bluuebunny/crossref_metadata_2025 huggingface dataset:
Prophylactic sclerotherapy in nonalcoholic liver cirrhosis: Preliminary results of a prospective controlled randomized trial
Authors: Russo Antonio , Giannone Giorgio , Magnano Antonio , Passanisi Guido , Longo Carmen
Published: May 2005

Between June, 1984 and December, 1985, a total of 41 patients were enrolled in a prospective controlled randomized trial comparing prophylactic sclerotherapy and medical treatment for the prevention of the first esophageal variceal bleeding. All patients had nonalcoholic liver cirrhosis, fourth degree varices, and no past history of gastrointestinal bleeding. The patients were randomly assigned to the control group (20 patients) or to the sclerotherapy group (21 patients); most of the patients belonged to Child's classes A and B.

After a mean follow‐up of 16.8 months, there were 3 variceal bleeding episodes and a 10% mortality rate in the control group whereas neither hemorrhage nor death was observed in the sclerotherapy group. In the latter group, severe complications occurred in 9.5% of the patients; the rate of recurrence after eradication of esophageal varices was 40%.

Although there were no statistically significant results, the favorable trend toward a lower bleeding risk and better survival observed in the treated patients suggests that a longer trial in a larger population of cirrhotic patients with a longer follow‐up should be considered.
Endoscopic treatment of bleeding peptic ulcers
Authors: Nakagawa Kunitoshi , Asaki Shigeru , Sato Toshio
Published: May 2005

Since June, 1979, patients with upper gastrointestinal bleeding, other than of the varices, have been subjected to the procedure of endoscopic hemostasis with injection of absolute ethanol. This method is based on the principle of tissue dehydration and fixation with absolute ethanol. In this procedure, the bleeding vessels are dehydrated and fixed with consequent vasoconstriction and necrosis of the vascular wall, including its endothelial lining, thereby facilitating thrombogenesis and hemostasis. We have applied this method in 147 cases of upper gastrointestinal bleeding, obtaining a successful temporary hemostasis in all cases. Rebleeding from the same site occurred in 5 cases and new bleeding from another site occurred in 6 cases; however, in these cases, hemostasis was successfully obtained by reinjecting ethanol. After hemostasis, 6 patients received elective surgery and another 2 were operated on due to perforation of the stomach. Of the patients treated by this method, 11 died due to causes unrelated to gastrointestinal bleeding. After the hemostatic procedure, cure of the ulcer by conservative treatment was attained in the remaining 136 cases. Therefore, the local injection of absolute ethanol is an effective hemostatic method for upper gastrointestinal bleeding.
Endoscopic laser therapy in the curative and palliative treatment of upper gastrointestinal cancer
Authors: Suzuki Hiroaki , Miho Otomi , Watanabe Yutaka , Kohyama Masayuki , Nagao Fusahiro
Published: May 2005

Endoscopic laser treatment was initially applied for gastrointestinal bleeding, but has been actively extended, especially in Japan, to the curative treatment of early upper gastrointestinal cancers.

We have treated 10 cases of early gastric cancer and 1 case of early esophageal cancer by Nd‐YAG laser radiation, and 2 cases of early gastric cancer by photochemical therapy (PCT) with argon laser + hematoporphyrin derivative. Also, 62 cases of advanced cancer were treated, 10 of the esophagus and 52 of the stomach, for bleeding (18 cases) or stenosis (34 cases). The cases were nonresectable or they were patients who refused surgery. Satisfactory results were obtained by treatment with YAG laser, but have not yet been obtained with PCT.

In order to find indications for the possible extension of endoscopic laser therapy to operable cases of early gastric cancer, we studied lymph node metastases in 200 cases of early gastric cancer surgically treated by us. It was found that early gastric cancers (both mucosal and submucosal) measuring less than 2 cm in diameter, of type I, IIa, and IIc (without ulcer scar), had no lymph node metastases and such cases can be treated by local therapy—such as endoscopic laser therapy.

In palliative endoscopic laser therapy for complications of advanced gastrointestinal cancers, there are no major problems with active performance. We obtained a high (90%) hemostatic rate in bleeding cases of upper gastrointestinal cancer and a satisfactory (65%) rate of dilating effect in cases of cancerous stenosis at the esophagus and cardia. A national survey in this field is also discussed in this report to show the present status of endoscopic laser therapy in the curative and palliative treatment of upper gastrointestinal cancer in Japan.
Percutaneous endoscopic gastrostomy: Indications, limitations, techniques, and results
Authors: Ponsky Jeffrey L. , Gauderer Michael W. L.
Published: May 2005

Percutaneous endoscopic gastrostomy was introduced in 1980 as an alternative to traditional operative methods for the creation of a feeding gastrostomy. The indications for the procedure are essentially the same as those for traditional gastrostomy and include the inability to swallow secondary to neurological impairment, oropharyngeal neoplasms, and facial trauma. The method is contraindicated in the presence of massive ascites, total esophageal obstruction, coagulation disorders, and sepsis. Several variations on the original technique have been developed, and results with each are comparable. The morbidity and mortality with percutaneous methods has been at least as good as those reported for operative techniques while the cost has been lower and patient acceptance high. In spite of the ease with which gastrostomy may be performed by the percutaneous method, patient selection must be appropriate and details of technique closely followed if results are to remain acceptable.
Intraoperative endoscopy of the gastrointestinal tract: Clinical necessity or lack of preoperative preparation?
Authors: Bowden Talmadge A.
Published: May 2005

Intraoperative gastrointestinal endoscopy is an evolving technique that has received limited attention in the literature through case and small series reports. This literature does contain some papers in which the method was employed instead of conventional endoscopy, but, in general, intraoperative endoscopy has been effectively used as an aid to the surgeon to locate pathology not otherwise detectable and to enhance diagnosis and therapy at laparotomy. The procedure will not be required often, but when used, has the potential to be of as much service to the surgeon as a scalpel or retractor. As more surgeons are being trained in gastrointestinal endoscopy, the indications and uses will surely expand.
Complications and hazards of gastrointestinal endoscopy
Authors: Habr‐Gama Angelita , Waye Jerome D.
Published: May 2005

The diagnostic and therapeutic contribution of fiberoptic endoscopy to the advancement of the knowledge of gastrointestinal disease and to its proper management is already established. Technical refinements in the new instruments and extensive acceptance of the advantages of the method makes fiberendoscopy a procedure widely used throughout the world. Therefore, the appreciation of its potential risk of complications and hazards is justified. This review summarizes the complications and hazards of fiberoptic gastrointestinal endoscopy gleaned from reports of endoscopic surveys and individual experiences. Causes and means whereby complications related to upper intestinal and colonic endoscopy can be prevented or treated are discussed.
Renal autotransplantation
Authors: Flatmark Audun , Albrechtsen Dagfinn , Sødal Gunnar , Bondevik Helge , Jakobsen Arnt , Brekke Inge B.
Published: May 2005

In the period, 1973–1985, a total of 305 renal autotransplantations (often with extracorporeal repair) were performed in 274 patients for fibromuscular (56) or atherosclerotic (98) renovascular disease, nephrolithiasis (97), renal tumor (15), or ureteral injury (8). One‐third of the patients had reduced renal function, and approximately half of the patients with renovascular lesions presented with severe or malignant hypertension. The postoperative mortality rate of 4% was related to age over 60 years and reduced renal function. Postoperatively, 3.6% of the autografted kidneys were lost due to vascular thrombosis (7) or other causes (4). Twenty‐five percent (69) of the patients had a solitary kidney. Two patients died postoperatively with functioning autografts. Long‐term renal function remained stable in 60 patients, and deteriorated in 7.

We conclude that autotransplantation and extracorporeal repair provide safe and efficient treatment for selected difficult renal lesions.
Results of treatment of patients with hepatocellular carcinoma with severe cirrhosis of the liver
Authors: Fujio Nagahisa , Sakai Katsuji , Kinoshita Hiroaki , Hirohashi Kazuhiro , Kubo Shoji , Iwasa Ryutaro , Choon Lee Kwang
Published: May 2005

We retrospectively classified patients with hepatocellular carcinoma by the results of tests of 15‐minute indocyanine green retention (ICGR15). Of the 201 patients with hepatocellular carcinoma admitted to our department in the past 6 years, 36 patients were assigned to group 1 (ICGR15 <10.0%), 81 patients to group 2 (ICGR15=10.1–20.0%), and 84 patients to group 3 (ICGR15≥20.1%). Of the total 201 patients, 72% underwent liver resection (78% of group 1 patients, 80% of group 2 patients, and 62% of group 3 patients).

We regarded the cirrhosis of the patients in group 3 as severe and studied their survival rate classified by the treatment used. Of these 84 patients, 52 patients were treated by liver resection, about half of whom were treated preoperatively by transcatheter arterial embolization (TAE). Another 9 patients were treated preoperatively by both TAE and portal vein embolization (PVE). At 2 years, and again at 3 years, the survival rate was significantly higher when TAE was used preoperatively than with resection alone. We think that the possibility of performing needed liver resection will be enlarged by preoperative PVE and that liver resection can be done more safely after use of PVE in some patients.
Differential diagnosis between secondary hyperparathyroidism and aluminum intoxication in uremic patients: Usefulness of99mTc‐pyrophosphate bone scintigraphy
Authors: Kinnaert Paul , Van Hooff Ingrid , Schoutens André , Bergmann Pierre , Fuss Michel , Dratwa Max , Vienne Anne , Pasteels Jean‐Lambert , van Geertruyden Jean , Vanherweghem Jean‐Louis
Published: May 2005

Forty‐one patients in chronic end‐stage renal failure and 4 patients with a functioning kidney transplant presented with spontaneous hypercalcemia or intolerance to vitamin D3 sterols and/or oral calcium supplements. Bone iliac crest biopsy with aluminum staining and Tc‐pyrophosphate bone scintigraphy with determination of Fogelman score were performed in all cases. Two patients had aluminum‐induced osteomalacia (AL O). Thirty‐eight biopsies showed renal osteodystrophy (secondary hyperparathyroidism or various combinations of osteitis fibrosa and osteomalacia): 19 with positive staining for aluminum (RO + AL) and 19 without aluminum deposits (RO). The series also comprised 2 cases of pure osteomalacia (OM), 2 cases of osteoporosis (OP), and 1 case of osteoporosis with aluminum accumulation (OP + AL). Mean Fogelman score in RO patients (9.1±0.3) was significantly higher than in all other categories (5.9±0.5 for RO + AL, and scores ranging from 0 to 8 in the last 7 patients,p<0.01). Patients with massive aluminum accumulation in bone (>75% of the total trabecular surface) showed no or very low uptake of the isotope by the skeleton. Fogelman scores of 9 or higher were always associated with histological secondary hyperparathyroidism.99mTc‐pyrophosphate bone scintigraphy is helpful to distinguish aluminum intoxication from secondary hyperparathyroidism in uremic patients.
Choledochal cyst resection and reconstruction by biliary‐jejuno‐duodenal diversion
Authors: González E. Moreno , García I. García , Pascual M. Hidalgo , Kempin J. Calleja , Blanch G. García , Gutiérrez M. Gomez , Díaz J. Arias , Santiuste A. Calle
Published: May 2005

From January, 1983 to December, 1986, a total of 9 patients, ranging in age from 2 years and 4 months to 36 years, with choledochal cysts were treated. Symptoms were right upper quadrant pain (n=9), ascending cholangitis (n=7), and jaundice (n=6). A right upper quadrant mass was palpable in 7 patients and gallstones were present in 5 patients. Diagnosis was established by intravenous cholangiogram and ultrasound.

The operation was performed through a right subcostal laparotomy. The choledochal cyst diameter ranged from 4.5 to 7 cm. The cyst and the common duct were dissected from the hepatic artery and portal vein. The choledochus was sectioned above the duodenum and the distal end was closed by interrupted sutures. The common duct was divided below the hepatic confluence and the diameter enlarged by longitudinal section of the left hepatic duct. A 30‐cm‐long segment of isolated jejunum was passed through the transverse mesocolon to the right of the middle colic vessels and behind the duodenum and then interposed between the hepatic confluence and the second portion of the duodenum. Biliary‐jejunal anastomosis was performed in 1 layer with interrupted absorbable stitches. No mortality or serious complications occurred during follow‐up (1–4 years). No cholangitis, fever, or pain have developed. All patients were studied postoperatively by biochemical test, ultrasonography, Tc 99m DISIDA, and barium meal swallow. Good liver function and biliary excretion, and absence of duodeno‐jejuno biliary reflux were demonstrated.
The use of blood components in the treatment of congenital coagulation disorders
Authors: Nilsson Inga Marie , Larsson S. Anders , Bergentz Sven ‐Erik
Published: May 2005

Hemophilia and von Willebrand's disease are the most common congenital coagulation and bleeding disorders. The situation for patients suffering from these conditions has changed drastically during the last 2 to 3 decades. It is the purpose of this article, first, to give data on demography and mortality in hemophilia and, then, to review basic problems of therapy, especially in connection with surgery in hemophilia and von Willebrand's disease with emphasis on the use of blood components.
The use of blood components in patients with malignancy
Authors: Murphy Scott
Published: May 2005

Many recent improvements in the management of patients with malignancy would have been impossible without parallel improvements in our ability to support patients through periods of severe bone marrow aplasia produced by the disease or aggressive therapy of the disease. The purpose of this article is to review the use of transfusion of platelets, erythrocytes, and granulocytes in the treatment of these patients.
Immune hemolytic transfusion reactions
Authors: Seyfried Halina , Walewska Irena
Published: May 2005

Hemolytic reactions such as immune complications of incompatible blood transfusion are described. Characteristics of the immediate intravascular and extravascular antibody mediated red cell destruction are presented with particular attention to delayed hemolytic transfusion reactions. Moreover, the most frequent causes of incompatible blood transfusion are summarized. A general strategy to assure the immunologic safety in blood transfusion is suggested.
Transmission of diseases by blood transfusion
Authors: Seidl Siegfried , Kühnl Peter
Published: May 2005

A major risk of blood transfusion is transmission of infectious diseases. The pattern of these diseases varies in different parts of the world. This article reviews the viral, bacterial, and parasitic infections that can be transmitted by transfusion of blood or blood products. A major part of the article deals with posttransfusion hepatitis, the most frequent complication.
Transfusion‐associated acquired immunodeficiency syndrome
Authors: Peterman Thomas A.
Published: May 2005

The acquired immunodeficiency syndrome (AIDS) is the most severe manifestation of infection with a newly recognized retrovirus known as HTLV‐III/LAV (human T‐lymphotropic virus type III/lymphadenopathy‐associated virus). Persons with AIDS have a severe disorder of the immune system that renders them susceptible to a number of opportunistic infections and cancers. Over 80% die within 2 years of diagnosis. Thousands of people have developed AIDS. Most are homosexual/bisexual men or intravenous drug users in the United States or highly sexually active heterosexuals in central Africa or Haiti. Many countries, however, are reporting rapid increases in the number of cases. A small proportion of AIDS patients have been infected by contaminated clotting‐factor concentrates or by blood transfusions. Although AIDS is a rare complication of blood transfusions, it has evoked more fear of transfusions than other more common infectious agents.

Strategies for preventing transfusion‐associated AIDS have been suggested by investigations of recipients who have developed disease, donors who have transmitted infection, and components that served as vehicles of transmission. HTLV‐III/LAV antibody tests are now available for screening blood before transfusion. The effectiveness of the prevention strategies and the properties of the HTLV‐III/LAV antibody tests are reviewed.
Acceptable hematocrit levels in surgical patients
Authors: Messmer K. F. W.
Published: May 2005

The ready availability of blood and blood components has resulted in a liberal use of blood transfusions; however, the transfusion of blood is still associated with significant risks for the recipient. The appearance of the acquired immunodeficiency syndrome and the evidence that homologous blood can induce immunosuppression and thereby impair the host resistance of surgical patients has led to a reconsideration of the indications for blood transfusions. It has also fostered application of alternative methods with the aim of reducing the number of homologous blood transfusions. Based on the data available from studies on intentional perioperative hemodilution in patients undergoing elective surgery, and data from patients in intensive care, a hematocrit level of about 30% is acceptable for surgical patients, provided oxygen transport is not impaired by the reduced saturation of arterial blood or inadequate perfusion. The basic mechanism that compensates for the reduced oxygen capacity of the blood is a rise in cardiac output and stroke volume, both depending on adequate venous return and myocardial function. The hematocrit setpoint has to be determined for the individual patient with regard to the history of the underlying disease, circulating blood volume, and actual oxygen needs. By accepting a perioperative hematocrit level of 30% for patients without respiratory and cardiac disease or increased oxygen demand, respectively, the number of transfusions of homologous blood can be reduced and dangerous side effects can be avoided.
Autologous blood predeposit for elective surgery: An Italian experience
Authors: Rebulla P. , Giovanetti A. M. , Mercuriali F. , Sirchia G. ,   “Autotransfusion Team”
Published: May 2005

A program of predeposit autotransfusion in elective surgery was implemented with the main purpose of decreasing the incidence of posttransfusion hepatitis and of conserving homologous blood. Specific procedures and computer programs were designed to monitor the transfusion practice by key indicators, and the incidence of posttransfusion hepatitis and HTLV‐III infections. Arrangements were devised to ensure the proper management of autologous and homologous units. In 1985, autologous units accounted for 13.5% of all units transfused in elective surgery. While encouraging, our results indicate that efforts have to be made to improve organization and increase awareness of the benefits of autotransfusion in the medical and lay communities.
Worldwide supply of blood and blood products
Authors: Britten Anthony F. H.
Published: May 2005

Blood services have achieved a high degree of sophistication, but there remain serious logistic problems which interfere with the adequacy of blood supplies. Many countries have not been able to implement modern component therapy. Supplies of certain specialized products, such as factor VIII, are insufficient almost everywhere. There is a lively international trade in blood products, and corresponding evidence of disease transmission when the rate of infection is relatively high in the exporting region. The answer to these problems lies in the development everywhere of effective blood programs, based on the organization of nonremunerated blood donors.
Fecal peritonitis: Microbial adherence to serosal mesothelium and resistance to peritoneal lavage
Authors: Edmiston Charles E. , Goheen Michael P. , Kornhall Sven , Jones Frank E. , Condon Robert E.
Published: May 2005

Fecal contamination of the peritoneal cavity is a serious and potentially life‐threatening event. While numerous models have been developed to study the pathogenesis of intraabdominal infection, to date, most investigations have failed to focus on the adherence of the contaminants to the serosal mesothelium. In the present investigation, the cecal ligation and puncture technique (CLP) was performed in Sprague‐Dawley rats to study the following: (a) the kinetics of microbial adherence to the serosal mesothelium, (b) the stability of the aerobic and anaerobic intraperitoneal/mesothelial populations, following extended saline lavage, and (c) the impact of antimicrobial lavage on the stability of the mesothelial microbial populations. The Enterobacteriaceae rapidly colonized the serosal mesothelium and were the predominant flora up to 4 hours post‐CLP. After 8 hours, theBacteroides fragilisgroup represented the predominant peritoneal wash and mesothelial‐associated microorganisms. Extended saline lavage failed to significantly reduce the mesothelial microbial populations. While antimicrobial lavage produced an immediate decrease in mesothelial microbial recovery, the results were transitory and the microbial populations achieved or exceeded prelavage levels at 24 hours postlavage. Microbial colonization of the peritoneal mesothelial surface is a rapid and stable phenomena following penetrating injury to the distal bowel. The results further suggest that the mesothelial populations are resistant to intraperitoneal lavage.
Principles and limitations of operative management of intraabdominal infections
Authors: Farthmann Eduard H. , Schöffel Ulrich
Published: May 2005

Operative management of intraabdominal infections still rests on the principles of elimination of focus, reduction of contamination of the peritoneal cavity, and treatment of residual infection. To control the source of contamination from a perforated viscus primary closure, exclusion or resection may be considered with respect to the severity of peritonitis and to the underlying disease. The principle of “peritoneal toilet” with complementary use of systemic and/or local antibiotics is generally accepted even if the value of aggressive debridement is still debated controversely. For the treatment of residual and the prevention of recurrent infection, closed and open lavage techniques, the left‐open abdomen, and planned relaparotomy represent the major approaches in severe generalized peritonitis when the infectious focus might not be securely controlled. The values and disadvantages of different regimens are discussed, additional measures are briefly described, and an outlook on areas of further research is given.
Etappenlavage: Advanced diffuse peritonitis managed by planned multiple laparotomies utilizing zippers, slide fastener, and Velcro® analogue for temporary abdominal closure
Authors: Wittmann Dietmar H. , Aprahamian Charles , Bergstein Jack M.
Published: May 2005

Etappenlavage is defined as a series of planned multiple operative procedures performed at a 24‐hour interval. It includes a commitment to reexplore the patient's abdomen at the initial corrective operation. This is a report of a prospective study of 117 patients treated by etappenlavage for severe advanced suppurative peritonitis in 2 institutions. Etappenlavage was performed in 15% of all patients with operations for peritonitis. In these patients, the abdominal infection had progressed to an advanced stage of severe functional impairment. A total of 669 laparotomies were performed and the abdomen closed temporarily utilizing retention sutures (n=45), a simple zipper (n=26), a slide fastener (n=29), and Velcro® analogue (n=17). An average of 6.1 procedures were necessary to control the infection. In 57% of the patients, additional complications were recognized and repaired after the initial operation. Patients were artificially ventilated for an average of 17 days. The median duration of therapy was 33 (range, 3–183) days. Twenty‐eight patients died between days 3 and 71 (median, 9) after initiation of therapy. In 88%, uncomplicated wound healing was observed after wounds were closed definitely. In the last 17 patients, no complications were attributable to the use of 2 adhesive sheets of polyamide plus nylon or perlon for temporary abdominal closure (Velcro®‐like artificial burr). APACHE II scoring predicted a median mortality of 47%. The actual mortality was 25%. Overall, the mortality of advanced diffuse peritonitis was reduced from a predicted 34–93% (APACHE II/SIS scoring) to 24%. Velcro® analogue (artificial burr) was the most practical device for temporary abdominal closure.
Herniorrhaphy and concomitant peritoneovenous shunting in cirrhotic patients with umbilical hernia
Authors: Belghiti Jacques , Desgrandchamps François , Farges Olivier , Fékété François
Published: May 2005

From 1981 to 1987, a total of 40 cirrhotic patients with umbilical hernia were treated either by conventional herniorrhaphy (26) or by herniorrhaphy and concomitant insertion of a peritoneovenous (PV) shunt (14). The aim of concomitant PV shunt insertion was to reduce postoperative complications of herniorrhaphy in those patients with intractable ascites, or in whom difficulty to control postoperative ascites was contemplated. In the group of patients with PV shunt, 8 were class B and 6 were class C according to Child's classification; 7 patients had complicated hernia including 2 patients with skin ulceration, 4 with rupture, and 1 with incarceration. In the group with standard herniorrhaphy, 5 patients were class A and 21 were class B; 13 patients were operated on electively for uncomplicated hernia without ascites, 6 had incarceration, and 7 had skin ulceration. The technical procedure of concomitant PV shunting and hernia repair included: insertion of the valve, surgical repair of the hernia, and insertion of the venous tube. In that order, in‐hospital mortality was nil. Postoperative complications included sepsis in 2 patients who had concomitant insertion of a PV shunt, and massive ascitic fluid production in 5 patients treated by conventional herniorrhaphy, resulting in ascitic leak from the surgical wound in 1 case. Recurrence of the hernia was observed in 6 patients treated by conventional herniorrhaphy, and in none who had a patent PV shunt. We conclude that concomitant insertion of a PV shunt should be considered in cirrhotic patients whose ascites does not respond to medical treatment or in patients with complicated hernia requiring an emergency procedure in whom poor liver function anticipates difficult management of postoperative ascites.
Evaluation of hemodynamics and hepatic mitochondrial function on extrahepatic portal obstruction in the rat
Authors: Omokawa Susumu , Asanuma Yoshihiro , Koyama Kenji
Published: May 2005

An animal model resembling clinical cases with extrahepatic portal vein obstruction was developed. The changes in hepatic mitochondrial function and the hepatic hemodynamics including hepatic regional blood flow, portal venous pressure, and portogram were evaluated to assess the effect of portal vein obstruction in the model.

Portal vein ligation in this model was a simple and easy maneuver and could produce collateral veins to the liver—cavernomatous transformation—which were obviously seen in clinical patients with extrahepatic portal obstruction. Hepatic blood flow was significantly decreased until 5 days after portal vein ligation; however, hepatic blood flow was gradually increased and reached the normal value at 3 weeks after portal vein ligation due to the formation of the collateral veins to the liver. Respiratory parameters of mitochondria were gradually decreased and reached the lowest levels at 5 days after portal vein ligation, while they recovered to normal values in accordance with increasing hepatic blood flow at 3 weeks after portal vein ligation.

In extrahepatic portal obstruction, although the liver is temporarily deteriorated by portal vein obstruction such as portal vein thrombosis, hepatic blood flow and the liver functions are to be normally improved with the formation of collateral veins to the liver.
Bleeding peptic ulcer: A prospective evaluation of risk factors for rebleeding and mortality
Authors: Branicki Frank J. , Coleman S. Y. , Fok Peter J. , Pritchett Christopher J. , Fan Sheung‐tat , Lai Edward C. S. , Mok Francis P. T. , Cheung Wai‐lam , Lau Peter W. K. , Tuen Henry H. , Lam Shiu‐kim , Hui Wai‐mo , Ng Matthew M. T. , Lam David K. H. , Tang Alan P. K. , Wong John
Published: May 2005

Clinical, endoscopic, and laboratory data were collected prospectively in 701 patients with bleeding peptic ulcer. The overall rebleeding rate was 16.1% and increased the risk of a fatal outcome by 17 fold (1.2% versus 20.6%,p< 0.001). Rebleeding was documented in more than 75% of the group who did not survive following initial conservative management. Rebleeding was more likely (24.1% versus 14.2%,p< 0.02) when shock was present on admission and the risk of a rebleed was doubled in patients over 60 years of age (22.1% versus 10.9%,p< 0.001). Ulcers greater than 1 cm in size carried twice the risk of rebleeding (23.9% versus 12.4%,p< 0.002).

Concomitant medical illness had a significant adverse effect on outcome (p< 0.05). Shock on admission was associated with a doubling of mortality figures (9.5% versus 3.7%,p< 0.01). The identification of endoscopic stigmata of recent hemorrhage (ESRH) tripled the risk of mortality (7.5% versus 2.4%,p< 0.002), ESRH were more frequently encountered when ulcer size was larger than 1 cm (61.4% versus 39.8%,p< 0.001). Respective mortality rates for ulcers less than or equal to 1 cm and greater than 1 cm in size were 1.6% and 12.5% (p< 0.001), corresponding mortality figures for patients over 60 years of age being 4.4% and 16.4% (p< 0.002). The risk of a rebleed tripled (6.7% versus 2.6%,p< 0.02) when ESRH were evident. There was a 6‐fold increase in mortality following emergency surgery when compared with conservative management of patients in whom no surgical intervention was necessary (2.6% versus 14.9%,p< 0.001). In summary, age over 60 years, previous medical illness, shock on admission, large ulcer size, and ESRH were each associated with an increased risk of rebleeding and mortality.
Primary hyperparathyroidism: Epidemiology, diagnosis and clinical picture
Authors: Ljunghall Sverker , Per Hellman  , Rastad Jonas , Åkerström Göran
Published: May 2005

Primary hyperparathyroidism (HPT) is a common disorder that mainly afflicts elderly women. It can be diagnosed in at least 1% of all postmenopausal females and autopsy studies indicate an even higher frequency. Although the widespread use of automated serum calcium analyses has increased the awareness of HPT, only 10% of all cases seem to be identified. The diagnosis relies on the demonstration of an inappropriately elevated serum concentration of parathyroid hormone (PTH) relative to the serum calcium value, which need not be markedly raised. Measurements of intact PTH with immunometric methods have considerably improved the diagnostic precision but it is still difficult to evaluate patients with only marginal hypercalcemia. Few patients with diagnosed HPT are completely without symptoms. Symptoms commonly encountered are psychiatric and neuromuscular disturbances. Subclinical bone disease might be relevant but there is insufficient information about its importance in otherwise asymptomatic individuals. Various cardiovascular risk factors appear more commonly in patients with HPT and untreated disease is associated with an increased risk of premature death.
Management of primary hyperparathyroidism caused by multiple gland disease
Authors: Goretzki P. E. , Dotzenrath Cornelia , Roeher H. ‐D.
Published: May 2005

Multiple gland parathyroid disease is the pathological finding in primary hyperparathyroidism (HPT) in about 10% to 20% of all patients and in approximately a third of all patients with persistent or recurrent disease. The variability of multiple gland disease spans from 2 adenomas to diffuse hyperplasia in patients with multiple endocrine neoplasia type 1. This variability calls into question the proposed common pathophysiologic background in all of these cases. As primary treatment of multiple gland primary HPT, subtotal parathyroidectomy and thymectomy or total parathyroidectomy and heterotopic autotransplantation including thymectomy can be equally advocated. Recurrent hyperparathyroidism frequently occurs in cases of diffuse parathyroid hyperplasia. This must be considered especially in patient follow up and before each surgical procedure. Thus, a defined but adaptable therapeutic regimen might prevent permanent hypoparathyroidism and persistent hyperparathyroidism.
The role of the pathologist in diagnosis and surgical decision making in hyperparathyroidism
Authors: Grimelius Lars , Åkerström Göran , Bondeson Lennart , Juhlin Claes , Johansson Henry , Ljunghall Sverker , Rastad Jonas
Published: May 2005

Hyperparathyroidism has been diagnosed with increasing frequency in recent decades. The concomitant awareness that the disease may be the cause of a concealed morbidity and even an increased mortality has resulted in more liberal indications for surgery. Many patients currently undergo surgery on the grounds of only mild hypercalcemia and in the absence of any apparent clinical symptoms. This policy of early surgical treatment has emphasized the importance of a histopathological parathyroid diagnosis, since many of these patients exhibit chief cell hyperplasia and minimal glandular enlargement. Light microscopic examination of frozen sections stained with hematoxylin‐eosin and with stains for demonstration of cytoplasmic fat in the parathyroid chief cells, and appropriate weight estimates of the parathyroid glands, constitute the conventional, intra‐operative basis for the diagnosis. The use of specific antiparathyroid antibodies is an important new tool in the histopathological parathyroid examination, mainly because of the ability to demonstrate the cause of increased parathyroid hormone release from the pathological parathyroid tissue. A careful histopathological examination in combination with gross inspection of the parathyroid glands by an experienced eye should contribute to adequate surgical treatment and minimize errors in operative management in patients with hyperparathyroidism.
Diagnosis and treatment of patients with parathyroid carcinoma: An update and review
Authors: Obara Takao , Fujimoto Yoshihide
Published: May 2005

Parathyroid carcinoma is a rare cause of primary hyperparathyroidism. However, to our best knowledge, at least 163 cases of functioning parathyroid carcinoma appeared in the English literature from 1981 to 1989. We summarize the available information obtained from the reports of those patients and compare it with previous descriptions of the disease. The etiology of parathyroid carcinoma is usually obscure, but the possibility of a radiation‐induced malignant change in the parathyroid gland became evident in a few patients. Clinical manifestations, including age, sex, symptoms, and biochemical findings in this review were comparable to those in previous reviews. Noninvasive localization studies such as ultrasonography may offer a diagnostic clue to parathyroid carcinoma. Measurement of DNA content is a useful adjunct for making the histologic diagnosis of parathyroid carcinoma and prediction of the clinical outcome. Since the initial operation offers the best chance for cure, preoperative suspicion and intra‐operative recognition of the parathyroid cancer are essential. The initial operation should been bloc resection of the tumor, avoiding rupture of the tumor capsule and spillage of tumor cells. As parathyroid carcinoma is a slow‐growing but tenacious malignancy, repeated resection of local recurrent tumors or even distant métastases is effective for palliation of recurrent hypercalcemia and occasional cure. When hypercalcemia is refractory to surgical therapy or no recurrent tumor can be identified, other modalities of therapy must be considered. New drugs to control hypercalcemia by inhibiting bone resorption may hold promise in patients with recurrent parathyroid carcinoma.
Subtotal parathyroidectomy versus total parathyroidectomy and autotransplantation in secondary hyperparathyroidism: A randomized trial
Authors: Rothmund Matthias , Wagner Peter K. , Schark Claudia
Published: May 2005

In a randomized study subtotal parathyroidectomy (sPTX) was compared with total parathyroidectomy and autotransplantation of fresh tissue (PTX+AT) in 40 patients with severe secondary hyperparathyroidism (HPT). After surgery both groups were followed at 19±6 months (PTX +AT) and 19±7 months (sPTX) and at 43±9 months (PTX+AT) and 40±7 months (sPTX). There were 17 patients alive in each group at the time of the second follow‐up. After sPTX, 2 patients required re‐operation because of recurrent disease originating from the remaining parathyroid gland in the neck and another 2 patients were hypercalcemic at follow‐up. After PTX + AT both serum calcium and alkaline phosphatase normalized significantly more often (p <0.03) than after sPTX. Re‐operations were not required in this group. Radiological signs also improved significantly more after PTX+AT, as did clinical signs like pruritus (p< 0.005) and muscle weakness (p<0.04). These results and the fact that in recurrent disease a re‐operation at the autograft in the forearm is simpler than a re‐operation in the neck, lead to the recommendation that PTX+ AT should be considered as the method of choice in the surgical treatment of secondary HPT.
Replantation of cryopreserved human parathyroid tissue
Authors: Wagner Peter K. , Seesko Hinrich G. , Rothmund Matthias
Published: May 2005

Twenty‐five patients with permanent postoperative hypoparathyroidism received cryopreserved parathyroid autografts. Twelve patients had undergone cervical re‐operations due to persistent or recurrent hyperparathyroidism and 10 patients had malfunction of a fresh autograft after total parathyroidectomy. Hypoparathyroidism occurred in 2 patients after subtotal parathyroidectomy and in 1 after the resection of a solitary adenoma following previous thyroid resection. The viability of the tissue was examined histologically prior to replantation in 22 patients and the amount of tissue needed for transplantation was determined by the ratio of necrotic cells vs. viable cells in the material. The patients were examined between 6 months and 125 months (median: 40 months) after replantation. Pre‐operatively each patient required high doses of calcium and vitamin D metabolites to establish normocalcemia. This medication was reduced postoperatively, with 16 patients requiring no supplemental treatment. Nine patients still needed low doses of calcium and/or vitamin D. At follow‐up all patients were free of hypocalcemic symptoms. Our results demonstrate that replantation of autologous cryopreserved parathyroid tissue is safe and effective therapy for permanent postoperative hypoparathyroidism. Thus, we regard it as an essential part of today's parathyroid surgery.
Complications associated with heal pouch‐anal anastomosis
Authors: McMullen Kevin , Hicks Terry C. , Ray John E. , Gathright J. Byron , Timmcke Alan E.
Published: May 2005

Seventy‐three patients underwent total colectomy, rectal mucosectomy, creation of J or S ileal reservoir, and ileal pouch‐anal anastomosis from 1982 to 1989. Mean follow‐up was 38 months, with a minimum of 3 months in 15 patients being followed long‐term at another institution. Forty‐eight (66 %) patients had histologically proven ulcerative colitis and 25 (34%) patients had familial polyposis. Thirty‐eight J reservoirs and 35 S reservoirs were constructed. There were no perioperative deaths. The failure rate (loss of pouch) was 3%. Thirty‐six complications in 34 (47%) patients were reported, 14 (19%) patients required surgery. Bowel obstruction was the most common postoperative complication (16%), followed by pouchitis (15%), and cuff infection (5%). Seventy‐eight percent of the complications were associated with the J pouch. Average stool frequency at 1 year was 4 per 24‐hour period. Other complications included postoperative pneumonia (1), peroneal nerve palsy (1), and temporary sexual dysfunction (1). Seven of 15 complications requiring surgical intervention occurred in the first 2 years of the study period, illustrating the learning curve associated with the procedure. Blood loss, transfusion requirements, and length of operation were not associated with higher complication rates. Use of the J pouch and experience of the individual surgeon affected morbidity.
Progress in the treatment of congenital malformations of the hand
Authors: Buck‐Gramcko Dieter
Published: May 2005

Treatment of congenital malformations of the hand and forearm has progressed not only from new procedures, but especially due to a new technique, namely microsurgery. Microsurgery enables skilled hand surgeons to operate on the tiny hands of babies without damaging the anatomical structures. The optimal time for the correction of many deformities is during the first 2 years of life. This gives excellent adaptation of the corrected structures to their altered function, especially in combination with a long period of further growth. Several new procedures are described which have been made possible only since the introduction of microsurgery, either by microvascular anastomoses or by meticulous dissection technique (toe transplantation, proximal toe phalanx transplantation, nail wall formation in complex syndactyly, transposition of digital parts in polydactyly and radial club hand).
Progress in peripheral nerve reconstruction
Authors: Millesi Hanno
Published: May 2005

The development of peripheral nerve surgery over the past 15 years has been fascinating to watch. Significant improvements have been achieved by the wide application of techniques which were developed before this period. New approaches may revolutionize the tactics of nerve repair in the near future.
Reconstruction of traumatically acquired defects of the phallus
Authors: Horton Charles E. , Dean John A.
Published: May 2005

Trauma to the male phallus may be treated in a systematic approach to achieve aesthetically and functionally pleasing results. Isolated burns should be treated early with excision and preputial flap or skin graft closure. Avulsion injuries are closed primarily or skin grafted. Subtotal loss can be treated with penile lengthening techniques. Total loss is treated with reimplantation or microvascular free tissue transfer phalloplasty. There are reconstructive surgical options, instead of penectomy, in patients with penile malignancies.
Breast reconstruction: Progress in the past decade
Authors: Elliott L. Franklyn , Hartrampf Carl R.
Published: May 2005

There have been numerous advances in breast reconstruction techniques of the past decade. The disappearance of the radical mastectomy along with the increased frequency of smaller tumor detection have contributed significantly to these changes. Furthermore, reliable studies have shown that breast reconstruction does not interfere with extirpative surgery or delay postoperative adjuvant therapy if indicated. Studies such as these have led increasing numbers of women to elect immediate breast reconstruction as opposed to delaying that reconstruction for months or even years after the tumor extirpation.

The advent of successful breast reconstruction using autogenous tissue provided the most radical change to reconstructive techniques over the past 10 years. The TRAM (transverse rectus abdominis myocutaneous) flap was the first of these techniques to be introduced and has rapidly assumed a position of prominence among those techniques chosen for breast reconstruction. The LTTF (lateral transverse thigh flap) and the buttock flap, while requiring microsurgical technique, are important alternatives for those patients who choose autogenous tissue breast reconstruction and should be presented to women during the discussion of alternatives for breast reconstruction.

Implant technology has continued to improve with the introduction of the tissue expander, the most important addition in the past decade. Investigations are currently underway to provide a long‐term tissue expander that does not have to be removed and replaced by a permanent implant. The ultimate end result would be to create a more normal breast shape without firmness. And the use of stacked or directional expanders may allow more freedom in creation of the new breast shape to conform to the opposite side.

Finally, nipple areola reconstruction has improved significantly as the tissues of the breast mound itself are used for the new nipple and areola, thereby avoiding the transfer of grafts from distant sites which do not generally maintain their size or projection over time.
Progress in flap surgery: Greater anatomical understanding and increased sophistication in application
Authors: Lamberty B. George H. , Chir B. , Cormack G. C. , Chir B.
Published: May 2005

An introduction summarizes the history of the development of flap surgery and puts the discovery of the fasciocutaneous flaps into historical perspective. The anatomical work underlying this discovery is presented and the way in which it has led to improved designs of flaps on the limbs is then described. Finally, the increased refinement and sophistication in the application of all types of flaps is demonstrated by a description of recent advances in the use of microsurgical free tissue transfer in 3 key areas of reconstructive surgery.
Dynamic properties of blood flow and leukocyte mobilization in infected flaps
Authors: Feng Lu‐Jean , Price David C. , Mathes Stephen J. , Hohn David
Published: May 2005

Two aspects of the inflammatory response to infection—blood flow alteration and leukocyte mobilization—are investigated in the canine model. The elevation of paired musculocutaneous (MC) and random pattern (RP) flaps allowed comparison of healing flaps with significant differences in blood flow (lower in random pattern flaps) and resistance to infection (greater in musculocutaneous flaps). Blood flow changes as determined by radioactive xenon washout were compared in normal skin and distal flap skin both after elevation and following bacterial inoculation. Simultaneous use of In‐111 labeled leukocytes allowed determination of leukocyte mobilization and subsequent localization in response to flap infection. Blood flow significantly improved in the musculocutaneous flap in response to infection. Although total leukocyte mobilization in the random pattern flap was greater, the leukocytes in the musculocutaneous flap were localized around the site of bacterial inoculation within the dermis. Differences in the dynamic blood flow and leukocyte mobilization may, in part, explain the greater reliability of musculocutaneous flaps when transposed in the presence of infection.