bluuebunny/crossref_metadata_2025 huggingface dataset:
Temporary and permanent left ventricular bypass: Laboratory and clinical observations
Authors: Bernhard William F. , Clay Warren , Gernes David , Hougen Thomas , Sherman Craig , Burke David , Schoen Frederick J. , Poirier Victor L.
Published: May 2005

Temporary circulatory support with a pneumatic, axisymmetric, paracorporeal ventricular assist device (VAD) has been undertaken in 22 postcardiotomy patients. During VAD function, 9 patients demonstrated hemodynamic improvement (group I), and eventually, 8 of these stabilized sufficiently to permit device removal. Three remain alive and well up to 5 years postoperatively. The clinical course of 13 others (group II) was complicated by severe postoperative bleeding and abnormalities in renal function, leading to lack of hemodynamic improvement and death. In group I, the duration of cardiopulmonary bypass (CPB) ranged from 4.3 to 9.0 hr (mean 6.0 hr), and in group II, from 3.7 to 10.0 hr (mean 5.9 hr). The duration of VAD function was 125 hr (mean) in group I, and 25 hr (mean) in group II. Major hematologic abnormalities (secondary to prolonged CPB) included thrombocytopenia, abnormal platelet function studies, severe hypofibrinogenemia, and low levels of fibrinogen/fibrin degradation products. Efforts to develop a permanent, electrically powered ventricular assist system (VAS) for patients with irreversible cardiomyopathy and end‐stage coronary artery disease are also progressing. In a recent series of animal experiments, 2 components of the VAS, an electromechanical energy converter and pusher‐plate blood pump (stroke volume 85 ml) were evaluated (9 calves, 30–149 days). The bloodcontacting surfaces of the device consisted of textured fibrils to attract a fibrin coagulum. Conversion of this layer to a collagenous membrane was achieved by preliminary seeding of the pump with cultured, bovine fetal fibroblasts (5 calves). These were compared with 4 non‐cell‐seeded devices (controls), and functioned for longer periods without thromboembolic complications.
Evaluation of surface‐bound heparin and platelet inhibition in a centrifugal pump left ventricular assist system
Authors: Musial Jacek , Gluszko Piotr , Edmunds L. Henry
Published: May 2005

Following the discovery of thrombi attached to polycarbonate connectors in a patient successfully perfused for 46 hr with a centrifugal pump‐left ventricular assist system, the combination of platelet inhibition and surface‐bound heparin was tested in vitro. Fresh citrated human blood to which calcium and prostaglandin E1was added was recirculated for 3 hr in a centrifugal pump‐left ventricular assist system. Circuits with ionically bound heparin and circuits with cross‐linked ionically bound heparin were compared to uncoated circuits to which low‐dose (0.15 U/ml) and high‐dose (0.5 U/ml heparin) had been added. Fibrinopeptide A concentrations progressively increased during 3 hr of recirculation, but were significantly higher with low‐dose heparin control than in either of the surface‐bound heparin circuits. Plasma heparin concentrations were significantly less in the heparinized circuits than in the low‐dose heparin control group. There were no significant differences between cross‐linked and non‐cross‐linked tridodecylmethyl ammonium chloride (TDMAC) heparinized circuits. The combination of platelet inhibition and ionically bound heparin in centrifugal pump‐left ventricular assist circuits reduces the rate of thrombus formation beyond that caused by heparin leached from the surface.
Successful treatment of profound left ventricular failure by automatic left ventricular assist system
Authors: Takano Hisateru , Taenaka Yoshiyuki , Nakatani Takeshi , Akutsu Tetsuzo , Manabe Hisao
Published: May 2005

We have developed an automatic left ventricular assist device (LVAD) system which can maintain the normal circulation irrespective of severity of the LV failure (LVF) and can restore the failing heart by decreasing the bypass flow (BF) through the LVAD as the heart recovers. The main parts of our control‐drive unit are an automatic ECG synchronization system and an automatic level control system for left atrial pressure (LAP) and total flow (TF). Profound LVF was induced by complete interception of blood supply (myocardial infarction: MI) to the extent of 50% (5 goats), 70–80% (6 goats), and 80–90% (3 goats) of the LV free wall. The air‐driven, diaphragm‐type pump was implanted between the left atrium and aorta. At the beginning of LVAD pumping, BF tended to be high to keep LAP at the preset level (0–5 mm Hg) and to maintain TF at a somewhat higher level (100–130 ml/kg per min). During the recovering stage from LVF, the preset level of LAP was gradually raised. When cardiac output exceeded 90–100 ml/kg per min, LVAD was removed. The 50% MI group recovered between 17 hr and 3 days, the 70–80% MI group between 6 and 16 days after the onset of LVAD pumping. However, the 80–90% MI group could not recover because of intractable ventricular fibrillation. This LVAD system was applied in 1 patient who fell into postcardiotomy profound LVF. The patient's entire circulation was maintained at normal levels by the LVAD during a 14‐day period. The failed heart gradually recovered and the pump was successfully removed. We believe that the decompression of LV at the beginning will prevent overextension of impaired myocardium and simultaneously accelerate the solid scar formation. Gradual increase of LV work will promote the compensation ability of the residual myocardium.
Status of the artificial heart program in Berlin
Authors: Bücherl E. S. , Hennig E. , Baer P. , Frank J. , Lemm W. , Zartnack F.
Published: May 2005

The artificial organs program in Berlin started more than 20 years ago. The main emphasis in the circulatory assist and replacement devices program was and still is on the development of an electro‐pneumatic total artificial heart (TAH) system. Additionally, a temporary assist system and investigations in the field of biomaterials are included in the research activities. Topics of the program are: interactions between natural and artificial materials, blood pump development and in vitro fatigue testing, driving units and energy transmission, measurement equipment needed for the surveillance and automatic control of the TAH system, in vivo studies of the response of the circulatory system and the organs, in vivo reliability, and training of the staff for clinical readiness. The joint efforts of engineers of different disciplines and medical doctors, working together in the department of experimental surgery, supported in the past by industrial partners, resulted after extensive in vitro and in vivo investigations in the clinical application of temporary assist devices and the realization of a percutaneous portable, electro‐pneumatic total artificial heart system.
Experimental results and future prospects for a nonpulsatile cardiac prosthesis
Authors: Yozu Ryohei , Golding Leonard A. R. , Jacobs Gordon , Harasaki Hiroaki , Nose Yukihiko
Published: May 2005

Replacing the heart function by means of a nonpulsatile blood pump is a great challenge to nature, which evolved pulsatile blood circulation. Some years ago, we hypothesized that mammalian physiology was capable of adapting to chronic nonpulsatile blood flow and maintaining normal organ function. The methodology of complete circulatory replacement with nonpulsatile flow has been established in awake calf experiments in our institution. To date, 5 animals have lived with nonpulsatile blood perfusion with near normal physiology for up to 3 months. Our studies on nonpulsatile biventricular animals have shown that immediately following surgery there is an adaptation phase which lasts approximately 7 to 10 days. This phase is characterized by increased total systemic vascular resistance (SVR), which appears to correlate with an increase in the circulating catecholamines. After this phase, these animals showed normal values of SVR, renal, biochemical, and endocrine function. Our data show that nonpulsatile blood flow is not a limiting factor to maintain mammalian life.
Intrathyroidal epithelial thymoma: An entity distinct from squamous cell carcinoma of the thyroid
Authors: Miyauchi Akira , Kuma Kanji , Matsuzuka Fumio , Matsubayashi Sunao , Kobayashi Akira , Tamai Hajime , Katayama Shoichi
Published: May 2005

We report 3 cases of intrathyroidal epithelial thymoma, a clinicopathologic entity distinct from squamous cell carcinoma of the thyroid. Two patients are long‐term survivors among 5 postoperative patients with squamous cell carcinoma of the thyroid. One has been free from the disease for 17 years, and the other with local recurrence died of an unrelated disease 18 years after the surgery. The diagnosis in these 2 was corrected to intrathyroidal epithelial thymoma following a review of the histological findings. These 2 tumors consisted of tumor cell nests resembling poorly differentiated squamous cell carcinoma surrounded by many lymphocytes. Features discriminating thymoma from squamous cell carcinoma included the lack of foci of anaplastic carcinoma and papillofollicular tumor, which are seen in squamous cell carcinoma of the thyroid. Two of the 3 patients with squamous cell carcinoma died within 1 year. We have found recently another case of thymoma.

The present observations indicate that: thymoma can arise in the thyroid gland presumably from aberrant thymic tissue, mimicking squamous cell carcinoma; and the prognosis of thymoma is favorable. Therefore, it is important to discriminate thymoma from squamous cell carcinoma of the thyroid, which is usually fatal.
Microwave surgery: Hepatectomy using a microwave tissue coagulator
Authors: Tabuse Katsuyoshi , Katsumi Masaharu , Kobayashi Yasuhito , Noguchi Hiroyuki , Egawa Hiromu , Aoyama Osamu , Kim Hideo , Nagai Yugo , Yamaue Hiroki , Mori Kazunari , Azuma Yoshinori , Tsuji Takeshi
Published: May 2005

The microwave tissue coagulator has been applied clinically with satisfactory results. In our system, 2,450‐MHz microwaves for medical use are generated and transmitted to a monopolar‐type needle electrode. This electrode is thrust directly into the liver tissue and this is repeated along the line where incision is anticipated. Between July 1980, and May 1983, this device was used in 60 patients having major hepatic resections for a variety of conditions. The average amounts of blood loss and blood transfusion were 860 ml and 416 ml, respectively. Seventeen patients did not need blood transfusions, and all cases were free from postoperative bleeding from the resected liver stump. Besides the complications similar to those occurring with other major operations, pyrexia and abdominal pain developed in some cases 2–3 weeks after this surgical procedure. These symptoms were thought to be ascribed to the microwave surgery. However, they remitted soon and the subsequent course was uneventful. All patients with benign or inflammatory diseases had a satisfactory postoperative course, and are well. Of the patients subjected to liver resection for malignant diseases, 4 (6.7%) died within a month after the operation. These findings led us to conclude that this new operative technique can be utilized safely, surely, and easily in the field of hepatic surgery.
Surgical treatment of liver injuries by application of Fibrinkleber
Authors: Giakoustidis E. , Drosinopoulos P. , Agouridakis K. , Galanis N.
Published: May 2005

The combination of highly concentrated fibrinogen, thrombin, clotting factor XIII, and fibrinolytic inhibitor aprotinin represents a new biological hemostatic, and adhesive system, known as “Fibrinkleber.” Liver injuries and injuries of parenchymatous organs, with the difficulties inherent in their surgical repair, are a suitable field of application for the new substance. In our experimental work, standardized sharp liver injuries in 29 rabbits were treated only by application of Fibrinkleber. In all cases, this procedure resulted in a complete control of bleeding as well as in a stable and lasting closure of wounds. Five of these animals died from causes unrelated to the liver trauma but rather to parasitosis. During the postoperative observation period, from 2 days to 2 months, microscopic and histological examination showed ideal repair of the glued wounds. In the control group, 5 rabbits were kept without application of Fibrinkleber. Three of the rabbits with liver injuries and all of the control group histological examinations showed separation of the wounds with minimal healing.
Indication for operation of patients with autonomously functioning thyroid tissue in endemic goiter areas
Authors: Goretzki P. E. , Wahl R. A. , Branscheid D. , Joseph K. , Tsuchiya A. , Röher H. D.
Published: May 2005

Four hundred thirty‐nine patients with autonomously functioning thyroid tissue (AFTT), 26% of all patients with AFTT diagnosed at the University of Marburg between 1970 and 1982, underwent thyroidectomy. One hundred ninety (43.3%) of these patients with AFTT were operated on for clinical hyperthyroidism, compared to only 62 patients with Graves' disease during this same time period. The remaining 249 patients with AFTT underwent surgery because of nonsuppressible uptake of technetium (TcTU) (3.5% or greater) by the thyroid.

AFTT was 5 times more common in women than men. Hyperthyroidism was more common in older patients (p< 0.001) and in patients with numerous autonomous nodules. Many patients had no obvious signs of hyperthyroidism, but 42.4% had cardiac disorders. A preceding history of goiter (mean 15.3 years) was present in patients with AFTT and hyperthyroidism. Serum T3and T4levels were elevated in 88.5% and 74.6% of AFTT patients with clinical hyperthyroidism, while in clinically euthyroid AFTT patients, T3and T4values were in the upper normal range, i.e., 53.7% and 15.2%, respectively.

Hyperthyroid patients were prepared for operation with antithyroid drugs. Additionally, propranolol was used in the perioperative period. Patients were operated on selectively after 1979, either by enucleation or unilateral thyroidectomy for unifocal AFTT, and subtotal thyroidectomy for bilateral disease. The results of treatment were most satisfactory and only 11 patients with AFTT (2.5%) developed recurrent hyperthyroidism. Surgical treatment of patients with hyperthyroidism and AFTT is a safe and effective therapeutic modality.
Present status of surgical treatment of esophageal varices in Japan: A nationwide survey of 3,588 patients
Authors: Inokuchi Kiyoshi
Published: May 2005

To assess the current status of surgical treatments for esophageal varices in Japan, a nationwide survey on the clinical results was performed by the Japanese Research Society for Portal Hypertension. Data were collected in 59 participating institutions on 3,588 patients with portal hypertension, subjected to portal nondecompression surgery between January, 1967, and January, 1982. In these patients the operative mortality rate was 8.3%, the survival rate was 68.6%, the postoperative bleeding rate was 6.9%, and the incidence of Eck's syndrome was 4.8%. Operative death occurred in 24.8% of 506 patients undergoing emergency operations. No gross difference was noted in these data between direct interruption procedure and selective shunt surgery. The overall results of portal nondecompression surgery were far superior to results of portal decompression surgery, done before 1967. Esophageal transection with wider devascularization from both thoracic and abdominal approaches and selective shunt (left gastric venous caval shunt and distal splenorenal shunt) led to a diminished incidence of recurrent bleeding in the later follow‐up period, as compared to devascularization, using a sole abdominal or thoracic approach.
Hirschsprung's disease: Progress in management and diagnostics
Authors: Nixon H. Homewood
Published: May 2005

Each of the basic operative methods for Hirschsprung's disease (the rectosigmoidectomy developed by Swenson, the retrorectal transanal approach developed by Duhamel, and the endorectal procedure developed by Soave and modified by Denda and Boley) can give good results. A protective colostomy should be routine. If only an occasional case is prevented from progressing to incontinence or septicemia and death, then I think this outweighs the hazards of the colostomy.

The 25‐year review of 84 of the first 87 Swenson‐type operations carried out at our hospital revealed that in adult life every patient is continent even though some had a degree of lack of control for a considerable time during childhood. A follow‐up of the group of Soave‐type operations from our clinic, followed between 10 and 17 years, also showed maintenance of normalcy. Our first Duhamel operations were carried out in 1958 and these patients also maintained control.

From the technical point of view, the remaining problem is that of the infant with a segment extending significantly proximally into the small intestine. Kimura's operation may prove to be the answer, although the rarest condition of total intestinal aganglionosis seems likely to remain insuperable and is mainly of clinical importance because of evidence that it recurs frequently in the family. Bodian preferred to call this condition agenesis of the intramural plexuses since there was no evidence of increased nerve bundles found in congenital aganglionosis.

Enterocolitis remains the main threat in management. The urgency of treatment needs wider recognition. Hirschsprung's disease should be diagnosable almost entirely in the neonatal period now that reliable and minimally disturbing rectal suction or punch biopsy is available. It must be accepted, however, that this diagnostic tool requires an expert and experienced pathologist and means, therefore, some centralization of the examination of the material even if not always of the baby itself.

The finding of overt neuropathological conditions in the presence of ganglia makes it likely that more subtle variations also exist and their recognition might account for some poor results of operation which are not explained by technical errors.

The difficult case, and in particular the child whose superficial biopsy is reported “ganglionic but not normal,” should be investigated by full‐thickness biopsy studied by such special techniques as histochemical and silver staining, electron microscopy, and perhaps hormonal immunofluorescent studies as indicated. Nevertheless, it appears that these conditions are not sufficiently common to justify the recommendation of full‐thickness biopsy under general anesthesia or the use of these elaborate studies as routine, whereas by the encouragement of early rectal suction biopsy diagnosis, the course of the vast proportion of children who have typical Hirschsprung's disease will be made simpler for the surgeon, the child, and the family.
New surgical approaches to ulcerative colitis in children and adults
Authors: Coran Arnold G.
Published: May 2005

Ulcerative colitis continues to be a devastating disease for the child and the young adult. In spite of intensive medical therapy with sulfasalazine and corticosteroids, the majority of patients with universal ulcerative colitis will ultimately require a total colectomy. The standard operation of a total proctocolectomy and a permanent end ileostomy is probably still the best procedure for the definitive management of this disease because all diseased tissue is removed with this operation; however, the resultant abdominal stoma can create significant psychological trauma in many of these patients. For that reason, sphincter‐saving operations were introduced in 1933 but were only marginally successful until 1977, when renewed interest in the endorectal pull‐through occurred. Since that time, several centers around the world have gained significant experience with the endorectal procedure, with or without the use of an ileal reservoir. Although the ileal reservoir appears to have certain advantages over the straight endorectal pull‐through, the procedure also is associated with a significant number of complications and is a far more complicated technical exercise.

The experience at the University of Michigan with the straight endorectal pullthrough procedure in patients with ulcerative colitis and familial polyposis during the period from 1977 to 1984 is herein reported. All of the patients in our series are continent and experience a median stool frequency of 6 per 24 hours 1 year after the procedure. Patient satisfaction has been excellent with the majority of patients preferring their lifestyle without an ileostomy to that experienced with an ileostomy. At the present time, we can strongly recommend the endorectal pullthrough procedure to all patients with ulcerative colitis.
Splenic preservation in children
Authors: Touloukian Robert J.
Published: May 2005

The diagnosis of splenic injury can be made with almost 100% certainty by physical examination and nuclear imaging or computerized axial tomography, eliminating the need for surgical exploration in children who are stable and have no evidence of an associated intra‐abdominal injury. The nonoperative approach of treatment has been successful in over 95% of selected cases. Operative splenic preservation methods, including splenorrhaphy with or without splenic artery ligation, hemisplenectomy, and splenectomy with autotransplantation have been attempted and each has a role in the unstable patient requiring operation. Splenectomy alone carries a 1.5% risk of overwhelming postsplenectomy infection which is only partially prevented by Pneumovax® and antibiotics. The regionalization of trauma care in children ensures proper monitoring of the injured child, and a surgeon knowledgeable about the treatment options has made splenic preservation a reality
Choledochal cyst
Authors: Cheney M. , Rustad D. G. , Lilly J. R.
Published: May 2005

Choledochal cyst is a congenital malformation of the pancreatobiliary system. Its pathogenesis is not completely understood. The pathologic features are cystic dilatation of the common bile duct, normal liver parenchyma, a normal intrahepatic biliary system (except when associated with Caroli's disease), and partial obstruction of the terminal common bile duct.

The presenting symptom in most children is mild intermittent jaundice. Ultrasound is the best initial investigation. Transhepatic cholangiography and endoscopic retrograde cholangiopancreatography define the extent of intrahepatic and extrahepatic disease but are not necessary studies in all patients.

Traditionally, cyst enterostomy (i.e., drainage of the cyst into interposed intestine) was the standard operative procedure. More recently, cyst excision has become the procedure of choice. We employ a technique in which excision is confined to the inside of the cyst which eliminates many of the technical hazards of resection. The procedure was performed in 11 infants and children with no mortality and minor morbidity.
Esophageal atresia: Embryogenesis and management
Authors: de Lorimier Alfred A. , Harrison Michael R.
Published: May 2005

The embryogenesis of esophageal atresia is reviewed. Esophageal atresia is frequently associated with other predictable anomalies and prematurity. The management of esophageal atresia will vary according to the size and vigor of the baby, the severity of complicating anomalies, and the distance between the 2 esophageal ends. Surgical repair is not urgent, since the infant can be maintained by sump suction of the proximal esophagus to prevent aspiration of mucus and by gastrostomy or jejunal feedings. When associated anomalies or pulmonary complications have been resolved, the definitive repair is performed. If there is a long distance between the esophageal ends, it is usually possible over a period of time to bring the 2 ends close together by bougie stretching and by performing a series of esophageal myotomies. Complications that should be anticipated following repair include anastomotic stricture, recurrent tracheoesophageal fistula, esophageal dysmotility, tracheomalacia, and gastroesophageal reflux with aspiration, impaired caloric intake, and esophagitis.
Shunt surgery for treatment of portal hypertension in children
Authors: Valayer J. , Hay J. ‐M. , Gauthier F. , Broto J.
Published: May 2005

Shunt surgery in children suffering from portal hypertension (PH) is considered as an immediate and definite mode of prevention of recurrent gastrointestinal hemorrhage. Certain conditions must be met: (a) normal liver; (b) normal veins available within the portal system; (c) a sufficient portosystemic gradient of pressure; and (d) a surgical team with experience in portal venous surgery. In patients in whom PH is an epiphenomenon of severe liver disease, other means of hemostasis for bleeding esophageal varices should be sought. The difficult decision is in the child with specific liver alterations without major hepatocellular dysfunction but in whom the prognosis cannot be precisely foreseen. A few more years will be needed before one can tell if shunt surgery is the best choice for this category of patient.
Surgery of gastroesophageal reflux
Authors: Carcassonne M. , Guys J. M. , Delarue A. , Sarles J.
Published: May 2005

During the last 20 years, 262 patients were diagnosed with gastroesophageal reflux (GER) at La Timone Children's Hospital, Marseille, France. Seventy‐eight patients (60 infants and 18 children) were treated operatively. Both newer investigations such as scintiscan and Ph measurements, as well as standard ones, such as barium esophagogram and esophagoscopy, failed to demonstrate a precise relationship between reflux and symptoms. Selection of patients for surgery depends on clinical symptoms linked to GER, for example, failure of a 3‐week medical trial, association with anatomic disorders such as hiatal hernia, and respiratory complications proven to originate from GER. Numerous surgical procedures have been described. The best appears to be the Nissen fundoplication associated with gastropexy.
Surgery of necrotizing enterocolitis
Authors: Kosloske Ann M.
Published: May 2005

Necrotizing enterocolitis (NEC) has become a frequent neonatal surgical emergency. This disease, characterized by crepitant intestinal necrosis, occurs primarily in premature infants. Operation is necessary if intestinal perforation or gangrene occurs. Of the many proposed indications for operation in NEC, those of proven validity are: pneumoperitoneum, a fixed dilated loop on serial x‐rays, erythema of the abdominal wall, an abdominal mass, or a positive paracentesis (consisting of brown fluid and/or bacteria on Gram's stain). Paracentesis has aided the early identification of infants with intestinal gangrene prior to perforation. Early recognition of gangrene is important because the mortality rate following operation after perforation (64%) is double that of operation for gangrene (30%). The cardinal principles of operation for acute NEC are excision of all the gangrenous bowel, exteriorization of the marginally viable ends, and preservation of as much intestine as possible. Our preferred method of exteriorization is by the Mikulicz enterostomy, because its subsequent closure appears to be safer than closure of a double enterostomy with separated stomas. The survival of infants operated on for NEC at the University of New Mexico Hospital was 34 of 63 (54%). Six late deaths occurred, for an overall survival of 28 of 63 (44%). Nine survivors (32%) required treatment for late intestinal strictures. Recent follow‐up studies on infants surviving NEC show an encouraging prognosis for normal growth and development.
Enteral and parenteral nutrition in the short bowel syndrome in children
Authors: Ricour C. , Duhamel J. F. , Arnaud‐Battandier F. , Couard Y. , Revillon Y. , Nihoul‐Fekete C.
Published: May 2005

Thirteen children, aged 2 to 16 years, had a subtotal resection of small bowel, following a mid‐gut volvulus in 10 cases. All children are alive, and their growth is normal; 36 cumulative patient‐years of parenteral nutrition and 11 years of constant‐rate enteral nutrition were performed. In 7 cases, in which residual small bowel varied between 30 to 120 cm, termination of all artificial nutritional support was possible 30 months in mean after intestinal resection. In contrast, if resection was near total with less than 20 cm remaining, life‐long dependence on parenteral nutrition is unavoidable unless intestinal transplantation becomes feasible. With cyclic parenteral nutrition at home, the patients' quality of life is near normal.
The cost‐effectiveness of early or delayed surgery in acute cholecystitis
Authors: Alinder Gunnar , Herlin Per , Lindgren Björn , Holmin Torsten
Published: May 2005

Early surgery has been recommended as the treatment of choice for acute cholecystitis in several clinical studies during the last 15 years. This was the outcome of a recent study from 4 Swedish hospitals, on which the present study on the economic aspects is based. Fifty‐three patients with acute cholecystitis treated at the University Hospital of Lund were analyzed. Acute cholecystectomy (early surgery =ES) was performed in 33 cases and 20 were subjected to delayed surgery (DS). Conservative treatment was found to be on an average 65% more expensive than early cholecystectomy. The average hospital cost for delayed surgery amounted to Swedish kronor (SEK) 22,755 ($3,034 U.S.). The corresponding sum for early surgery was SEK 13,755 ($1,834 U.S.). These findings support the opinion that early surgery is to be recommended in the management of acute cholecystitis.
Reinnervation of the endocrine pancreas after autotransplantation of pancreatic fragments in the spleen of the dog: A morphofunctional study
Authors: Madureira Mário L. C. , Adolfo A. , Dias J. , Sebe M. , Carvalhais H. A. , von Hafe P.
Published: May 2005

Secondary diabetes following pancreatectomy in the dog was prevented by autotransplantation of pancreatic fragments in the spleen. The function and composition of the endocrine elements were analyzed by functional studies and by light and electron microscopy at 4, 8, and 24 weeks. During these different periods, splenectomy proved that all the animals were dependent on the transplanted tissue for normoglycemia. The morphologic study of the spleen showed the survival of the intrinsic pancreatic ganglia as well as the presence of an amyelinic, terminal nervous network, with adrenergic varicosities, exclusively related to the endocrine elements.

Nerve endings were identified in close contact with beta, alpha‐2, and alpha‐1 cells, either isolated in the splenic pulp or forming insular structures with a variable size and composition. No cholinergic varicosities could be identified nor was there any innervation in the ductal and acinar tissue.

From 4 weeks on, Schwann cells could be seen coating large surfaces of the endocrine cells at the same time as they sheathed nervous elements, thus creating true “neuroinsular complexes” with beta and alpha‐2 cells. The few ganglia that could only be identified under light microscopy, as well as the ultrastructural characteristics of the innervation, suggest that the sympathetic fibers of the perivascular, trabecular and capsular plexus of the spleen had grown and invaded the inoculated endocrine tissue in the splenic pulp.
Neuroendocrine tumors of the gut
Authors: Durning Patricia , Galland Robert B. , Nagorney David M. , Welbourn Richard B.
Published: May 2005

Of 75 patients with neuroendocrine tumors of the gut, 50 had functioning lesions, causing endocrine syndromes. These included 16 insulinomas, 13 gastrinomas, 5 vipomas (4 pancreatic, 1 adrenal), 4 corticotrophinomas, and 1 renal enteroglucagonoma. Three patients had mixed endocrine syndromes. Eight or 9 patients with pancreatic lesions had multiple endocrine adenopathy (MEA I), including 3 of 4 patients with multiple insulinomas and all 3 patients with malignant gastrinomas. Localization of the pancreatic insulinomas, vipomas, and mixed tumors by arteriography was excellent, but few gastrinomas were detected before operation. Eight patients developed the malignant carcinoid syndrome with metastases from primary tumors in the ileum (6 patients), bronchus, and stomach. Hepatic artery embolization provided palliative relief for several with this and some other syndromes. Twenty‐five patients had tumors that caused nonspecific features only. These included 18 appendicular carcinoids, 5 islet cell carcinomas, and 2 other apudomas (1 hepatic and 1 whose primary site is unknown). The importance of the latter is that they are more responsive to therapy and have a better prognosis than the more common acinar tumors. Over 40% of the patients had lesions that were cured surgically and over 80% obtained some benefit from treatment.
Václav Treitz (1819–1872): Czechoslovakian pathoanatomist and patriot
Authors: Fox Richard S. , Fox Claire G. , Graham William P.
Published: May 2005

Václav Treitz (1819–1872) qui fut un grand anatomiste et pathologiste d'origine tchèque s'est opposé à la domination autrichienne de son pays et à la germanisation de l'enseignement de l'Université Charles Ferdinand siège de l'une des plus anciennes des Ecoles de Médecine européennes. Il a lutté toute sa vie en faveur de la Bohême sa patrie et pour que l'enseignement médical à Prague soit dispensé en langue tchèque bien qu'il ait fait ses études médicales en pays germanique, à Vienne, capitale du monde médical au milieu du dix‐neuvième siècle.

Au cours de ses périgrinations entre Vienne où il étudia, Prague et Cracovie où il enseigna il suivit toujours la même conduite, s'interessant à 1'anatomie, à l'anatomie‐pathologique et à la chirurgie. En 1853, alors qu'il exerçait à Cracovie il publia en allemand pour diffuser ses idées la description du ligament suspenseur de l'angle duodéno‐jéjunal qui porte son nom depuis lors. Il décrivait aussi d'autre formations constituées de fibres lisses au niveau du pharynx, de la troisième couche de l'estomac, du sphincter anal, de la vessie et de la “tunica dartos” du sacrum. En 1857, il publia un autre article important intitulé: hernie rétro‐péritonéale, contribution à l'histoire des hernies. En 1859, son dernier travail important consacré aux “lésions intestinales de l'urémie” décrivait non seulement les lesions mais le mécanisme de leur constitution. Esprit ouvert il fut l'un des premiers à soutenir la thèse de Semmelweis affirmant que la fièvre puerpérale était d'origine infectieuse, l'infection étant transmise par le corps saignant, et aussi à prouver le traitement de la tuberculose par le repos.

Esprit contestataire et frondeur mais avisé et rigoureux, Václav Treitz fut un grand anatomiste innovateur, un pathologiste rigoureux et aussi un grand patriote dont la Tchécoslavaquie peut être fière.
Rare late complication after operation of traumatic aneurysm of the thoracic aorta
Authors: Heberer G. , Stelter W. J. , Jauch K. ‐W.
Published: May 2005

In a 60‐year‐old patient, an anastomotic aneurysm developed 22 years after interposition of a Dacron® prosthesis for repair of a traumatic aneurysm of the descending aorta. Computed tomography and transfemoral aortography suggested a complete suture dehiscence with a free‐floating graft. Operation confirmed that the silk sutures had completely disappeared. A new 20‐mm woven Dacron® prosthesis was inserted with nonresorbable suture material.

We recommend long‐term follow‐up with chest x‐ray in all patients after prosthetic aortic reconstruction. Noninvasive computed tomography and contrast‐enhanced computed tomography have proven a very useful and sensitive method for detection of suture dehiscence, false aneurysm, and other complications.
Resection and embolization in the management of secondary hepatic tumors
Authors: Blumgart Leslie H. , Allison David J.
Published: May 2005

The management of hepatic metastases either by means of hepatic resection or by hepatic artery embolization is reviewed. Hepatic resection is of value either as a palliative or potentially curative measure, especially in secondary deposits arising from primary sites in the colorectum. Approximately 26% of patients with primary colorectal cancer will have hepatic metastases at diagnosis and, of these, some 5–10% will be amenable to resection. Untreated, all patients die within 5 years, but resection of solitary metastases would appear to offer a 20% chance of 5‐year survival. Better results have been obtained with resection carried out for smaller lesions. Major resections carried out for large lesions are not as successful.

Hepatic artery embolization is useful in a wide variety of secondary hepatic deposits, not only to treat local symptoms but also to ameliorate the systemic effects produced by secondary deposits arising from primary endocrine tumors. Controlled clinical studies allowing comparison of the results of tumor embolization with those of other forms of palliative therapy or of symptomatic treatment are now necessary.
Primary carcinoma of the liver: Improvement in sight?
Authors: Bengmark S. , Hafström L. , Jeppsson B. , Sundqvist K.
Published: May 2005

A retrospective analysis of 99 histologically verified primary liver carcinomas seen at the Department of Surgery, University of Lund, from 1965 to 1978 has been performed. The material is comparable to other studies with regard to age and sex distribution and occurrence of cirrhosis. The common presenting symptoms were abdominal discomfort and weight loss. During 1965–1970, most diagnoses were made at laparotomy or at autopsy. There was a low incidence of resectability and a short mean survival rate. In the latter half of the study, 1971–1978, wider use of thin needle biopsy, angiography and liver scan has contributed to more accurate preoperative diagnoses in this group. Diagnoses seemed also to be made at an earlier stage of the disease in this group, which led to a higher resectability. This, in combination with postoperative adjuvant chemotherapy, may have contributed to the favorable results, with more than half of the patients alive 24 months after resection.
Metastatic disease in the liver from colorectal cancer: An appraisal of liver surgery
Authors: Bengmark Stig , Hafström Larsolof , Jeppsson Bengt , Jönsson Per‐Ebbe , Rydén Stefan , Sundqvist Kaj
Published: May 2005

This study supports the opinion that liver resection or metastasis enucleation with a margin of normal tissue around the tumor for liver metastases from colorectal cancer can be recommended. The 3‐year survival rate of 20–25% is far better than the 3‐year survival rates reported after resection of the primary organ for cancers such as, for example, the pancreas and esophagus and is almost as good as that of surgery of primary rectal cancer Dukes' C. Liver resection has an acceptably low postoperative mortality (less than 10%), morbidity, and complication rate.
The Aarhus County Vagotomy Trial: Trends in the problem of recurrent ulcer after parietal cell vagotomy and selective gastric vagotomy with drainage
Authors: Andersen Daniel , Amdrup Erik , HØstrup Hans , SØrensen Finn Hanberg
Published: May 2005

In a prospective, randomized study, 691 patients with duodenal (DU), pyloric (PU), or prepyloric (PPU) ulcers have been followed for 2–5 years after operation with parietal cell vagotomy (PCV) or selective gastric vagotomy with drainage (SGV+D). About half the patients have been followed for 5 years. Cumulative 5‐year recurrence rates, calculated by a life table method, suggest a higher recurrence rate for patients with DU when operated with PCV (15%) than when operated with SGV + D (9%), but the difference was not statistically significant (p>0.05). Patients with PU/PPU had higher recurrence rates following either procedure than patients with DU (PCV: 33%; SGV+D: 14%).

A study of the change in recurrence risk as a function of time after operation suggests that the recurrence rate following SGV+D when used for DU will continue to rise after 5 years, but probably very slowly. The recurrence rate after 5 years is unpredictable, however, for PCV when used for DU, and unpredictable for both methods when used for PU/PPU.

The recurrence rate was found to be independent of the level of preoperative gastric acid secretion, and this was true for both PCV and SGV+D, An increased recurrence rate was, on the other hand, found to be associated with <50% postoperative reduction in pentagastrin‐stimulated acid secretion.
Measurement of duodenogastric reflux with99mTc‐HIDA in duodenal ulcer patients
Authors: Schmidt Gerd F. , Schneider Johann A. , Bauer Hartwig , Frey Kurt W. , Holle Fritz
Published: May 2005

There are contradictory reports as to whether the pylorus plays an important role in preventing duodenogastric reflux. In the present study we measured bile reflux under fasting conditions, employing a new radionuclide method which was modified for easy and standardized use. Intravenously administered99mTc‐HIDA (0.1 mCi) is detected in gastric juice aspirated during routine gastric secretion analysis. In order to prove that the radioactivity in the aspirate comes from reflux, in preliminary intraoperative experiments we clamped the antrum and measured the intraluminal activity. Only a very low amount of free activity was found. We found the same result in 3 Heidenhain pouch dogs. We then studied the bile regurgitation in 60 patients with duodenal ulcer disease and in 30 patients operated on for duodenal ulcers (selective proximal vagotomy with pyloroplasty). Preoperatively, we found bile reflux in 66% of the patients. There was a distinct difference between active and chronic ulcers. In the florid state, 76% of our patients had bile reflux as compared to 58% in the chronic state. After pyloric surgery, with a pyloroplasty appropriate to form and function, bile reflux was not increased. Our conclusion is that the pylorus seems to have no important reflux‐preventing properties.
Biliary scintiscanning in suspected acute cholecystitis
Authors: Ram M. D. , Mattingly Sally S. , Kim E. Ed , Coupal J. , Griffen Ward O.
Published: May 2005

The value of biliary scintiscanning in the early diagnosis of suspected acute cholecystitis was studied in 50 patients. All the patients had clinical features and laboratory data suggestive of acute cholecystitis. Scintigraphy was performed using99mTc HIDA and BIDA and the results were compared to oral cholecystography (OCG) and ultrasonography (US). Nineteen patients were proven at operation and at subsequent histologic examination to have had acute cholecystitis, while the other 31 had different conditions. The scan was 100% sensitive and 96% accurate, while OCG was sensitive in 93% and accurate in 86% in this group. US was not very useful in our experience. Scintiscanning could be performed in the acute stage even in the presence of vomiting and jaundice and was not associated with any adverse reactions. It is very valuable in the diagnosis of patients with suspected acute cholecystitis.
Operative procedures in the management of liver hydatidoses
Authors: Dugalić D. , Djukić V. , Milićević M. , Stevović D. , KneŽević J. , Pantić J.
Published: May 2005

Scintiscanning and laboratory and clinical examinations in most cases lead to accurate preoperative hydatid cyst diagnosis and reveal the localization of the cyst in the liver. Selecting the adequate operative procedure and taking all precautions to prevent contamination during surgery, ensure good results and minimize the incidence of postoperative complications. Experience with 204 patients is presented.
Simultaneous colostomy and ileostomy—ileostomy with an autonomically continent sphincter
Authors: Palma Eduardo Carlos
Published: May 2005

A technique is described for performance of a simultaneous colostomy and ileostomy by detaching and exteriorizing the cecal fundus and the distal end of the last ileal loop, and by making an ample opening of the fundus. The ileocecal sphincter remains intact and serves as an autonomically functioning sphincter for the ileostomy.

Forty‐one patients were operated on; there were good results in 40 patients (97.6%) and one death (2.4%). Through the ileostomy, total diversion of feces was obtained. The ileocecal sphincter functioned autonomically with intermittent and widely spaced evacuation of feces. A double enterostomy was used with good results:

As an associated complementary operation in 19 patients, with no operative death; 17 were left colectomies for cancer, and 2 for complicated sigmoiditis (late mortality, 15.8%);

As a complementary operation in 20 cases of occlusion, with one operative death; 15 were severe intestinal occlusion (late mortality, 20%) and 5, occlusive peritonitis (late mortality, 40%);

In 2 cases of severe intractable hemorrhagic ulcerative colitis (with no deaths). Total proctocolectomy was performed subsequently, preserving the ileostomy with a sphincter.

The last ileal loop became enlarged and functioned as a colon voiding feces autonomically during 3 or 4 short periods daily, after meals.

From the above results, the author concludes that this technique is a valuable procedure: (a) to be used instead of transverse colostomy in colectomies; (b) for retrograde decompressive aspiration of the small gut in severe intestinal occlusion; and (c) to perform as ileostomy with an autonomically functioning sphincter.
Intestinal function after total gastrectomy and possible consequences of gastric replacement
Authors: Olbe Lars , Lundell Lars
Published: May 2005

About half of the patients subjected to total gastrectomy experience weight loss. Malabsorption, particularly fat malabsorption, is a common feature after total gastrectomy. This may be due to shortened intestinal transit time and small bowel bacterial overgrowth, but is less often due to diarrhea or pancreatic exocrine insufficiency. Malabsorption is not closely related to weight loss, which is mainly caused by recurrent malignant diseases and a low postoperative calorie intake. The low calorie intake persists in half of the patients despite supervision of the patients by clinical nutritionists at the outpatient clinic. Roux‐en‐Y reconstruction of the esophago‐intestinal canal has minimized the problem of postoperative reflux esophagitis. Severe postprandial symptoms are uncommon although epigastric oppression and fullness is an obligatory feature in the immediate postoperative period but successively vanishes in half of the patients.

Gastric replacement by various enteric reservoirs has been used to improve nutrition after total gastrectomy. The effect of gastric replacement is, however, uncertain since no prospective, randomized studies are available. A gastric substitute seems to have only a marginal effect on meal size, daily caloric intake, and weight gain. A reservoir function of gastric substitutes has been documented but the effect on intestinal transit time is unknown. Stagnation of intestinal contents in a gastric replacement is common, but its significance for bacterial overgrowth, malabsorption, and clinical outcome remains to be determined.