bluuebunny/crossref_metadata_2025 huggingface dataset:
Piriform sinus fistula: An underlying abnormality common in patients with acute suppurative thyroiditis
Authors: Miyauchi Akira , Matsuzuka Fumio , Kuma Kanji , Takai Shin‐ichiro
Published: May 2005

We have previously reported that an internal fistula (piriform sinus fistula) was the apparent route of infection in 15 patients with acute suppurative thyroiditis (AST). Here, we describe 43 patients with AST, most of whom had a demonstrable fistula.

The characteristic clinical features included: onset in infancy or childhood in 74% of cases, a left‐sided predominance of involvement (40∶3), and frequent recurrence. Twenty‐nine patients had had several previous episodes of AST. The fistula was demonstrable in 38 of 42 patients examined by barium meal. Twenty‐seven patients underwent fistulectomy. Six of 16 patients who declined fistulectomy had recurrences and 2 of them underwent surgery thereafter. None of 29 patients who had fistulectomy developed recurrences, except for 2 patients in whom the fistula could not be removed completely. The fistula ended medial or lateral to the thyroid lobe, attached to or entered the lobe in 6, 3, 6, and 12 cases, respectively. The thyroid specimens showed several features of inflammatory change.

Thus, we concluded that the piriform sinus fistula is the most common underlying abnormality in patients with AST. Recurrence of inflammation can be prevented by complete fistulectomy.
Laboratory comparison of diagnostic specificity of intact hormone and region‐specific immunoassays of parathyroid hormone
Authors: Aston J. Paul , Wheeler Malcolm H. , Brown Richard C. , Curley Ian R. , Woodhead J. Stuart
Published: May 2005

A 2‐site immunochemiluminometric assay (ICMA) for intact parathyroid hormone (PTH) has been developed to overcome the problems of limited sensitivity and specificity associated with conventional PTH immunoassays. The present investigation assesses the relative merits of the 2‐site intact PTH (ICMA) and a midmolecule PTH radioimmunoassay (RIA). Immunoassay profiles of dispersed hyperparathyroid cell supernatants and hyperparathyroid sera obtained during parathyroidectomy and from renal failure patients, fractionated by gel filtration chromatography, facilitated a direct comparison of the specificity of PTH immunoassays. Using gel filtration matrices which permitted the separation of intact hormone, large C‐terminal fragment(s), and a small midmolecule fragment in adenomatous cell supernatant and peripheral sera, the intact PTH (ICMA) assay consistently yielded a single peak of immunoreactivity. In contrast, the midmolecule RIA yielded 2 and 3 broad peaks of immunoreactivity after fractionation of serum and adenomatous cell supernatant, respectively. There was no evidence for the secretion of a small midregion fragment in vitro or its peripheral derivation in vivo. These studies demonstrate the superior specificity of the 2‐site intact PTH assay compared with a midmolecule RIA and, thus, confirm the potential diagnostic superiority of the ICMA.
Prediction of distant metastasis in follicular adenocarcinoma of the thyroid
Authors: Iwasaki Hiroyuki , Matsumoto Akihiko , Ito Kunihiko , Kure Yoshio , Suzuki Akira , Sugino Kiminori , Ozaki Osamu , Noh Jaeduk
Published: May 2005

Follicular adenocarcinoma of the thyroid sometimes displays distant metastasis in spite of its low histological grade of malignancy. We have studied whether distant metastasis can be detected by the presence of blood vessel invasion. We have also examined the problem from the viewpoint of cell‐to‐cell conjugation.

This study examined 160 cases of follicular adenocarcinoma of the thyroid. Histological specimens were made by sectioning tumors at their largest diameter. Blood vessel endothelia were specifically stained immunohistochemically with factor VIII‐related antigen and Ulex europeaus agglutinin I (UEA‐1). Then, the presence of blood vessel invasion was examined in detail. Furthermore, the conjugation of lectin‐derived wheat germ agglutinin (WGA) to tumor cells was examined. Conjugation of tumor cells was also examined using sialic acid as a marker.

Blood vessel invasion was recognized in 95 (59.4%) of 160 cases. Distant metastases were identified in 25 cases (15.6%) in which blood vessel invasion was also found. Relative to the group without distant metastases, the group with distant metastases showed not only a significantly higher sialic acid content but also higher levels of WGA‐binding protein in the tissues. The risk of distant metastasis in patients with follicular adenocarcinoma of the thyroid appears to be related both to the extent and to the frequency of blood vessel invasion. Furthermore, assessment of the conjugation of cells appears to have predictive value for occurrence of distant metastases.
Thyroid carcinoma in Graves' disease
Authors: Ozaki Osamu , Ito Kunihiko , Kobayashi Kaoru , Toshima Koji , Iwasaki Hiroyuki , Yashiro Tohru
Published: May 2005

The pathogenesis of thyroid carcinoma in Graves' goiter is still obscure and the methods for preoperative diagnosis of such carcinomas is not well established. We studied the incidence, clinical features, and pathological findings of thyroid carcinoma in Graves' goiter. From October, 1983 to September, 1985, a total of 739 patients with Graves' disease underwent subtotal thyroidectomy at Ito Hospital, Tokyo. All of these patients underwent roentgenography of the neck before surgery. Thyroid carcinoma was revealed in the resected specimen in 15 (2.0%) of 739 patients. During the same period, another 4 patients underwent surgery for thyroid carcinoma who had had Graves' disease previously and these 4 cases were included in the present study. The incidence of thyroid carcinoma associated with Graves' disease was 2.6% (19 of 743 cases). Histological examination revealed 15 papillary and 4 follicular carcinomas. The size of the carcinoma foci was 13.8±15.6 mm in diameter (range: 1–60 mm), 10 (52.6%) foci being 10 mm or greater. Invasive growth into the surrounding thyroid tissue was predominant and regional lymph node metastasis was noted in all 6 patients who underwent cervical dissection. Preoperative roentgenography revealed calcification in 5 (26.3%) of 19 cases. Our present study indicates that thyroid carcinoma in Graves' goiter may show markedly invasive growth with lymph node metastasis even though the primary tumor is small in size, and it is suggested that the detection of calcification may serve as a part of the diagnostic measures when the carcinoma focus is difficult to palpate in the diffusely‐enlarged Graves' goiter.
The influence of surgery on endocrine ophthalmopathy
Authors: Frilling Andrea , Goretzki Peter E. , Grußendorf Martin , Erbslöh Markus , Röher Hans‐D.
Published: May 2005

Since the pathogenesis of endocrine ophthalmopathy is unclear, there has been little agreement on the treatment of the disease. The influence of thyroid surgery on endocrine ophthalmopathy is controversial. To evaluate the effect of thyroid surgery on the course of the disease, we developed a special ophthalmopathy index. As a standard procedure, subtotal thyroidectomy with thyroid remnants of 3–5 g was performed. A total of 176 patients with Graves' disease underwent the above treatment between 1986 and 1988. In 78 patients suffering from concomitant endocrine ophthalmopathy, ocular status was examined prior to operation and postoperatively. The history of endocrine ophthalmopathy had been present less than 2 years preoperatively in 74% of the patients. Follow‐up ranged from 6 to 36 months. Postoperatively, 54 (69%) patients showed a marked improvement of their eye symptoms. In 18 (23%), there was no change and, in 6 (8%) patients, the severity of the eye symptoms increased after the operation. As a result of these data, a cautious and preliminary conclusion may be justified—that subtotal thyroidectomy may have a positive effect on endocrine ophthalmopathy.
The role of noninvasive testing in the evaluation of chronic venous problems
Authors: Yao James S. T. , Flinn William R. , McCarthy Walter J. , Bergan John J.
Published: May 2005

Noninvasive instrumentation is now available to evaluate venous function in patients with a wide variety of chronic venous problems. The present analysis attempts to review the use of directional flow detection by Doppler ultrasound, venous refilling or maximal venous outflow by plethysmography, and the newly introduced venous imaging techniques (B‐mode and duplex scanning) in evaluation of patients with varicose veins, the postphlebitic syndrome, sequelae after acute deep‐vein thrombosis, and venous reconstructive surgery. Venous refilling time recorded by the photoplethysmograph is the simplest technique for assessment of venous dysfunction, and it can identify venous stasis or ulcer as a result of long saphenous vein insufficiency. Both the B‐mode and the duplex scan allow direct examination of venous valve motion and determination of valve competency. The latter technique holds promise in the evaluation of venous valve reconstructive surgery and, more important, in accurate assessment of venous valve damage following acute deep‐vein thrombosis.
The value of dynamic venous pressure measurements
Authors: Nicolaides Andrew N. , Zukowski Andrew J.
Published: May 2005

This article describes the technique of measuring ambulatory venous pressures and their value in the diagnosis and assessment of the severity of venous hypertension as well as their contribution toward our understanding of venous hemodynamics and the pathophysiology of venous disorders. It demonstrates that ambulatory venous pressures are not only of diagnostic significance, but also of prognostic significance. Competent popliteal valves will protect the leg from venous hypertension despite proximal (iliofemoral) occlusion. Although the measurement of ambulatory venous pressures is the “gold standard,” it is invasive and cannot be repeated frequently nor can it be used as a screening test. It has been employed in the validation of a number of noninvasive tests now used for the routine screening of patients. Nevertheless, ambulatory venous pressure measurements are essential if the beneficial hemodynamic effect of surgical reconstructive procedures is to be convincingly demonstrated.
Five years' experience with vein valve transplant
Authors: Taheri Syde A. , Heffner Reid , Budd Thomas , Pollack Larry H.
Published: May 2005

Since 1980, the vein valve transplant has been used to treat the venous insufficiency syndrome (VIS) in 66 patients (71 limbs). Seventy‐eight percent of patients who had close long‐term follow‐up reported improvement or complete relief of symptoms. On examination, 75% had decreased or resolved leg edema. In addition, 17 of 18 ulcers healed. The vein valve transplant is an effective long‐term treatment for VIS in patients who have failed initial medical management.
Future prospects in the treatment of venous disease
Authors: Bernstein Eugene F.
Published: May 2005

Our current knowledge of the natural history of venous disease suggests that congenital venous valve insufficiency and left iliac vein compression predispose to later deep vein thrombosis (DVT) and pulmonary embolism. Available longitudinal studies are, however, inadequate to justify prophylactic treatment of these conditions at the present time. Furthermore, our knowledge of the natural history of acute venous thrombosis, of which venous valves are critical, and of the sequelae of ileofemoral venous thrombosis is also inadequate. Finally, the long‐term results of venous reconstructive surgery are still not known. For this reason, long‐term studies of large patient cohorts for each of these areas will be necessary. Nevertheless, I believe future treatment of venous disease will include earlier widespread DVT prophylaxis using both medical and surgical methods, more effective and complete thrombolysis, earlier surgery, and the use of new reconstructive surgical methods. Early identification of patients at high risk prior to their disease, followed by selective diagnostic separation of patients with significant obstruction and/or insufficiency and the availability of long‐lasting surgical procedures that can be offered with low morbidity will justify earlier and more widespread prophylactic therapy.
New aspects in the management of alveolar echinococcosis involving the liver
Authors: Schröder Rolf , Robotti Guido
Published: May 2005

The experience with 8 consecutive patients with alveolar echinococcosis of the liver is reported. The follow‐up period varied between 4 and 17 years. In 4 cases, the parasite could be removed by liver resection; 3 developed subsequent inoperable recurrences. Four patients had primary inoperable disease. All patients are being treated by long‐term mebendazole. The evolution of the disease was followed by serial computed tomography scans measuring the parasitic volume. One patient is disease‐free 8 years following bilateral liver resection. The volume of the parasite remained unchanged in 6 patients. In 1 case, the lesions disappeared. The presumed parasitostatic effect of mebendazole must be taken into consideration in the management of alveolar echinococcosis.
Exposure to bile acids and bacteria over 24 hours following partial gastrectomy, vagotomy, and pyloroplasty
Authors: Poxon Valerie A. , Morris David L. , Youngs Denise J. , Albutt Eileen C. , Keighley Michael R.
Published: May 2005

Hourly measurements of bile acids, bacterial flora, and pH were made from gastric aspirates collected over 24 hours in subjects taking a controlled diet. Significantly higher concentrations of total bile acids were found following truncal vagotomy and antrectomy (TV+A), 2.73±1.16 SEM mmol/l, than after truncal vagotomy and pyloroplasty (TV+P), 0.88±0.56 mmol/l (p<0.002), and controls, 0.43±0.22 mmol/l (p<0.002). These observations were due to differences in nocturnal reflux only. Free secondary bile acids were identified more frequently after TV+A (19% of aspirates) than TV+P (6%) or controls (2%).Streptococcus faecalis andVeillonella spp, the principal organisms known to deconjugate and hydrolyze bile acids, were present in 65% of aspirates after TV+A compared with 35% after TV+P, and 33% of the controls. Mean pH values were 5.12 after TV+A, 2.82 after TV+P, and 2.14 in the controls. We conclude that antrectomy is associated with a greater incidence of duodenal reflux and a more suitable environment for the formation of secondary bile acids than vagotomy and pyloroplasty or in normal subjects.
Sphincter of Oddi and gastrointestinal motility disturbance following alcohol administration in the opossum
Authors: Coelho Julio C. U. , Gouma Dirk J. , Moody Frank G. , Senninger Norbert , Li Yong F. , Chey William Y.
Published: May 2005

Myoelectric activity of the gastrointestinal tract and sphincter of Oddi was recorded in 7 awake opossums. The animals were subjected to gastrojejunostomy with duodenal exclusion to study the effect of alcohol on the gastric, duodenal, and jejunal mucosa. The response to intravenous infusion was also evaluated. Radioimmunoassay of motilin was performed in 5 other opossums during phases I, II, and III of the control migrating myoelectric complex (MMC) and during the phase III‐like activity following administration of alcohol. Phase III‐like activity was observed following infusion of alcohol into the duodenum in 26 studies (87%), into the stomach in 20 (67%), and intravenously in 9 (22%). Alcohol blood level after duodenal and intravenous instillation of ethanol was 45 and 190 mg/100 ml, respectively (8 experiments of each). There was no difference in the concentration of plasma motilin obtained during phase III‐like activity (41.5±4.6 pM/ml) and phase III of the MMC (35.6±4.7). We conclude that instillation of alcohol into the stomach or duodenum produces intense bursts of spike potentials in the sphincter of Oddi and duodenum. There is no correlation between alcohol blood levels and occurrence of this intense spike activity.
Prophylactic regimens in colorectal surgery: An open, randomized, consecutive trial on metronidazole used alone or in combination with ampicillin or doxycycline
Authors: Roland Magne
Published: May 2005

In 17 Scandinavian hospitals, an open, randomized, consecutive trial was made on the use of prophylactic antibiotics in colorectal surgery. Metronidazole used alone was compared with metronidazole supplemented by ampicillin or doxycycline. Each type of drug was given as a single preoperative intravenous infusion. With metronidazole alone, postoperative infection occurred in 12.9% of all patients. This figure was significantly reduced to 3.2% by adding ampicillin or doxycycline to the prophylactic regimen (p=0.01). The additional effect achieved by ampicillin or doxycycline was due to a significant reduction of wound infections in cases of rectal surgery. For operations on the right and left colon, no significant improvement was obtained by adding ampicillin or doxycycline to metronidazole (p=0.19). For no type of colorectal surgery was there any significant difference in infection rate between patients who received metronidazole plus ampicillin and those who were given the combination of metronidazole and doxycycline. It is concluded that ampicillin and doxycycline are equally effective. Ampicillin is recommended, however, due to the increasing selection of tetracycline‐resistant bacteria. One single preoperative infusion of each drug gave the same effect as found in a previous study after multiple infusions, the first of them being given preoperatively. It is concluded that a satisfactory prophylactic effect is obtained by a single preoperative infusion of antimicrobial drugs directed against anaerobic as well as aerobic bacteria.
Breast‐conserving surgery with radiation therapy for operable mammary carcinoma: A 25‐year experience
Authors: Spitalier J. M. , Gambarelli J. , Brandone H. , Ayme Y. , Hans D. , Brandone J. M. , Bressac C. , Amalric R. , Santamaria F. , Robert F. , Seigle J. , Amalric F. , Pollet J. F. , Kurtz J. M.
Published: May 2005

This article describes the long‐term results of breast‐conserving treatment for 1,133 consecutive patients with operable mammary cancer treated from 1961 to 1979 by limited surgery followed by curative irradiation. Follow‐up ranged from 5 to 23 years. The percentage of patients (clinical stages I and II combined) alive and well at 5, 10, and 15 years was 86%, 80%, and 62%, respectively. The percentage of cured patients having retained their treated breast was 85% at 15 years. One hundred forty‐nine patients (13.2%) developed recurrence in the treated breast and 67 patients (5.9%) recurred in the axilla, most commonly in conjunction with breast failure. Ninety‐one percent of the local‐regional recurrences were operable, and the 5‐year survival following salvage surgery was 61%. The cosmetic results of therapy were judged to be good or excellent in 70% of patients at 15 years, with 2–4% of the patients having unacceptable results. It is concluded that breast‐conserving surgery followed by radiation therapy for clinical stages I and II results in survival rates equivalent to those achieved by primary radical surgery. This method allows reliable local‐regional disease control while permitting the majority of patients to retain their breasts in an esthetically acceptable condition. In contrast to recurrences after radical surgery, local‐regional recurrences after conservative therapy can be successfully treated by further surgery.
Lobar and segmentai atrophy of the liver
Authors: Ham J. M.
Published: May 2005

Lobar atrophy of the liver has been recognized as a complication of hepatic and biliary disease for many years. Previously regarded as rare and clinically unimportant, it is now accepted as reasonably common and clinically significant in many patients. Atrophy of liver lobes and, now, also segments, is much more frequently diagnosed because of the routine use of ultrasound and computed tomography scanning in the assessment of hepatobiliary disease, together with its recognition on angiograms and at laparoscopy.
Hepatic vein and retrohepatic vena caval injury
Authors: Ciresi Kevin F. , Lim Robert C.
Published: May 2005

Retrohepatic venous injury presents as a rare but frequently lethal complication of trauma. The anatomic arrangement makes management of these injuries difficult at best. Operative exposure and isolation techniques ranging from cross‐clamping the aorta, portal triad, suprarenal vena cava, and suprahepatic vena cava to the use of internal shunts are described in this report.

Our experience from 1968 to 1987 with internal shunting techniques includes 27 patients. We have successfully resuscitated 12 patients for an acute mortality of 55 %. We believe that this figure is high but compares favorably with published results. Late deaths from sepsis, disseminated intravascular coagulation, or multiple systems organ failure remain as significant causes of overall mortality.

Many techniques have been successfully employed over the years in achieving vascular isolation of the liver. The methods all have their own merits, but the key factor in each is the recognition that they need to be employed. Conservative selection of patients is undoubtedly justified, but aggressive approaches should not be delayed until they are the methods of last resort.
Conservative treatment of liver trauma
Authors: Andersson Roland , Bengmark Stig
Published: May 2005

A marked change toward a more conservative approach in the treatment of abdominal trauma has been noted, especially during the last decade. This change in regimen was first seen in the handling of splenic trauma, initiated by pediatric surgeons. Later, the concept of conservative management was also introduced among adults and it is now widely accepted. Here, an almost mandatory splenectomy has been replaced by attempts at various forms of splenic salvage. The development followed an initial report by King and Shumacker in 1952 [1] on an increased susceptibility to overwhelming sepsis in splenectomized children, findings which later also were demonstrated among adults [2, 3]. It has also been shown that the bleeding from intraparenchymal lesions with an intact splenic capsule or minor capsular tears frequently ceases spontaneously, hereby making nonoperative management possible in selective cases [4, 5].
Current management of intrahepatic stones
Authors: Choi T. K. , Wong J.
Published: May 2005

A high incidence of intrahepatic stones occurs in East Asia. The surgical management of intrahepatic stones is problematic because it is difficult to locate and remove all the stones and relieve the accompanying biliary strictures. Consequently, the rate of recurrent cholangitis is high. Many new techniques have been introduced to locate, fragment, and retrieve gallstones. Operative procedures to relieve biliary strictures have also undergone development. These new procedures and techniques have been applied to intrahepatic stones. The initial results are good. Whether these good results can be maintained in the long‐term remains to be seen.
Pancreatic abscess and other pus‐harboring collections related to pancreatitis: A review of 108 cases
Authors: Bassi Claudio , Vesentini Sergio , Nifosì Filippo , Girelli Roberto , Falconi Massimo , Elio Amedeo , Pederzoli Paolo
Published: May 2005

This is a report on 108 cases collected from 1970 to 1987, in the same department, of surgically‐detected pancreatic abscesses or pus‐harboring collections. The purulent areas were either of a spreading pattern or represented a clearly localized mass. To the spreading pattern belong 47 cases of necrotizing pancreatitis, without discontinuity in the clinical course from the early toxic to the late septic phase, 4 cases of acute pancreatitis, initially in remission and later complicated by septic collections, and 4 cases which developed after an acute attack of chronic pancreatitis. The abscess pattern was made up of 19 each of pseudocysts and predisposing pancreatitis, 10 cases of chronic pancreatitis, and only 5 necrotizing “nonstop” pancreatitis.

The surgical treatment in all cases consisted of multiple drainages and postoperative irrigation. We exclude 3 cases of associated open packing. The etiological, clinical, and biochemical features of each group of patients are reported and discussed. Computed tomography availability seems to be the most important improvement reported as regards diagnosis and surgical tactics. The overall mortality rate was 15.7% with a significant difference between the 2 patterns (23.6% for the spreading pattern versus 7.5% for the abscess pattern). On the basis of this experience, it is possible to establish a relationship between the gross appearance of the collection and the underlying pancreatic disease with differences in terms of prognosis, morbidity, and mortality. Finally, a simple nomenclature can be chosen which is capable of distinguishing between the diverse pancreatic purulent collections. While the presence of pus may characterize the course of severe acute pancreatitis in many cases, the low incidence of “true” pancreatic abscess is emphasized.
Electromyographic activity of the gastrointestinal tract following cholecystectomy
Authors: Coelho Julio C. U. , Pupo Cesar A. , Campos Antonio C. L. , Moss Adyr A.
Published: May 2005

Electromyographic activity of the stomach and small bowel, both in the fasting and fed states, was evaluated in the postoperative period of 8 patients subjected to cholecystectomy. The migrating motor complex (MMC) was recorded on the first postoperative day in 5 patients, on the second day in 2, and on the third day in 1. Vomiting occurred in 1 patient in whom the MMC was recorded only on the third postoperative day. Feeding caused substitution of the MMC by the fed pattern in the stomach and small bowel in all patients. It is concluded from this study that gastric and small bowel motility is normal on the first 2 days of the postoperative period in most patients subjected to cholecystectomy.
Hepatic segmentectomy with caudate lobe resection for bile duct carcinoma of the hepatic hilus
Authors: Nimura Yuji , Hayakawa Naokazu , Kamiya Junichi , Kondo Satoshi , Shionoya Shigehiko
Published: May 2005

From 1979 through 1989, surgical resection was performed in 55 of 66 patients with carcinoma of the hepatic hilus after improving jaundice by percutaneous transhepatic biliary drainage (PTBD). Selective cholangiography through PTBD was done to define precisely the anatomical location—extent of the obstructing lesion in each segmental hepatic duct. Percutaneous transhepatic cholangioscopy was performed through the sinus tract of PTBD after replacing the drainage catheter with a 15 French catheter for superselective cholangiography and biopsy to make the definitive diagnosis of the histological extent of the tumor and any variation of each segmentai hepatic duct that joins the hepatic hilus.

In 46 (69.7%) of 66 patients, curative resection was possible. Forty‐five of these underwent various types of hepatic segmentectomy with caudate lobectomy for a morbidity rate of 41.3% and an operative mortality rate of 6.4%. Fourteen (31.1%) advanced cases underwent combined resection of the portal vein together with hepatectomy. Microscopic tumor involvement in the caudate branches was confirmed in 44 of 45 patients who underwent caudate lobe resection. The 3‐year survival rate for all 43 patients surviving the curative excision was 55.1% and the 5‐year survival rate was 40.5%. All 11 patients who had an unresectable advanced tumor died within 9 months.

Curative resection should be designed according to the preoperative findings of the extent of cancer in each segmental duct, and caudate lobe resection should be performed together with the smallest necessary hepatic segmentectomy possible.
Duodenal atresia and stenosis: Reassessment of treatment and outcome based on antenatal diagnosis, pathologic variance, and long‐term follow‐up
Authors: Grosfeld Jay L. , Rescorla Frederick J.
Published: May 2005

Duodenal atresia and stenosis was observed in 103 infants and children from 1972 to 1991. There were 59 girls and 44 boys. Atresia was noted in 79 instances and stenosis in 24. Maternal hydramnios was detected in 33 cases, 46 babies were premature, and 31 had Down's syndrome. Fifty‐four infants had significant associated anomalies including 35 with cardiac defects. Diagnosis was achieved by prenatal ultrasound examination in 14 cases, observation of a double‐bubble sign on abdominal radiograph in 73, and contrast studies in 30 infants including 24 with stenosis. At operation annular pancreas was noted in 37 cases, malrotation in 37 cases, anterior portal vein in 4, and a second web in 3. Surgical treatment included duodenoduodenostomy in 85, duodenotomy and web excision in 8, and duodenojejunostomy in 10. Operative survival was 95%. Deaths were related to complex cardiac defects. Despite antenatal diagnosis, prompt intervention, and apparent early surgical success (95% survival), late deaths (5%) and late complications including motility disorders, megaduodenum, gastroesophageal reflux, duodenal‐gastric reflux, gastritis, peptic ulcer disease, blind loop syndrome, and biliary‐pancreatic conditions may be observed months to years after management during the neonatal period. Modifications in surgical technique including early tapering duodenoplasty may be useful, and close long‐term follow‐up is an essential component of patient care.
Contemporary management of meconium ileus
Authors: Rescorla Frederick J. , Grosfeld Jay L.
Published: May 2005

Meconium ileus was noted as an early manifestation of cystic fibrosis in 60 neonates between 1972 and 1991. There were 20 girls and 40 boys. A family history of cystic fibrosis was present in six children. Twenty‐five neonates had uncomplicated meconium ileus due to inspissated meconium within the terminal ileum. Thirty‐five neonates presented with 56 complications of meconium ileus, including volvulus (n=22), atresia (n=20), perforation (n=6), and giant cystic meconium peritonitis (n=8). Clinical presentation included abdominal distension, bilious vomiting, and failure to pass meconium. In two recent cases, prenatal ultrasonography detected a mass with proximal bowel distension indicative of cystic meconium peritonitis. Mechanical bowel obstruction in the other neonates was diagnosed from plain abdominal radiographs and barium enema. Ten patients with uncomplicated meconium ileus were successfully treated with a diatrizoate meglumine (Gastrografin) enema. The remaining 15 patients required a laparotomy, with 9 treated by bowel resection and enterostomy and 6 recent cases managed with enterotomy and irrigation. Complicated cases were managed by bowel resection and anastomosis (n =15) or enterostomy (n=20). Survival at 1 year was 92% in patients with uncomplicated meconium ileus and 89% for those with complicated meconium ileus. The therapy of choice for uncomplicated meconium ileus is nonoperative Gastrografin enema, with enterotomy and irrigation reserved for enema failures. Complicated cases require exploration and, in the absence of giant cystic meconium peritonitis, are usually amenable to bowel resection and primary anastomosis.
Current concept of the treatment of biliary atresia
Authors: Miyano Takeshi , Fujimoto Takao , Ohya Toshiki , Shimomura Hiroshi
Published: May 2005

Hepatic portoenterostomy (Kasai operation) for the patient with biliary atresia (BA) can restore the bile flow in approximately 80% of children operated on before 60 days of life [1]. However, in terms of long‐term survival, according to a recent nationwide survey among the major pediatric centers in Japan, only 325 of 2013 patients had more than 10 years' survival, and only 157 patients (7.8%) remained jaundice‐free with normal liver function [2]. About 20% of BA cases without jaundice are generally able to survive for long periods; and most of those patients have portal hypertension or abnormal liver function [3–5].

As the results of liver transplantation have improved, controversy has arisen over the optimal care of these children [4, 6, 7]. Some investigators have claimed that transplantation is the favored primary therapy for most patients with BA [8]. We are thus at a turning point concerning the primary therapy of BA, which makes it necessary to determine the exact indications for the Kasai portoenterostomy and the timing of liver transplantation. This paper describes our strategy for the optimal treatment of BA patients based on our 117 patients who have had various form of portoenterostomy.
Contemporary management of congenital diaphragmatic hernia
Authors: Butler Marilyn W. , Stolar Charles J. H. , Altman R. Peter
Published: May 2005

Despite advances in infant transport and intensive care, congenital diaphragmatic hernia (CDH) still poses a serious threat to life during the neonatal period. Only with the introduction of extracorporeal membrane oxygenation (ECMO) has mortality declined significantly. Understanding the pathophysiology of CDH and its devastating effect on the lungs' bronchial and vascular development assists the clinician in rational management during the perioperative period. Successful treatment demands prompt diagnosis, informed preoperative assessment and preparation, carefully timed surgical repair, and aggressive postoperative intensive care with a thorough understanding of the role of ECMO. Improvements in ventilatory support and pharmacologic management of pulmonary hypertension have allowed surgeons to delay repair until circulatory hemodynamics, electrolytes, and oxygenation can be optimized, even resorting to preoperative ECMO in selected cases if needed. Patients with severe bilateral pulmonary hypoplasia pose serious dilemmas in terms of selection for ECMO, as well as for surgical repair. Long‐term follow‐up of patients after CDH repair reveals persistent hypoperfusion of the involved lung but no debilitating pulmonary disease. Future therapies may include early fetal intervention or lung transplantation, although these areas remain controversial and experimental, and clinical experience is limited.
New trends in the management of congenital heart disease
Authors: Heimansohn David A. , Turrentine Mark W. , Kesler Kenneth A. , King Harold , Brown John W.
Published: May 2005

Considerable improvements have been made in the diagnosis and treatment of congenital heart disease during the last decade. Many congenital heart lesions are now treated successfully during the neonatal period that previously were associated with high mortality. Improved echocardiographic imaging, catheterization techniques, and earlier surgical repair are factors that have resulted in greater success in the treatment of congenital cardiac disease. Diagnosis has been improved greatly with advancements in echocardiography and angiography. Better ultrasound technology combined with doppler techniques and transesophageal echocardiography allow more accurate preoperative assessment and therefore more successful surgical repair. Cardiac catheterization techniques have also improved and, when combined with treatment such as balloon angioplasty, have changed the treatment of certain cardiac anomalies such as pulmonary stenosis or coarctation of the aorta. Operative treatment of congenital heart disease has improved the short‐ and long‐term survival of most infants with congenital cardiac anomalies. Improved cardiopulmonary bypass techniques, better suture material, and the ability to perform cardiac transplantation are examples of technology that allows earlier, more complete repair of these complex cardiac defects. Reviewed here are improvements in the treatment of four complex cardiac anomalies that occur in newborns and are associated with high mortality when left untreated. All four anomalies have undergone significant changes in the approach to their treatment with dramatic improvements in survival.
Effect of peritoneal fluid pH on outcome of aminoglycoside treatment of intraabdominal infections
Authors: Simmen Hans‐Peter , Battaglia Hugo , Kossmann Thomas , Blaser Jürg
Published: May 2005

Netilmicin and clindamycin were administered to 47 patients with an intraabdominal infection who underwent emergency laparotomy. Thirty‐one patients were cured, seven were improved, and therapy failed in nine patients despite the fact that all aerobic bacteria isolated from these patients were sensitive to netilmicin as determined by standard in vitro susceptibility tests. The pH of peritoneal and drainage fluid collected intraoperatively and during follow‐up correlated with clinical outcome. Acidic pH was found in 21 of 33 (64%) specimens sampled from patients with therapeutic failure compared to 17 of 80 (21%) obtained from the categories “cured” and “improved” (p<0.001).Netilmicin concentrations in serum or peritoneal/drainage fluid did not correlate with clinical outcome. Netilmicin levels were above the minimal inhibitory concentration of the pathogens in 59 of 64 (92%) drainage fluid specimens in which aerobic bacteria were isolated. Aerobic bacteria were isolated in 91% of drainage fluid specimens if the pH was less than 7.0, compared to 37% if pH was more than 7.0 (p<0.001). Reduction of pH antagonized aminoglycoside activity in vitro against clinical isolates ofEscherichia coli.Surgical reexploration should be considered in cases of deterioration following a laparotomy associated with detection of acidic drainage fluid.
Follow‐up of anal dynamic graciloplasty for fecal continence
Authors: Konsten Joop , Baeten Cor G. , Spaans Frank , Havenith Miek G. , Soeters Peter B.
Published: May 2005

The feasibility of anal dynamic graciloplasty (transposition of the gracilis muscle and subsequent implantation of a stimulation device) to restore continence, was assessed in a case‐control study of 26 patients with severe fecal incontinence. It was shown that anal dynamic graciloplasty is capable of achieving the sphincter tone of healthy persons, as stimulated graciloplasty increased anal pressure from 46 mmHg without stimulation to 65 mmHg with stimulation (mean increase 19 mmHg; 95% confidence interval 13, 25;n=25;p<0.01). Time to retain a 250‐ml phosphate enema increased from 52 seconds before to 204 seconds after 8 weeks of electrical stimulation (mean increase 151 seconds; 95% confidence interval 61, 241;n=25;p<0.01). Complete fecal continence was achieved in 17 patients (65%); two of these patients developed a wound infection, but one of the two realized continence without stimulation and the other patient became continent after reimplantation. Three other patients improved after anal dynamic graciloplasty, but infection necessitated removal of the stimulation device. One patient developed a fistula. Failures were encountered in five patients. Although our long‐term follow‐up results suggest a learning curve, it is concluded that electrical stimulation improves the results of conventional graciloplasty and avoids construction of a colostomy.
Comparison of factors influencing the prognosis of Japanese, German, and Dutch gastric cancer patients
Authors: Bonenkamp J. J. , van de Velde C. J. H. , Kampschöer G. H. M. , Hermans J. , Hermanek P. , Bemelmans M. , Gouma D. J. , Sasako M. , Maruyama K.
Published: May 2005

As a result of Japanese reports of improved survival of gastric cancer patients after extended lymph node dissection, a study was undertaken to evaluate factors that might influence these results. The influence of staging was evaluated by stratifying 1085 patients of the National Cancer Center of Japan and grouping them according to the three commonly used systems; UICC's old and new TNM systems (fourth edition) and the system of the Japanese Research Society for the study of Gastric Cancer (JRSGC). No survival difference was found between the stages of the three systems, except for stage II, where the new TNM and the JRSGC differed(p<0.05). In a second analysis, the incidence of the most important prognostic factors for advanced gastric cancer was compared among three institutions: the National Cancer Center Tokyo, Japan (NCC), the University Hospital Erlangen, Germany (UHE) and the University Hospital Maastricht in The Netherlands (UHM). Japanese patients were on average 3 years younger than the German patients and 8 years younger than the Dutch patients, and had a higher proportion of advanced (T4) carcinomas. Male‐female distribution, histology, and lymph node invasion were comparable in the three groups. From these data a rather worse prognosis for Japanese advanced gastric cancer patients could be expected. However, the observed 5‐year survival rates show a marked advantage for the Japanese patients: 57% (NCC) versus 34% (UHE) and 31% (UHM). The survival difference for stage II patients between the new TNM and the JRSGC staging systems is not sufficient to explain this advantage. This result underlines the importance of the Japanese therapeutic approach. Whether this approach (i.e., extended lymph node dissection) actually improves survival or merely improves classification, is currently the subject of a prospective randomized trial in The Netherlands.
Pathology of carcinoma of the gallbladder
Authors: Sumiyoshi Kinjiro , Nagai Eishi , Chijiiwa Kazuo , Nakayama Fumio
Published: May 2005

A clinicopathologic study of 40 cases of carcinoma of the gallbladder is presented. Twenty‐six cases resected were assessed retrospectively with respect to the operative procedures employed and the results based on the pathologic findings from the resected specimens.

The relationship between clinical features, macroscopic forms of tumor, histological types, liver invasion, and lymph node metastasis were investigated. Papillary, papillary infiltrative and nodular forms were classified as either papillary adenocarcinoma or well‐differentiated tubular adenocarcinoma and invasion of the liver and lymph node metastasis were rare. Frequent lymph node metastasis was encountered in the nodular infiltrative form and invasion of the liver was frequently present in the infiltrative form. Invasion of the liver, lymph node metastasis, and the presence of gallstones were less frequent in papillary adenocarcinoma. In contrast, moderately‐differentiated tubular adenocarcinoma frequently had lymph node metastasis. Invasion of the liver and lymph node metastasis were, however, present regardless of the histologic types and were more related to the extent of subserosal involvement present. A female preponderance was noted in poorly‐differentiated adenocarcinoma. The main reasons for surgery being limited to exploratory laparotomy only or palliative procedures included carcinoma infiltration into the hepatoduodenal ligament, carcinoma extension to the neighboring structures, multiple liver metastases, peritoneal dissemination, large liver invasion, and multiple metastases to the paraaortic lymph nodes.
The effect of acetylsalicylic acid on the outcome after lower limb arterial surgery with special reference to cigarette smoking
Authors: Lassila Riitta , Lepäntalo Mauri , Lindfors Olof
Published: May 2005

A prospective controlled study of 144 patients with peripheral obstructive arterial disease was undertaken to evaluate the efficacy of acetylsalicylic acid (ASA) treatment (250 mg daily) on the outcome after lower limb arterial surgery which mainly involved endarterectomy. By random enrollment, 2 groups of 72 patients were formed after the surgery. Patients with ASA treatment for 3 months, starting from the seventh postoperative day, were compared with patients who were not treated with ASA. The patients in both groups had similar characteristics as to sex ratio, age, concomitant diseases, preoperative arm‐ankle systolic blood pressure index, and type and primary success of the reconstruction. Forty‐seven of the ASA‐treated and 48 of the untreated patients reported to continue cigarette smoking. Postoperative ASA‐treatment protected against local adverse events which occurred in 15 patients (21%) of the ASA‐treated group compared with 31 patients (43%) of the untreated group (p<0.01). Among heavy smokers (>15 cigarettes/day) the efficacy of antiplatelet treatment was not detectable. These results imply that, in patients with peripheral arterial disease, ASA prevents platelet interaction to endarterectomized and atherosclerotic lower limb arteries thereby affecting the subsequent risk of occlusion; however, heavy cigarette smoking, which is very common among patients with peripheral arterial disease, counteracts the local antithrombotic potency of ASA.
Should both schistosomal and nonschistosomal variceal bleeders be disconnected?
Authors: Abu‐Elmagd Kareem M. , Ezzat Farouk A. , Fathy Omar M. , El‐Ghawlby Nabih A. , Aly Mohamed A. , El‐Fiky Amgad M. , El‐Barbary Mohsen H. , El‐Ebady Gamal E. , El‐Hak Nabil G.
Published: May 2005

Splenopancreatic disconnection (SPD) was conceived and implemented as a technical addition to distal splenorenal shunt (DSRS) to maintain its selectivity and preserve portal perfusion. The proposed hemodynamic and metabolic stability of hepatocytes after DSRS‐SPD should improve survival. In this nonrandomized study, 145 consecutive (Child A/B) variceal bleeders were electively subjected to selective shunt with DSRS in 93 and DSRS‐SPD in 52 patients. The 2 groups were similar before surgery with a mean follow up of 24±12 (DSRS) and 27±14 (DSRS‐SPD) months. DSRS‐SPD had an operative mortality of 3.8%. Postoperative pancreatitis occurred in 7.7% after DSRS‐SPD and 3.2% after DSRS alone, with schistosomal hepatic fibrosis representing 86% of morbid cases. Shunt patency was high and recurrent variceal hemorrhage was low in both groups. Clinical encephalopathy was significantly reduced after DSRS‐SPD (p<0.05). The addition of SPD significantly reduced both the incidence of chronic hyperbilirubinemia in the schistosomal patients (p< 0.05) and the difference between the changes in total serum bilirubin in all patients (p=0.001). Portal perfusion was preserved after DSRS‐SPD in all of the angiographically‐studied patients. The overall survival was 84% after DSRS and 88% after DSRS‐SPD. The schistosomal patients showed an incidence of 95% and 96% survival after DSRS and DSRS‐SPD, respectively. DSRS‐SPD was able to improve survival (92%) better than DSRS (77%) among well‐matched nonschistosomal patients. These data show: (1) DSRS‐SPD still has low operative mortality and a high patency rate with a low incidence of recurrent variceal hemorrhage, (2) DSRS‐SPD maintains portal perfusion, achieves better survival, and reduces the incidence of encephalopathy, especially in patients with nonalcoholic cirrhosis and mixed liver disease, (3) in the schistosomal population, DSRS‐SPD reduces the incidence of chronic hyperbilirubinemia but increases the risk of postoperative pancreatitis.
The influence of surgery on the risk of death in patients with primary hyperparathyroidism
Authors: Hedbäck Gunilla , Odén Anders , Tisell Lars‐Erik
Published: May 2005

The previous finding of an increased risk of premature death in a consecutive series of 896 patients operated on for primary hyperparathyroidism between 1953 and 1982 [1] raised the question of the role that surgery plays in relation to the risk of death. In the present study, undertaken to examine that issue, 3 factors—age, calendar year of surgery, and time passed after surgery—have been found to be significantly related to the risk of death (p<0.001), each factor contributing independently. A correlation was found between a late calendar year of surgery and a low degree of hyperparathyroidism as evaluated by serum calcium and creatinine levels. There was an increased risk of premature death in all age groups. The risk was less among patients operated on in later years. The observed normalization of the increased risk of death with time after surgery also took place sooner in patients operated on in later years. Our finding of improved survival following surgical intervention contrasts favorably with the findings of others in studies of subjects with untreated mild hyperparathyroidism. We have also found that preoperative serum calcium levels affect the risk of death, and that there is an additional factor related to the calendar year of surgery affecting the risk of death. Circumstantial evidence indicates that the duration of hyperparathyroidism contributes to this factor. Our results also show that early surgery decreases the risk of premature death in mild cases of the disease.