bluuebunny/crossref_metadata_2025 huggingface dataset:
Results of surgical treatment of hepatic hydatidosis: Current therapeutic modifications
Authors: González E. Moreno , Selas P. Rico , Martínez Bercedo , García I. García , Carazo F. Palma , Pascual M. Hidalgo
Published: May 2005

Hepatic hydatidosis is an endemic disease that affects vast segments of the populations of various countries in the Mediterranean region, South America, the Pacific, and temperate zone nations that possess large numbers of sheep. Four hundred and ten patients bearing 561 hydatid cysts were treated at 2 major hospitals in Madrid, Spain in the period 1974–1989. In order to establish the modifications in diagnostic and therapeutic management introduced as a result of modernization of our clinical facilities and improved technological standards, they were divided into 2 groups: group A corresponded to the period 1974–1984, and group B, corresponded to the period 1985–1989. Since no effective parasiticide agent is available, hepatic hydatidosis must be treated surgically. Today's better knowledge and advancements in liver surgery have made it possible to extirpate the cyst completely with little risk and improved results; hepatic resection should only be considered in exceptional cases; aspiration, drainage procedures, or partial resections of the cyst yield inferior results. We have had no relapse of the hydatid disease in the liver or in any other abdominal site.
Surgical treatment of hepatocellular carcinoma: Experience with liver resection and transplantation in 198 patients
Authors: Ringe Burckhardt , Pichlmayr Rudolf , Wittekind Christian , Tusch Günter
Published: May 2005

Surgical therapy offers the only chance for long‐term cure of patients with hepatocellular carcinoma. The role of partial and total hepatectomy with subsequent liver replacement was analyzed in a consecutive series of 198 patients. It was the aim of this study to compare both treatment modalities on the basis of various clinicopathological prognostic factors including the TNM system of pathological classification. One hundred thirty‐one resections and 61 transplantations were performed for the following histological diagnoses: hepatocellular carcinoma without coexisting liver disease (86) or associated with various hepatic abnormalities (79), fibrolamellar carcinoma (19), and mixed hepatocholangiocellular carcinoma (8). Overall actuarial survival rates at 5 years were 35.8% following resection and 15.2% after transplantation, respectively. For partial hepatectomy, factors significantly associated with improved long‐term outcome were: age 30–50 years, hepatocellular carcinoma without coexisting liver disease, fibrolamellar carcinoma, solitary tumor, unilobar location, absence of vascular invasion, portal vein thrombosis or extrahepatic spread, primary tumor categories pT 2/3, stage groups II/III, and curative operation (R0). Regarding total hepatectomy, the corresponding figures were: pT2, absence of portal vein thrombosis or extrahepatic spread (negative regional lymph nodes, no distant metastases), stage group II, and curative surgery. It could be clearly shown by uni‐ and multivariate analyses that the pTNM classification is of clinical value regarding the assessment of prognostic significance after resection and transplantation. A group of 13 patients had secondary resection (8) or transplantation (6) for intrahepatic tumor recurrence. Whereas in all resected patients cancer recurred again, 5 of 6 transplant recipients are alive and disease‐free at 12–40 months. The results of this study demonstrate that liver resection is the treatment of choice for primary liver cancer while transplantation may be indicated, especially in cases of nonresectable or recurrent lesions. Thus, the therapeutic spectrum for hepatocellular carcinoma should include both partial and total hepatectomy, being integrated into one common concept.
Change of gastric liquid emptying after highly selective vagotomy and pyloric dilatation for patients with obstructing duodenal ulcer
Authors: Wang Chia‐Siu , Tzen Kai‐Yuan , Huang Miau‐Ju , Chen Pang‐Chi , Chen Miin‐Fu
Published: May 2005

Gastric liquid emptying was studied in duodenal ulcer patients with and without stenosis before highly selective vagotomy (HSV) and 1 week, 3 months, and 1 year after. The test meal consisted of 1 mCi of 99m Technetium‐diethylene penta‐acetic acid (DTPA) in 500 ml of isotonic saline. The patients were divided into 2 groups: group 1 (16 cases) without clinical stenosis, who underwent HSV alone, served as control; group 2 (14 cases) with mild to moderate stenosis, who underwent HSV and transgastric dilatation to 20 mm in diameter.

Before HSV, the stenotic group showed a significantly slower liquid emptying than the nonstenotic. Most of the stenotic group could resume a normal diet quickly after operation, but they still had prolonged liquid emptying. At 3 months, the emptying curve of the stenotic patients had approached that of the preoperative controls without a significant difference, while the nonstenotic patients showed an accelerated initial emptying. Although there was a significant improvement with the appearance of accelerated initial emptying at 1 year, the stenotic group still demonstrated slightly slower emptying than the nonstenotic group. A temporary state of preexistent gastric atony due to chronic outlet obstruction may explain the delayed emptying in the early postoperative period; however, minor residual resistance in the fibrotic, scarred tissue was postulated to be persistent despite dilatation, and responsible for the slower emptying of the stenotic than the nonstenotic group at 1 year.
Prognosis in gastric cancer associated with pregnancy
Authors: Ueo Hiroaki , Matsuoka Hideo , Tamura Shigeaki , Sato Koichi , Tsunematsu Yoshihiro , Kato Tetsuo
Published: May 2005

Gastric cancer concomitant with pregnancy is rare. In order to determine the clinical problems and practical guidelines on this particular subject, 61 Japanese patients were analyzed for clinical features and the results of obstetric and surgical treatment corresponding to the time of detection of the gastric cancer during the gestational period. The data indicated a limitation in diagnostic approaches caused by pregnancy and difficulty in saving both the mother and the fetus. Only 20 (58.8%) of the pregnant women underwent both obstetric treatment for the fetus and surgical treatment for gastric cancer. Fifty‐nine of the gastric cancer cases (96.7%) were advanced and resectability was consistently low (47.5%). The patients who received gastrectomy had a high incidence of hospital death (22.7%) and a poor prognosis—21.1% 3‐year survival. Based on the authors' cases of both early and advanced gastric cancer associated with pregnancy, the importance of early detection by gastroendoscopy is emphasized.
Gastric antral patch esophagoplasty for extensive corrosive stricture of the esophagus
Authors: Hugh Thomas B. , Meagher Alan P. , Li Bei
Published: May 2005

A case is reported of a patient with a 9‐cm stricture of the esophagus caused by ingestion of sodium hydroxide, who was treated by gastric antral patch esophagoplasty. In this procedure, a full‐thickness pedicled patch of gastric antrum, based on the left gastroepiploic artery, was used to enlarge the esophageal lumen, thus allowing preservation of esophageal continuity and utilization of a functioning lower esophageal sphincter. The patient ate normally after the operation, and radiological, manometric, and esophageal pH monitoring studies indicated satisfactory esophageal function.

Gastric antral patch esophagoplasty avoids the complications associated with esophageal bypass or resection. Previous long‐term results of this procedure in patients with reflux‐induced esophageal stricture have been good, and the technique merits consideration in the treatment of severe corrosive strictures.
Transthoracic needle biopsy
Authors: Weisbrod Gordon L.
Published: May 2005

Percutaneous fine‐needle aspiration biopsy is a relatively simple invasive procedure with good patient acceptance, low morbidity, and almost negligible mortality. It provides a diagnosis of pulmonary, hilar, and mediastinal masses quickly and accurately, thus eliminating many laboratory tests, saving hospital days, and thereby saving time and money. Percutaneous One‐needle aspiration biopsy should be performed early in the investigation of many types of intrathoracic lesions.
Staging and management of lung cancer: Sleeve resection
Authors: Deslauriers Jean , Mehran Reza John , Guimont Chantai , Brisson Jacques
Published: May 2005

Sleeve lobectomy is a lung‐saving procedure usually indicated for central tumors for which the alternative is a pneumonectomy. It preserves normal lung tissue and may enable pulmonary resection to be done in selected patients with inadequate cardiac or pulmonary reserve. One experience extends from January 1972 to December 1991, during which time 142 patients underwent a variety of sleeve resections for bronchogenic neoplasms. The majority of operations were upper‐lobe sleeve resections (N=110) and most procedures were considered complete and potentially curative (87%). There were three postoperative deaths (surgical mortality of 2.5%) and prolonged atelectasis was the most common major complication (N=9). Follow‐up was complete for the 139 survivors (mean follow‐up time of 2,149 days) and overall survival was 46% at 5 years and 33% at 10 years. Five‐ and 10‐year survivals for patients with stage I disease were 63% and 52%, respectively, while only 14% of patients with stage III disease survived 5 years. Local recurrences occurred in 23% of patients but when the resection had been complete, this incidence was 17% (21/124). These results indicate that sleeve resection is an adequate cancer operation for both compromised and uncompromised patients. Operative mortality, survival, and incidence of local recurrence are not different than what is seen after more conventional procedures.
Radiotherapy in the management of non‐small‐cell lung cancer
Authors: Bezjak Andrea , Payne David
Published: May 2005

Radiation plays an important role in the management of patients with non‐small‐cell carcinoma of the lung. Understanding the impact of radiation on this tumor and on normal tissues requires a knowledge of the natural history of the tumor, and of basic sciences, including radiation physics and biology. This review gives a brief outline of the scientific basis of radiotherapy, followed by a discussion of some practical issues concerning radiation tolerances of tissues within the thorax, the acute and late sequelae of radiation, and the treatment planning process. The role of radiotherapy is explored in the following settings: Radical radiation with curative intent for early stage disease, adjuvant mediastinal irradiation for completely resected tumors, radiation of known residual disease after surgical resection, preoperative radiation, prophylactic cranial radiation, radiation of locally advanced unresectable disease, and, finally, radiation with palliative intent in patients with metastatic disease. Pertinent studies, with the emphasis on randomized trials, are outlined to document the present state of understanding with respect to the impact of radiation in each of these situations. Several of the controversies in this area are addressed, with particular emphasis on selection of patients for high‐dose radiation and recent results of combined modality treatment with radiation and chemotherapy.
Pyloric exclusion in severe penetrating injuries of the duodenum
Authors: Degiannis E. , Krawczykowski D. , Velmahos G. C. , Levy R. D. , Souter I. , Saadia R.
Published: May 2005

This study comprises 74 patients with penetrating injuries of the duodenum. Sixty‐three of these had sustained gunshot wounds, many of which were high velocity. The change in the incidence and the severity of the gunshot injuries within the last few years resulted in changes in the operative management of the duodenal wound with gradually improving results. When pyloric exclusion was added to the operative management of grade III duodenal injuries, the postoperative leakage rate was 12%. When only primary repair was done, the leakage rate was 43%. We suggest that pyloric exclusion be added to the treatment of most severe grade II and all grade III gunshot duodenal injuries. The adequacy of primary repair and pyloric exclusion in grade IV injuries requires further study.
Does esophagectomy cure a resectable esophageal cancer?
Authors: El Nakadi Issam , Houben Jean ‐Jacques , Gay France , Closset Jean , Gelin Michel , Lambilliotte Jean ‐Pierre
Published: May 2005

During the years 1978–1990, 401 patients with esophageal cancer were evaluated for curative resection.

A retrospective study was undertaken to estimate the efficacy of surgery and select criteria for long‐term survival.

After investigation, 187 patients (47%) underwent surgery. To evaluate the long‐term results, 101 curative esophageal resections classified into stage I (11 patients), II (24 patients), and III, pathological TNM (66 patients), with at least 2 years' follow‐up, were considered. Esophagogastrectomy was performed in 91% of the cases and gastric transposition was achieved in 96% of the patients.

The anastomoses were intrathoracic (98%) and at the apex of the right thorax for tumors of the middle third of the esophagus. Staplers were used in 76% of sutures. Postoperative hospital mortality was 5.9%. Specific morbidity included strictures 11%, esophagitis 12%, and anastomotic leak 2%.

Actuarial 5‐year survival was 90.9% in stage I, 52.3% in stage II, and 17.7% in stage III. The overall 5‐year survival rate was 34.2%, 64.8% for the No patients, and decreased to 17.7% when node involvement was observed. Five‐ to 8‐year survival is also considered.

It is concluded from this study that esophagectomy is actually the appropriate treatment in patients with nonmetastatic resectable carcinoma with an overall 34.2% 5‐year survival.

The operation can be performed with a low morbidity and mortality rate if done in experienced centers.
Cancer of the stomach: A review of two hospitals in Korea and Japan
Authors: Mok Young Jae , Koo Bum Whan , Whang Chung Woong , Kim Sae Min , Maruyama Keiichi , Sasako Mitsuru , Kinoshita Taira
Published: May 2005

The records of 525 patients with primary adenocarcinoma of the stomach treated at Korea University Hospital (K.U.H.), Seoul, Korea, and 1,932 patients treated at National Cancer Center Hospital (N.C.C.), Tokyo, Japan, over a 7‐year period were reviewed to study biologic characteristics and treatment results in the two hospitals. More than 70% of the patients were 41 to 70 years old in both hospitals, though K.U.H. had more younger patients and N.C.C. had more older patients. Comparison in regard to clinicopathologic features showed significant differences in type of cancer, tumor size, depth of invasion, lymph node metastasis, stage, and histologic type. Such a difference mostly was due to a greater frequency of early gastric cancer in N.C.C. patients (51.2%) than in K.U.H. patients (19.0%). Patients of K.U.H. were more likely to have advanced cancer, large invasive tumors, a higher percentage of lymph node metastasis, a higher stage, and more undifferentiated tumors. The 5‐year survival rate of all resected cases was 69.5% in N.C.C. and 54.2% in K.U.H. (p>0.05). Those factors which showed a significant difference in clinicopathologic features did not affect the survival difference between the two hospitals except in stage IIIb and signet‐ring‐cell cancer. The 5‐year survival rate for stage IIIb was 18.0% in K.U.H. and 36.8% in N.C.C. It would seem that survival difference in stage IIIb related to extensive lymph node dissection in N.C.C. Survival difference in signetring‐cell gastric cancer (31.2% in K.U.H. and 91.0% in N.C.C.) was related to the fact that 79.1% of signet‐ring‐cell gastric cancer patients in N.C.C. had early gastric cancer. This present study once again demonstrates the importance of early detection in the treatment of gastric cancer and suggests that gastric cancer of two countries is not different.
The pathological basis of resection margin for hepatocellular carcinoma
Authors: Lai Edward C. S. , You Kok ‐Tjan , Ng Irene O. L. , Shek Tony W. H.
Published: May 2005

At the time of hepatectomy for primary hepatocellular carcinoma (HCC), the necessary amount of surrounding nontumorous liver to be sacrificed, or the resection margin, which will ensure a complete histologic disease clearance is uncertain. Twenty‐three resected liver specimens were studied by serial section followed by histological examination prospectively. All histologic diseases identified were assumed to spread radially in all directions from a unicentric lesion. Histologie disease from capsular and liver invasion was found confined to the immediate surrounding liver parenchyma. Eleven of the 14 large (≥5 cm) tumors and all six small (<5 cm) HCCs had either microsatellites and/or histologic venous permeation found beyond 1 cm from the lesion. A large tumor, multinodular lesions, macroscopic venous thrombi, liver invasion, and nonencapsulation were associated with an extensive spread of histologic disease. In the presence of either microsatellites or histologic venous permeation, no distance could ensure a complete disease clearance.
Role of surgical treatment for recurrent hepatocellular carcinoma after hepatic resection
Authors: Nakajima Yasuaki , Ohmura Takashi , Kimura Jun , Shimamura Tsuyoshi , Misawa Kazuhito , Matsushita Michiaki , Sato Naoki , Une Yshie , Uchino Junichi
Published: May 2005

From 1978 to 1989, 164 patients underwent hepatic resection for hepatocellular carcinoma at our institution. The carcinoma was resected completely in 149 patients. Sixteen patients were excluded from this study because it was not known whether they were recurrent or disease free, or because death occurred as a result of surgical complications. Recurrent disease occurred in 48.1% of the remaining 133 patients. Fifty‐seven patients had recurrent tumor only in the residual liver. A second hepatic resection was performed in 14 cases, 22 received intraarterial chemotherapy and/or arterial embolization without resection, and the remaining 21 received no anticancer therapy. The 5‐year survival rate of patients who had a second resection was 92.0%. Recurrences in distant organs occurred in 14 patients, and the recurrent carcinoma was resected in five cases. Four of these 5 patients survived more than 3 years after the second surgery. Aggressive surgical resection of recurrent HCC, even for distant metastasis, is a viable approach, and may produce long‐term survivors.
Multifactorial analysis of local recurrences in rectal cancer, including DNA ploidy studies: A predictive model
Authors: Moran Manuel R. , Rothenberger David A. , Gallo Roel A. , Goldberg Stanley M. , James Edwin C.
Published: May 2005

DNA ploidy studies were performed in 188 patients operated on for rectal cancer. In order to define different risk groups of patients, a stepwise logistic regression was carried out in 138 patients who underwent abdominal “curative” resections. Thirtyseven variables were analyzed. Although several variables were significant, only three improved the prognostic value: (1) more than three positive lymph nodes (p=0.0007); (2) macroscopic local tumor invasion (p=0.01); and (3) DNA ploidy (p=0.03). Standardized discriminant coefficients were used to obtain a model and format for predicting local recurrences. This is the first time that a predictive model for rectal cancer, using DNA ploidy as a variable, is reported.

Based on calculated discriminant values (DV), patients can be divided into three subgroups: (1) low risk for local recurrences (DV<−1.9,n=56)—local recurrences were observed in two patients (3.6%); (2) moderate risk (DV between −1.9 and −0.6,n=55)—local recurrences occurred in nine patients (16.4%); and (3) high risk (DV>−0.6,n=27)—local recurrences occurred in 14 patients (51.8%). This predictive model for local recurrences has much better prognostic value than Dukes' staging (p<0.0001).
Suppressibility of serum levels of PTH by calcium in the immediate postoperative period after surgery for primary hyperparathyroidism
Authors: Bergenfelz Anders , Ahrén Bo
Published: May 2005

The ability of calcium to suppress the secretion of parathyroid hormone (PTH) is impaired in primary hyperparathyroidism (pHPT). Whether the nonadenomatous glands in pHPT also exhibit altered calcium/PTH homeostasis is not known, but this may be the case since in the immediate postoperative period after surgery for pHPT, hypocalcemia often evolves in spite of a rapid normalization of serum levels of PTH. In this study, therefore, the suppression of serum levels of PTH by an oral calcium load was investigated pre‐ and postoperatively in 12 patients operated on for parathyroid adenoma. There was no difference in the calcemic response during the calcium load pre‐ and postoperatively. We found that the suppression of serum levels of PTH by calcium was increased already on the first postoperative day. However, postoperatively, the suppression of serum levels of PTH corrrelated positively to serum levels of ionized calcium and, furthermore, negatively to the weight of the excised parathyroid adenoma and the preoperative serum levels of ionized calcium. The results indicate that the function of the remaining parathyroid glands in patients with parathyroid adenoma could have been altered during the hyperparathyroid state and that postoperative hypocalcemia more readily evolves in patients with severe pHPT and impaired suppressibility of PTH (by calcium) in the remaining parathyroid glands.
Correlation of metabolic acidosis with outcome following injury and its value as a scoring tool
Authors: Falcone Robert E. , Santanello Steven A. , Schulz Malcolm A. , Monk John , Satiani Bhagwan , Carey Larry C.
Published: May 2005

This study looked at preresuscitation arterial pH as a predictor of outcome in injury. Seriously injured patients admitted to the Trauma Service over a 5‐month period were evaluated prospectively. Data collected included basic patient demographics, initial arterial blood gas determinations (ABGs) including pH, bicarbonate (HCO3), base deficit or excess (BASE), admitting trauma score (TS), discharge injury severity score (ISS), total blood products used for initial resuscitation (TBP), and outcome. There were 191 patients averaging 34.7 years old with average TS 13.6, ISS 19.5, initial pH 7.38±0.09, HCO3 20.9±4.0, and BASE −3.3±4.7. The average TBP was 1309 cc, and overall mortality was 13/191 (6.8%). Comparing survivors to nonsurvivors, the ISS (18.2 vs. 38.3), TS (14.1 vs. 7.8), TBP (976 vs. 5881 cc), HCO3 (21.1 vs. 17.6), and BASE (−3.1 vs. −5.8) data were significantly different; pH (7.38 vs. 7.36) and age (34.4 vs. 38.5) were not. Using multiple regression with TBP as the dependent variable, BASE, age, TS, and to a lesser extent pH and HCO3 correlated (r=0.536; p<0.001); using outcome as the dependent variable, only TS and age correlated (r=0.465; p<0.0001). Although metabolic acidosis (pH, HCO3, BASE) predicts the TBP used, it does not improve on TS and age for predicting outcome.
Role of parenteral nutrition in preventing malnutrition and decreasing bacterial translocation to liver in obstructive jaundice
Authors: Chuang Jiin‐Haur , Shieh Chie‐Song , Chang Nyuk‐Kong , Chen Wei‐Jen , Lin Jer‐Nan
Published: May 2005

Surgery in patients with obstructive jaundice is associated with significant infectious complications probably due to impaired immune function and malnutrition. Total parenteral nutrition (TPN) may alleviate malnutrition but may also promote bacterial translocation (BT) from the gut. To elucidate if TPN can prevent malnutrition without promotion of BT in obstructive jaundice, 40 dogs underwent laparotomy for tissue sampling and placement of a central venous line and were allocated into one of four groups: I (PO‐control) received dog chow and water ad libitum; II (PO‐CBDL) underwent ligation of common bile duct (CBDL) and was fed dog chow; III (TPN‐control) received TPN; and IV (TPN‐CBDL) underwent CBDL and received TPN. Body weight, blood samples for liver function tests and bacterial culture, and tissues from liver and mesenteric lymph nodes (MLN) for quantitative bacterial culture and for histology were obtained prior to and 2 weeks after the experiment. The incidence of BT to MLN was 40% in the PO‐CBDL and TPN‐CBDL animals, which was significantly different from the other two groups (0%);p<0.05). The incidence of BT to liver was 70% (7/10) in the PO‐CBDL animals, which was significantly higher than that in groups I, III, and IV (0%, 20%, 20%, respectively) (p<0.05). The PO‐CBDL animals showed a significant decrease in body weight and prealbumin compatible with malnutrition, whereas the TPN‐CBDL animals showed a significant increase in alkaline phosphatase and a consistent cholestasis on histology. The data suggest that TPN can prevent jaundice‐associated malnutrition and decrease BT to liver but should be administered cautiously because it may precipitate cholestasis.
Evaluation of “Gastric” emptying time in the J pouch compared with a standard esophagojejunal anastomosis
Authors: McAleese P. , Calvert H. , Ferguson W. R. , Laird J.
Published: May 2005

Gastric emptying times and symptoms were recorded in 18 patients after total gastrectomy and either a 15‐cm J‐pouch (n=10) or a standard esophagojejunal anastomosis (n=8). A solid test meal labeled with99mTc was used to compare the emptying times. The postoperative symptoms and nutritional status were also assessed. The J‐pouch resulted in a prolonged period of food retention in the upper jejunum (p<0.02) compared to that with a standard esophagojejunal anastomosis. The patients with a Jpouch had fewer episodes of postprandial pain (p<0.03) or vomiting (<0.04). They also had fewer dietary restrictions (p<0.04) and better nutritional status.
Endocrine‐metabolic response to abdominal aortic surgery: A randomized trial of general anesthesia versus general plus epidural anesthesia
Authors: Smeets Harm J. , Kievit Job , Dulfer Frans T. , van Kleef Jack W.
Published: May 2005

The influence of epidural anesthesia on the endocrine‐metabolic response following abdominal aortic reconstruction was studied in a prospective randomized trial. Cortisol and catecholamine responses and nitrogen balance were measured in two groups of five patients receiving general anesthesia only (group 1) or general anesthesia combined with epidural bupivacaine (group 2). The study lasted from preoperatively until the first postoperative day. At 2100 hours on the day of surgery serum cortisol concentrations were higher in group 1 than in group 2 (1.41 versus 0.82 μmol/L; p<0.01). Likewise the total perioperative hypercortisolemia, expressed as the area under the curve, was significantly higher in group 1 (11.7 versus 5.7 μmol/L/hr, p<0.01). Intraoperative urinary excretion of epinephrine and postoperative norepinephrine excretion were significantly higher in group 1 than in group 2. Urinary excretion of free cortisol and cumulative nitrogen balance were not different between the groups. Although the number of patients was limited and the sensory nerve block level was not measured perioperatively, this study suggests that epidural anesthesia attenuates the stress response to aortic surgery.
Palliation of malignant dysphagia using the Nd:YAG laser
Authors: Carter R. , Smith J. S. , Anderson J. R.
Published: May 2005

A group of 141 patients with biopsy‐proved malignant dysphagia, treated with neodymium YAG laser between April 1985 and November 1988, have been prospectively evaluated. Patients treated since November 1988 have not been included to allow minimum follow‐up of 18 months. The success of treatment has been assessed in terms of survival, relief of dysphagia, complications, and length of inpatient stay. One‐ and two‐year survival rates were 12.6% and 3.5%, respectively (mean survival 24.7 weeks). Ninety‐two percent of patients were returned to a semisolid diet or better. In 4% recanalization was impossible, and 4% swallowed only liquids despite an adequate channel. Tumor histology, site of tumor, and length of previous treatment had no significant influence on outcome. The presence of metastases significantly influenced survival (p=0.007). The principal complications were perforation (6.4%) and tracheoesophageal fistula (2.8%). Laser recanalization provides effective palliation for malignant dysphagia.
Amiodarone‐induced thyrotoxicosis: Is there a place for surgery?
Authors: Meurisse Michel , Hamoir Etienne , D'Silva Milbhor , Joris Jean , Hennen Georges
Published: May 2005

Amiodaroneinduced hyperthyroidism has on most instances been reported as mild, and thyroid functions return to normal after discontinuation of the drug. Nevertheless, lifethreatening amiodaroneinduced thyrotoxicosis has also been described. Conventional treatments such as antithyroid drugs (thionamide) and corticosteroids are essentially ineffective or fail to alter the dramatic course of the thyroid crisis. This limited effectiveness of medical therapy, particularly in patients with previously neglected or unknown thyroid disease, prompted us to intervene surgically. We report a series of nine patients who underwent total or neartotal thyroidectomy as a firstline therapy for five of them. Surgery resulted in rapid resolution of thyrotoxicosis with an uneventful postoperative course. This approach has the advantage of immediate effectivity, low risk of relapse, and appears to be the only treatment that permits continued therapy with amiodarone when the drug appears needed to control a lifethreatening arrhythmia.
Transplantation of human cryopreserved adenomatous and hyperplastic parathyroid tissue to the hypocalcemic Nude mouse
Authors: Goudet P. , Cougard P. , Zeller V. , Brunet‐Lecomte P. , Viard H.
Published: May 2005

Cryopreserved parathyroid glands from patients operated on for hyperparathyroidism were stored for further auto‐ or allografting. In an attempt to better use cryopreserved parathyroid glands in humans, we designed a study whose goal was to compare human parathormone (hPTH) secretion from cryopreserved parathyroid glands with regard to tissue histology (adenoma or hyperplasia), mass, and time of storage in hypocalcemic Nude mice and to be able to better use them in humans. A new hypocalcemic experimental model, using parathyroidectomized Nude mice was set up. Hypocalcemicmice received calibrated grafts from human parathyroid glands cryopreserved between 1982 and 1992 originating from 30 patients (15 adenomas, 15 hyperplasias). Each parathyroid was grafted into two mice under the ratio of one mass‐unit (12 mg) and three mass‐units (36 mg). The hPTH concentration was assessed by an immunoradiometric method 21 days after grafting. The mean cryopreservation time was 677 days (54–3187 days). The time of cryopreservation was identical in the two kinds of tissue (p=0.88). The hPTH concentration in 59 living mice was 72.2 ±271.4 (SD) ng/ml (3–1936 ng/ml). This concentration was 7.1 ±4.3 ng/L for adenomas versus 139.4 ±378.6 ng/L for hyperplasias (p=0.003) and 87.1 ±352.6 ng/L for one‐unit‐mass grafts versus 56.7 ±152.5 ng/L for three unit‐mass grafts (p=0.824). Hyperplastic glands showed more secretion, which was confirmed in both mass related groups (p=0.02,p=0.006). The multiple linear regression showed no hPTH concentration difference related to mass or time of cryopreservation (p>0.15), and it confirmed that the highest secretion of hPTH was in the hyperplastic tissues (p=0.0001). These results show that cryopreservation preserves glands for several years, and that hyperplastic tissue preferentially should be used.
Incidentalomas of the adrenal gland: 36 Operated patients and review of literature
Authors: Sirén Jukka E. , Haapiainen Reijo K. , Huikuri Kauko T. , Sivula Arto H.
Published: May 2005

Incidental discovery of an adrenal mass during radiologic‐examinations is common. Several recommendations have been made for the management of so‐called incidentalomas. It has become clear that not all incidentalomas should be operated, but the criteria for nonoperative treatment have been under continuous debate. In this study 36 operated incidentalomas are presented, and the indications for operative treatment are discussed with a review of the recent literature on the subject. Four pheochromocytomas and three hormonally active cortical adenomas, two producing cortisol and one androgens, were found. In this series there were no malignancies. The operation could have been avoided in most cases, and patients could have been followed up with repeated radiologic‐examinations. It is suggested that masses smaller than 6 cm in diameter be followed radiologically after 3, 9, and 18 months. Masses between 3 and 6 cm could be further examined using magnetic resonance imaging and fine needle aspiration and then operated if features suggestive of malignancy are found. Masses larger than 6 cm in diameter should be treated operatively.
Role of extracorporeal shock wave lithotripsy in hepato‐biliary‐pancreatic surgery
Authors: van der Hul René L. , Plaisier Peter W. , Terpstra Onno T. , Braining Hajo A.
Published: May 2005

Since the early 1980s extracorporeal shock wave lithotripsy (ESWL) has partially replaced major operative procedures in various fields of surgery. In the interest of the patient, it is important to determine the exact role of ESWL in surgery. Comparing our own prospectively followed patients with other patient series, we have tried to assess this role. We treated 133 patients with cholecystolithiasis, 80 patients with choledocholithiasis, and 17 patients with pancreatic stones using a second‐ generation lithotriptor, the Siemens Lithostar (Siemens, Erlangen, Germany). The results suggest a limited role of ESWL for cholecystolithiasis, in which it is reserved for patients with high operative risk and patients who reject an operation. For choledocholithiasis ESWL seems to become an integral part of the treatment in the elderly patient in whom endoscopic stone removal proved impossible. Finally, ESWL could become a first option for the treatment of intractable pain in patients with chronic calcifying pancreatitis.
Clinicopathologic factors influencing survival of patients with bile duct carcinoma: Multivariate statistical analysis
Authors: Bhuiya Md. Mukhlesur Rahman , Nimura Yuji , Kamiya Junichi , Kondo Satoshi , Nagino Masato , Hayakawa Naokazu
Published: May 2005

To evaluate the influence of various clinicopathologic factors on survival, a computer analysis was performed on 70 patients who underwent resection for bile duct carcinoma. Univariate analysis of overall survival involving all the patients identified 10 factors that were associated with a significant outcome: location of primary lesion (p=0.01), pancreatic invasion (p=0.004), duodenal invasion (p=0.005), macroscopic and microscopic vascular involvement (tp=0.009 andp=0.04), perineural invasion (p=0.02), lymphatic vessel involvement (p=0.04), lymph node metastasis (p=0.02), histologictype (p=0.02), and depth of cancer invasion (p=0.04). However, when the interactive effects of these factors were taken into account, the pancreatic invasion and perineural invasion were selected as the two most significant prognostic factors in a multivariate analysis using the Cox stepwise proportional hazards model. The age, sex, size of the tumor, macroscopic type of lesions, hepatic infiltration, serosal invasion, resected surgical margin at the proximal and distal ends, exposed surgical margin, peritoneal dissemination, and hepatic metastasis were not significantly associated with prognosis.
Redo hepatic resection for metastatic colorectal carcinoma
Authors: Fowler Wyatt C. , Hoffman John P. , Eisenberg Burton L.
Published: May 2005

Redo hepatic resection for recurrent colorectal metastasis was performed in eight patients. There was no operative mortality; major morbidity occurred in 25% and minor morbidity in 13% of patients. Four patients are alive and disease‐free at 9, 23, 39, and 49 months, respectively, after their repeat hepatic resection. Four patients have died of recurrent disease, with a median time to recurrence of 6 months and median survival of 15 months. Patterns of failure include hepatic failure alone in two patients and pulmonary and hepatic failure in two. Repeat liver resection can be performed safely and may be beneficial in some patients with recurrent metastases confined to the liver after previous hepatic metastasectomy.
Orthotopic liver transplantation in the presence of partial or total portal vein thrombosis: Problems in diagnosis and management
Authors: Cherqui D. , Duvoux C. , Rahmouni A. , Rotman N. , Dhumeaux D. , Julien M. , Fagniez P. L.
Published: May 2005

From January 1989 to May 1992, 70 orthotopic liver transplantations (OLT) were performed in 69 patients, 53 of whom had cirrhosis (77%). Eleven patients (16%) had preoperative partial or total portal vein thrombosis (PVT). Ten of these patients had cirrhosis of various causes. PVT was total in three cases and partial in eight. Total PVT was detected preoperatively in all three cases. By contrast, partial PVT was diagnosed preoperatively in only three of the eight cases. In the five other cases of partial PVT, the obstruction was discovered intraoperatively during dissection of the portal vein. Surgical management of PVT consisted of phlebothrombectomy in ten cases followed by usual end‐to‐end portal anastomosis in nine cases and anastomosis of the graft's portal vein to the splenomesenteric confluence in one case. Atypical anastomosis of the graft's portal vein to a dilated choledocal vein was performed in one case of total PVT. There were no deaths or complications related to the presence of preoperative PVT or to its management. One patient died postoperatively of primary graft nonfunction at day 5. One patient had arterial thrombosis 3 months after OLT and was successfully retransplanted. Two patients died of recurrent carcinoma 3 and 7 months after OLT. Eight patients are alive 4 to 39 months after OLT. We conclude from this series that (1) the prevalence of preoperative PVT among patients transplanted for advanced cirrhosis may be high (19% of the cirrhotics in this series); (2) PVT is often partial and so difficult to diagnose preoperatively; (3) PVT, even when total, can be managed successfully during surgery and does not seem to affect survival.
Electrorectography in chronic proctitis
Authors: Shafik Ahmed
Published: May 2005

Rectal electrical activity, measured by electrorectography (ERG), was studied in 18 patients with chronic proctitis (11 ulcerative and 7 bilharzial proctitis). Mean age was 36.6±9.4 (SD) years. Eight healthy volunteers were included as controls. Monopolar recordings were made from silver‐silver chloride electrodes situated 1 cm from the tip of the catheter, which was applied to the rectal mucosa. Signals from the electrode were displayed on a U‐V recorder. Rectal neck and rectal pressures were recorded simultaneously. Pacesetter potentials (PP) were also recorded from all subjects. The healthy volunteers had a mean frequency of 2.6±0.6 cycles per minute (cpm), an amplitude of 2.4±0.5 mV, and a velocity of 4.3 ± 0.5 cm/sec. The potentials had the same frequency and regular rhythm when the test was repeated and were followed randomly by bursts of action potentials (AP). The rectal pressure increased simultaneously with the AP. In the proctitis patients the PP frequency was higher than normal (mean 8.2 ±1.6 cpm in patients with bilharziasis and 8.9 ± 2.1 cpm in those with ulcerative proctitis) (p<0.001), whereas the amplitude and velocity were lower than normal (p<0.05 andp<0.01, respectively). APs had higher frequency and amplitude and were accompanied by higher rectal pressure than in the normal volunteers. The increased PP, or tachyrectia, may be due to rectal wall or rectosigmoid pacemaker irritation caused by proctitis, whereas the diminished amplitude and velocity may be caused by a diseased rectal wall. The increased AP frequency and amplitude seem to cause increased rectal contractile activity with a resulting tenesmus. ERG is safe, noninvasive, nonradiologic, and it may prove helpful for diagnosing proctitis.
Paracolostomal hernia: Repair with use of a Dacron prosthesis
Authors: Alexandre J. H. , Bouillot J. L.
Published: May 2005

Several surgical procedures have been described for the repair of paracolostomal hernia. We describe a local technique approach using stoma relocation with insertion of a Dacron prosthesis. Among 14 patients operated on for paracolostomal hernia, this technique was used in 10 patients. There was no mortality or morbidity (no prosthesis infection). During follow‐up there was one recurrence, which was reoperated with a good final result. This technique can be recommended for the few patients in whom a surgical repair is mandated.
Three‐dimensional imaging in craniofacial surgery
Authors: Zonneveld Frans W. , Lobregt Steven , van der Meulen Jacques C. H. , Vaandrager J. Michiel
Published: May 2005

Over the past decade, three‐dimensional (3‐D) imaging has been developed to such a stage of perfection and to such a level of interactive selective imaging of specific anatomic and pathologic structures that craniofacial surgeons can now use this technique effectively in the planning of complicated reconstructive surgery. In addition, modeling techniques have been devised that can be used in surgical simulation and in the manufacture of implants and prosthetic devices.

The technical aspects of 3‐D imaging are discussed in relation to their applications in Craniofacial Surgery, and reference is made to the literature describing these techniques in full detail.

The results are illustrated with cases that the authors have processed by means of: (a) a clinical research program that was developed on a general purpose computer which provided full flexibility in changing and improving the reconstruction algorithms (Lobregt algorithms and DEC VAX 750 computer), (b) a system under development (Pixar PICS 2000), and (c) a commercial system (Cemax 1500X).

Finally, a number of emerging techniques are discussed such as surgical simulation (electronic sculpting), and trends such as multimodality imaging.
Craniosynostosis
Authors: Marchac Daniel , Renier Dominique
Published: May 2005

Craniosynostosis affects approximately one infant out of one thousand. Increase of intracranial pressure and risks of functional problems are more frequent than previously thought, especially in single‐suture synostosis. Frontocranial remodeling will correct both functional and esthetic consequences of craniosynostosis. The best time for surgery is the first year of life, 2–3 months of age for the brachycephalies, and 6–9 months of age for the other craniosynostoses. Not only does growth not deteriorate after forehead remodeling, but the adjacent orbitonasal areas improve with time. In Crouzon's disease and Apert's syndrome, early frontal advancement does not prevent the midface retrusion, and a radical frontofacial advancement may be occasionally indicated in very severe cases. Frontocranial remodeling is also indicated in children presenting with sequelae of classical neurosurgical treatment or those who have had no treatment.
Treacher Collins Syndrome: Present concepts of the disorder and their surgical correction
Authors: Argenta Louis C. , Iacobucci John J.
Published: May 2005

Treacher Collins Syndrome is a rare bilateral congenital deformity occurring in 1 in 10,000 births. It is also known, in the European literature, as Franceschetti Syndrome, and is additionally known as mandibulofacial dysostosis. It is a syndrome with a very wide spectrum of manifestations characterized by distortions of the orbit secondary to hypoplasia of the maxilla, mandible, and, most markedly, of the zygoma. Soft tissue deformities include lower lid colobomas, laxity and dystopia of the lateral canthus, microtia, and a paucity of the muscular aponeurosis of the midface. The syndrome is frequently accompanied by significant hearing loss, early failure to thrive, chronic respiratory insufficiency, and sleep apnea. Intelligence is usually within normal limits although learning disabilities are common in early life. These major anatomical and physiological abnormalities, as well as the psychological and social stigma associated with severe facial deformity, make this syndrome one of the most challenging reconstructive problems presented to the craniofacial surgeon.
Anastomotic leakage after resection and bypass for esophageal cancer: Lessons learned from the past
Authors: Lorentz Theo , Fok Manson , Wong John
Published: May 2005

A retrospective study of anastomotic leakage has been undertaken in 730 patients who had resection or bypass for carcinoma of the esophagus during the period 1964–1982 at the Department of Surgery, University of Hong Kong, Queen Mary Hospital, Hong Kong. Partial or complete gangrene of the substitute loop also resulting in anastomotic disruptions were excluded from this series. Anastomotic leakage due to suture line failure occurred in 182 patients (24.9%).

Two factors were found by multivariate analysis to influence leakage: the type of operation and the choice of organ used as substitute. Leakage occurred more than twice as often in bypass (42.7%) than in resection (18.3%). When the substitute used for reconstruction was viable, jejunum was associated with the lowest incidence of leakage followed by whole stomach, distal stomach, and colon in that order. The risk of leakage for any combination of the type of operation (resection or bypass) and substitute loop used was calculated. The probability of leakage was lowest when a resection was performed and jejunum was used as substitute. In view of the simplicity and relative safety of using the whole stomach, esophagectomy followed by gastric reconstruction is still the procedure of choice for the majority of patients. A bypass procedure using colon as substitute has the highest leakage rate. A low leakage rate should now be obtained, otherwise nonoperative therapy has a legitimate claim as the preferred alternative treatment modality.
Proposed definitions for diagnosis, severity scoring, stratification, and outcome for trials on intraabdominal infection
Authors: Nyström Per ‐Olof , Bax Richard , Dellinger E. Patchen , Dominioni Lorenzo , Knaus William A. , Meakins Jonathan L. , Ohmann Christian , Solomkin Joseph S. , Wacha Hannes , Wittmann Dietmar H. ,   Joint Working Party of SIS North America and Europe
Published: May 2005

Analysis of the experience with scientific studies on patients with secondary intraabdominal infection has revealed that problems of interpretation and comparability between studies exist as they relate to variable diagnostic criteria, unmeasured severity of disease, and unclear outcome measures. A consistent system of definitions has been developed to address these deficiencies. Intraabdominal infection is defined as clinical peritonitis requiring both operative and microbiological confirmation for proof of infection. The APACHE II system is proposed for grading the severity of the infection and for stratification of patient risk of mortality. Mortality and time until death, on one hand, and recovery and time until recovery, on the other, are proposed as the main outcome measures, both being independently and positively defined. It is anticipated that this system of minimum rules will produce studies that can be compared, hence, accelerating knowledge and understanding about intraabdominal infection and its best treatment.