (range 14–570 days). Statistical analysis showed that an end‐to‐end anastomosis was preferred by the surgeons for less severe bile duct injuries and a biliodigestive repair for more severe injuries. Three patients died owing to a delayed detected bile duct injury. Twelve bile duct strictures occurred after repair, leading to a stricture rate of 25%. The time elapsed between repair and occurrence of a stricture was 134 days (range 13–270 days). The type of repair or the severity of the bile duct injury did not determine the outcome of the repair. Histologically proved cholecystitis predisposed a stricture at the repair site. It was concluded that treatment of bile duct injuries is associated with a high stricture rate at the repair site of the anastomosis. End‐to‐end anastomosis is mostly successful for the less severe injury detected during laparoscopic cholecystectomy. For all other cases this repair can at least be considered a temporary internal drainage procedure. The biliodigestive anastomosis can best be considered a delayed repair after a drainage procedure has resolved the local inflammatory status.
Extended cholecystectomy for carcinoma of the gallbladder
Authors: Onoyama Hirohiko , Yamamoto Masahiro , Tseng Anthony , Ajiki Tetsuo , Saitoh Yoich
Published: October 2004

We evaluated extended cholecystectomy, wedge resection of the gallbladder bed, and regional lymphadenectomy for carcinoma of the gallbladder. Between 1971 and 1993 we treated 227 patients, 59 of whom were treated with simple cholecystectomy and 66 with extended cholecystectomy. The tumors were classified according to the stages proposed by the Japanese Society of Biliary Surgery. For Stage I and II discase extended cholecystectomy had a better result than simple cholecystectomy. For the extended cholecystectomy cases the cumulative 5‐year survival rate was 78.9% for Stage I, 63.6% for Stage II, 44.4% for Stage III, and 8.3% for Stage IV. The survival of Stage I patients was excellent. For cases more advanced than Stage II (S3, N2, Hinf1, and Binf1), the prognosis was significantly worse. In these cases more aggressive surgery may be needed.
Clinical experience with the intrahepatic posterior approach to the portal triad for right hepatectomy and right segmental resection
Authors: Maddern Guy J. , Manganas Dimitrios , Launois Bernard
Published: October 2004

An intrahepatic posterior approach to the portal triad has been used over a 2‐year period to perform right hepatectomies and right segmental resections in 29 patients (20 men, 9 women; median age 63 years, range 22–82 years). Two resections were palliative for cholangiocarcinomas; the remainder included 9 hepatocellular carcinomas, 12 colorectal metastases, 2 adenomas, 3 cancers of the gallbladder, and one case of chronic hepatic fibrosis. The median operative time was 3 hours 40 minutes (3:40; range 2:20–7:00) with a median period of hepatic ischemia of 87 minutes (range 27–152 minutes). Median blood transfused was 0 unit (range 0–12 units) with only three patients requiring intensive care admission. There was one hospital death. All but one patient was followed up after surgery (median period 24 months; range 1–36 months) at which time there had been three deaths from metastatic disease; the remaining patients were free of clinical recurrence. This operative approach allows minimally resective surgery to be performed safely with excellent shortand medium‐term results.
Electrorectography in chronic constipation
Authors: Shafik Ahmed
Published: October 2004

The rectal electrical activity recorded by electrorectogram (ERG) was studied in 22 chronically constipated subjects and 16 healthy colunteers. The latter had a mean (±SD) age of 42.6±8.5 years; 10 were men and 6 women. Of the 22 constipated patients, 14 had inertia‐type age 38.4±12.2 years. The rectal electrical activity was recorded by a silver‐silver chloride electrode situated 1 cm from the tip of a 6 F catheter, which was applied to the rectal mucosa by suction. At least four recording sessions of 120 minutes each were performed for each individual. In normal volunteers, regular and reproducible pacesetter potentials (PPs) were recorded with a mean frequency of 2.8±0.8 cycles/min (cpm), amplitude 2.1±0.8 mV, and velocity 4.6±0.8 cm/sec. They were followed randomly by action potentials (APs). In IC patients the PPs were so infrequent that in most cases half an hour would have elapsed without recording a PP; the mean frequency was 2.4±0.2 cycle/60 min, amplitude 0.92±0.02 mV, and velocity 4.1±0.6 cm/sec. APs were not recorded in 10 patients during the recording time; in two patients they were occasional. In OC subjects regular and reproducible PPs were recorded with a higher frequency (p<0.01) and velocity (p<0.05) than normal. Two ERG patterns were identified in those with chronic constipation: bradyrectia and tachyrectia. The former was recorded in the IC subjects and the latter in OC subjects. It is concluded that ERG is a technique by which electromechanical activity is recorded. It is noninvasive and nonradiologic, and it can be included as an investigative tool for rectal detrusor disorders.
Current melanoma epidemic: A nonmetastasizing form of melanoma?
Authors: Burton Robert C. , Armstrong Bruce K.
Published: October 2004

During the mid to late 1980s in white populations in Australia, New Zealand, and Scotland, melanoma incidence increased sharply above preceding long‐term trends. Most of this increase was in thin melanomas (<1.50 mm thick), and men were more affected than women. Thick melanomas also generally increased in incidence, particularly in men 65 years or older. Although advancement of the time of diagnosis was a likely factor in the increase in melanoma incidence, the maintenance of new higher incidence levels and the increase in the incidence of thick lesions indicated that earlier diagnosis did not explain most of the increase. Real increases in incidence due to continuation of long‐term trends and the increasing diagnosis of a preexisting, nonmetastasizing form of thin melanoma probably explain most of the recent increases in melanoma incidence.
Megestrol melanoma study
Authors: Nathanson Larry , Garrison Michael
Published: October 2004

The progestogen megestrol acetate (160 mg/day PO continuously starting 2 days before chemotherapy) plus chemotherapy with dacarbazine (220 mg/m2/day IV for 3 days), cisplatin (25–30 mg/m2/day IV for 3 days) every 3 weeks, and carmustine (150 mg/m2 IV single dose every 6 weeks) were administered to 22 patients, 18 of whom were evaluable. Toxicity was tolerable, and more than 80% of ideal dosing was achieved during the first two cycles of treatment. A net weight gain of 0.95 kg was observed during this program of treatment. A 56% objective response rate, including visceral responding sites, with a median duration of response of 37.5+weeks was achieved. A median survival of 15 months for all evaluable study patients was seen, which is somewhat longer than that achieved by most prior studies, including those employing the same chemotherapy regimen plus tamoxifen. Megestrol acetate may contribute to a high objective response rate and prolonged median survival in viscerally dominant mètastatic melanoma when used with a chemotherapy regimen of dacarbazine, carmustine, and cisplatin.
Local melanoma recurrences in the scar after limited surgery for primary tumor
Authors: Drzewiecki Krzysztof T. , Andersson Anders P.
Published: October 2004

The clinical and histologic records of 46 consecutive patients were reviewed who during the period 1980–1993 had recurrence from melanoma in the scar after limited surgery for a skin tumor. They constituted about 50% of all patients admitted with local recurrence from melanoma during this period. At reexamination of the primary tumors, 16 were found to be malignant melanomas and 9 were nevi (four atypical and five benign). Twenty‐one specimens were missing, 11 of which had never been sent for histologic examination. The median thickness of nine measurable melanomas was 0.66 mm. The recurrences in scar consisted of 34 primary melanomas: 18 superficial spreading, 4 nodular, 3 lentigo malignant, and 9 unclassified. Twelve tumors were dermal melanoma metastases. The median thickness of the 25 measurable melanomas was 0.78 mm. The 5‐year overall survival was 69%. At the closing date of the study 15 patients had died, 13 of them because of disseminated melanoma. A comparison of the survival curves from this study with those from other series of melanomas with comparable tumor thickness indicates a considerably worse prognosis than is expected with such thin tumors. We believe that the considerable number of local recurrences in the form of a new primary in a scar following limited surgery supports the theory of limited field change around a primary melanoma. Furthermore, limited procedures for primary melanoma, if followed by a recurrence in the scar, worsen the prognosis.
Involvement of the 4q21 region in human malignant melanomas: Cytogenetic and immunocytochemical characterization of three primary cell cultures
Authors: Grammatico P. , Roccella M. , Catricalà C. , Roccella F. , Bucher S. , Mordenti C. , Amantea A. , Di Rosa C. , Del Porto G.
Published: October 2004

The GRO1 oncogene (melanoma growth‐stimulating activity alpha)_has been localized in region 4q21. The involvement of this chromosomal region in clonal aberrations found in primary melanoma cell cultures could have an important role in the etiology and pathogenesis of this tumor. We characterized three primary cell cultures obtained from different patients, each of which showed clonal chromosomal aberrations involving the 4q21 region.
Spontaneous regression of human melanoma/nonmelanoma skin cancer: Association with infiltrating CD4+ T cells
Authors: Halliday Gary M. , Patel Anita , Hunt Michelle J. , Tefany Frances J. , Barnetson Ross St. C.
Published: October 2004

Spontaneous regression occurs in some human malignant melanomas and basal cell carcinomas (BCCs). We have compared the cellular infiltrate in regressing and nonregressing tumors in order to analyze the mechanism by which regression occurs. Regressing primary melanomas and BCCs were infiltrated with a larger number of CD4+, but not CD8+, T lymphocytes than were seen in nonregressing tumors. The number of interleukin 2 receptor‐positive (early activation marker) but not transferrin receptor‐positive (intermediate activation marker) T cells was increased, indicating that the infiltrating T cells were activated. Large numbers of Langerhans cells, macrophages, and other class II major histocompatibility complex (MHC)‐expressing cells were present but were not increased in the regressing tumors. There were no detectable B lymphocytes, and the regressing tumor cells displayed levels of HLA‐DR expression similar to those of the nonregressing tumors. Comparison of squamous cell carcinoma (SCCs) with keratoacanthomas (KAs), which are likely to be a spontaneously regressing form of SCC, also showed increased infiltration of activated CD4+, but not CD8+, T cells within the KA. A murine ultraviolet (UV)‐induced squamous tumor that spontaneously regresses when transplanted into immunocompetent syngeneic mice was also infiltrated with increased numbers of activated CD4+, but not CD8+, T cells prior to and during rejection. These results indicate that spontaneous regression of human skin tumors is likely to be immunologically mediated, and that CD4+ T lymphocytes seem to mediate this regression.
Laparoscopy for management of nontraumatic acute abdomen
Authors: Navez B. , d'Udekem Y. , Cambier E. , Richir C. , de Pierpont B. , Guiot P.
Published: October 2004

The diagnostic and therapeutic influence of laparoscopy has been studied in 255 patients presenting with nontraumatic acute abdominal pain. Laparoscopy provided a correct diagnosis in 93% (236 of 255) of the cases, the others requiring a laparotomy. An erroneous preoperative diagnosis was corrected by laparoscopy in 50 patients (20%), which called for a change of treatment in 25 patients (10%). Seventy‐three percent (186 of 255) of acute abdominal conditions were treated exclusively by laparoscopy, 23% (58 of 255) by conventional surgery, and 4% (11 of 255) by laparoscopically assisted surgery. Mortality was 2% (5 of 247) and morbidity 11% (28 of 247). We conclude that laparoscopy is a valuable tool for the general surgeon facing a patient with an acute abdomen.
Laparoscopic cholecystectomy: An original three‐trocar technique
Authors: Slim Karem , Pezet Denis , Stencl Jan , Lechner Christian , Le Roux Stéphane , Lointier Patrice , Chipponi Jacques
Published: October 2004

At present, laparoscopic cholecystectomy is the treatment of choice for gallbladder stones. The operating technique reported by most authors includes the use of four trocars. We report a group of 710 consecutive patients treated by an original three‐trocar technique. The use of the fourth trocar was necessary in only 55 cases (8%). However, among 56 cases of acute cholecystitis the use of the fourth trocar was necessary in 14 cases (25%) (p<0.01). Twenty‐six laparoscopies were converted to open procedures (3.6%). Four common bile duct injuries were observed (0.5%): two of them among the 655 operations with three trocars (0.3%) and two after application of the fourth trocar at the beginning of the procedure because of dissection difficulties. Our results are similar to those using the “classic” four‐trocar technique. Moreover, this technique is less expensive and allows one less scar.
Surgery for chronic pancreatitis: What quality of life ahead?
Authors: Petrin Pietro , Andreoli Amelia , Antoniutti Michel , Zaramella Dellina , Da Lio Corrado , Bonadimani Bruno , Garbin Luigi , Pedrazzoli Sergio
Published: October 2004

We attempted to evaluate the quality of life of patients with proved long‐lasting chronic pancreatitis. We measured the clinical and psychological status of 60 patients who had undergone various surgical treatments for their disease. The presence and severity of depression and other symptoms of distress were assessed, as were disease‐specific functional and physical problems. Few patients had serious conditions, such as pain, malnutrition, or psychoneurotic complaints. The relation between depression and the time of onset of symptoms and of surgery appeared doubtful, and no statistically significant correlations were found between severity of emotional disturbance and other functional characteristics. Insulin‐dependent diabetes and correlated diseases had the most negative influence on everyday well‐being. Postoperative follow‐up and the need for recurrent medical control and care did not lead to negative feelings.
Resection of the pancreatic head with or without gastrectomy
Authors: Watanapa Prasit , Williamson Robin C. N.
Published: October 2004

Early and late results of proximal pancreatoduodenectomy were determined in a personal and consecutive series of 100 patients (64 men, 36 women, mean age 51.9 years). Final diagnoses were chronic pancreatitis in 35, idiopathic bile duct stricture in 1, carcinoma of the head of pancreas in 27, and other periampullary tumors in 37 (duodenal carcinoma 11, ampullary carcinoma 11, neuroendocrine tumor 10, cholangiocarcinoma 5). Mean follow‐up period was 30.5 months (range 3.5–132.0 months). Resection was conventional (including distal gastrectomy) in 39 patients and conservative (retaining the stomach, pylorus, and duodenal cap) in 61 patients. Resection for inflammatory disease caused greater operative blood loss (mean 2.29 versus 1.75 L;p=0.054) and a longer operative time (6.2 versus 5.2 hours;p=0.040) than resection for neoplastic disease. There were four operative deaths, two from leakage of the pancreatic anastomosis; another two patients survived pancreatojejunostomy leaks. Twenty patients developed postoperative complications, seven of whom required reoperation. Good pain relief was obtained in 76% of patients with chronic pancreatitis, but five required completion distal pancreatectomy at a mean 22.8 months after the first resection. Mean survival of patients with pancreatic cancer was 13.2 months. Sixteen patients with other periampullary cancers are still alive 41.6 months after the operation.
Effect of low‐dose subcutaneous heparin on postoperative wound hematomas: Randomized clinical trial on hospitalized inguinal hernia patients in Germany
Authors: Schmitz Rainer , Kansy Marion , Moser Karl‐Heinz , Treckmann Jürgen
Published: October 2004

A randomized prospective study of low‐dose heparin was performed in 89 surgical patients during and after Bassini‐Lotheissen repair. The patients were divided into two groups: (1) Low‐dose heparin: 5000 units 2 hours before operation and 5000 units every 8 hours for 5 days after the operation. (2) Dextran 40 (Rheomacrodex); administered during the operation, with an additional infusion of dextran (500 ml/day) for the next 3 days. The frequency of wound complications in 45 the heparin‐treated patients was 22.0% (comprising 10 hematomas), compared to only 4.5% in the dextran‐treated patients (n=44 patients). These findings are significant (p<0.05). Low‐dose heparin should therefore be administered routinely only to patients with increased risk of thromboembolism.
General rules for recording endoscopic findings of esophagogastric varices (1991)
Authors: Idezuki Yasuo ,   Japanese Research Society for Portal Hypertension
Published: October 2004

The general rules made in 1980 for recording endoscopic findings of esophageal varices have widely been used in Japan and in other countries. However, since the development of endoscopic sclerotherapy and other modalities of endoscopic treatment, these 1980 rules were found to be insufficient for recording mucosal changes after treatment. The general rules as revised in 1991 recognize mucosal changes such as erosion, ulcer, scar, thrombosed varices, and bleeding signs. These new 1991 rules, which seem useful for recording initial evaluation of gastroesophageal varices and for describing mucosal changes after sclerotherapy as well, are described here.