bluuebunny/crossref_metadata_2025 huggingface dataset:
Preventive effect of nicardipine on hyperplastic changes in venous bypass grafts
Authors: GökÇe özcan , GökÇe Çi¯gdem , Günel Salih , özden Akin , Hüseyinoğlu Kemal , UÇar özcan , Güngen Yücel
Published: May 2005

Nicardipine is a relatively new calcium channel blocker with important properties that could result in attenuation of the adverse proliferative changes in autogenous vein bypass grafts. In this experimental, randomized, controlled study, the effect of nicardipine on the pathologic findings in aortoaortic bypass grafts was assessed. Forty‐two male rabbits (Orycytolagus cuniculus) were randomized to three groups: group 1 received nicardipine and groups 2 and 3 placebo for 4 weeks, after which an aortoaortic bypass was realized with an autogenous inferior vena cava segment. During the following 4 weeks, groups 1 and 2 received nicardipine, and placebo was continued in group 3. The animals were sacrificed at the end of the study to permit removal and evaluation of the bypass grafts. The mean intimal and medial thickness values for groups 1 and 2 were lower than those for group 3, indicating that nicardipine has a significant preventive effect on the hyperplastic changes in venous bypass grafts compared to placebo. The mean intimal and medial thickness values of group 1 were also lower than those of group 2, and the differences carried statistical relevance, suggesting that the use of nicardipine before grafting could potentiate its protective effect. To provide stimulus for further research, an attempt is made to relate the hyperplasia‐preventing effect of nicardipine to possible mechanisms.
Cholecystectomy and drainage: Ultrasonographic and radioisotopic evaluation
Authors: Kapoor Vinay K. , Ibrarullah Mohammad , Baijal Sanjay S. , Kulshreshtha Akhilesh , Mittal Bhagwant R. , Saxena Rajan , Das Birendra K. , Kaushik Satyendra P.
Published: May 2005

Eighty patients undergoing cholecystectomy were either assigned deliberately (n=30) or randomized (n=50) to drainage (n=38) or nondrainage (n=42). Subhepatic collections were seen on ultrasonography (US) after 48 to 72 hours in 12 of 35 patients with drainage and 24 of 42 patients without drainage (p<0.05). Only two patients with subhepatic collections were symptomatic, and none required treatment. Postoperative infective complications were seen in 13 of 38 patients with drainage and 4 of 42 without drainage (p<0.01). Five of 12 patients with drainage and with a collection, and none of the 18 patients without drainage and without a collection had postoperative infective complications (p<0.05). Cholecystectomy was then performed in 100 patients without using a drain. BULIDA radioisotope scans revealed a bile leak in only 4 of 34 patients studied. Subhepatic collections were seen on US after 48 to 72 hours in 42 patients. The collection resolved in 22 patients and was smaller in 6 on repeat US. None of the patients with collection was symptomatic, and none required treatment. Postoperative infective complications were seen in 7 of 42 patients with a collection and 5 of 58 patients without a collection (not significant). We conclude that (1) cholecystectomy with drainage is associated with more infective complications than when a drain is not used; (2) cholecystectomy without drainage is safe; and (3) asymptomatic nonbilious subhepatic collections are common after cholecystectomy without drainage but do not require treatment, resolving spontaneously.
Abdominal wall retraction during laparoscopic cholecystectomy
Authors: Araki Keisuke , Namikawa Kazuo , Yamamoto Hirotoshi , Mizutani Junichi , Doiguchi Miyuki , Arai Mitsuhiro , Yamaguchi Tetsuya , Uno Keisuke , Ido Yasunori , Hayashi Naoko , Ogawa Michio
Published: May 2005

Laparoscopic cholecystectomy has represented a potentially more morbid procedure than open cholecystectomy. Some of this morbidity has been due to complications associated with pneumoperitoneum. We have developed a technique that employs abdominal wall retraction during laparoscopic cholecystectomy and allows access to the right upper part of the abdomen without maintenance of pneumoperitoneum. Among 151 patients who underwent laparoscopic cholecystectomy using abdominal wall retraction there were no recognized adverse effects. Abdominal wall retraction enables the surgeon to minimize the risk of serious complications associated with pneumoperitoneum during laparoscopic cholecystectomy.
Apparent normobasemia as a negative prognostic sign immediately after hepatectomy
Authors: Wada Yasuo , Mori Keiichiro , Sugano Motoki , Fujii Tsuneo , Shimahara Yasuyuki , Yamaoka Yoshio , Ozawa Kazue
Published: May 2005

The acid‐base balance from the postoperative day (POD) 1 to POD 3 after cirrhotic liver resection was investigated in relation to operative outcome by conducting a retrospective study on the changes in arterial ketone body ratio (AKBR), which reflects the hepatic mitochondrial redox state, and arterial blood gas analysis. Patients were grouped according to their outcome: hospital death (HD) and or good outcome, the latter group acting as controls (CTR). Metabolic alkalosis developed in a significant number of the CTR patients (p<0.01), who had high AKBR values. By contrast, metabolic alkalosis did not develop in the HD group, with significantly lower AKBR (p<0.001), and there was almost normobasemia. There were no significant differences in the need for mechanical respiratory assistance, the amounts of fresh frozen plasma administered, and renal function test results between the two groups on each of 3 postoperative days. These data indicated that the absence of metabolic alkalosis during the early postoperative days reflects disruption of energy metabolism in the remnant liver, and that the apparent normobasemia is a significant indicator of poor prognosis after cirrhotic liver resection.
Is there a place for gastroenterostomy in patients with advanced cancer of the head of the pancreas?
Authors: van der Schelling George P. , van den Bosch Rene P. , Klinkenbij Jean H. G. , Mulder Paul G. H. , Jeekel Johannes
Published: May 2005

There remains doubt about the need for gastroenterostomy in patients with advanced cancer of the pancreatic head, performed either prophylactically or when passage of food becomes impossible. The records of 142 patients admitted for advanced pancreatic cancer to the Erasmus University Hospital over a period of 11 years were reviewed. We concentrated especially on the pre‐ and postoperative intake of food in cases involving gastroenterostomy and the morbidity and mortality associated with abdominal surgery in these patients. Of 129 patients without symptoms of gastric outlet obstruction at the time of diagnosis, 31 underwent prophylactic gastroenterostomy. The procedure did not prevent gastric outlet obstruction in 4 patients. Of the remaining 98 patients, 15 developed gastric outlet obstruction. Cox proportional hazards analysis showed no significant difference in the interval to the occurrence of a symptomatic obstruction between these two groups, taking into account other covariables. Postoperative complications and mortality regarding a gastroenterostomy were high, ranging from 9% to 41% and 11% to 33%, respectively. Our results do not indicate that prophylactic gastroenterostomy may significantly prevent future gastric outlet obstruction; therefore, as it also increases morbidity, it should not be performed. A gastroenterostomy to relieve symptoms should be considered carefully, as the success rate is low and is accompanied by a considerable incidence of morbidity and mortality.
Surgical treatment of portal hypertension: A historical perspective
Authors: Donovan Arthur J.
Published: May 2005

Portal hypertension has been treated surgically by diversion of blood from the portal system, by interruption of the flow of blood to esophageal varices, or by direct obliteration of the varices. At the beginning of the twentieth century, portal diversion was achieved by omentopexy and, in a few patients, by the creation of a portacaval shunt. The latter operation was abandoned because of high mortality and morbidity rates, including shunt encephalopathy. In the 1940's, interest was renewed in the portacaval shunt. Improved understanding of hepatic physiology and the establishment of precise criteria for selection of cases for surgery resulted in a low operative mortality rate. The operation was highly successful in the control of hemorrhage from esophageal varices but was associated with an undesirable incidence of impairment of hepatic function. Currently, selective decompression of varices by the distal splenorenal shunt is under evaluation as a method of preventing variceal hemorrhage, while preserving hepatic function. Elimination of the threat of hemorrhage from varices by arterial ligation, sclerotherapy, or direct suture has been practiced for almost a century. The result remains one of temporary control with recurrent hemorrhage in the majority of cases.

Ascites was formerly considered the dominant manifestation of portal hypertension. Currently, it is usually well controlled by diuretics. Surgery is reserved for the rare case of intractable ascites, often with hepatorenal syndrome. In such cases, a shunt is established between the peritoneal cavity and the systemic venous system, a procedure first performed early in this century.
Nonsurgical management of emergency hemorrhage from esophageal varices
Authors: Schiff Eugene R.
Published: May 2005

The emergency management of bleeding esophageal varices should be successful in at least 50% of cases. The sequence of medical steps instituted will vary depending on the resources of the center. The prevention of exsanguination is paramount initially and then bleeding must be stopped. Replacement of blood, intravenous vasopressin, and balloon tamponade, carried out in an intensive care unit, remain the mainstay of medical therapy. The increasing availability of endoscopic sclerotherapy with flexible instruments has more recently introduced a more direct means for stopping the hemorrhage as well as preventing recurrences.
Portacaval shunts
Authors: Callow Allan D.
Published: May 2005

Although portacaval shunt has been amply demonstrated as providing effective therapy for the control of bleeding varices, it produces total diversion of portal flow with a high incidence of hepatic failure which, if not fatal, is frequently associated with encephalopathy. Various modifications of the portacaval shunt, physiologically a central shunt, are associated with the same immediate and delayed negative side effects as the standard end‐to‐side portacaval shunt. Numerous therapeutic modifications intended to lessen the incidence and severity of post‐shunt encephalopathy, such as limitation of protein intake, antibiotics, normalization of plasma amino acids, and modification of the gastrointestinal flora, are largely unsuccessful. Trials of adjuvant procedures such as arterialization of the portal vein and colon exclusion, as well as attempts to reduce the mortality rate of the first variceal hemorrhage by either prophylactic shunt or emergency portacaval shunt, have produced disappointing results in most instances. End‐to‐side portacaval shunt is not the therapeutic final solution. It may be indicated in the patient with intractable or severe ascites, in the presence of massive uncontrolled hemorrhage (an emergency situation), and to a very limited extent, in the presence of a few otherwise uncontrollable metabolic diseases such as hyperlipidemia. Ideally, one would prefer to restrict this operation to those patients who are destined to bleed from varices again.
Mesentericocaval shunt (MCS) with autologous jugular vein
Authors: Stipa Sergio , Ziparo Vincenzo
Published: May 2005

We report our personal experience of 114 patients with portal hypertension treated with mesentericocaval shunt (MCS) and 167 with portocaval anastomosis (PCA). In addition, the 2 procedures were evaluated in a controlled trial of 21 MCS patients and 25 PCA patients. We found no significant difference in the results of the 2 operations in terms of operative mortality rate, incidence of hepatic encephalopathy, and long‐term survival. The surgical procedure of MCS is no easier to perform than PCA; it requires the preparation of the graft, 2 vascular anastomoses, and longer operative time. It seems appropriate to select this operation only with those patients who, for anatomical reasons, cannot undergo PCA.
Fifteen years' experience with left gastric venous caval shunt for esophageal varices
Authors: Inokuchi Kiyoshi , Beppu Kazushige , Koyanagi Nobuhiro , Nagamine Kenji , Hashizume Makoto , Iwanaga Tetsuya , Sugimachi Keizo
Published: May 2005

Data on 231 patients with esophageal varices and portal hypertension secondary to intrahepatic block who underwent a left gastric venous caval shunt are presented herein. Operative death occurred in 5 (2.2%) and late death in 80 (34.6%), resulting in 146 survivors at a mean follow‐up period of 66 months. Postoperative variceal bleeding occurred in 17 (7.4%). Five‐year survival rate was 69.8% overall, and 62.0% in patients with cirrhosis. Eck's syndrome occurred in none, and a prograde portal flow was preserved in all 43 patients who were examined angiographically or ultrasonically.

Left gastric venous caval shunt is a safe and effective surgical treatment which provides less insult to portal hemodynamics for a long postoperative period of time.
Changing trends in the management of combined pancreatoduodenal injuries
Authors: Moore John B. , Moore Ernest E.
Published: May 2005

Management of combined injury to the duodenum and pancreas remains controversial. Our review includes a 5‐year period ending June, 1982, in which 34 patients with combined pancreatoduodenal injuries were treated operatively. Nineteen (56%) sustained penetrating injuries and 15 had blunt trauma. Twelve patients underwent active sump drainage and repair. The remaining 22 required more extensive procedures including pyloric exclusion with or without pancreatic resection in 14, and pancreatodu‐odenectomy in one. The overall mortality rate was 9% with 2 early deaths secondary to associated injuries and 1 late death due to the pancreatoduodenal injury. Complications directly related to the combined injury occurred in 47% of the patients, including a 20% incidence of pancreatic fistulas. Although no single procedure uniformly applies to these complex injuries, we advocate frequent use of active sump drainage, pyloric exclusion, and early nutritional support via needle catheter jejunostomy.
The role of lymph node surgery in gastric cancer
Authors: Mishima Yoshio , Hirayama Renzo
Published: May 2005

In Japan, gastric cancer is the primary cause of death in both males and females. Among early gastric cancers, the elevated lesion is almost always the differentiated type, whereas almost half of the depressed lesions are undifferentiated types. As for advanced gastric cancer, the differentiated type tends to grow expansively as in Borrmann I and II. In contrast, the undifferentiated type is an invasive lesion as in Borrmann III and IV, and preferentially metastasizes to both the peritoneum and regional lymph nodes. Both peritoneal dissemination and lymph node metastasis are more frequently noticed in younger patients than in older patients. The standard operation performed for gastric cancer in Japan is usually gastric resection including complete dissection of group II lymph nodes, which are found along the left gastric and common hepatic arteries, and around the celiac artery. Apart from lymph node metastasis, an important factor influencing the long‐term result of surgery is serosal invasion. In order to improve long‐term results, more aggressive lymph node dissection as well as effective management of the peritoneal invasion should be mandatory. Although there is no therapy superior to that of surgery for gastric cancer, it should be stressed that this malignancy should be treated with an appropriate combination of therapies.
Can radical surgery improve survival in colorectal cancer?
Authors: Jeekel J.
Published: May 2005

Prospective, randomized trials that study the best surgical technique to prevent local and distal metastases in colorectal cancer have not yet been performed. Prevention of local recurrence must be a major effort achieved by radical resection of the tumor area, by minimizing the possibility of suture line recurrence and of tumor remnants in intramesenteric lymph nodes or surrounding tissue, and by avoiding spillage of tumor cells. Extended resections of mesenteric lymph nodes or pelvic lymphadenectomy did not prove to be of significant benefit in most retrospective studies. In the case of adjacent organ involvement, en bloc resection is indicated since long‐term survival can be obtained. This operation can be performed with low operative mortality rates even in the case of pancreas or duodenum involvement as is shown in our series of 34 patients (3% operative mortality). Frozen sections of the resection area have to be included in the operative procedure. For prevention of distant metastases, the no‐touch technique of Turnbull should be performed. In a prospective, randomized trial of 236 patients operated on for colon cancer, liver metastases appeared later and to a lesser degree in patients operated on with the no‐touch isolation technique, particularly in the case of angioinvasive growth of the tumor.
Progress in gastric cancer surgery in Japan and its limits of radicality
Authors: Maruyama Keiichi , Okabayashi Kenzo , Kinoshita Taira
Published: May 2005

Radical surgery of gastric cancer has become more widely utilized in Japan. Topics explored in gastric cancer surgery include the extended lymph node dissection guided by the node staining method with India ink, left upper abdominal organs exenteration for advanced cancer of the upper stomach, and pancreaticoduodenectomy for advanced cancer of the lower stomach. Through the progress of surgical treatment as well as that of the early detection system, the treatment results have been improved. Using the data from nationwide registrations (5,706 and 11,845 cases) and those from the National Cancer Center Hospital (3,176 cases), the 5‐year survival rate of total primary resected cases was 44.3% in the first period (1963–1966), 56.3% in the second period (1969–1973), and 61.6% in the third period (1971–1985). Between the first and the third period, the 5‐year survival rate of patients with stage 2 cancer increased from 60.6% to 71.7%, and that of stage 3 increased from 32.7% to 44.3%; however, the limits of radical surgery were also clarified, especially in patients with peritoneal dissemination, liver metastasis, distant lymph node metastasis, and diffusely infiltrating carcinoma (Borrmann type 4). For such patients, chemotherapy, hormonal therapy, immunotherapy, radiotherapy, and hyperthermia should possibly be employed in hopes of improving treatment result.
The value of preoperative radiotherapy in esophageal cancer: Results of a study of the E.O.R.T.C.
Authors: Gignoux Marc , Roussel Alain , Paillot Bernard , Gillet Michel , Schlag Peter , Favre Jean‐Pierre , Dalesio Otilia , Buyse Marc , Duez Nicole
Published: May 2005

Attempts to combine radiation therapy and surgery in patients with operable carcinoma of the esophagus began 30 years ago. The first reported surgical series showed a low rate of resectability and a high postoperative mortality. Results of radiation therapy alone were also disappointing in the long run, especially in patients who appeared to be excellent operative risks with small localized tumors. The rationale for a combined approach was that x‐ray therapy could bring about a reduction of tumor activity and bulk, an improvement in nutritional state through the restoration of the ability to swallow, a reduction of transplantability of the tumor, and a curative effect on periesophageal regional disease which is not treated well by surgery. On the other hand, surgery often allowed an extended resection, clearing residual foci or distant esophageal wall extension. The limit of a combined approach is the toxicity of the preoperative radiation which must be mild enough to allow surgery to proceed without excessive delay or increased mortality. Numerous radiotherapy schedules were tried using different fields, doses, and fractionations, most of them in nonrandomized studies. Two prospective randomized trials have been recently reported. The final results of a third prospective trial, run by the E.O.R.T.C., will be presented.
Preoperative chemotherapy in esophageal carcinoma
Authors: Kelsen D. P.
Published: May 2005

Preoperative chemotherapy for localized esophageal cancer is an area of increasing interest because neither surgery nor radiation has had a major impact on disease‐free or overall survival. This is probably because, as several autopsy series have demonstrated, esophageal cancer is a systemic disease. Preoperative chemotherapy thus, in theory, allows a simultaneous attack on both the primary and metastatic disease. A number of single‐arm, Phase II, multimodality trials have been completed. Toxicities of chemotherapy, while substantial, have been tolerable. With careful attention to detail, operative morbidity and mortality have not been increased. Although the theory is attractive, large‐scale randomized trials are now needed to evaluate the impact of this technique on disease‐free and overall survival before recommending it for general use.
Adjuvant treatment in colorectal cancer: An update
Authors: Douglass Harold O.
Published: May 2005

Analysis of current and recently completed trials of adjuvant therapy for colorectal cancer permit a few very broad generalizations. Survival of patients initially treated by resection has improved during the past 2 decades, unrelated to adjuvant therapy. While pilot, uncontrolled, and historically controlled studies often suggest a treatment benefit, controlled trials have, to date, failed to show any advantage for adjuvant therapy in colon cancer. For rectal cancer, only those trials including radiation therapy alone or in combination with chemotherapy have provided enhanced patient survival. Superiority of preoperative versus postoperative radiotherapy has not been demonstrated.

Of interest is the current United States intergroup trial in colon cancer which is evaluating levamisole in combination with 5‐fluorouracil, based on preliminary experience in a smaller study of the North Central Cancer Treatment Group which suggests that levamisole and 5‐fluorouracil may be a potentially beneficial adjuvant combination. Recent reports of pharmacologic modulation of 5‐fluorouracil resulting in significantly enhanced response rates in advanced metastatic colorectal cancer invite a trial of this pharmacologic concept for surgical adjuvant therapy.
Local procedures in the management of rectal cancer
Authors: Heberer Georg , Denecke Heiko , Demmel Nikolaus , Wirsching Rainer
Published: May 2005

Of 1,134 patients treated for rectal cancer from 1973 to 1985, local therapy was used in 310. Forty‐two underwent local excision and the operative morbidity and mortality were lower than after radical operations. The 5‐year survival rate was 84%. This treatment should be reserved for patients who have totally resectable tumors of 3 cm or less in size and of low histologic grade (1 or 2).

For local palliation, cryosurgery was applied in 268 patients. By use of this low‐risk treatment, a colostomy could be avoided in 80% of patients (mean observation time 2.3 years). The best results were achieved for “small” carcinomas in high‐risk patients (no evidence of disease in 24 of 31 patients). Local palliation by cryosurgery does not influence the prognosis of survival if distant metastases are present.
Resection of liver metastases—When is it worthwhile?
Authors: Adson Martin A.
Published: May 2005

Most of what has been learned about resection of hepatic metastases comes from the study of colorectal cancer because such lesions are so common. One‐fourth or more of patients who have liver metastases from such lesions have hepatic tumors that can be removed, but only about 25% of these patients will live 5 years or more after such tumors have been removed. When resection so often fails to improve survival, there is a need to know when metastatic lesions should be removed. Study of determinants of prognosis, patterns of failure, and the natural history of the disease have shown that surgical failure is determined by the presence of extrahepatic metastases (even when removed) and limited resective margins. The patient's gender and the locoregional stage of the primary resected lesions influence survival, but not so much as to withhold resective treatment from these less favored groups. Studies of size, site, and number of hepatic metastases removed show therapeutic limitations associated with extremes, but these determinants of prognosis after resection must be studied in better ways. Although, at times, palliation is a reasonable goal, this aspect of resective treatment has not been studied well. When there are no good therapeutic alternatives to resection of hepatic metastases and when risk is low, such palliative operations may be justified. Only with further study will absolute contraindications to surgical therapy be well defined. There is an obvious need for biologic control of cancer.
Regional and systemic chemotherapy for colorectal metastases to the liver
Authors: Balch Charles M. , Levin Bernard
Published: May 2005

The fluoropyrimidines 5‐FU and FUDR are antimetabolites that have limited activity in the treatment of patients with colorectal metastases. The availability of implantable or portable drug infusion pumps has caused a renewed interest in continuous infusion therapy using these drugs for patients with colorectal metastases to the liver. While the search for new, more effective agents or combinations continues, it is reasonable to evaluate dose schedules and drug combinations that would maximize the effectiveness of these fluoropyrimidines and lower their toxicity in investigational protocols. In most series both drugs have higher response rates, less myelosuppression, but greater liver toxicity when given by continuous intraarterial infusions compared to bolus injections given intravenously. Nevertheless, there is still insufficient data to conclude that survival rates are sufficiently prolonged in patients for whom an implantable drug infusion pump has been used for regional FUDR chemotherapy. On the other hand, symptomatic patients may have sufficient palliation to constitute an identifiable group for whom this approach is justified. Results of several randomized prospective studies addressing the efficacy of regional versus systemic FUDR chemotherapy infusions will be available in the near future. If these demonstrate improved survival for patients receiving regional FUDR chemotherapy, it will be appropriate to consider this approach in selected patient settings. Until such data are available, routine use of this approach in asymptomatic patients is not warranted.
Isolated regional perfusion in malignant melanoma of the extremities
Authors: Koops Heimen Schraffordt , Oldhoff Jan , Oosterhuis J. Wolter , Beekhuis Henk
Published: May 2005

Isolated perfusion for regional chemotherapy is only practical for tumors located on the extremity, because this is the only site where adequate vascular occlusion can be achieved. Indications for perfusion in clinical stage I melanoma patients are determined by microstaging of the tumor. At our institution, patients with Clark's levels III, IV, or V and a Breslow thickness of ≥1.5 mm are eligible. Lower limb perfusions are started through an iliac perfusion. Two perfusions are performed for foot lesions, local recurrences, satellitosis, or intransit metastases.

Flow rates for leg perfusion vary from 600 to 1,000 ml/min. During the past few years, higher flows (up to about 1,200 ml/min) have been utilized. Less toxicity developed with better tissue perfusion, and the dosage of cytostatics could be increased. The dosage of cytostatic drugs is calculated by limb volume, as determined by immersion in water. In our opinion, hyperthermia yields superior results for cases of local recurrence or intransit métastases. It is not known if a combination of cytostatic drugs might improve results compared to a single drug.
Pattern of recurrence in liver resection for colorectal secondaries
Authors: Ekberg Henrik , Tranberg Karl ‐Göran , Andersson Roland , Lundstedt Christer , Hägerstrand Inga , Ranstam Jonas , Bengmark Stig
Published: May 2005

The pattern of relapse and factors influencing the site of recurrent disease were studied in 68 patients subjected to liver resection of colorectal metastases. Fifty‐three (78%) patients had recurrence. Liver, lungs, and peritoneal cavity were most frequently involved, and all patients with relapse had recurrence in one or more of these sites. Intraabdominal relapse occurred in 50 (74%) patients (94% of patients with relapse). The liver was involved in 44 (65%) patients and was the only site of recurrence in 19 (28%). Extrahepatic metastases developed in 34 (50%) patients. Four or more liver tumors, a resection margin of less than 10 mm, and extrahepatic disease were the main determinants of hepatic recurrence. Bilateral intrahepatic spread, as compared to unilateral disease, major liver resection, as compared to wedge resection, and percent liver tumor volume were also associated with an increased risk of liver recurrence. The presence of extrahepatic disease before resection was the only factor that could be demonstrated to increase the risk of (further) extrahepatic spread. It is concluded that the number of liver metastases, the resection margin, and the presence or absence of extrahepatic disease helps in predicting the risk of hepatic recurrence after resection for colorectal liver cancer. No variable presently available is of any help, however, in predicting the extrahepatic recurrence affecting about half of the patients having no evidence of extrahepatic disease before liver resection. This finding should urge improved evaluation of candidates for liver resection and should influence adjuvant treatment protocols.
Arterial bullet embolism with radiologic demonstration of vessel entrance site
Authors: Falkmer Lennart , Eriksson Anders , Arnerlöv Conny , Domellöf Lennart
Published: May 2005

A case of embolism of a. 22 caliber revolver bullet to the left deep femoral artery after penetrating the abdominal aorta is described. The case is discussed in relation to previous reports with special reference to the surgical intervention. The importance of whole body fluoroscopic search for all bullets not accounted for is emphasized. When the bullet entrance site is in the abdominal aorta, emboli should be expected to locate to the lower extremities.
The application of ultrasound during brain surgery
Authors: Chandler William F. , Rubin Jonathan M.
Published: May 2005

The use of intraoperative, real‐time ultrasound imaging during intracranial neurosurgical procedures is described. This technique has proven to be extremely useful for localization of a wide variety of deep and superficial brain lesions, and for needle biopsy or aspiration of selected lesions. The precise localization provided by ultrasonic imaging shortens the time of surgery and increases the safety for the patient.

Every type of primary and metastatic tumor of the brain has imaged well, and low‐grade gliomas are often better defined with ultrasound than by computed tomographic scanning. Abscesses can be imaged and aspirated, and hematomas are easily imaged. A variety of vascular lesions including aneurysms and arteriovenous malformations can be localized and characterized. Structural abnormalities such as hydrocephalus and Arnold‐Chiari malformation can be well delineated.
The use of operative ultrasonography for the localization of renal calculi
Authors: Alken P. , Thüroff J. W. , Hammer C.
Published: May 2005

The ultrasonically guided nephrotomy technique using B‐scanning to identify the localization of stones and Doppler sonography to identify avascular parenchymal areas for nephrotomies allows for transparenchymal stone removal without the need for renal artery clamping and renal cooling. In 175 procedures the average blood loss was 1,350 ml and the rate of residual stones requiring a secondary intervention was 2.8%. Despite the advent of new noninvasive treatment modalities, this technique is still applied in 23% of staghorn stones.
The use of ultrasound during reconstructive arterial surgery of the lower extremities
Authors: Rosenbloom Mark S. , Flanigan D. Preston
Published: May 2005

Real‐time, B‐mode ultrasonography is a dependable method of vascular imaging for use during arterial reconstruction. It has been demonstrated in both animal and human studies to detect accurately intimal flaps, arteriotomy stricture, and intraluminal thrombi. Sonographic images are 3‐dimensional and dynamic. Scans can be repeated as often as necessary and in different views to characterize lesions fully. Operative sonography has a sensitivity of 100%, specificity of 94%, and accuracy of 94% compared to 68%, 85%, and 83%, respectively, for operative arteriography. There are limitations to sonography. It can only evaluate vessels in the operative field and is useless for assessment of the arterial run‐off. The high sensitivity of sonography will lead to the discovery of defects that likely pose no threat to the success of the reconstruction. The surgeon will have to decide what lesions are significant and what lesions warrant reexploration. The role of operative ultrasonography in arterial surgery is to complement arteriography. This can be accomplished by assessing areas not readily visualized by arteriography and by providing additional information to assist the surgeon in obtaining a technically successful reconstruction.
Comparison of operative ultrasonography and radiography in screening of the common bile duct for calculi
Authors: Jakimowicz Jack J. , Rutten Harm , Jürgens Philip J. , Carol Erik J.
Published: May 2005

We report a 4‐year experience of operative ultrasonography in 449 patients who underwent cholecystectomy for biliary lithiasis. Intraoperative ultrasonography and intraoperative cholangiography were performed in all of these patients and compared with the operative findings. The diagnostic accuracy of sonography was 97.5% and that of cholangiography was 94.4% in the patient group as a whole. The predictive value of a positive sonogram in this group was 96.4%, while that of a positive cholangiogram was lower at 86.9%. In 148 patients who underwent surgical exploration of the common duct, sonography appeared to have more accurately predicted presence or absence of stones (92.5%) than did cholangiography (79.8%). Use of these intraoperative screening tests together led to a positive common duct exploration in 76.6% of the 148 patients, which is higher than our previous experience in which common duct exploration was performed on the basis of clinical criteria. In 7% of the 301 cholecystectomized patients, unpredicted stones were detected at operative sonography and cholangiography. If the common duct exploration were to be performed based solely on the outcome of the sonogram, the rate of positive exploration could be 97%. Overall morbidity in this series was 9%, and retained stones following duct exploration were encountered in 1 patient. The overall mortality rate of the entire patient group was 0.9%. Operative ultrasonography of the biliary tract as a screening procedure is, in experienced hands, a reliable method and substitute for operative cholangiography.
The prevention of arterial collaterals after repeated temporary blockade of the hepatic artery in pigs
Authors: Persson Bo G. , Jeppsson Bengt , Andersson Lena , Strand Sven‐ Erik , Ekelund Leif , Bengmark Stig
Published: May 2005

Hepatic dearterialization and permanent hepatic artery ligation can induce tumor necrosis but only of limited duration, partly due to a rapid development of arterial collaterals. The aim of this study was to determine if collateral formation could be reduced or prevented by repeated, transient dearterialization.

Three groups of pigs were repeatedly and transiently dearterialized daily for 2 hours (n=5), 4 hours (n=5), and 6 hours (n=4), respectively, over a 4‐week‐period by means of a totally implantable vascular occluder described earlier by us. These pigs were compared with a group having permanent hepatic dearterialization (n=4). An additional group (n=3) served as a control and did not have dearterialization. After 4 weeks of treatment, hepatic angiograms were taken and absolute hepatic arterial blood flow was measured according to the reference sample method with radiolabeled microspheres. There were no demonstrable collaterals in the 2‐hour group, formation of some small collaterals in the 4‐hour group, and a fully developed collateral network in the 6‐hour group, with similar findings in the permanently dearterialized group. Absolute hepatic arterial blood flow was significantly lower in the 4‐hour group with obstructed hepatic artery compared to permanent hepatic dearterialization (p<0.01, Wilcoxon rank sum test) and highly significantly lower in the 2‐hour group (p<0.0001, Wilcoxon rank sum test).

Thus, repeated and brief dearterialization seems to prevent the formation of arterial collaterals and makes repeated arterial ischemia of the liver possible which could be of value in the treatment of liver tumors. In addition, a patent artery makes continuous intra‐arterial cytostatic infusion possible.
The indocyanine green test enables prediction of postoperative complications after hepatic resection
Authors: Matsumata Takashi , Kanematsu Takashi , Yoshida Yasuhiro , Furuta Toshiya , Yanaga Katsuhiko , Sugimachi Keizo
Published: May 2005

We evaluated the postoperative course of 50 patients who underwent hepatic resection, using the ratio of indocyanine green (ICG) retention rates measured on the third postoperative day to values estimated immediately after the operation. This ratio was expressed as the remnant liver ICG index. Group A included 22 patients with a remnamt liver ICG index of less than 1.0, which meant that the ICG retention rate at 15 minutes on the third postoperative day showed improvement, compared to events immediately after the operation. In group B, there were 28 patients whose index on the third postoperative day was over 1.0, thereby indicating exacerbation of the ICG clearance rate after hepatic resection. Serious complications including intraabdominal sepsis and hyperbilirubinemia occurred postoperatively in 2 (9.1%) in group A and 16 (57.1%) in group B (p<0.001). One patient (4.5%) in group A died, while 9 patients (32.1%) in group B died during hospitalization (p< 0.02). There were no significant differences with regard to preoperative liver function and clinical parameters. These observations suggest that improvement in the ICG clearance rate on the third postoperative day, compared to that immediately after the operation, is useful to predict the postoperative course of hepatectomized patients.
The value of intraoperative scintigraphy as a routine procedure in thyroid carcinoma
Authors: Lennquist Sten , Persliden Jan , Smeds Staffan
Published: May 2005

Intraoperative scintigraphy (IOS) was performed with a previously developed and described technique in a prospective study of 64 patients with highly differentiated thyroid carcinoma. Residual iodine uptake after macroscopically radical thyroidectomy was registered at IOS in 43 patients. IOS permitted identification and removal of the residual tissue in 33 of these patients, leading to negative postoperative scintigraphy in 27. Of the 10 patients in whom the residual iodine uptake at IOS could not be eliminated, 3 had metastases outside the operative field (treated with postoperative radioiodine ablation) and 7 had a tiny remnant of thyroid tissue behind the entrance of the inferior laryngeal nerve.

The residual tissue detected by IOS was localized in or associated with the pyramidal lobe in 11 patients, and in 8 it was immediately behind and below the entrance of the inferior laryngeal nerve. Other locations were lymph nodes along the carotid artery or internal jugular vein, in the supraclavicular fossa or in the ligated inferior thyroid artery.

Conclusions from this case series were that IOS is more sensitive than regular postoperative scintigraphy for detection of residual thyroid tissue, that it significantly reduces the need for postoperative radioiodine ablation (which was avoided in more than half of the patients with residual uptake at IOS), and that it technically facilitates performance of the operation and greatly enhances the possibility of achieving complete thyroidectomy.
Evaluation of surgical results and prediction of prognosis in patients with medullary thyroid carcinoma by analysis of serum calcitonin levels
Authors: Miyauchi Akira , Matsuzuka Fumio , Kuma Kanji , Takai Shin ‐ichiro , Nakamoto Kembu , Nakamura Kenji , Nanjo Satoru , Maeda Masazumi
Published: May 2005

Serum calcitonin levels before (S1) and after (S2) surgery were measured in 67 patients with medullary thyroid carcinoma and the patients were followed with serial calcitonin measurements for a mean duration of 7 years. The calcitonin doubling time (T2) was calculated in patients with elevated postoperative calcitonin levels. Assuming that the serum calcitonin level is linearly correlated with tumor weight, the residual tumor weight (W2) is estimated as W1S2/(S1−S2) where W1 is the weight of the resected tumor. The reduction index (α) is defined as W2/(W1+W2)=(1/2)α.αT2indicates the expected prolongation in survival (EPS) by surgery. The survival index (β)is defined as the number of doublings of residual tumor until it weighs 1,000 g, which would generally kill the host. The expected duration of survival (EDS) after surgery is estimated asβT2.Death within 3 years after surgery or recurrence within 5 years was best associated with short EPS followed by short T2 or smallα.S2had a rather weak correlation and S1had almost no correlation with the prognosis. The duration of survival in 3 patients who died of the disease was very close to the EDS. T2indicates growth rate of the tumor,αindicates degree of radicality of the surgery, EPS indicates the effects of the surgery, and EDS indicates duration of survival after surgery. These parameters allow quantitative judgment of the effect of surgery and quantitative prediction of the prognosis in each patient.
Blood flow and tissue reaction at skin wound closures
Authors: Nagamachi Yukio
Published: May 2005

The purpose of this study was to compare blood flow and tissue reaction in rats following wound closure with either staples or interrupted sutures using nylon pr silk. Microblood flow over a period of 6 days was measured in each layer of normal skin and at the incision site, Macroscopic changes in skin incisions were evaluated 2 hours after closure and 6 days after closure for histologic examination. Measurements of blood flow in normal skin showed the greatest amount of the stratum papillare of the corium. Blood flow in wound tissue closed with staples increased from baseline after 1 hour and continued over the 6‐day period, suggesting active regeneration of new capillaries. Blood flow in rats sutured with nylon decreased markedly to below baseline value, but increased after 3 days and 6 days. A similar trend occurred in wounds closed with silk although the decrease was greater and blood flow did not increase above the baseline at 6 days. Wound healing was complete 6 days after closure with staples, skin color normal, the incision hardly discernible. The wound sutured with nylon showed anoxia of tissue after 2 hours, but at 6 days, appeared similar to the stapled wound. Six days after closure, the silk suture site was swollen, dark in color, and tight. Histologic findings revealed no hypertrophy of the regenerated epidermis at the stapled suture site. The nylon group showed slight hypertrophy of the epidermis, inflamed cells in the subcutaneous tissues, and slight edema at the wound site. It is my conclusion that blood flow and wound healing are most satisfactory when staples are used for wound closure.
Penetration of cefazolin, ceftriaxone, cefoperazone, and ceftazidime into human gallbladder tissue and bile
Authors: Berger Stephen A. , Levy Yeheskel , Halevy Ariel , Gorea Alfred , Orda Ruben
Published: May 2005

Forty patients underwent elective cholecystectomy following administration of a single intravenous dose of cefazolin, ceftriaxone, cefoperazone, or ceftazidime. Mean gallbladder bile concentrations of cefoperazone (398.8μg/ml and ceftriaxone (153.4μg/ml) were significantly higher than those of cefazolin (12.3μg/ml) and ceftazidime (3.08μg/ml) (p<0.008). Mean gallbladder tissue levels of cefazolin (30.1μg/g), ceftriaxone (50.5μg/g), and cefoperazone (91.0μg/g) exceeded that of ceftazidime (7.25μg/g) (p<0.001). When adjusted for known in vitro activity against biliary pathogens, these data suggest that cefoperazone and ceftriaxone are superior to ceftazidime and cefazolin for prophylaxis in elective biliary surgery.
A new method of reconstruction after pylorus‐preserving pancreatoduodenectomy
Authors: Suzuki Takashi , Imamura Masayuki , Kajiwara Takehiro , Kim Hwi ‐Cha , Miyashita Tadashi , Tobe Takayoshi
Published: May 2005

In pylorus‐preserving pancreatoduodenectomy, it has been traditional to perform the duodenojejunostomy distal to the biliojejunal and pancreatojejunal anastomoses. In 11 patients, we performed a new type of reconstruction: the cut end of the duodenum was anastomosed to the fourth portion of the duodenum or to the jejunum, which was shifted retrocolically, then the pancreas and the choledochus were anastomosed to the distal jejunum. In this Billroth I type of reconstruction, regulation of the pH in the duodenum and proximal jejunum and enzymatic digestion of diet in the small intestine contents are thought to be maintained more physiologically than after the former Billroth II type reconstruction, because food or gastric juice passing through the pylorus immediately stimulates the duodenum and the proximal jejunum to release various gut hormones such as secretin, cholecystokinin, somatostatin, gastric inhibitory peptide, etc., resulting in prompt mixing of the food with the pancreatic juice and bile. The postoperative course of the patients was uneventful. They gained weight to the preoperative level within 12 months. No marginal ulcer has developed in these patients.
Total pancreatectomy for ductal adenocarcinoma of the pancreas: An update
Authors: van Heerden Jon A. , McIlrath Donald C. , Ilstrup Duane M. , Weiland Louis H.
Published: May 2005

From 1951 through December, 1985, a total of 89 patients underwent total pancreatectomy for ductal adenocarcinoma. Of the 89 patients, 54 were male and 35 were female; their average age was 60.0 years. Histologic grading (Broders') demonstrated that 56% of the patients had a grade 2 tumor and 38%, a grade 3 tumor. None of the patients had grade 4 tumors. Peripancreatic lymph nodes were positive in 47% of the patients at the time of resection. Multicentricity was noted in 32.5% of patients. The operative mortality was 10.1%; however, for the patients who had surgery after January, 1980, the operative mortality was 6.2%. At the completion of the study, 78 patients had died and 11 were alive. The principal cause of death was recurrent malignancy. The median duration of survival, including the duration of survival in patients who had operative deaths, was 1.03 years. The influence of sex, tumor grade and size, multicentricity, and nodal status was evaluated multivariately with Cox's proportional hazard model.