bluuebunny/crossref_metadata_2025 huggingface dataset:
Long‐term Graft Acceptance in Rat Heart Transplantation by CTLA4Ig Gene Transfection Combined with FTY720 Treatment
Authors: Ohba Masanao , Li Xiao‐Kang , Kita Yusuke , Enosawa Shin , Funeshima Naoko , Nagai Haruko , Zhang Hui‐qi , Okuyama Torayuki , Ogoshi Shohei , Sasaguri Shiro , Amemiya Hiroshi , Suzuki Seiichi
Published: August 2002

CTLA4Ig strongly adheres to B7 molecules on antigen‐presenting cells to block intracellular signal transduction via CD28 on helper T cells, which eventually inhibits immune responses. We have demonstrated that the administration to recipient animals of adenoviral vectors containing CTLA4Ig gene (adCTLA4Ig) prolonged graft survival, although the gene expression diminished in a time‐dependent manner and the grafts were finally rejected. In addition, recipient animals treated with FTY720, a new immunosuppressant, exhibited a decrease in the number of peripheral lymphocytes due to apoptosis. In this study, we performed adCTLA4Ig transfection combined with FTY720 treatment in heart‐grafted rats to determine if the combination could induce a mutual effect on graft survival. The recipient animals were given injections of 1 × 109 plaque‐forming units of adCTLA4Ig via the tail vein immediately after grafting. On the day before transplantation we administered FTY720 orally to some of these animals at a dosage of 5 mg/kg and again on the day of transplantation. The median graft survival period in the adCTLA4Ig‐only group was 27 days, whereas that in the combination group was markedly prolonged to 56 days. Of 15 grafts, 5 survived indefinitely. In these groups we observed detectable levels of CTLA4Ig in the sera 49 days after grafting; the levels were always higher in the combination group than in the adCTLA4Ig‐only group. As a result, this study revealed that FTY720 and adCTLA4Ig have a potent mutual effect on graft survival during rat heart transplantation. Furthermore, it is highly possible that FTY720 enhances gene expression of adCTLA4Ig, which may be related to the long‐term acceptance of grafts.
Van Swieten and the Renaissance of the Vienna Medical School
Authors: Kidd Mark , Modlin Irvin M.
Published: August 2002

The period until 1745 found the Viennese medical system languishing far behind advances made in other major European centers. This chaotic situation was reversed by the foresight and breadth of vision of the Empress Maria Theresa, who initiated considerable reform in Austria by actively recruiting the best minds of the time to reduce the intellectual and technologic differences. Her ability to entice one of Boerhaave's most eminent pupils, Gerard van Swieten, to leave Leiden for Vienna, particularly benefited the Vienna Medical School. In 1745 van Swieten assumed responsibility for reconfiguration of the patronage and nepotism‐ridden medical system of the Austro‐Hungarian Empire. As a first task, he swiftly expunged the influence of the Jesuits and other religious orders from medicine and established formal training and examinations, transforming the medical discipline into a meritocracy. Excelling as a physician and an innovative teacher, he also established a close personal relationship with the Empress and became her medical confidante. To a large part, the success of this first great Viennese medical school was owed to de Haen, who left Leiden to implement Boerhaave's method of clinical teaching. As a result of these innovations and with considerable support from the Empress, the University of Vienna, particularly its medical school, within a few decades achieved recognition throughout Europe as a seat of learning and scholarship. Van Swieten would not be remembered today if his contribution had been only scholarly or scientific achievements. He propelled Austrian medicine to a level commensurate with that of other European states of the day by 27 years of dedicated and industrious service.
MODS/SIRS: Result of an Overwhelming Inflammatory Response?
Authors: Goris R.J.A.
Published: August 2002

Multiple organ dysfunction syndrome and the systemic inflammatory response syndrome are expressions of an inappropriate, generalized inflammatory response to severe inflammatory stimuli, which may be bacterial or nonbacterial in nature. The clinical signs and symptoms, morphologic alterations, and changes in oxygen transport seem to be the direct effect of phagocyte activation. So far, identifying the microorganisms and neutralizing their toxins has not been helpful in improving prognosis. As an essential adjunct to treating the bacterial or nonbacterial causes, finding safe ways of modulating the phagocyte response should be considered.
Indications and Results of Balloon Angioplasty for Arterial Occlusive Lesions
Authors: Kalman Peter G. , Johnston K. Wayne , Sniderman Kenneth W.
Published: August 2002

This paper describes the current techniques for percutaneous transluminal angioplasty (PTA) of peripheral arteries, summarizes the long‐term results of the procedure, and identifies the variables that are predictive of long‐term success of PTA performed in the iliac and femoropopliteal segments.
Indications and Results of Arterial Stents for Occlusive Disease
Authors: Ahn Samuel S. , Concepcion Blessie
Published: August 2002

The application of stents for treatment of peripheral arterial occlusive disease has gained widespread clinical use, but their safety and efficacy remain unclear. Stent technology is still evolving, and long‐term follow‐up data are sorely needed. Stents have had good success in providing a scaffold to maintain the intraluminal structure and patency of an artery. As such, stents appear to play a role in improving early results after failed or inadequate balloon angioplasty. However, stents do not prevent restenosis due to intimal hyperplasia. Furthermore, stents may be thrombogenic and prone to extrinsic compression in the peripheral position. Thus patency results are clearly worse in the femoral artery (47% at 3 years) than in the iliac artery (82–84% at 6–24 months). Furthermore, there is no evidence so far that stents improve long‐term patency over standard balloon angioplasty without stents; and complication rates of stent procedures are generally 10%. Currently in the United States stents are approved for use in the iliac artery position. However, routine use of stents cannot be recommended until studies demonstrate that the results with stents are better than those with balloon angioplasty alone.
Functional and Morphometric Study of Cryopreserved Human Parathyroid Tissue Transplanted into Nude Mice
Authors: Tanaka Yuji , Funahashi Hiroomi , Imai Tsuneo , Wada Masaki , Tominaga Yoshihiro , Mishra Saroj K. , Takagi Hiroshi
Published: August 2002

As part of an ongoing study of the characteristics of transplanted fresh normal and pathologic parathyroid tissues, we transplanted cryopreserved human parathyroid tissue into nude mice. Hyperplastic glands cryopreserved for various lengths of time (<2 weeks and >1 year) were transplanted into the gluteus muscle of nude mice. Specimens grafted were of two sizes: 10 mg and 30 mg. Serum human parathyroid hormone (hPTH) concentration was estimated by a double‐antibody immunoradiometric assay prior to transplantation and 2, 4, and 8 weeks after transplantation. A low‐calcium diet was given to some mice to evaluate any effects on the grafts of low serum concentrations of calcium. All mice were killed 4 hours after injection of bromodeoxyuridine (Brd U) for assessment of the cell proliferation in grafted parathyroid tissue. Although hPTH secretion of cryopreserved tissue was only half that of fresh tissue, the cryopreserved tissue released hPTH, as did fresh tissue. hPTH secretion was accelerated by stimulation of a low‐calcium diet, and PTH secretion was positively correlated with the volume of transplanted tissue. The number of Brd U‐immunoreactive cells was correlated with the serum concentration of hPTH (r= 0.95), which indicates that cell proliferation is closely related to PTH secretion under the condition of successful transplantation. The experimental transplantation of cryopreserved tissue into nude mice, coupled with a concise immunohistochemical study of the grafts conducted prior to their transplantation into humans, can contribute to the evaluation of PTH secretion and cell proliferation.
Pheochromocytomas: Tendency to Degenerate and Cause Paroxysmal Hypertension
Authors: Ito Yukio , Obara Takao , Yamashita Tomoyuki , Kanbe Masako , Iihara Masatoshi
Published: August 2002

Eighty‐four patients with pheochromocytoma underwent surgery during the 13‐year period from 1981 to 1994. These patients were divided into three groups according to the degree of parenchymal degeneration, which was estimated by preoperative dynamic computed tomography (CT) scans and resected specimens: solid group, cystic group, and highly cystic group. The relation between the degree of parenchymal degeneration and the clinical variety, size of the tumor, predominant plasma catecholamine, and type of blood pressure disturbance was analyzed. There were 39 cases of solid pheochromocytoma, 37 cases of cystic tumor, and 8 cases of highly cystic pheochromocytoma. The maximal mean diameters for each group were as follows: 5.1 ± 2.3, 6.8 ± 3.0, and 7.9 ± 3.2 cm, respectively. Of the tumors < 3 cm in diameter, 84% were solid; when the tumors were ≥ 6 cm in diameter, approximately 50% were cystic and 20% highly cystic. Of the adrenal pheochromocytomas, 60% were degenerated; 79% of the extraadrenal tumors were solid. Of the epinephrine‐secreting tumors, 70% were degenerated, and 55% of the norepinephrine‐secreting tumors were solid. The clinical pattern of hypertension was related to the degree of degeneration: In the paroxysmal hypertension group 87% of the tumors were degenerated, and in the sustained hypertension group 69% were solid. We therefore believe that parenchymal degeneration of pheochromocytoma is highly correlated with the tumor diameter, location of the tumor, secreted catecholamine, and clinical pattern of hypertension.
Experiences with Percutaneous Endoscopic Gastrostomy
Authors: Gutt Carsten N. , Held Sinikka , Paolucci Vittorio , Encke Albrecht
Published: August 2002

Today the procedure of choice for long‐term enteral tube feeding in patients with prolonged swallowing difficulties or inabilities is percutaneous endoscopic gastrostomy (PEG). The primary indications are head and neck cancers, neurologic dysphagia, cancer cachexia, and obstruction of the esophagus and pharynx with enough space for an endoscopic procedure. This technique requires no general anesthesia and is possible in patients with contraindications to surgical gastrostomy. Between September 1994 and April 1995 a total of 115 patients underwent PEG placement attempts. We employed the pull‐technique with 15‐Freka PEG tubes. The average procedure time, including esophagogastroduodenoscopy, was 17 minutes. In nine cases PEG insertion was impossible owing to severe obstruction of the esophagus. In 46 (40%) patients local abdominal pains started on the first or second postoperative day; 7 of these patients required surgical consultation, and no further intervention was needed. In only one patient was there a serious complication that required surgical intervention: a presumed perforation that turned out to have no correlate upon review. All patients received single‐shot antibiotic prophylaxis; and only in those patients with abdominal symptoms do we recommend a prolonged antibiosis. The abdominal symptoms reported were due to a slight leak of gastric fluid causing a topical peritonitis, which required no further treatment. In our experience PEG is a useful alternative to surgical gastrostomy. The simplicity of this procedure leads to low complication rates, short hospitalization, and is possible on an outpatient basis. It is cost‐efficient and has a much better psychological tolerance than nasogastric tubes.
Parathyroid Hormone Content Distinguishes True Normal Parathyroids from Parathyroids of Patients with Primary Hyperparathyroidism
Authors: Weber Collin J. , Russell John , Chryssochoos John T. , Hagler Mary , McGarity William C.
Published: August 2002

The purpose of this study was to clarify the pathophysiology of primary hyperparathyroidism by looking for differences between parathyroids from eucalcemic patients and patients with primary hyperparathyroidism (HPT) with respect to the following parameters: intracellular parathyroid content of parathyroid hormone (PTH) and parathyroid hormone messenger RNA (PTH mRNA); and serum PTH and calcium levels of patients and patient age. Coded samples of human parathyroid biopsies were assayed for PTH content with a C‐terminal‐specific radioimmunoassay. Total cellular RNA was extracted, and PTH mRNA was quantified by dot‐blot analysis. These results were tabulated along with associated data on patient age, preoperative serum PTH, and preoperative calcium levels. The content of PTH was significantly higher in true normal (TN) parathyroids than in parathyroids from patients with hyperparathyroidism. PTH content of adenomas and hyperplasias were similar. PTH content of normal parathyroids biopsied from patients with parathyroid adenomas (NA) was statistically higher than that of adenomas but statistically lower than that of TN parathyroids. PTH mRNA and PTH content were correlated (p< 0.001) for TN parathyroid glands; however, it was not true for glands (grossly normal or otherwise) in patients with HPT. Patient groups were similar with regard to mean patient age and intracellular PTH mRNA levels. Hypercalcemic patients were similar with regard to preoperative serum calcium and PTH levels. NA parathyroids, adenomas, and hyperplasias are different from TN parathyroids with regard to their PTH content. PTH mRNA was similar across all groups. The relation between intracellular PTH mRNA and PTH was significantly absent in patients with HPT compared with TN glands. Furthermore, we have found that PTH content of normal parathyroid in patients with adenoma is similar to that of hyperplastic and adenoma tissues. These data suggest that the PTH content of parathyroid tissues may be of use in differentiating normal from abnormal parathyroids.
Endoscopic Injection Treatment of Gastrointestinal Bleeding in Hemophiliacs
Authors: Ziemski Jan M. , Szczepanik Andrzej B. , Misiak Andrzej , Rudowski Witold J.
Published: August 2002

The aims of this prospective study were to determine the patterns of gastrointestinal (GI) bleeding in hemophiliacs and to assess the hemostatic effect of injection therapy with alcohol. During a 5‐year period (1990–1994) 89 hemophiliacs were admitted to our department with acute GI bleeding. Among these patients duodenal ulcer was found endoscopically to be the most common (42.7%) cause of hemorrhage; gastric ulcer was the source of the bleeding in only three patients (3.4%). A group of 46 patients met the criteria of active or recent bleeding and underwent injection therapy with alcohol. The injected bleeding lesions were duodenal ulcer in 32 patients, duodenal erosion in 2, gastric ulcer in 3, and other gastric lesions (Mallory‐Weiss tear, Dieulafoy lesion, stomal ulcer, erosions) in 9 patients. Initial hemostasis was achieved in 100% and permanent hemostasis in 82.6%. Rebleeding was observed in eight patients (17.4%), with five of them successfully treated by reinjections. Three patients (6.5%) required emergency surgery. The mortality rate in the group of injected patients was 2.2%. One patient died of stroke on day 10 after partial gastrectomy. All injected patients were given replacement therapy with factor VIII or IX for 2 days (29 patients) or 7 to 14 days (17 patients). Analysis of the hemostatic effect achieved in these two subgroups indicate that short‐term replacement therapy (2 days) may be sufficient to ensure adequate hemostasis in hemophiliacs. The results of the present study indicate that injection therapy with alcohol is an effective, safe, proved method to control GI bleeding in hemophiliacs.
Prognostic Significance of Proliferative Cell Nuclear Antigen in Carcinoma of the Extrahepatic Bile Duct
Authors: Nishida Toshirou , Nakao Kazuyasu , Hamaji Masayasu , Nakahara Masa‐Aki , Tsujimoto Masahiko
Published: August 2002

Bile duct cancers are still difficult to cure, and even if curatively resected locoregional recurrences are frequent. Biologic proliferative activity of the cancer may influence postoperative recurrence and the prognosis. A retrospective study was performed with the medical records of 44 consecutive patients who underwent surgery for histologically extrahepatic bile duct cancer (stage 3 or 4) at Osaka Police Hospital during the period 1980 to 1992. Univariate analysis suggested that the stage according to the UICC classification, curability, DNA ploidy, proliferating cell nuclear antigen (PCNA), S‐phase and G2M‐phase fractions, and histologic differentiation were significant prognostic factors. The Cox's proportional hazard model indicated that PCNA and histologic differentiation were independent prognostic factors for crude and cause‐specific survival. When PCNA was omitted from the analysis, DNA ploidy and histologic differentiation were independent prognostic factors for both crude and cause‐specific survival. These results suggested that proliferative activity influenced the postoperative prognosis of extrahepatic bile duct cancer.
Surgery for Early Gastric Cancer: A European One‐Center Experience
Authors: Jentschura Dirk , Heubner Cornelia , Manegold Bernd Cristoph , Rumstadt Bernhard , Winkler Markus , Trede Michael
Published: August 2002

Between 1972 and 1995 a total of 251 patients with early gastric cancer underwent resection in our department of surgery. At the time of the operation 10.8% of the patients were proved to have lymph node involvement, and two already had distant metastases. A subtotal gastric resection was performed in 59.8% of cases (n= 150), a total gastrectomy in 33.8% (n= 85), and either a proximal or an atypical resection in 6.4% (n= 16). Since 1985 subtotal distal resection and total gastrectomy were accompanied by a systematic lymphadenectomy of compartments I and II. The overall postoperative morbidity was 18.3%, and the hospital mortality, 4.9%; it was only 1.6% within the last decade. Concerning these short‐term results there were no statistically significant differences between the different surgical procedures. The cumulative overall 5‐year‐survival rate was 82.6%. There was no statistically significant influence of either the different surgical procedures or the histologic types according to the Japanese classification of early gastric cancer.
Segment III Cholangiojejunostomy for Carcinoma of the Gallbladder
Authors: Chaudhary Adarsh , Dhar Puneet , Tomey Sudhir , Sachdev Ajay , Agarwal Anil
Published: August 2002

Jaundice in patients of advanced carcinoma of the gallbladder requires palliation for the distressing symptoms of pruritus and cholangitis. Intrahepatic segment III duct cholangiojejunostomy is a means for alleviating the obstruction with malignant porta block. The authors reviewed their experience with this procedure in 48 patients of carcinoma of the gallbladder. All patients had jaundice; pruritus was present in 44 (92%) and cholangitis in 14 (29%). The level of obstruction was determined preoperatively by percutaneous transhepatic cholangiography. In 32 patients the block was below the level of the bifurcation of the right and left ducts, and 16 patients had a block involving the confluence, isolating the two lobes of the liver. Following segment III cholangiojejunostomy, pruritus was relieved in all and cholangitis in 86% of patients. At the end of 6 weeks a significant fall in serum bilirubin and alkaline phosphatase levels was seen with both types of hilar obstruction. Varying degrees of pain relief was also noted in 75% of patients. Segment III biliary bypass is an effective, one‐time, reliable means of palliation for carcinoma of the gallbladder with hilar obstruction. Its efficacy appears to depend on the duration and depth of the jaundice and on the anatomy of the biliary ductal system in the left hemiliver rather than on the type of hilar obstruction.
Reduced Postoperative Morbidity after Elective Laparoscopic Cholecystectomy: Stratified Matched Case‐Control Study
Authors: Sarli Leopoldo , Pietra Nicola , Sansebastiano Giuliano , Cattaneo Gaetano , Costi Renato , Grattarola Mario , Peracchia Anacleto
Published: August 2002

To answer the question whether laparoscopic cholecystectomy (LC) or open cholecystectomy (OC) is safer in terms of complications and to what extent the “learning curve” influences the frequency of complications after LC, we conducted a matched case–control study. First, 200 patients undergoing LC (LC group A), and two groups of 200 patients undergoing LC at two different periods of the learning curve (LC groups B and C) were matched, taking into account sex, age, anesthesiologic risk, and surgical difficulties. We evaluated the frequency and grade of postoperative complications of these patients and of the last 200 patients undergoing OC before the introduction of LC, retrospectively matched with the LC groups. The total rate of complications in the OC group was 16.0% compared with 5.5% in the LC groups (p < 0.003); the difference was particularly significant for complications classified as grade I, in female patients, those younger than 70, those with low anesthesiologic risk (ASA), and those after cholecystectomy without surgical difficulties. Matched case–control analysis revealed that the complication rate in the LC group significantly decreases with experience (p < 0.01). We conclude that LC is today the treatment of choice for symptomatic cholelithiasis and is replacing OC as the gold standard against which new therapies should be compared.
Immature Host for Xenotransplantation
Authors: Michler Robert E. , Minanov Oktavijan P. , Artrip John H. , Itescu Silviu
Published: August 2002

The overall shortage of appropriate donor organs has prompted transplant physicians and surgeons to consider using organs from other nonhuman species. The shortage of appropriate human donor hearts for newborn recipients is especially severe. Presently, the pig appears to be the most appropriate source for organs. Humans and baboons uniformly develop high titers of complement‐fixing (IgM) anti‐pig xenoantibodies, resulting in complement‐mediated hyperacute rejection (HAR) of pig organs transplanted into mature baboons within minutes to hours. In contrast, newborn humans and baboons do not have high titers of anti‐pig IgM xenoantibody, and consequently pig cardiac xenografts transplanted into newborn baboons do not undergo HAR. Rather, these organs are rejected at days 3 to 4 by a distinctive immunologic process that involves natural killer cells and macrophages. With the addition of cyclosporine‐based triple immunosuppression, this process is reduced and graft life is prolonged to 6 to 7 days. This therapy, however, is not sufficient to prevent the induced humoral response to the graft, and the organs are rejected by antibody‐ and complement‐dependent mechanisms. Future treatment strategies to reduce this humoral response must incorporate immunodepletion columns, soluble complement‐inhibiting agents, and additional anti‐B lymphocyte agents. These strategies, in conjunction with the use of transgenic pig organs that express human membrane‐bound complement regulatory proteins or reduced xenoantigenic epitopes could further prolong graft life. Clinical trials are being formulated that would utilize pig organs as a “bridge,” sustaining a newborn human in need of a heart transplant until an appropriate donor is located.
Survival following Orthotopic Cardiac Xenotransplantation between Juvenile Baboon Recipients and Concordant and Discordant Donor Species: Foundation for Clinical Trials
Authors: Bailey Leonard L. , Gundry Steven R.
Published: August 2002

It has been more than a decade since the last clinical trial of cardiac xenotransplantation in a newborn infant. Since that event, laboratory research at Loma Linda University has focused on survival studies of orthotopically xenografted juvenile baboon recipients. Both concordant and discordant donor species have been used. Transgenic donors have not been explored at Loma Linda. Instead, simplified host immunoregulative protocols, consistent with those used in neonatal cardiac allografting, have been adapted to xenotransplant research. Xenograft bridge to alloengraftment was evaluated in a series of five juvenile baboon recipients. Heterotopically implanted cardiac xenografts stimulated host production of xenoreactive antibody. Orthotopic cardiac allografting was then carried out. Xenoantibody appeared to play little role in immediate or chronic survival of experimental hosts. A clinical protocol of xenobridging to allotransplantation would likely succeed. Two consecutive series of orthotopically xenotransplanted hosts using rhesus monkey cardiac donors demonstrated unprecedented long‐term survival. Splenectomy combined with maintenance therapy consisting of FK‐506 and methotrexate contributed to survival of up to 502 days in one series of xenografted baboon hosts selected for ABO blood grouping, mixed lymphocyte culture, and crossmatch compatibility. Survival beyond a year (maximum 515 days) among three consecutive juvenile baboon recipients of orthotopically implanted rhesus monkey hearts, in which splenectomy was omitted and cyclosporine was substituted for FK‐506, represents a benchmark achievement. Commencing maintenance immunosuppression several weeks prior to transplantation appeared to improve chronic survival significantly. Investigation of discordant (pig‐to‐baboon) host survival has focused on adsorption of naturally occurring xenoreactive antibody at the time of transplantation. This strategy, combined with pretransplant total lymphoid irradiation and both pre‐ and posttransplant immunosuppression, succeeded in preventing hyperacute rejection and resulted in survival of up to 24 days, thereby permitting observation of the delayed xenograft rejection phase. Data support consideration of additional clinical trials of concordant neonatal cardiac xenotransplantation and offer promise for the development of discordant xenotransplantation as an ultimate therapeutic resource.
Diets and Infection: Composition and Consequences
Authors: Alexander J. Wesley , Ogle Cora K. , Nelson Jeffrey L.
Published: August 2002

This brief review focuses on the effects of nutrient composition of enteral diets on the outcome of surgical patients and experimental models of infection. Complete enteral diets containing combinations of immunonutrients (arginine, glutamine, RNA, omega‐3 fatty acids), when given postoperatively or after trauma to surgical patients, can reduce hospital stay, overall costs, and the incidence of wound complications and acquired infections. Immunonutrient diets can also reduce the length of hospital stay when given to patients admitted to the surgical intensive care unit. A high protein diet is usually required for optimal benefit, although administration of high protein immunoenhancing diets may have adverse effects in animals with severe untreated peritonitis because of a sustained overproduction of cytokines.
Historical Development of Surgical Instruments Exemplified by Hemostatic Forceps
Authors: Sachs Michael , Auth Marcus , Encke Albrecht
Published: August 2002

We describe the historical development of surgical instruments exemplified by hemostatic forceps, starting with antique and medieval forceps used for the arrest of bleeding to modern atraumatic hemostatic forceps used for vascular reconstruction. Their development proceeded mainly in three steps: (1) development of ligature forceps directly for hemostasis (Celsus, first century ad; Paré, 1582; L. Heister, 1743; (2) development of atraumatic forceps, which facilitate vascular reconstruction or anastomosis creation by temporarily clamping vessels (Höpfner, 1903; Stich, 1907; Jeger, 1913; (3) construction of tangential forceps, which, by partially clamping vessels with partial maintenance of blood flow, allow the reconstruction or anastomosis of large vessels in a side‐to‐side technique. The first tangential occlusion clamp was developed by Friedrich Trendelenburg (1844–1924) in 1908, when he established the operative treatment for embolism of the pulmonary artery. This clamp was later modified by A.W. Meyer (1927) and V.P. Satinsky (ca. 1950).
Limited Tumor Involvement Found at Multiple Endocrine Neoplasia Type I Pancreatic Exploration: Can It Be Predicted by Preoperative Tumor Localization?
Authors: Skogseid Britt , Öberg Kjell , Åkerström Göran , Eriksson Barbro , Westlin Jan‐Erik , Janson Eva Tiensuu , Eklöf Hampus , Elvin Anders , Juhlin Claes , Rastad Jonas
Published: August 2002

Radiologically demonstrable pancreatic endocrine tumors are a frequent requirement for exploration in patients with multiple endocrine neoplasia type I (MEN‐I). Such delayed intervention is accompanied by a 30% to 50% incidence of pancreatic endocrine metastases. This study explores biochemical tumor markers and operative findings in relation to preoperative pancreatic radiology in 25 MEN‐I patients. They underwent pancreatic surgery with (n= 19) or without (n= 6) radiologic signs of primary tumor and absence of metastases upon conventional examination, including OctreoScan testing (n= 10). Biochemical diagnosis required an increasing elevation of at least two independent pancreatic tumor markers. Tumor diameters averaged 1.1 cm (0–5 cm) and 0.9 cm (0.2–1.5 cm) in the patients with and without positive preoperative radiology, respectively. These investigations never displayed more than one of the consistently multiple tumors, and the results were falsely positive in 26%. Preoperatively unidentified regional or hepatic metastases were found at surgical exploration in 26% of patients with radiologic localization and in none of the others. Limited pancreatic tumor involvement necessitated intraoperative absence of metastases and pancreatic lesions ≤ 1 cm in diameter on palpation, intraoperative ultrasonography, and microscopy. It occurred in 37% and 50% of the patients with and without radiologic tumor localization, respectively. The number of positive tumor markers was similar for patients with limited and major disease (2.3 vs. 2.7), whereas four or more such markers were found in all those with malignancies. The mean marker level was higher in patients with radiologically demonstrable tumors and lower in those with limited disease, but with a substantial overlap. OctreoScan testing was negative in all cases with limited disease and was the single most sensitive method (75%) in the others. Limited pancreatic disease could not be identified preoperatively, and the present means of biochemical pancreatic tumor identification invariably involved the presence of at least one lesion ≥ 7 mm in diameter. Conventional pancreatic imaging is insensitive and nonspecific for recognizing even substantial pancreatic tumors associated with MEN‐I.
Double Parathyroid Adenoma, a Clinically Nondistinct Entity of Primary Hyperparathyroidism
Authors: Szabo Eva , Lundgren Ewa , Juhlin Claes , Ljunghall Sverker , Åkerström Göran , Rastad Jonas
Published: August 2002

Double parathyroid adenoma (DA) has been suggested to be a clinically distinct entity of primary hyperparathyroidism (HPT). Altogether 659 patients with sporadic primary HPT were analyzed retrospectively by evaluating consecutive primary operations for more than three decades. Patients with postoperatively persistent HPT and those with incomplete medical, operative, or histologic records were disregarded. The mean age (± SD) at surgery was 60.9 ± 12.7 years; 78% of the patients were female; and the duration of postoperative follow‐up averaged 7.8 ± 7.2 years. DA, defined as two enlarged parathyroid glands, was found in 77 patients (12%). Enlargement of a single gland (SA) or three or more glands (MA) occurred in 80% and 8%, respectively. DAs were bilateral in 72% of patients, and the weight of the two glands differed by 317 ± 407 mg. The three histologic subgroups of patients exhibited no significant discrepancy with respect to age, classic symptoms of HPT, proportion of overtly asymptomatic individuals, or parathyroid tissue weight. A lower female predominance and extent of hypercalcemia and higher preoperative serum creatinine level occurred with DA and MA compared to SA. SA and DA differed from MA with respect to variably strong trends to lower postoperative incidences of recurrent HPT and hypoparathyroidism. DA seems to comprise an underrated histologic cause of HPT, which is eligible for a conservative operative approach. Clinical characteristics consistent with a distinct entity of sporadic primary HPT were not seen.
Late Results of Heterotopic Autotransplantation of Splenic Tissue into the Greater Omentum
Authors: Weber Thomas , Hanisch Ernst , Baum Richard Paul , Seufert Rainer Maria
Published: August 2002

There is still controversy about the beneficial effects of splenic autotransplantation. As a result, replantation of the spleen has almost been abandoned for surgical treatment of splenic injuries. To learn more about the long‐term effects we have analyzed eight patients 9.2 ± 1.2 years after autotransplantation of the spleen into the greater omentum. Splenic replants could be detected by scintigraphy in seven patients (87.5%). Splenic size, measured by single‐photon emission computed tomography, varied between 19.344 and 471.705 units of volume (UoV). Two patients with the smallest replants had pathologic changes of leukocytes and lymphocyte subsets in 12 of 16 measurements (75%). These changes closely resembled a spleenless state and were similar to those in the patient with no detectable splenic autograft. In contrast, five patients with large splenic replants (49.192–471.705 UoV) revealed pathologic findings in only 2 of 40 measurements (5%). Based on an extensive review of the literature and our own results, it can be concluded that splenic autotransplantation into the greater omentum is superior to splenectomy but undoubtedly less effective than in situ preservation of the spleen. Therefore splenic replantation should still be considered, particularly in pediatric surgery, when in situ preservation of the spleen is not possible by other techniques.
Choledocholithiasis: Percutaneous Treatment
Authors: Navarrete Claudio G. , Castillo Cecilia T. , Castillo Pedro Y.
Published: August 2002

The percutaneous approach to retained biliary duct stones is most reasonable in the presence of a T‐tube because of the low morbidity and mortality as well as its low cost. We report our experience with 353 patients, emphasizing the technique and the solutions to some frequent problems.
Influence of Bile Duct Stones on Patient Features and Effect of Endoscopic Sphincterotomy on Early Outcome of Edematous Gallstone Pancreatitis
Authors: Hammarström Lars‐Erik , Andersson Roland , Stridbeck Hans , Ihse Ingemar
Published: August 2002

The objective of this study was to study the influence on patients’ features and the effect on early outcome of the presence of bile duct stones and endoscopic sphincterotomy (EST), respectively, in the presence of edematous gallstone pancreatitis
(GSP). It was a retrospective review of a patient series from 1981 through 1992 at a university teaching hospital. Altogether 96 patients aged 42 to 93 years (median 74 years) with edematous GSP were investigated by endoscopic retrograde cholangiography (ERC) in our department, 75 of whom underwent ERC at first admission. A total of 49 patients (group 1) had common bile duct (CBD) stones, and in 47 (group
2) no CBD stones were found. All patients in group 1 and 15 in group 2 underwent EST; 57 of the 75 patients had EST at first admission. The main outcome measures were pancreas‐related complications and the length of the hospital stay. The early major complication and stone clearance rates of the EST procedure were 3.2% and 96%, respectively. Duration of symptoms prior to ERC was similar in groups 1 and 2 (median
5 and 8 days, respectively). Serum amylase activity was higher in group
2 patients than in group 1 patients [21–258 (median 75) μkat/L vs.
10–328 (median 48) μkat/L (p= 0.01)], but the length of hospital stay was similar: [4–39 (median 11) days vs. 4–19
(median 9) days (p= 0.05)]. Cholangitis at acute admission was more common in group 1 than in group 2 patients (31% vs.
7%; p= 0.02), whereas a history of pancreatitis was noted more often in group 2 patients (49% vs. 8%; p< 0.001). ERC was done 1 to 18 days (median 2 days) and 1–16 days
(median 5 days) (p= 0.02) after admission in groups 1 and 2 respectively, because of the more frequent cholangitis symptoms in group 1. It was concluded that the history and features at admission differed between patients with and without CBD stones at ERC done during an attack of GSP. Early EST had no influence on outcome or hospitalization. This study does not support routine EST in conjunction with mild GSP.RID="" ID="" Correspondence to: L.‐E. Hammarström, M.D., Ph.D., Department of Surgery, Mälarsjukhuset, S‐631 88 Eskilstuna, Sweden
Recombinant Human Erythropoietin and Hemoglobin Concentration at Operation and during the Postoperative Period: Reduced Need for Blood Transfusions in Patients Undergoing Colorectal Surgery—Prospective Double‐blind Placebo‐controlled Study
Authors: Qvist Niels , Boesby Steen , Wolff Birgit , Hansen Carsten P.
Published: August 2002

In a double‐blind placebo‐controlled study we investigated the effect of recombinant human erythropoietin (r‐HuEPO), on the perioperative hemoglobin concentration and the use of blood transfusions in patients undergoing elective colorectal surgery with a preoperative hemoglobin level ≤8.5 mmol/L. Altogether 100 were included, and 81 patients could be evaluated. A total of 38 patients received r‐HuEPO in a dose of 300 IU/kg body weight on day 4 before surgery and 150 IU/kg daily for the following 7 days; 43 patients received placebo. In addition, all patients received daily doses of 200 mg iron orally for 4 days before surgery. There were no differences between the two groups with regard to sex, height, weight, serum electrolytes, and liver function tests at study entry. The preentry hemoglobin concentration was similar in the two groups, with a median value of 7.9 (range 5.3–8.5) mmol/L in the erythropoietin group and 7.6 (5.1–8.5) mmol/L in the placebo group. On the day of surgery the median hemoglobin concentration was 7.8
(5.3–9.2) mmol/L in the erythropoietin group and 7.2 (4.6–8.5) mmol/L in the placebo group (p < 0.05). On postoperative days 3 and 7 the values were 7.2 (5.3–8.2) and 7.5 (5.4–9.4) mmol/L, respectively, in the erythropoietin group compared to 6.7 (5.2–7.8)
and 6.9 (5.1–8.6) mmol/L in the placebo group (p <
0.01). At discharge the hemoglobin concentration was 7.8 (5.9–8.8)
mmol/L in the erythropoietin group and 7.2 (5.4–8.6) mmol/L in the placebo group (p < 0.002). The blood loss during operation was similar in the two groups. In the erythropoietin group the median value was 280 ml (range 25–2000 ml), with the lower and upper quartiles 150 and 500 ml, respectively. In the placebo group the blood loss was median 300 ml (range 50–1800 ml), with the lower and upper quartiles 200 and 750 ml, respectively. The number of blood transfusions given was significantly lower in the erythropoietin group, with a mean of 0.3 (range 0–6) units compared to 1.6 (0–9) units in the control group (p < 0.05). In conclusion, the hemoglobin concentration at the time of surgery and during the week following surgery was significantly higher in the group of patients receiving r‐HuEPO perioperatively compared to the placebo group together with a significant lower use of blood transfusions in the r‐HuEPO group. However, the clinical implications of these findings has yet to be proven.RID="" ID="" Correspondence to: N. Qvist, M.D., D.Sci.
Informed Consent in Surgical Trials
Authors: Etchells Edward
Published: August 2002

All participants must provide a valid consent to surgical clinical trials. A valid consent requires patient capacity, adequate disclosure of information, and voluntariness. Capacity is the ability to understand information relevant to making a decision and to appreciate the reasonably foreseeable consequences of a decision or lack of decision. To protect vulnerable persons, an incapable person should not be enrolled in most clinical trials. The only exception is if the study can only be conducted on incapable persons. If the willing research participant is incapable, consent must be obtained from others through a process called substitute (or proxy) consent. Disclosure refers to the provision of relevant information to the patient and its comprehension by the patient. Most surgical trials carry more than minimal risks, so the requirement for careful disclosure of these risks to potential participants is generally stringent. Voluntariness refers to the freedom of a person to make a treatment decision. In specific circumstances related to emergency research, the requirement for consent may be waived. Waiver can be justified only if the delay required to obtain consent would prevent the research from occurring and only after prior consultation with from the “community” of potential research participants.
I. Short Story of Theodor Kocher's Life and Relationship to the International Society of Surgery
Authors: Liebermann‐Meffert Dorothea
Published: August 2002

With the aim of promoting progress in surgery through the friendly exchange of views and experience, the International Society of Surgery was founded in Brussels in 1902, thereby helping to overcome the narrow boundaries of that time's nationalism. At its first congress, the International Society of Surgery (ISS), otherwise known by its French name, Société Internationale de Chirurgie (SIC), already numbered 638 members, among them the most important surgeons from all over the world. Theodor Kocher (1841–1917) was the president of the first congress, held in Brussels in 1905, and was also responsible for the choice of topics. His presidential address clearly reflected the high aims the Society set for itself. Kocher's personal and professional authority, his surgical skill, which he liked so much to communicate to his colleagues, and his international thinking shaped the young Society. He remained on the international committee of the ISS until his death. Renowned surgeons from all over the globe traveled to Bern to see Kocher at work, among whom were many distinguished leaders of U.S. surgery. Thus Kocher's contribution had a great impact on the developing surgery, in particular in the United States. A short curriculum outlines the personality of this outstanding surgeon.
Lidocaine‐metabolizing Activity after Warm Ischemia and Reperfusion of the Rat Liver In Vivo
Authors: Izuishi Kunihiko , Wakabayashi Hisao , Maeba Takashi , Ryu Munemasa , Maeta Hajime
Published: August 2002

The effect of warm ischemia on lidocaine‐metabolizing activity was examined in vivo. Total liver ischemia was produced for 1 hr in Sprague‐Dawley rats by clamping the portal vein and hepatic artery at the hilum. Livers were then reperfused, and liver microsomes were prepared before and 0, 2, 6, and 24 hr, and 3, 6, and 10 days after reperfusion. Microsomal lidocaine‐metabolizing activity and cytochrome P‐450 content were examined. Lidocaine N‐deethylase activity was decreased from 2.25 ± 0.33 to 0.97 ± 0.21 nmol/mg protein/min (mean ± SD) 24 hr after reperfusion. This inhibition was prolonged, and activity gradually recovered after 10 days. The cytochrome P‐450 content showed the same tendency. On the other hand, serum levels of alanine aminotransferase increased significantly 2 hr after reperfusion and returned to control levels 3 days after reperfusion. Liver blood flow recovered rapidly after unclamping and reached baseline levels within 6 hr. Our results suggest that after warm ischemia, prolonged hepatic dysfunction in drug metabolism, which cannot be detected by evaluating serum enzymes or liver blood flow, exists at the microsomal level.
Pathologic Evaluation of Surgical Margins and Local Recurrences after Breast‐conserving Surgery without Irradiation
Authors: Kato Takao , Kimura Tsunehito , Ishii Nobue , Fujii Akiho , Yamamoto Kazuko , Kameoka Shingo , Nishikawa Toshio , Kasajima Takeshi
Published: August 2002

This study was undertaken to evaluate the status of margins of the excised breast tissue using our own method. We also determined the indications for breast‐conserving surgery without irradiation by examining the characteristics of patients with local recurrence and comparing relapse‐free survival (RFS) and overall survival (OS) of patients who underwent wide excision without irradiation with those of 267 patients who underwent total mastectomy. Eighty‐two patients with a 3 cm diameter or less invasive carcinoma were treated with wide excision and axillary dissection between 1987 and 1996. Patients who histologically had four or more axillary lymph node metastases, positive pathologic margins, or a high degree of in situ ductal carcinoma around the main tumor in consecutive step‐sections were excluded from this study. During a median follow‐up of 6 years (range 2–11 years), six patients (7.3%) had local recurrence and five (6.0%) had regional or distant recurrences as their site of first failure. At 11 years the life‐table values for RFS and OS for the wide excision‐treated group were 84.7% and 92.1%, respectively, compared with 85.0% and 90.0%, respectively, for patients treated by total mastectomy. RFS and OS were similar in the two treatment groups. Results in the present study indicate that if the patients treated by breast‐conserving surgery are carefully selected and there are no foci in the pathologic margins, there is a low degree of in situ ductal carcinoma around the tumor, and no multicentricity, it might be unnecessary to administer radiation therapy.
Musculature of the Alimentary Tract
Authors: Skandalakis John E.
Published: August 2002

Leiomyomas and leiomyosarcomas are derived from smooth muscle tissues. Smooth muscle cells also surround the blood vessels that supply the alimentary tract. These cells have at times been said to contribute to the formation of smooth muscle tumors in the alimentary canal. With such an abundance of smooth muscle, there is little reason at present to implicate the smooth muscle elements of blood vessel walls.
Effect of Laparoscopic Cholecystectomy on Platelet Aggregation
Authors: Yol Serdar , Kartal Adil , Çalişkan Ümran , Tavli Şakir , Şahin Mustafa , Bozer Mikdat
Published: August 2002

The purpose of this study was to investigate the effect of laparoscopic cholecystectomy on platelet function. We operated on 40 women with symptomatic gallbladder stone, 20 of whom (study group) underwent laparoscopic cholecystectomy and 20 of whom (control group) open cholecystectomy. Patients with a history of bleeding, abnormal platelet count, or systemic disorders and those who were on salicylates, heparin, or oral anticoagulants were excluded. Blood parameters were checked at the beginning and the end of the operation, including platelet aggregation using adenosine 5′‐diphosphate (ADP), collagen, and ristocetin in a whole‐blood aggregometer. Platelet aggregation was evaluated by percent aggregation. Platelet aggregation due to collagen and ristocetin increased significantly at the end of the operation in the study group (p < 0.001). Aggregation due to ADP did not differ significantly from the start to the end of the operation. Control group results did not show any differences. Although the clinical findings of aggregated platelet are not frequently observed in practice, we suggest that laparoscopy increases platelet aggregation.