bluuebunny/crossref_metadata_2025 huggingface dataset:
Systemic antibacterial mechanisms in trauma
Authors: MacLean Lloyd D.
Published: May 2005

Host defense mechanisms are cell‐ mediated, humoral and phagocytic. Acquired derangements of one or many of the immune antibacterial defenses are common after injury. These defects include (a) a failure of T‐ cell response (DTH) to antigen stimulation manifested by negative skin test reactions to common antigens (anergy); (b) a failure of humoral response, or B‐ cell depression after appropriate antigen stimulation; and (c) development of serum inhibitors of phagocyte chemotaxis.

Anergy reflects an immunodeficiency state more profound than impaired T‐ cell function alone and, if left uncorrected, is associated with a markedly increased incidence of sepsis and associated mortality. Therapeutic implications of these findings for now and the future are summarized.
Selective mesenteric vein catheterization and plasma serotonin determination in patients with carcinoid tumors
Authors: Nobin Anders , Axelsson Sture , Falck Bengt , Ingemansson Stig , Lunderquist Anders , Mårtensson Hans , Reichardt Wolfgang
Published: May 2005

Selective abdominal vein catheterization with blood sampling for serotonin determination was evaluated regarding its use in the diagnosis, location, and characterization of carcinoids. Serotonin was determined in a platelet‐poor plasma fraction (PPP) by an enzymatic procedure.

In 5 normal subjects the concentration of serotonin in PPP in the celiac artery, the hepatic vein, and different intestinal and pancreatic veins ranged from 1.2 to 5.4 ng/ ml. In 10 patients with carcinoid tumors, the concentration of serotonin in tumor‐draining veins was clearly elevated and ranged from 10 ng/ml to 88 ng/ml PPP. 5‐HIAA urine levels were false‐negative in 4 cases, liver scintiscan was false‐negative in 3 cases, and the angiograms were not conclusive in 2 cases.

The technique with plasma serotonin determination in combination with selective catheterization is a useful complement to other investigative techniques in the diagnosis, location, and follow‐up of patients with carcinoid tumors.
Abdominoperineal excision of the rectum: A prospective study based on a standardized method
Authors: Liavåg Ivar , Roland Magne
Published: May 2005

A prospective and consecutive series of 72 patients with rectal carcinoma was subjected to excision of the rectum. The operations were performed according to a standardized program based on previous studies and established surgical principles:

Two days on a liquid diet, laxative, and enemas.

Irrigation of the pelvic cavity with 5 liters of saline solution after removal of the specimen.

Leaving the pelvic peritoneum unsutured.

Obliteration of the presacral cavity with living omentum, uterus, or small intestine.

Suprapubic, closed suction drainage.

Primary closure of abdominal and perineal wounds without drainage.

Antibiotic prophylaxis against aerobic as well as anaerobic bacteria.

Parenteral nutrition from the first postoperative day and until the bowel acts properly.

Two patients died postoperatively (3%), and 93% achieved primary healing of the perineal wound.
Abnormal sex‐steroid milieu in young adults with hepatocellular carcinoma
Authors: Malt Ronald A. , Galdabini James J. , Jeppsson Bengt W.
Published: May 2005

Five of 7 patients in the age group 20–30 years treated for hepatic cell carcinoma during the past 15 years had an endogenous or exogenous disturbance of gonadal function. The 2 men were taking methyltestosterone. Two of 5 women had taken long courses of oral contraceptives; a third had Stein‐Leventhal syndrome; one woman was infertile for 18 months. Fibrolamellar‐variant carcinomas were present in 4 women and a trabecular‐variant carcinoma in one. Stopping methyltestosterone or oral contraceptives and performing a major hepatectomy apparently cured 3 patients. Although the data are consistent with a role for sex steroids in some cases of hepatic carcinogenesis, a casecontrol study would be necessary to eliminate chance concurrence of fibrolamellar‐variant cancer in the age group most likely to be taking oral contraceptives or to be concerned about infertility.
Localization of the antral‐corpus boundary in proximal gastric vagotomy: An experimental comparative study
Authors: Ramos Carlos Martinez , Pelayo Adela , de Vega Damaso S. , Jerez L. , Cazenave E. , Pardo Pilar , Nuñez J. R. , Tamames S.
Published: May 2005

A comparative, experimental study has been done in which 3 methods were utilized to determine the macroscopic antral corpus boundary in proximal gastric vagotomy: anatomical references (A.R.), pHmetry, and Congo red (C.R.). Acute experiments were done on 10 dogs in which, after stimulation of the gastric secretion with 6 pg/kg of pentagastrin intravenously, the macroscopic antral‐corpus boundary was determined at the level of the lesser curvature of the stomach using the 3 methods. At the same time a series of specimens of gastric mucosa was obtained along the whole of the lesser curvature, to determine the relation between these macroscopic results and the microscopic limit.

The results indicate that the A.R. gave an average error of 0.20±0.47 cm in relation to the microscopic limit, which was not significant (p>0.30). The average error produced by pHmetry was 1.45±0.36 cm, and that obtained with C.R. was 2.25±0.72 cm, which were both statistically significant (p<0.001). If these results are contrasted 2 by 2, it is found that the error with A.R. is significantly less than with pHmetry and with C.R. (p< 0.001). Likewise, the error with pHmetry is significantly less than with C.R. (p<0.05).

We conclude that the determination of the macroscopic antral‐corpus boundary in proximal gastric vagotomy should preferably be done using anatomical references, since this procedure is the most precise in relation to the microscopic line and is also the easiest to perform.
Villous adenoma of the stomach
Authors: Herrington J. Lynwood , Powell Stephen , Granda Antonio
Published: May 2005

Villous adenomas are common neoplasms in the rectum and distal colon. They occur less frequently in the remainder of the gastrointestinal tract but irrespective of location are associated with a high malignant potential. The stomach is an unusual site of involvement and only approximately 100 cases have been recorded. Gastric villous lesions may be multiple and may coexist with an independent gastric carcinoma or be associated with neoplasms elsewhere in the gastrointestinal tract.

Gastric villous tumors demonstrate carcinomatous changes in from 25 to 72% of cases, and complete surgical removal is mandatory for cure. Since preoperative endoscopic frozen section examinations and frozen section studies at operation are unreliable in detecting carcinomatous changes, the surgeon may be faced with a difficult decision in choosing the proper operative procedure. Lesions located in the proximal stomach pose a more difficult problem in surgical judgment than do distally located lesions, particularly when multiple frozen section studies fail to reveal malignant features and yet the possibility of carcinoma exists. Such a case is described and the operative approach is outlined.
Pulmonary edema: Current concepts of pathophysiology, clinical significance, and methods of measurement
Authors: Demling Robert H.
Published: May 2005

By definition, pulmonary edema is simply excess fluid in the lung. The distribution of the fluid dictates the clinical significance of the edema. As far as a mechanism of edema formation, microvascular hydrostatic pressure remains the predominant Starling force. The lung interstitium is a major factor in determining both the amount of edema formed as well as the distribution. Increased permeability edema, with a more peripheral distribution of fluid as seen in the adult respiratory distress syndrome, may well be the result of interstitial matrix and basement membrane changes rather than simply more holes in the endothelial membrane. The significance of the edema, again, depends on its distribution, with perihilar interstitial fluid being much less significant than alveolar flooding. The relevance of the measurement of lung water, therefore, is dependent as much on where the water resides as on the absolute amount. The clinical applicability of methods that do not give information on distribution, therefore, is dependent on the clinician's understanding of the differences in distribution with various disease states and, therefore, the importance of the water in producing the pulmonary abnormalities.
The hypermetabolism organ failure complex
Authors: Cerra Frank B.
Published: May 2005

Multisystem organ failure remains the predominant cause of death in the surgical intensive care unit. What used to be thought of as isolated organ failure, such as adult respiratory distress syndrome, is now seen as part of the systemic response to injury and of a systemic injury and repair process. Sepsis has become the systemic inflammatory response to invading microorganisms; the same response is now recognized after severe perfusion deficits and in the presence of continuing sources of dead and injured tissue. Once present, the organ failure syndrome continues to have a high mortality rate. From a treatment perspective, it is being recognized that there is probably no “magic bullet”; that regimens will probably be time‐dependent and “multiple‐drug”; and that the best treatment is prevention. Malnutrition, as a distinct entity from the changes in body composition that occur as a result of disease process, has become a recognized co‐factor in patients with persistent hypermetabolism. In addition, the metabolic processes of hypermetabolism have become increasingly well defined and understood. The result of these 2 processes has been the development of metabolic support principles that are distinct from those of nutritional support and are designed to prevent the end‐organ changes of malnutrition, prevent the development of substrate‐limited metabolism, to support organ structure and function, and to arrest the metabolic processes. The current state of the art has been to learn to do no harm, an outcome reasonably achieved. In addition, several beneficial results have been recognized, including new substrate techniques to better support total body protein synthesis, hepatic protein synthesis, and energy production. Techniques to better support organ structure and function are currently being tested. No techniques are currently available to control proteolysis and the redistribution of skeletal muscle nitrogen. A great deal of research is necessary in this field which is still in its infancy.
Corticosteroids, nonsteroidal anti‐inflammatory drugs, and naloxone in the sepsis syndrome
Authors: Long William M. , Sprung Charles L.
Published: May 2005

Corticosteroids have proven to be effective as adjunctive treatment in sepsis and severe typhoid fever when used early and in high doses. If corticosteroids are given in high doses (30 mg/kg), they should be administered in 1–2 doses, and not to exceed 4 total doses within 24 hours. The efficacy of the drug may be diminished in more severe sepsis, but use of corticosteroids in severe sepsis may delay death. If the benefit of corticosteroid use in late sepsis is only to prolong impending death, then steroid administration is probably futile; however, the alternative view is that corticosteroid use may constitute one step in a series leading to shock reversal and recovery. Risks and benefits of corticosteroid use should be tailored to the individual patient with consideration given to the nature and extent of the underlying disease. Although the pathophysiology of the sepsis syndrome remains elusive, new therapeutic regimens may evolve using nonsteroidal anti‐inflammatory drugs and neuropeptide antagonists. As with corticosteroids, their application before or early after the onset of shock appears more beneficial; however, the patient population that will benefit most from treatment with these drugs remains, for the most part, unidentified, and more clinical trials are needed.
Prevention of postoperative wound infection after appendectomy by local application of tinidazole: A double‐blind study
Authors: Eklund Anders ‐Erik , Tunevall T. Göran
Published: May 2005

The effect of local application of tinidazole on wound infection rates has been studied in 510 patients undergoing acute appendectomy. Patients with perforation of the appendix were not included in the study. After suture of the peritoneum, the exposed tissues were washed with 200 ml of tinidazole solution 2 mg/ml or, in control cases, with the same amount of saline solution. The study was prospective, controlled, and double‐blind. The total number of postoperative wound infections was 3.5% (18 patients). Among 116 patients with gangrenous appendicitis, a significant reduction of postoperative wound infections was observed in the group given tinidazole prophylaxis (p=0.02). The infection rates observed were 2.0% in the treatment group and 13.8% in the control group. The costs for prophylactic tinidazole to avoid 1 infection was estimated at 568 Swedish kronor (SEK) ($73, U.S.) while every infection gives rise to an extra cost of 10,100 SEK ($1,295, U.S.). Local application of tinidazole in cases of gangrenous appendicitis thus proved to be highly cost‐effective.
Cancer of the thyroid in youth
Authors: Buckwalter Joseph A. , Gurll Nelson J. , Thomas Colin G.
Published: May 2005

This is a review of 68 patients 20 years of age and younger with well‐differentiated carcinoma of the thyroid seen at the University of North Carolina Memorial Hospital and University of Iowa Hospital since 1935. These patients are included in the Thyroid Carcinoma Registry that provides continuing follow‐up of all patients with carcinoma of the thyroid at these 2 hospitals. The historical, clinical, laboratory, and surgical pathological findings in these 68 patients, their treatment, and survival are reported. Comparisons are made with findings in the 486 patients 21 years of age or older with well‐differentiated carcinoma of the thyroid seen during the same time. The most striking finding of this clinical investigation is that only 1 of the 68 patients, followed up for as long as 30 years, has died as a result of the well‐differentiated thyroid carcinoma. There was a history of irradiation to the head or neck, 28% of patients younger than 15 years of age, 15% of those 15 to 20 years of age, and 6% of patients older than 21 years. The results of this study reaffirm the conclusion that the treatment of well‐differentiated carcinoma of the thyroid in young patients as in older patients is empirical. Our experience suggests that the surgical approach should be determined by the biologic aggressiveness of the disease. Lobectomy, including isthmusectomy, is performed for well‐circumscribed lesions less than 2 cm in diameter in the absence of lymph node metastases. Near total thyroidectomy is advised in the presence of unilateral disease and ipsilateral lymph node metastases. Total thyroidectomy is performed for multifocal disease, when required to remove gross neoplasm, with bilateral lymph node metastases, and with follicular carcinoma in the presence of metastatic disease. Thyroid hormone therapy is used prophylactically. Radioiodine is advised for inoperable, residual, or recurrent disease.
TSH suppression in the management of thyroid nodules and thyroid cancer
Authors: Clark Orlo H.
Published: May 2005

Clinical and experimental data concerning TSH suppression, by giving exogenous thyroid hormone, in patients with goiter and in patients with thyroid cancer show a beneficial effect. In the goiter patients, TSH suppressive therapy seems most effective in young patients with diffuse or newly discovered goiters, in hypothyroid patients, and in patients with chronic lymphocytic thyroiditis or compensatory thyroid hypertrophy after partial thyroidectomy. With TSH suppressive therapy about 2/3 of thyroid nodules become smaller, but only about 5% to 10% disappear. In patients with differentiated thyroid cancer (papillary, mixed papillary‐follicular, and follicular), tumor recurrence, tumor progression, and long‐term survival all seem to be influenced favorably by TSH suppressive therapy. Experimental investigations demonstrate that both benign thyroid adenomas and differentiated thyroid carcinomas have TSH receptors situated on the plasma membranes. These TSH receptors appear to be coupled to the activation of adenylate cyclase in a one‐to‐one relationship. Experimental and clinical studies strongly support the use of thyroid hormone both for the treatment of patients after thyroidectomy for thyroid cancer and as prophylaxis to prevent the development of thyroid cancer in high‐risk irradiated patients. The dose of thyroxine recommended for adequate TSH suppression is the lowest dose of thyroxine that will completely block the TSH response to TRH (usually 0.2 to 0.25 mg).
Results of surgical treatment of early gastric cancer in 113 patients
Authors: Gentsch Hans H. , Groitl Heiner , Giedl Josef
Published: May 2005

From 1961 to 1978, 113 patients with early gastric cancer were treated surgically at Erlangen University. The lesions were located in the lower 1/3 of the stomach in 47% of the patients, in the corpus and fundus in 46%, and in the gastric stump after resection in 7%. Surgical techniques included subtotal distal resection, proximal resection, total gastrectomy, local excision and polypectomy, and their use depended on the circumstances. The tumors were classified as intestinal type carcinoma in 71% of patients and diffuse type carcinoma in 29%. The 5‐year survival rates calculated by the actuarial method were 74% (observed) and 87% (age corrected). Tumors in the lower 1/3 of the stomach had a better prognosis than tumors of other regions. Tumors limited to the mucosa had a higher 5‐year survival rate than those with invasion of the submucosa. In Europe, as in Japan, early gastric cancer has a much better prognosis than all other forms of gastric cancer.
Amylase creatinine clearance ratio following biliary tract surgery
Authors: Tonelli Francesco , Senati Emidio , Indinnimeo Marileda
Published: May 2005

An increase in the amylase creatinine clearance ratio (ACCR) is considered to be a more specific diagnostic test of acute pancreatitis than elevation of the serum or urine amylase activity. Simultaneous serum and urine samples for the determination of amylase and creatinine were obtained preoperatively and at various intervals postoperatively in 75 patients undergoing surgery. No increase in ACCR was observed in a control group of 5 patients who underwent extra‐abdominal surgery. ACCR increased significantly following cholecystectomy (40 patients) and sphincterotomy (10 patients), but did not increase in patients in whom cholecystectomy was performed without operative cholangiography and in those who underwent cholecystectomy and prophylactic treatment with Trasylol. Use of a different technique in performing sphincterotomy, probing the papilla and the duct of Wirsung transduodenally, did not lead to a significant difference in the postoperative ACCR increase. The increase in postoperative ACCR was significantly higher in patients who underwent cholecystectomy with sphincterotomy than in those who underwent cholecystectomy alone. Serum amylase levels exceeded the normal range only in a few patients. These results suggest that sphincterotomy and operative cholangiography performed without control of infusion pressure cause an increase in ACCR with values similar to those found in acute pancreatitis. However, damage to the pancreas must be mild since none of the patients developed clinical features of acute pancreatitis.
Idiopathic perforation of the sigmoid colon in Japan
Authors: Kasahara Yoh , Matsumoto Hiroki , Umemura Hiroya , Shirafa Sei , Kuyama Takeshi
Published: May 2005

This is a report of a case of idiopathic perforation of the sigmoid colon, a rare condition, and a review of 65 cases collected from the Japanese literature including our own. The ratio of males to females was 42∶23, the ages ranged from 16 to 87 years, and 68% of the patients were in the sixth decade or older. The perforation sites were in the middle of the sigmoid colon in 43 cases, of which 79% were at the antimesenteric border, and in the rectosigmoid region in 2 cases. Several pathogenetic factors are considered to be responsible for this perforation, among which constipation and raised intra‐abdominal or intraluminal pressure may be most important. In the cases associated with constipation, differential diagnosis must be made by histologic examination. Free air under the diaphragm was noted on x‐ray in 46% of patients and leukopenia under 4000/mm3in 35% of the cases. Only 2 patients with confined perforation were diagnosed preoperatively by barium enema x‐rays. The overall mortality rate was 35%. Exteriorization or resection of the perforated site resulted in the best prognosis among the various operative procedures. There were 5 instances of colocutaneous fistula in 13 patients who underwent simple closure of the perforation.
The problem of classifying obesity
Authors: Scuro Ludovico A. , Bosello Ottavio
Published: May 2005

The numerous attempts to classify obesity demonstrate the difficulty of grouping the obesity syndrome into a single schema. The criteria can be subdivided into 3 groups: the first based on etiology and pathogenesis; the second based on clinical observation, anthropomorphic measurements and adipose tissue histology; and the third based on psychological and nutritional behavior, and environmental elements. The etiological classification subdividing obesity into genetic, hypothalamic, nutritional, physical inactivity, and endocrine groups is important because it best approximates the clinical reality of obesity.

Recently acquired knowledge about adipose tissue cellularity and its metabolism has become important for clinical classification of the different types of obesity. Now we can divide obesity into hypertrophic (the weight of the adipocite increases), hyperplastic (only the number of adipose cells increases), and combined (number and weight of adipocite increase). Pure hyperplastic obesity is rarely found, while combined obesity is more frequent; the hypertrophic form is associated with obesity arising in adult life.

Considerable information is gained from the study of anomalous nutritional behavior. The excess of food intake has psychologically disparate motivations that are caused by emotional reaction to anxiety‐provoking events or to a developing modification of personality. The first is reactive obesity, the second developmental obesity. However, among the obese there are individuals who have no specific psychological problems and are prompted to hyperfeed by environmental factors. In this case, the term “environmental obesity” is used. As regards a proper therapeutic approach, these distinctions are very important.
Psychological evaluation of extremely obese patients before and after surgical treatment
Authors: Husemann B. , Erzigkeit H.
Published: May 2005

The psychological and psychosomatic status of extremely obese patients were analyzed before and after surgical weight reduction (jejunoileostomy or gastric bypass) by means of questionnaire and interview. Somatic discomfort, disturbances of vegetative functions, and depressive mood can be considered the results of obesity. They improve with weight reduction. However, normal values are not achieved after either jejunoileostomy or gastric bypass. For this reason, weight reduction alone cannot be considered the optimal treatment for obese patients. Additional supportive medical and psychological measures are necessary.
Effect of endogenous secretin on plasma glucagon after total pancreatectomy
Authors: Sudo Takaaki , Suzuki Takashi , Tobe Takayoshi , Umemura Hiroya , Shiraha Sei , Kuyama Takeshi
Published: May 2005

Normal dogs and totally pancreatectomized dogs with intact stomach and duodenum were given 0.1 N hydrochloric acid directly into the duodenum in a study of the effect of endogenous secretin on glucagon secretion. The glucagon responsive to 30K antibody first decreased after total pancreatectomy, but increased with time if no insulin was administered. Total pancreatectomy was followed by a gradual, statistically significant increase in the basal secretion of blood secretin. The endogenous secretin secreted in response to the infusion of 0.1 N hydrochloric acid into the duodenum in no way varied the blood glucagon level in normal dogs, but slightly decreased blood gut glucagon in totally pancreatectomized dogs. The secretion of blood secretin in response to the infusion of 0.1 N hydrochloric acid into the duodenum was maintained even after total pancreatectomy.
Prophylaxis of recurrent goiter by high‐dose L‐thyroxine
Authors: Goretzki P. , Roeher H. D. , Horeyseck G.
Published: May 2005

In a prospective, randomized, controlled study of 64 patients after bilateral subtotal thyroidectomy, a high dosage of 1.0 mg L‐thyroxine taken once a week was compared to the usual intake of 0.1 mg L‐thyroxine daily for prevention of recurrent goiter. During a follow‐up study for 52 weeks, the effectiveness and acceptability of an intermittent high dosage was assessed clinically and also by measuring basal TSH, stimulated TSH, iT4, and iT3. In both groups, postoperative elevated TSH levels could be reduced to subnormal levels by L‐thyroxine intake. iT3 and iT4 levels remained in the normal range after either daily or intermittent therapy. The weekly high dosage of 1.0 mg L‐thyroxine has proved to be at least as effective as the usual therapy with no apparent disadvantage.
Results of surgery in fibrodysplastic renal artery stenosis
Authors: Jakubowski Hans D. , Eigler Friedrich W. , Montag Heinrich
Published: May 2005

At the University of Essen Hospital, 202 patients underwent operations for renovascular hypertension between September, 1971, and August, 1979. In 75 (37.2%) of the patients (64 female and 11 male, ages 8–55 years), a fibrodysplastic stenosis of one or both renal arteries was found. These patients were treated after angiographic demonstration of a renal artery stenosis, with no further functional testing, e.g., renal vein renin ratio or Saralasin test. Operative procedures included resection of the stenosis and reanastomosis in 45, vein patch angioplasty in 13, vein graft reconstruction in 11, and reimplantation of the renal artery into the aorta in 6 patients. In 5 patients (6.7%) a nephrectomy was necessary because of artery thrombosis. There were no operative deaths. Ninety‐six percent of the patients showed a normal or improved blood pressure in the immediate postoperative course. In more than 85% of the patients, reinvestigated 2, 4, and 6 years after the operation, hypertension was cured or improved. We conclude that surgical treatment of renal artery stenosis of flbrodysplastic origin is indicated without further functional tests.
Surgical closure of patent ductus arteriosus outside the operating theater
Authors: Pate James W. , Korones Shelton , Sarasohn Charles
Published: May 2005

The widespread availability of newborn centers and competent management of respiratory problems in the newborn have allowed survival of many infants with patent ductus arteriosus (PDA) who previously would have died.

Most deaths after surgical correction of PDA in the newborn have been due to problems in management of ventilation and nursing care. Since most patients are intubated and on respirators prior to election of operative closure, we decided to close the ductus in the newborn center, without moving the patient or disturbing the equipment. The same nurses and pediatric fellows would manage the infant after surgery.

The first 9 consecutive premature infants with near‐fatal respiratory problems associated with patent ductus arteriosus and operated upon in the newborn center all survived, improved, and were discharged home. There were no infections or other major surgical complications. We conclude that, in properly selected patients, surgical closure of the patent ductus arteriosus is best done in the newborn center under local anesthesia.
Surgical and metabolic management of patients with external fistulas of the small intestine associated with Crohn's disease
Authors: Hill Graham L. , Bourchier Russell G. , Witney Graham B.
Published: May 2005

In order to define more clearly the principles of surgical and metabolic management of patients with external small bowel fistulas in association with Crohn's disease, a consecutive series of 85 patients (26 with Crohn's disease) was studied. The patients were all managed by one surgeon and, in the last 60 patients, management was according to a standard protocol. In 19 cases, detailed metabolic studies (body composition, plasma proteins, and total energy expenditure) were conducted at intervals during the period of treatment.

In 69 (82%) of the 85 patients, successful closure of the fistula was achieved (36 spontaneously, and 33 surgically), and the mortality rate was 16%. The overall results were similar for the Crohn's patients, except that spontaneous closure occurred significantly less often (in 4 of 26 patients). Two distinct types of Crohn's fistula were observed. In 10 patients, the fistula arose in the early postoperative period and was not associated with residual Crohn's disease. The pattern of behavior and overall results of treatment of these patients were the same as for non‐Crohn's patients. In 16 patients whose fistula arose from an area of Crohn's disease (6 postoperatively, 10 spontaneously after discharge of an abscess), spontaneous closure was not observed. Surgery was undertaken in 15 of these patients, and was successful in 14; one patient died.

Studies of body stores of protein showed that massive losses (2% per day) occurred in patients in whom sepsis was uncontrolled, in spite of intravenous nutrition (IVN). Although the total energy expenditure of Crohn's patients was no different from that of non‐Crohn's patients (45 kcal/kg per day), studies of total body protein while the patients were being given IVN showed that, when active Crohn's disease remained in situ, the expected increase in body protein stores of about 1 kg did not occur.

It is concluded that fistulas unassociated with residual Crohn's disease should be managed along conventional lines. Those fistulas arising from diseased small intestine all require surgery. This is performed after sepsis has been drained, metabolic deficits (but not necessarily deficits of body protein) have been corrected, and the anatomy of the fistula has been defined. The surgical procedure is a radical one involving complete dissection of the entire small intestine, resection of the bowel involved, and performance of a primary anastomosis.
Carcinoma of the gastric cardia: Surgical management and long‐term survival
Authors: Moreaux Jean , Msika Simon
Published: May 2005

From 1964 to 1985, a total of 114 patients (94 men and 20 women) were operated on. The resectability rate was 71%, and 53% of the patients were thought potentially curable. Either abdominal or combined abdominal and thoracic approaches were preferred. Proximal esophagogastrectomy (54 cases) was performed in cases with wide esophageal extension and total gastrectomy (27 cases) was performed for tumors localized in the gastric cardia. There was intraoperative examination of the esophageal margin. There was lymph node involvement in 57% of cases and esophageal extension in 59%. Three patients died in the postoperative course, none after curative resection. There was 1 (1.2%) clinical anastomotic leak. The overall 5‐year survival rate was 18.5%. The actuarial 5‐year survival rate was 29±8% after resection and 40±7% after curative resection, and the 10‐year survival rate was 20±7 and 28±7, respectively. Symptom duration, age, or sex had no significant influence on prognosis. Lymph node involvement, tumor depth penetration, and esophageal extension were the main prognostic factors.
Long‐term survival in Japanese patients with far advanced carcinoma of the stomach
Authors: Korenaga Daisuke , Tsujitani Shunichi , Haraguchi Masaru , Okamura Takeshi , Tamada Ryuichiro , Sugimachi Keizo , Akazawa Kohei , Nose Yoshiaki
Published: May 2005

Among 1,220 Japanese patients with gastric carcinoma who had undergone resection in the Department of Surgery II, Kyushu University Hospital, Fukuoka, Japan from 1965 to 1980, there were 432 (35.4%) with far advanced carcinoma, designated as a lesion with factors such as peritoneal dissemination, hepatic metastasis, widespread nodal involvement extending to tertiary (hepatoduodenal, retropancreatic, and mesenteric) or quaternary (middle colic and paraaortic) nodes, or direct invasion to adjacent organs. The overall 5‐year survival rate in these 432 patients was 10.2%. The 5‐year survival rate in patients with a single factor was 16.3%, being significantly higher than the 2.8% or less in cases with more than 2 factors (p<0.01). Patients with tertiary nodal involvement or directly invaded organs alone survived at a rate of 26.1% and 21.8% in the 5‐year follow‐up, respectively. Radical procedures such as extensive lymphadenectomy and combined resection of the invaded organs further lengthened the survival time. The 5‐year survival rates were less than 10% in patients with other factors, singly or more than 2 factors in combination. There appear to be 2 subgroups in whom the rates of survival differ: potentially curable and noncurable patients. More intensive therapeutic regimens corresponding to both groups need to be considered.
Effect of oral branched chain amino acids on behavior and brain serotonin metabolism in portacaval shunted rats
Authors: Bengtsson Finn , Nobin Anders , Falck Bengt , Gage Fred H. , Jeppsson Bengt
Published: May 2005

It has been suggested that administration of branched chain amino acids (BCAA) can reverse some of the alterations in metabolism and behavior seen in patients with portal‐systemic encephalopathy (PSE). We investigated the effects of a diet enriched in BCAA on serotonin metabolism in the central nervous system (CNS) and on behavior in rats with a chronic portacaval shunt (PCS).

In a first trial (trial 1), an increased CNS serotonin synthesis rate and impaired behavior were observed in PCS rats given a standard laboratory diet. Thereafter, the rats in the trial were given an equicaloric and equinitrogenous diet with (36% BCAA) or without (21% BCAA) BCAA enrichment for an additional 2 weeks. Intake of the BCAA‐enriched diet resulted in normalization of CNS serotonin metabolism, similar to shamoperated rats (with unaltered CNS serotonin metabolism given BCAA enrichment or not), in comparison with PCS rats without BCAA enrichment in their food. The behavioral alterations following PCS were, however, not reversed by BCAA feeding.

In a second trial (trial 2), we investigated the behavioral effects of 4 weeks of oral BCAA. From the results, we could state only minor effects of this treatment on impaired behavior following PCS, when compared with PCS without BCAA‐enriched diet.

In both trial 1 and 2, the high plasma ammonia levels of the PCS rats were unaffected by the oral treatment of BCAA. The overall nitrogen balance remained comparable between all groups.

The present study demonstrates that a BCAA‐enriched diet normalizes CNS serotonin metabolism in the PCS rat. The impaired behavioral performances could not, however, be completely reversed, suggesting that factors other than brain serotonin may also be involved in the development of PSE.
Necrosectomy and postoperative local lavage in patients with necrotizing pancreatitis: Results of a prospective clinical trial
Authors: Beger Hans G. , Büchler Markus , Bittner Reinhard , Oettinger Wolfgang , Block Silvia , Nevalainen Timo
Published: May 2005

Seventy‐four patients with necrotizing pancreatitis were included in a prospective clinical trial of a surgical management protocol comprising necrosectomy and postoperative local lavage of the lesser sac and of the necrosis cavity. Fifty‐eight patients showed preoperative organ failures such as pulmonary dysfunctions (57%), renal dysfunctions (37%), shock (12%), and sepsis (26%) in spite of intensive care treatment. The median value of the early prognostic signs was 4.5 points. Intraoperatively, 62% of the patients revealed extensive intrapancreatic parenchymal necrosis, 69% had extrapancreatic necrosis, and 39% showed bacterial contamination of the necrotic material. Following the necrosectomy, postoperative local lavage was performed for an average period of 25 days with 7 liters (median) of lavage fluid per 24 hours. In each of 18 studied patients, a considerable release of immunoreactive trypsin was demonstrated and, in each of 20 studied patients, a high concentration of immunoreactive phospholipase A2 was demonstrated in the lavage fluid up to the 12th/14th postoperative day. The intensive care period averaged 6 1/2 days, the hospital stay averaged 54 days. The hospital mortality rate was 8.1%. It is concluded that restricted necrosectomy and postoperative local lavage treatment correspond in particular to the pathomorphologic conditions and to the local release of biologically active compounds such as bacteria, endotoxin, trypsin, and phospholipase A2 in patients with necrotizing pancreatitis.
Quality of life and patterns of recurrence following transhiatal esophagectomy for cancer: Results of a prospective follow‐up in 50 patients
Authors: Barbier Peter A. , Luder Peter J. , Schüpfer Guido , Becker Christoph D. , Wagner Hans E.
Published: May 2005

A prospective follow‐up was performed in 50 consecutive patients who had previously undergone transhiatal esophagectomy without thoracotomy (THE) for esophageal carcinoma. The follow‐up period ranged from 1 to 5 years (mean, 18.4 months). At each control, a clinical, laboratory, and radiologic examination including barium esophagography and computed tomographic (CT) scan was obtained in order to assess quality of life and to detect tumor recurrence.

Twenty‐three patients (46%) developed recurrent carcinoma, all but one within 12 months of surgery. The survival rates were 57% at 1 year, 34% at 2 years, and 23% at 3 years. The median survival time was 15.7 months. Recurrence was initially confined to the mediastinum in 50% of patients, whereas 50% already had systemic metastases when recurrence was first detected.

Radiologic examinations, especially CT, were far more sensitive in detecting tumor recurrence than was the clinical evaluation, thus, offering the chance to initiate an appropriate adjuvant therapy at the earliest possible time. Stage I and stage II tumors as well as differentiated tumors showed a significantly lower recurrence rate than tumors of stages III and IV and low‐grade tumors. THE offers good quality of life in virtually all patients and is able to restore a normal food intake in all but a few patients. Due to the high rate of local tumor recurrence, it is suggested that THE should probably be reserved for poor‐risk patients whereas good‐risk patients with limited disease would profit from a thoracoabdominal esophagectomy with lymph node dissection.
Caroli's disease
Authors: Mercadier M. , Chigot J. P. , Clot J. P. , Langlois P. , Lansiaux P.
Published: May 2005

In 1958, Caroli [1, 2] was the first to describe congenital dilatations of intrahepatic bile ducts concerning a segment, a sector, a lobe, or both halves of the liver. Sometimes the dilatations are associated with congenital hepatic fibrosis as described in 1954 by Grumbach [3], dilatations of biliary ductules (biliary angiomatosis), and parenchymal sclerosis. This hereditary autosomal recessive disease is associated in many cases with nephrospongiosis or Cacchi‐Ricci's disease [4].

Caroli's disease is quite rare. By 1982, a total of 99 cases had been reported in the world literature. Aside from these cases we have seen and operated on 10 patients [5, 6].

In Caroli's disease, stenosis and dilatations give rise initially to biliary stasis and, secondly, to intrahepatic biliary lithiasis and biliary infection. The normal course in Caroli's disease consists of suppurative cholangitis, septicemia with gram‐negative organisms, and intrahepatic and subphrenic abscesses. The disease must be recognized before these serious complications arise. The new hepatobiliary imaging procedures should now allow an early diagnosis and, therefore, a better therapeutic approach.
Choice of treatment for hepatolithiasis based on pathological findings
Authors: Koga Akitoshi , Miyazaki Kohji , Ichimiya Hitoshi , Nakayama Fumio
Published: May 2005

The results of surgical treatment in 56 patients with hepatolithiasis are reported including a follow‐up study on 53 patients who survived more than 1 year (median, 5 years and 8 months). Patients were treated by 4 different procedures, i.e., common duct exploration in 32 patients, hepatic resection in 13 patients, hepatic resection with intrahepatic cholangiojejunostomy in 6 patients, and endoscopic stone removal in 5 patients. These procedures were combined with additional procedures, i.e., sphincteroplasty and bilioenteric anastomosis when necessary. There were no operative deaths. The stones were completely removed in 51.8% of the patients. Follow‐up study for 1 to 10 years showed good results in 70.8% of the patients. Residual stones were often observed in the cases with stricture at the liver hilum and this led to poor results at follow‐up. The results of various procedures were evaluated in relation to the prevailing pathology such as bile duct stricture and the location of stones.
Multimodal therapy in anaplastic giant cell thyroid carcinoma
Authors: Werner B. , Abele J. , Alveryd A. , Björklund A. , Franzén S. , Granberg P. ‐O. , Landberg T. , Lundell G. , Löwhagen T. , Sundblad R. , Tennvall J.
Published: May 2005

A therapy aiming at pre‐ and postoperative radiotherapy with concomitant chemotherapy has been used in 19 patients with anaplastic giant cell carcinoma of the thyroid gland. Radiotherapy was administered twice daily, 5 days a week; the cytostatic drugs employed were bleomycin, cyclophosphamide, and 5‐fluorouracil. Patients with advanced disease (distant metastases and/or vocal cord paralysis,n= 9) had a median survival time from diagnosis of 7 months, while patients with less advanced disease survived on average 12 months. In the latter group there were 3 survivors. The patients who died succumbed to metastatic disease rather than to local growth. No patient required tracheostomy and the side effects due to treatment were usually well tolerated.
Complications of the Swan‐Ganz catheter
Authors: Slung Hilton B. , Scher Kenneth S.
Published: May 2005

Two hundred thirty Swan‐Ganz catheters were inserted into 225 patients. Meticulous attention was paid to techniques of insertion and post‐insertion catheter care. The preferred route of insertion was via the right internal jugular vein.

Minor problems included neck hematomas in 5 attempts (2.2%), catheter migration after insertion in 13 cases (5.6%), and 1 balloon rupture. Only 9 of 230 catheter insertions (3.9%) were associated with major complications. Six of 9 problems, classed as major, were transient arrhythmias which occurred during catheter insertion but were rapidly corrected. In one patient the catheter knotted and had to be removed in the cardiac catheterization laboratory. Two patients (0.9%) suffered non‐fatal pulmonary artery injuries. There were no episodes of catheterrelated sepsis nor were there any deaths attributed to the use of the catheter.

We conclude that the flow‐directed pulmonary artery catheter is a relatively low‐risk monitoring device.
Chronic acalculous gallbladder disease: A clinical enigma
Authors: Nora Paul F. , Davis Robert P. , Fernandez Michael J.
Published: May 2005

Patients with classic symptoms of gallbladder disease who have negative oral cholecystograms (OCG) or ultrasonography present perplexing management problems. The surgical literature attests to the fact that there is a marked difference of opinion as to the role of surgery in these patients. The high recurrence rate of symptoms in patients following surgery reported in some series has been a source of major concern.

We have attempted to define the appropriate approach to this problem for the past decade. Initially, the findings of prolonged visualization of the gallbladder on OCG in association with a fatty meal was considered an indication for surgery. This initial group of patients followed over a decade showed about 75% to be symptom free. Subsequently, additional patients were subjected to cholecystokinin oral cholecystography (CCK‐OCG). With follow‐up for over 6 years, the results have shown about 80% relief of biliary tract symptoms in these patients (CCK‐OCG category) following surgery.

Continued attempts to further define those patients who will benefit from surgery has resulted in the utilization of radionuclide imaging in association with cholecystokinin injection (CCK‐RNI). One hundred patients were subjected to CCK quantitative biliary imaging. Seventy‐six patients were considered to have inadequate gallbladder emptying; 30 patients with no gallbladder emptying on CCK‐RNI were subjected to cholecystectomy. All patients subjected to cholecystectomy showed abnormal histological findings in the gallbladder. These 30 patients have been followed from 1 to 3 1/2 years and there has been no recurrence of symptoms in any following surgery.
Segmental versus total colectomy for large bowel Crohn's disease
Authors: Stern H. S. , Goldberg S. M. , Rothenberger D. A. , Nivatvongs S. , Schottler J. , Christenson C. , Nemer F. , Balcos E.
Published: May 2005

Reports of the long‐term results of excisional surgery for Crohn's disease restricted to the large intestine have revealed apparently conflicting data. Recurrent enteritis after colectomy and ileotomy varies from 3% to 46%. Variations in patient selection, differences in pathologic criteria and criteria for defining recurrences, and length, completeness, and accuracy of the follow‐up may well explain such differences in the literature. Certainly, the extent of the operative procedure could influence recurrence rates. A retrospective review was undertaken to determine whether segmental colon resection was ever justified in patients with Crohn's disease clinically confined to the colon.
Excessive bleeding at hepatic resection after experimental liver denervation
Authors: Kullendorff C. ‐M. , Zoucas E. , Lindfeldt J. , Holmin T.
Published: May 2005

The effects of microsurgical denervation of the liver on blood loss, bleeding time, platelet count, and partial thromboplastin time (APT‐time) after standardized liver resection were studied in the rat. The hepatic nerves in the hepatoduodenal ligament were dyed, identified, and resected with the aid of a microsurgical technique. During the same anesthesia and also one week after denervation, a 3‐ to 4‐fold increase in blood loss and bleeding time was demonstrated when compared to sham‐operated and control rats. As a result of the increased blood loss, hemoglobin and hematocrit values fell, whereas platelet count and APT‐time were essentially unchanged. The denervation procedure had no influence on platelet aggregation. In all probability, the increased bleeding after hepatic resection in the denervated rats is a reflection of an interrupted nerve supply to the liver. The results may have interesting implications for human liver surgery.