bluuebunny/crossref_metadata_2025 huggingface dataset:
The J ileal pouch‐anal anastomosis
Authors: Taylor Barry A. , Dozois Roger R.
Published: May 2005

The experience at the Mayo Clinic, Rochester, Minnesota, U.S.A., with abdominal colectomy, mucosal proctectomy, and ileo‐anal anastomosis is now approaching 600 patients. The procedure is safe and, with careful timing and selection of patients, can be performed with minimal mortality. Postoperative morbidity, however, is still considerable, even in the most experienced hands. Increasing experience with the procedure has been shown to be associated with a continuing decline in the incidence of postoperative complications, and a defunctioning ileostomy is still a necessity in the majority of patients.

Long‐term functional results of the procedure are satisfactory and have been shown to improve both with the experience of the operator and with the passage of time after surgery. Patient acceptance remains the ultimate sanction, and it appears that the majority of patients are satisfied with their outcome after ileo‐anal anastomosis, with only very few being prepared to consider an alternative. The operation appears to provide a superior quality of life relative to that expected after proctocolectomy and Brooke ileostomy.

Not all patients with chronic ulcerative colitis or adenomatosis coli are potential candidates for this procedure, however. The problems of age, obesity, indeterminate colitis and Crohn's disease, co‐existing colorectal neoplasia, technical difficulties at the time of the operation, and the wishes of the patient all must be taken into consideration when assessing the optimal operation in a particular situation. Proctocolectomy with Brooke ileostomy or continent ileostomy and total abdominal colectomy with ileo‐rectal anastomosis both still have roles in the management of diseases such as chronic ulcerative colitis and adenomatosis coli. For a patient who is young, relatively fit, and well motivated and in whom there is little or no doubt about the diagnosis, ileo‐anal anastomosis must be considered as the possible treatment of choice. Increasing experience with the procedure and improvements in functional results seem to be confirming this position.
The S ileal pouch‐anal anastomosis
Authors: Vasilevsky Carol‐Ann , Rothenberger David A. , Goldberg Stanley M.
Published: May 2005

In order to determine the results with the S ileal pouch‐anal anastomosis, 116 consecutive patients who had undergone total abdominal colectomy with rectal mucosectomy and endorectal ileal pouch‐anal anastomosis were assessed following ileostomy closure. In 11 patients (9.5%) pouch removal and/or conversion to permanent ileostomy was necessary because of Crohn's disease (3), pelvic sepsis (3), pouchitis (2), incontinence (2), or perineal fistula (1). Although no postoperative mortality was experienced, one or more complications was experienced in 87 patients. These consisted mainly of small bowel obstruction in 35%, pouchitis in 22%, anastomotic stricture in 14%, pelvic sepsis in 9.5%, and perianal abscess or fistula in 5%. Laparotomy was required in 29% of patients mostly for resolution of small bowel obstruction. Follow‐up in the remaining 105 patients ranged from 5 to 67 months with a mean of 28 months following ileostomy closure. Stool frequency was 6.6 bowel movements per day and 1.4 bowel movements per night. Eighty‐nine percent evacuated their pouches spontaneously, and 61% did not require the use of medication for bowel movement regulation. Major daytime incontinence occurred in 4%, while 15% reported nocturnal incontinence. Minor incontinence was experienced by 30% and 48% during daytime and nighttime, respectively. Despite a myriad of complications, 96% of patients unhesitatingly stated that they would undergo the procedure again so that they could avoid a permanent stoma. We conclude that restorative proctocolectomy utilizing the ileal S pouch‐anal anastomosis is an acceptable procedure that should be considered as a viable choice in the treatment of chronic ulcerative colitis and familial polyposis requiring surgical intervention.
The use of the cecum for cecocystoplasty
Authors: Ashken Michael Handley
Published: May 2005

Cystoplasty is a well‐established technique for the enlargement of a contracted bladder due to tuberculosis or interstitial cystitis. It may also be a practical alternative to urinary diversion for some bladder tumors and in carefully selected forms of neuropathic bladder.

The choice of bowel segment used for bladder augmentation or substitution will depend largely on the personal preference of the individual surgeon, for no one segment is clearly any better than many others. My own preference is for the ileocecal segment because it gives a flexibility of reconstruction, particularly for replacing diseased ureters as well as the bladder. Apart from its suitable shape, it also has a good blood supply and relative freedom from compromising pathological conditions.

The functional results of a supratrigonal cecocystoplasty are better than those of a subtotal or total cystectomy with ureteroileal cecocystoplasty because the lack of bladder sensation in these latter groups results in nocturnal incontinence. By voiding at suitable intervals, diurnal continence is often achieved.

If incontinence becomes a serious problem, it may be corrected with either an artificial urethral sphincter or a colposuspension operation with intermittent self‐catheterization for any urinary retention.

It is essential to follow these patients carefully, both clinically and radiologically, and with urodynamic studies. This gives the basis for logical pharmacological and endoscopic control of the voiding balance between bladder pressure and outflow resistance.
Continent urinary diversion by means of a cecal reservoir
Authors: Månsson Wiking , Colleen Stig
Published: May 2005

An ileocecal segment was used to construct a continent urinary reservoir in 30 patients beginning in 1977, with technical modifications successively introduced. An intussuscepted ileal nipple valve protruding into the cecal cavity is responsible for continence. In the current model, valve stability is achieved by means of mesenteric exclusion from the valve, a fascia strip sling around the nipple base, fixation of the valve to the inner cecal wall, and anchoring of the nipple base to the anterior rectus sheath. The ureters are implanted into the cecum with antireflux technique. Most of the early complications were of types associated with any mode of urinary diversion. The most common late complication was malfunction of the ileal nipple valve, and 16 patients required revisional procedures. Of 29 patients eligible for assessment, 25 achieved a good functional result, i.e., a dry stoma and easy catheterization. Augmentation of the reservoir was needed in 1 patient. Apart from low serum cobalamin levels in 2 patients, no metabolic or electrolyte disturbances were seen. Clinical signs of urinary tract infection appeared only in patients with obstruction of the upper urinary tract. The renal function was unaltered at long‐term follow‐up despite intermittently high intrareservoir pressure. For selected patients the continent cecal reservoir should be considered as an important alternative to other forms of urinary diversion.
Biological consequences of exposing ileal mucosa to urine
Authors: Philipson Bertil M. , Höckenström Thomas , Åkerlund Staffan
Published: May 2005

Segments of ileum are often used as conduits in connection with supravesicle diversion or sometimes for bladder augmentation. This implies that ileal mucosa will be deprived of the normal intestinal contents and instead exposed to urine. Reports on the morphological consequences of exposure to urine have been contradictory. Either normal structure or various degrees of atrophy have been reported. For this reason, an investigation was designed for systematic follow‐up of effects on the ileal mucosa in patients with continent ileal reservoirs for urinary collection (Kock pouch). These investigations showed that there were significant changes in villous height, crypt depth, and number of goblet cells starting early after construction and leading to complete atrophy in certain areas. Electron microscopy and enzyme histochemistry also showed, in the epithelial cells, that there was a reduction in the number of cell organelles and microvillous units, and also decreased metabolic activity. Reductions were also recorded in studies of net transport of both water and electrolytes across the mucosa of the ileal reservoir used for urinary collection.

From the clinical point of view, the adaptive changes recorded in the investigations of ileal mucosa exposed to urine are advantageous, since the risk of metabolic disturbances due to reabsorption of urine is diminished.
Volume capacity and pressure characteristics of various types of intestinal reservoirs
Authors: Berglund B. , Kock N. G.
Published: May 2005

The volume capacity and the pressure characteristics of 3 types of intestinal reservoirs, the continent ileostomy, the continent ileal urostomy, and the continent cecostomy, were studied in patients at intervals after surgical construction of the reservoirs. The volume increases of the ileostomy and the urostomy reservoirs were almost identical but were significantly greater than that of the cecal reservoir. The basal pressure was low in all types of reservoirs, although somewhat higher in the cecal reservoir at greater filling volumes. In the ileal reservoirs, motor activity appeared at a filling volume of about 40% of the maximal capacity, whereas in the cecal reservoir motor activity was recorded at all filling levels. The motor activity increased with greater volumes. The amplitude of the highest pressure wave in the cecal reservoir was twice as high as that of the ileal reservoirs. The motor activity of the cecal reservoir, calculated in 2 different ways, was 10–20 times greater than in the ileal reservoirs. Reflux into the afferent loop was demonstrated in the ileostomy reservoir at a filling volume of approximately 30% of the maximal volume capacity.
Carcinoma of the colon: Long‐term survival and prognosis after surgical treatment in a series of 798 patients
Authors: Moreaux Jean , Catala Marc
Published: May 2005

From 1964 to 1985, a total of 798 patients (405 female, 393 male) were operated on for a single cancer of the colon. Fifty‐eight percent of the patients were between 60 and 80 years of age. Liver and/or peritoneal métastases were present in 16.3% of the 818 cases. Resection was performed in 754 cases (92.2%), and was considered to be curative in 646 (78.9%). Tumors were differentiated in 90.5% of the cases. Regional lymph nodes were involved in 33.3% and serosal penetration was present in 19.5% of the cases.

There were 7 postoperative deaths, 3 (0.5%) of them after curative resection. The actuarial curves of survival showed a probability of survival after all operations of 62% at 5 years and 46% at 10 years, and after curative resection of 78% at 5 years and 58% at 10 years. Prognosis has been established from the 513 patients operated on before 1980; follow‐up data were available for all but 4 of them. Tumor site in the right or left colon did not relate significantly to survival. Tumor staging was the main prognostic factor. The 5‐year survival rate was 40% in patients with positive nodes, 74.7% in those with negative nodes (p<0.001), 97.6% in those with invasion limited to mucosa or submucosa, and 41.9% in those with serosal invasion (p<0.001). Based on Dukes' classification, the 5‐year survival rates for A, B, C., and D tumors were 91%, 76.7% (p=0.01), 53.1% (p<0.001), and 4.7% (p<0.001), respectively. Time elapsed between first symptom and operation did not relate significantly to survival. Prognosis was better in patients less than 50 years old when compared with patients 50–70 years of age (p<0.01), and was better in female patients than in male patients (p =0.02).
The turnover of brain monoamines after total hepatectomy in rats infused with branched chain amino acids
Authors: Bugge Mogens , Bengtsson Finn , Nobin Anders , Jeppsson Bengt , Herlin Per
Published: May 2005

The metabolism of monoamines in the brain of rats in fulminant hepatic failure was studied after administration of branched chain amino acids (BCAA). Male Sprague‐Dawley rats were exposed to a total hepatectomy or a sham operation and infused intravenously for 5 hours with a 10% glucose solution alone or 10% glucose + 0.24 mol/l BCAA (0.08 mol/l of each valine, leucine, and isoleucine). Thirty minutes before decapitation, a decarboxylase inhibitor (NSD 1015®), blocking the conversion of 5‐hydroxytryphtophan (5‐HTP) to 5‐hydroxytryptamine (5‐HT), and dihydroxyphenylalanine (DOPA) to dopamine (DA), was injected intraperitoneally. The concentrations of 5‐HTP, 5‐HT, and 5‐hydroxyindoleacetic acid (5‐HIAA) were analyzed by high‐performance liquid chromatography, DOPA, DA, and norepinephrine (NE) by a radio‐enzymatic method in 8 different regions of the brain and spinal cord. The concentrations of 5‐HTP were increased in the brains of hepatectomized rats, indicating an increased synthesis rate of the indoleamines. After administration of BCAA to hepatectomized rats, the synthesis rate was decreased to normal or, in some brain regions, even to subnormal values. The brain and spinal cord concentrations of DOPA and DA were unchanged in hepatectomized rats compared to sham‐operated animals, indicating an unchanged turnover of the catecholamines. The levels of NE in the diencephalon and in the spinal cord were decreased after hepatectomy. The level of consciousness was not influenced by the BCAA infusions.

It is concluded that BCAA infusion may normalize brain indoleamine synthesis in hepatectomized rats, whereas the catecholamine synthesis and the level of consciousness are unaffected by the BCAA administration.
Basal and dose‐response studies of gastric mucosal blood flow: Comparison of duodenal ulcer patients before and after highly selective vagotomy with normal volunteers
Authors: McIsaac Richard L. , Johnston Belinda J. , Fielding L. P. , Dudley Hugh A. F.
Published: May 2005

Gastric mucosal blood flow (neutral red clearance, NRC) and acid secretion were measured before and after highly selective vagotomy (HSV). Eleven patients with duodenal ulcer were studied before and 12–21 days after HSV. Eight volunteers were also studied using the histamine‐H2‐receptor antagonists cimetidine and ranitidine. Basal secretion was collected for 40–50 minutes and pentagastrin was given in increasing doses each for 40 minutes. Data were analyzed using Wilcoxon's signed‐ranks test for paired samples and an analysis of covariance. Basal NRC was similar both for patients and for volunteers and was unaffected by HSV. There was a linear correlation between NRC and acid output. The patients with duodenal ulcer had a lower ratio of NRC to acid during pentagastrin stimulation than was found in normal subjects, but the regression line after HSV was comparable to that found for the volunteers. Although stimulated acid output was reduced by HSV, NRC was significantly higher after HSV than before. The 2 histamine‐H2‐receptor antagonists reduced both NRC and acid to a similar extent, and this could not be overcome by increasing the dose of pentagastrin. These results indicate that mucosal blood flow and acid secretion may not be unconditionally linked, although a linear relationship was always found. HSV produces an effect on blood flow that is not linked to the reduction in acid output.
Bronchoplasty for bronchogenic carcinoma
Authors: Ayabe Hiroyoshi , Nakamura Yuzuru , Miura Toshio , Kugimiya Toshiyasu , Koga Yasunori , Tsuji Yasukuni
Published: May 2005

This report details our experience in 34 patients with primary bronchogenic carcinoma who underwent broncho‐plastic lobectomy between 1969 and 1981. Twenty‐four had squamous cell carcinoma, 6 had adenocarcinonia, 2 large‐cell carcinoma, 1 small‐cell carcinoma, and 1 combined type. Twelve patients had no lymph node involvement, while 10 had hilar node metastasis and 12 had mediastinal node metastasis.

Sleeve lobectomy was accomplished in 19 patients and wedge lobectomy in the remaining 15. Bronchoplasty was performed for direct tumorous invasion in 26 patients, whereas in 8 patients this procedure was done when metastatic cancer had involved the main bronchus.

There were 3 operative deaths (8.8%). One was ascribed to tension pneumothorax, one to postoperative bleeding, and the other to myocardial infarction. One patient developed a bronchopleural fistula and died 44 days after completion pneumonectomy. Another died of massive hemorrhage from a bronchopulmonary artery fistula in the fourth postoperative month. Bronchial stenosis was observed in 4 patients: 3 granulation formation and 1 local recurrence.

The 5‐year survival rate was 17%, which was higher than that of pneumonectomy. Early postoperative pulmonary function studies revealed good function of the reconstructed lung.

Bronchoplasty for bronchogenic carcinoma is an effective procedure for preserving pulmonary parenchyma and controlling the disease.
Rate of wound sepsis with “selective” short‐term antibiotic prophylaxis in gastric surgery
Authors: Keighley Michael R. B. , Burdon Douglas W. , Gatehouse David
Published: May 2005

A policy of selective antibiotic prophylaxis was used in 75 consecutive patients undergoing elective gastric operation. Only patients with preoperative bacterial counts in the gastric aspirate exceeding 106 organisms/ml were given antibiotics, and the choice of agent was determined by preoperative gastric culture. Using this policy, only 8% of patients developed wound sepsis and only 19 patients received an antibiotic. There was a close correlation between the pH of the gastric aspirate and bacterial contamination, which indicates that the measurement of the pH may serve as a basis for prophylactic antibiotic administration and obviate the need for elaborate preoperative bacteriological studies. The results were significantly better than in a previous group of 73 patients who were given no antibiotic cover irrespective of the preoperative gastric microflora.
A modification of the Warren shunt
Authors: Raju Seshadri
Published: May 2005

A technical modification of the Warren distal splenorenal shunt is described. A segment of internal jugular vein is utilized to connect the distal splenic vein to the renal vein. This technical modification results in significant reduction in operating time and intraoperative blood loss and is technically easier to perform. These benefits accrue primarily by avoiding extensive mobilization of the splenic vein, a step otherwise necessary in performing the original Warren shunt. The modified shunt was successfully carried out in 10 patients. There was a single in‐hospital death following the procedure. In a follow‐up period ranging from 3 months to 5 years and 6 months, shunt patency was demonstrated to be excellent.
Transaxillary thoracic sympathectomy for primary hyperhidrosis of the upper limbs
Authors: Sternberg Ahud , Brickman Shmuel , Kott Itamar , Reiss Raphael
Published: May 2005

Although a benign condition, primary hyperhidrosis of the upper limbs (palmar and axillary) may cause considerable psychological, social, and occupational disturbances. Definitive surgical treatment (i.e., upper dorsal sympathectomy) is justified after failure of conservative measures. Of the various surgical approaches to the upper thoracic sympathetic chain, one must select the approach that combines excellent results (cosmetic outcome included) with only minor and infrequent complications and side effects.

Our experience with 70 thoracic sympathectomies (initially performed through a wide thoracotomy, currently by the transaxillary approach) followed up for an average of 25 months (range 1–87 months), corresponds with these strict criteria: 94% completely dry hands; 86% total, and an additional 10% partial, subjective satisfaction with the results; minimal and relatively mild side effects and complications.

These results compare favorably with reports in the literature regarding thoracic sympathectomies performed through alternative approaches, indicating that the transaxillary approach is at least as good as the other approaches. At the same time, side effects and complications are less frequent and of a milder character with the transaxillary approach. We, therefore, recommend the axillary approach for thoracic sympathectomy in cases of hyperhidrosis of the upper limbs.
A clinical and physiological evaluation of bowel preparation for elective colorectal surgery
Authors: Keighley M. R. B.
Published: May 2005

Efficient mechanical bowel preparation is essential for satisfactory double‐contrast barium enema and colonoscopy. Satisfactory mechanical preparation is also important for reducing the risk of anastomotic dehiscence and sepsis in elective colorectal surgery. Traditional mechanical preparation by fasting, purgation, and enemas is timeconsuming, unpleasant for patients and nursing staff, and in our center, results in a perfect preparation in only 23% of patients. Elemental diets are expensive and inefficient when used for only 5 days. Whole bowel irrigation involves the use of a nasogastric tube and provides a rapid preparation with a perfect result in 61% of patients, but is not recommended for patients with stenosing tumors. Furthermore, irrigation with saline causes sodium and water retention which may precipitate heart failure in the elderly unless preceded by furosemide. The use of a balanced electrolyte solution reduces the risk of these side effects. Recently, oral irrigation with mannitol has become popular, but in our experience, results in a perfect preparation in only 41% of patients unless followed by a short saline lavage (85% satisfactory). Mannitol also produces potentially explosive gas mixtures by bacterial fermentation unless oral antimicrobials (neomycin and metronidazole) are used immediately before operation. Therefore, we recommend mannitol, saline lavage, and antibiotics in most cases, but still find a place for traditional preparation over 5 days for patients with tumors associated with severe stenosis of the left colon.
Function of pancreatic endocrine cells in experimental acute pancreatitis
Authors: Kinami Yoshio , Mura Toshinari , Sugii Mamoru , Miyazaki Itsuo
Published: May 2005

This experimental study was carried out to clarify changes in pancreatic endocrine function in acute pancreatitis. Male Donryu rats were divided into 2 groups, consisting of a group with acute pancreatitis induced by Block's method, and another group with simple laparotomy as control. Histological examination in the former group revealed an interstitial edematous pancreatitis, but there was no marked alteration of endocrine cells in spite of inflammatory changes in the exocrine region. Insulin and glucagon levels in the pancreatic tissue of rats with acute pancreatitis were significantly lower than those of control rats. Autoradiographic studies using3H‐leucine showed a significant decrease of grain counts for endocrine granules in rats with acute pancreatitis. The release of insulin from isolated islets of Langerhans was not reduced until 72 hours after the development of acute pancreatitis, while the release of glucagon from isolated islets was reduced 6 hours after the development of acute pancreatitis. These findings indicate that there is a reduction of synthesis and secretion function in endocrine cells of the pancreas in acute pancreatitis, and suggest that the damage to A cells occurs more rapidly than damage to B cells.
Cadaveric organ retrieval for transplantation
Authors: van der Vliet J. A. , Kootstra G. , Krom R. A. F.
Published: May 2005

To relieve the persistent shortage of cadaveric donor organs for transplantation, organ harvesting may become a routine procedure in all general hospitals. Because of that prospect, the selection of donors, donor management, techniques of nephrectomy, hepatectomy, and pancreatectomy, and preservation procedures are described. Finally, criteria for the establishment of regional procurement programs, involving a professional transplant coordinator, are elucidated.
Successful closure of a traumatic pulmonary arteriovenous fistula of the main pulmonary artery
Authors: Stelter W. ‐J. , Walter P. , Ernst R. , Werdan K.
Published: May 2005

The case of a 53‐year‐old man who suffered from a penetrating chest injury in World War II is reported. Thirty‐four years later, an arteriovenous pulmonary fistula arising from this injury was diagnosed and closed by direct suture. A review of the literature indicates that this is the fifth case of a pulmonary fistula of traumatic origin, and the first case in which such a fistula has been successfully closed without resection of lung tissue.
Primary resection in perforating diverticulitis of the colon
Authors: Risholm Lars
Published: May 2005

The surgical treatment of perforated diverticulitis of the colon remains a controversial issue. Since 1974 the author's surgical group has consistently utilized emergency removal of the perforated section of the colon in 37 consecutive cases. Resection with primary anastomosis was done in 6 cases, and exteriorization in the remainder (Hartmann's procedure, 26 cases; Bloch‐Mikulicz, 5 cases). There were 2 postoperative deaths in elderly females. Postoperative course was uneventful in the other cases, there being no serious complications. Our conclusion is that it should be considered essential to remove a perforated colonic segment from the peritoneal cavity.
Endoscopic insertion of the celestin tube in patients with esophageal cancer
Authors: Struve‐Christensen E. , Aasted A. , Bertelsen S.
Published: May 2005

A new method for inserting endoesophageal tubes is described. In patients with stenosing, inoperable esophageal malignancies, a passage through the neoplastic masses must be secured to avoid dysphagia and salivation. By first dilating the tumor lumen with the Eder‐Puestow apparatus and then inserting the correctly cut tube using endoscopic equipment, an operation can be avoided.

In 28 patients, a Celestin tube was thus inserted. The method involved only a few complications. It can be recommended as an alternative to existing operative methods for endoesophageal intubation.
Evolution and pathology of rectal cancer
Authors: Hermanek Paul
Published: May 2005

In the evolution of rectal cancer, the adenoma‐carcinoma sequence is of the greatest importance. In the rectum, we should employ the termcarcinomaonly when the tumor has penetrated the muscularis mucosae and has invaded at least the submucosa. If the invasive growth is limited to the submucosa (early colorectal carcinoma), the prognosis is excellent. The further progression of the tumor is both horizontal and vertical. With increasing vertical growth (penetration), the incidence of lymphatic metastases rises. Lymphatic spread follows certain rules, which are of significance in the selection of surgical procedure. Histological evidence of venous invasion signals the danger of hematogenic dissemination.

Tumors with different histological grades of malignancy also reveal a different pattern of biological behavior. The individual pathology of the tumors is characterized by typing, grading, and staging. This provides the basis for the planning and performance of surgical therapy, in the sense of a “histology‐ and stage‐adapted therapy,” and for an assessment of the prognosis, and also is prerequisite for the subsequent evaluation of the results of treatment.
Assessing the problem, preparing the patient, and minimizing the risks in rectal cancer surgery
Authors: Alexander‐Williams J. , Keighley M. R. B.
Published: May 2005

Before treating rectal cancer, the surgeon should assess accurately the size, differentiation, and invasiveness of the tumor, as well as the patient's mental and physical preparedness for the planned therapy. When sphincter‐saving surgery is intended, anal function should be measured. With the patient in the optimal mental and physical state, the bowel should be prepared before operation in the most economical and least physiologically disturbing manner. With careful attention to minimizing the risks of sepsis and cardiorespiratory, thromboembolic, and urinary complications, the mortality from major potentially curative rectal operations should now approach zero.
Per‐anal anastomosis
Authors: Parks Alan G.
Published: May 2005

Between 1973 and 1980, a total of 76 patients with rectal carcinoma underwent rectal resection and restoration of bowel continuity by means of a sutured anastomosis between the colon and anal canal. The pathological characteristics of these tumors were similar to those of all cases of carcinoma of the rectum treated at St. Mark's Hospital between 1948 and 1972. Two patients developed pelvic sepsis following colonic necrosis and anastomotic breakdown. Eight developed pelvic sepsis without major anastomotic breakdown. No patient died as a result of pelvic sepsis. Sixty‐nine of the 70 patients who were able to be assessed were either completely normal functionally or had only minor deficiencies of bowel function.

Six patients have been observed to develop recurrent pelvic tumor, localized to the pelvis in 4 and concurrent with the development of widespread metastases in 2. Twenty‐one of 32 patients are alive 3 years and 12 of 19 patients are alive 5 years after a curative operation for rectal carcinoma. These results are comparable with those seen following total excision of the rectum and pelvic floor for similarly sited tumors.
The parasacral sphincter‐splitting approach to the rectum
Authors: Allgöwer M. , Dürig M. , Hochstetter A. v. , Huber A.
Published: May 2005

The parasacral, in most instances sphincter‐splitting, approach to the lower rectum has been used in 79 instances with no operative mortality; 36 cases of low rectal cancer were the subject of this paper. In UICC stages Ia and Ib (limited to mucosa and submucosa) and stage‐II tumors, those of the T2N0 type (penetration of rectal musculature wall with no lymph node involvement), are good indications for this conservative surgery of very low rectal malignancies at any age; the stage of local lymph node invasion and the depth of rectal invasion require intraoperative histological evaluation. In more advanced tumor stages this approach should be considered only if abdominoperineal amputation is categorically refused or if the patient is at very high risk (e.g., in very old patients). The parasacral operation is surprisingly well tolerated, provided the 2–3‐hour procedure is carried out under optimal cardiorespiratory supervision and care.
Management of the colostomy
Authors: Schwemmle K. , Kunze H. ‐H. , Padberg W.
Published: May 2005

Although the care of the artificial anus is solved to a satisfactory degree and most of the patients have no problems with it, the decision to perform a definitive colostomy must be reflected thoroughly. It should not be performed unless alternative methods, particularly the deep anterior resection of the rectum, can be excluded. In stoma care the peristomal skin must be completely covered to avoid inflammatory reactions caused by contact with stool and secretions. All stoma patients should be familiar with the use and performance of the irrigation, since this permits evacuation of the bowel at a convenient time.

Among experimental studies of operative measures to accomplish a certain sphincter function of the artificial anus, the magnetic closure device and the free muscle transplantation have gained some popularity. Further experience is necesssary with the hydraulic sphincter prosthesis.
The follow‐up of patients after definitive resections for large bowel cancer
Authors: Enker Warren E. , Kramer Robin G.
Published: May 2005

The follow‐up of patients with colorectal cancer is a representative model for the management of solid tumors. A program that integrates multidisciplinary care serves the best interests of patients in the areas of identification and management of recurrence, identification and prevention of metachronous disease, detection of independent new primary cancers, and establishment of programs for particular high‐risk categories. Data evolving from such organized follow‐up efforts will benefit the management of all patients.
Parietal cell vagotomy: Experience with 114 patients with prepyloric or duodenal ulcer
Authors: Hollinshead John W. , Smith Ross C. , Gillett David J.
Published: May 2005

A review of 114 patients following parietal cell vagotomy (PCV) is presented, showing a satisfactory result in duodenal ulcer patients (recurrence rate, 5.8%; Visick grade III and IV, 16%) but unsatisfactory results in patients with prepyloric or combined duodenal and gastric ulcers (recurrence rate, 44%; Visick grade III and IV, 62%). We conclude that parietal cell vagotomy is an excellent operation for duodenal ulcer, but it is unsatisfactory when there is evidence of past or present gastric ulceration.
The role of portal blood factors in regeneration of the liver
Authors: Takeshige Kotohito , Kuroda Hirofumi , Fukaya Yoshitaka , Suzuki Hiromichi , Hasegawa Makoto , Yamamoto Sadahiro
Published: May 2005

A new hepatic blood flow diversion method was undertaken to investigate further the influence of pancreatic hormones and hepatic blood flow on the functional regeneration of the liver. The new technique does not use venograft. The splenic vein was dissected and anastomosed to the proximal portal vein, which supplied the right lobes, and the mesenteric vein was dissected and anatomosed to the left portal vein at the hilus of the liver, which supplied the left lobes.

Mongrel dogs weighing approximately 10 kg were used. The right lobe received pancreatico‐gastrosplenic blood. The left lobe received intestinal blood. After hepatectomy, which removed 10% from the right side and 40% from the left side, blood flow volume to the right and left lobes was almost equal. The right lobes increased in weight significantly more than the left lobes. The extraction rates of indocyanine green of the right and left lobes were not significantly different. The right lobe revealed typical regeneration histologically, but the left lobe showed no signs of atrophy. Although pancreatic hormones were sufficiently supplied to the left lobe through the hepatic artery, they were not degraded. Pancreatic hormones could be a modifying factor affecting the quantity of hepatic regeneration. The study of both the quantity and the functional quality of the regenerated liver is important.
Results of surgical treatment in N2 lung cancer
Authors: Martini Nael , Flehinger Betty J. , Zaman Muhammad B. , Beattie Edward J.
Published: May 2005

Eighty patients were treated by resection for carcinoma of the lung with mediastinal lymph node metastases. Complete resection of the primary tumor and a mediastinal lymph node dissection were performed on all patients. The majority also received postoperative external radiation therapy to the mediastinum. Survival after resection was 47% at 3 years and 38% at 4 years. Survival was better when the histologic diagnosis was adenocarcinoma, when the primary tumor was small, and when the mediastinum appeared normal on regular chest roentgenograms.
Chemotherapy of non‐small cell lung cancer: Clinical trials at the Memorial Sloan‐Kettering Cancer Center
Authors: Gralla R. J. , Wittes R. E. , Casper E. S. , Kelsen D. P. , Cvitkovic E. , Magill G. B. , Krown S. E. , Golbey R. B.
Published: May 2005

Bronchogenic carcinoma is one of the most difficult and pressing problems in cancer therapy. Overall survival of 799 primary cases at Memorial Sloan‐Kettering Cancer Center was 7.8%, reflecting the advanced nature of most lung cancer at the time of presentation and the inadequacy of current local therapies as potential cures. The need for effective systemic therapy having acceptable toxicity is obvious. From 1972 to 1975, four combination drug regimens were tested at the Center: MAV, MFC, CAMF, and VAB. Despite the lack of significant responses, the median survival was 2.5 to 6 months. A subsequent study of the effect of high doses of cyclophosphamide, followed by high doses of methotrexate with leukovorin rescue, produced significant toxicity; partial responses were seen in 5/20 patients. Other agents tested have included pyrazofurin, vindesine, chlorozotocin, PCNU, PALA, m‐AMSA, and interferon. Only vindesine has shown promise. Recent trials of cisplatin (DDP) in combination with vindesine have been encouraging. Eighty‐one patients with measurable inoperable non‐small cell lung cancer have been treated with this combination. Toxicity has been easily managed. Complete or partial responses have been demonstrated in 43 percent of 35 patients. Duration of response has been significantly greater for patients receiving high‐dose DDP as compared to low‐dose DDP. Addition of cyclophosphamide to the regimen appeared to offer no obvious advantages. Future studies include a clinical trial of the DDP‐vindesine combination in the adjuvant setting.
The place of radiotherapy in the treatment of lung cancer
Authors: Hilaris Basil S. , Martini Nael , Nori Dattatreyudu , Beattie Edward J.
Published: May 2005

Few patients with bronchogenic non‐oat cell carcinoma are treated when the disease is at a relatively early stage. Surgery is presently the most effective treatment for this group of patients. The majority of the patients are treated when the disease is relatively advanced and when there is a high tendency for lymphatic and hematogenous spread. A large proportion of these patients are currently treated by irradiation. Radiotherapy, like surgery, is expected to contribute to locoregional control. The radiotherapeutic management of lung cancer at Memorial Hospital differs from that in other institutions by the extensive utilization of both internal and external beam radiotherapy. Interstitial brachytherapy adds, on the average, 45 minutes to 1 hour to the operating time, does not increase the hospital stay, and converts an exploratory thoracotomy into a therapeutic procedure. The morbidity and mortality in our experience has not been excessive. This combined approach enables us to improve the local tumor control and nodal sterilization and to spare the normal lung tissue. Interstitial brachytherapy alone has been shown to be a satisfactory alternative to surgery for patients with limited lung cancer (stage I) who cannot have resection because of limited cardiopulmonary reserve. The number of patients in this category is small, but even so, 6/12 patients (50%) have survived for 5 years or more. This combined approach, however, has failed to prolong survival in the more advanced stages, especially when the mediastinal nodes were involved.
Resectability of lung cancer and survival in the New York Lung Cancer Detection program
Authors: Flehinger Betty J. , Melamed Myron R. , Zaman Muhammad B. , Heelan Robert T. , Perchick Wendy , Martini Nael
Published: May 2005

Of the 10,040 men who are enrolled in the New York Early Lung Cancer Detection program, 206 have now developed carcinoma of the lung, and 107 (52%) have been treated by complete resection. One hundred forty‐seven lung cancers (71%) were detected and diagnosed by the screening examination; 59 were interval cases diagnosed because of symptoms or on x‐rays taken elsewhere. Of the former group, 93 (63%) were completely resected, whereas only 14 (24%) of the latter group were resectable. Survival without regard to tumor stage or cell type is estimated to be 65% at 6 years for the carcinomas treated by complete resection, and 8% at 4 years for all others.
Evaluation of clinicopathological analysis of the early gastric cancer
Authors: Sowa Michio , Ohkita Hiyoshi , Nitta Mitsugu , Yoshimoto Takayuki , Matsuzawa Hiroshi , Miki Atsushi , Sugano Seiji , Aoki Toyoaki , Kamino Kenjin , Umeyama Kaoru
Published: May 2005

Clinicopathological data obtained in 174 cases of early gastric carcinoma were reviewed. They covered 183 lesions composed of 88 intramucosal lesions (m) and 95 submucosal lesions (sm). Of the 183 lesions, 46 (25.2%) were of a protruded or an elevated type, and 135 (73.7%) of a depressed or an excavated type, while 2 were of a flat type. Thus, the depressed type (IIc) was predominant. Furthermore, of the 183 lesions, about 58% developed in the middle part (M) of the stomach, about 40% in the lower part (A), and slightly over 2% in the upper part (C).

Histologically papillary adenocarcinomas were of the protruded or elevated type and about 86% of poorly differentiated adenocarcinomas came under the depressed or excavated type. No metastasis occurred in any type when cancer cells remained within the mucosa. When cancer cells invaded the submucosa, the incidence of metastasis was 23/ 174 (13.2%) in early gastric cancer, and was somewhat higher in IIa + IIc type cancer. Lymph node metastases were noted in the primary (n1)or second (n2)group but not in the third group. These results suggest that resection of early gastric cancer should be coupled with cleaning the lymph nodes in the first 2 groups as a rule. The 5‐year survival rate in our patients was 98%.

Early gastric carcinoma was classified histologically and its possible relation to intestinal metaplasia in the perifocal mucosa was sought by the Tes‐tape method.
Clinical aspects and therapy of early gastric cancer
Authors: Gebhardt C. , Husemann B. , Hermanek P. , Gentsch H. H.
Published: May 2005

In the last 10 years, 130 patients with early gastric carcinoma were operated on at the Surgical University Clinic of Erlangen. The ulcerous type was the most frequent (85%) and had the best prognosis with a 5‐year survival rate of 87% excluding operative mortality, and 100% when agecorrected.
Proximal or Total gastrectomy for benign and malignant lesions of the stomach
Authors: Hamanaka Y. , Yoshioka Y. , Ohsugi H. , Sakai T. , Yean‐Kun C. , Sakai K.
Published: May 2005

During the 15 years and 7 months from January, 1965 to July, 1980, a total of 306 patients were subjected to proximal or total gastrectomy. In the latest period of 7 years, various operative procedures were employed depending on the pathological conditions of individual patients, as follows: patients with benign lesions or stage I and II tumors were subjected mainly to proximal gastrectomy plus pedicled jejunal interposition between the esophagus and gastric stump; those with stage III tumors were subjected to total gastrectomy plus pedicled jejunal interposition between the esophagus and duodenum; and those with stage IV tumors were subjected to total gastrectomy plus Roux‐en‐Y esophagojejunostomy. The incidence of postoperative complications was lowest after pedicled jejunal interposition between the esophagus and gastric stump, followed by pedicled jejunal interposition between the esophagus and duodenum. Roux‐en‐Y esophagojejunostomy had the highest incidence of complications.
EEA stapler in large bowel surgery
Authors: Marti M. ‐C. , Fiala J. ‐M. , Rohner A.
Published: May 2005

Ninety‐eight surgical procedures with one of the EEA staplers are reported. In 79 instances of large bowel anastomosis, 3 clinical anastomotic leaks and 7 radiological leaks occurred with spontaneous healing. The EEA stapler allows safe anastomosis even at a very low level; carcinologic criteria for bowel resection must, nevertheless, be absolutely respected to avoid local recurrences.
Multimodal treatment for advanced cancer of the pancreas
Authors: Onodera T. , Okamoto A. , Ito I. , Matsuda T.
Published: May 2005

Conclusions

For advanced cancer of the pancreas, a combination of intraoperative radiotherapy and chemotherapy may be one of the most useful treatments.

Intraoperative radiotherapy apparently reduced the size of the tumor of the pancreas.

Intraoperative radiotherapy palliated the pain due to cancer of the pancreas.
Surgical treatment of the hepatic hydatid cyst
Authors: Jove R. G. , Allamand L. H. , Fernandez H. F. , Fonseca F. H. , Lopez M. A.
Published: May 2005

Hepatic hydatid cysts were seen in 79 patients between 1973 and 1980: 23 were treated by cystectomy, 33 by partial hepatectomy, and the remaining 23 by internal drainage. The indication for internal drainage was bacterial infection of the cyst, or the anatomical site of the cyst preventing excision. There were 3 deaths, 2 due to sepsis following internal drainage, and the third due to sepsis following a postoperative hemoperitoneum. The most serious complications seen were intraperitoneal bleeding and infection. Of the 5 cases of intraperitoneal bleeding, 3 followed partial hepatectomy; one complicated cystectomy alone; and one occurred after internal drainage. Septic complications were seen in 15 cases. Following internal drainage there were 10 cases of subphrenic, hepatic or subhepatic abscess; 3 similar cases were seen in the hepatectomy group and 1 in the cystectomy group. The average postoperative stay was 5 days for the cystectomy group, 20 for the partial hepatectomy group, and 30 for the internal drainage group. Partial hepatectomy, by removing the fibrous ecto cyst cavity, reduces the risk of abscess formation at this site.
Liver injuries
Authors: Kovic M. , Prinicic J. , Pegan V. , Bedencic N. , Gadzijev E.
Published: May 2005

In Yugoslavia, liver injuries are still the most frequent indications for liver surgery. From 1975 through 1979, a total of 75 patients with liver injuries were treated operatively; 69 (92%) were caused by blunt and 6 (8%) by sharp trauma.

In minor liver ruptures, we removed the devitalized liver tissue by means of the finger‐fracture technique with ligation of blood and bile vessels. After removing the devitalized area, we left the liver widely open and drained with Penrose drains. In major or deep liver ruptures, we performed resection of the affected liver lobes or segment. We always drained the common bile duct with a T‐tube to obtain postoperative information on either patency or leakage from the biliary tree. This procedure has always been free from complications.

We performed a resection in 21 patients (28%); of these 4 had a segmentectomy; 3, an atypical resection; and 14, a formal resection. The ages of the patients ranged from 5 to 71 years. After resection, 3 patients died.

Seven patients had trauma restricted to the liver, 16 sustained injury to the liver and spleen, and 52 presented with trauma involving the liver and two or more other organs. Injury was further complicated by liver abscess in 7 patients (9.3%), hemobilia in 9 patients (12%), and bile leakage in 2 patients (2.6%). Eight patients (10.6%) required repeated surgery for bleeding and 3 (4%) developed hepatic coma. Forty‐six patients (61.3%) were free of any complications. Mortality was 24%, 18 of 75 patients treated.
Experience with a new device for colostomized patients: External magnetic ring
Authors: Desaive C. J. , Louis J. C.
Published: May 2005

In this paper we have examined the preliminary results concerning a new covering device for colostomies. This device can only be used for end colostomies, provided that the stoma is flat and its diameter is less than 3 cm. The magnetic ring proved to be light, flexible, discreet, and very effective on odor and noise prevention. The adhesive part can be left in place for several days and permits colostomy washouts or the use of colostomy bags.
Pathophysiology of acute pancreatitis
Authors: Trapnell John E.
Published: May 2005

Local parenchymal damage in acute pancreatitis has been well recognized for many years. This damage leads to a considerable leak of extracellular fluid and so to gross hypovolemia. It also produces the pain that is a major clinical feature of the disease. More recently, the autodigestive process has been recognized to generate, within and around the gland, a “broth” of many components that is vasoactive and tissue destructive and which, in turn, produces systemic changes. These changes affect the whole body and may lead to multiorgan damage. The coagulation mechanism, heart action, peripheral resistance, liver function, as well as the lungs, kidneys, brain, and endocrine homeostatic mechanism are all affected; these patterns and their clinical implications are reviewed. When this multisystem failure occurs in its severest form, the patient may best be described as in a state of “enzymic shock.” This hypothesis is not just of academic interest; it provides a working concept upon which to base a more scientific treatment of acute pancreatitis.