bluuebunny/crossref_metadata_2025 huggingface dataset:
Localization of Endocrine Pancreatic Islets
Authors: Fiedor Piotr S. , Oluwole Soji F. , Hardy Mark A.
Published: August 2002

Transplantation of whole pancreas or pancreatic islets remains a promising approach to treatment of diabetes mellitus. Because at present there is no efficient method for in vivo early diagnosis of pancreatic islet rejection or for disorders of pancreatic endocrine function, we examined if dithizone (DTZ) and a synthetic iodo‐derivative of DTZ (I‐DTZ) can be used as a potential radioactive marker for monitoring viable transplanted pancreatic islets. Human pancreatic islets harvested from multiorgan donors were tested ex vivo after intraductal injection of DTZ solution for islet staining. Lewis rats were used in the in vivo experiments for localizing pancreatic islets in situ after intravenous injection of various concentrations of DTZ or I‐DTZ. Fresh rat islets were transplanted into streptozotocin‐induced diabetic recipients, either underneath the kidney capsule or intraperitoneally. Intravenous DTZ or I‐DTZ was then used for macroscopic and microscopic identification of viable transplanted islets. These studies indicate that DTZ and I‐DTZ solutions specifically stain pancreatic islets in vivo after intravenous injection without damage to their endocrine function as assessed by plasma insulin and glucose levels. Human islets stain red in in vitro studies similar to the DTZ (I‐DTZ) effect in rats. We conclude that DTZ and I‐DTZ are effective in the in vivo and in vitro identification of pancreatic islets and may have potential clinical application in the detection of pancreatic islet tumors (insulinomas) and in the diagnosis of rejection of pancreatic organ allografts or islets.
Management of Acute Steroid‐Resistant Rejection after Liver Transplantation
Authors: Platz Klaus‐Peter , Mueller Andrea R. , Zytowski Michael , Lemmens Peter , Lobeck Hartmut , Neuhaus Peter
Published: August 2002

Prior to the FK506 era, OKT3 was primarily used for treatment of steroid‐resistant rejection. Initially FK506 has been used as a last treatment of refractory acute or chronic rejection. We provide strong evidence that the use of FK506 is more successful if rescue therapy is performed early instead of using it as the last resort. Between September 1988 and March 1995 a total of 600 liver transplantations were performed in 550 patients. Of these 550 patients, 426 received primarily cyclosporine A (CsA)‐based immunosuppression. Of the 426 CsA patients, 70 (16.4%) required either FK506 (51.4%), or OKT3 rescue therapy (27.1%), or a combination of the two drugs (21.5%). The latter group of patients received first OKT3 and then FK506 rescue when OKT3 therapy failed. Treatment was initiated simultaneously (within 1 week) in 11 patients, and 4 patients received FK506 rescue later during the course of rejection. The highest success rates (88.9%) were observed in patients given FK506 rescue therapy. Retransplantation was necessary more often in patients receiving OKT3 than in those with FK506 rescue therapy (15.8% versus 5.5%, respectively). Retransplantation and death due to chronic rejection increased with the need for additional FK506 rescue therapy after OKT3 failure. This increase was most pronounced in patients receiving FK506 during the late course of rejection, reaching a failure rate of 75.0% (50.0% of deaths were due to chronic rejection). The lowest incidence of cytomegalovirus infection and of infectious, neurologic, and renal complications was observed in the FK506 rescue group. We conclude that early FK506 rescue therapy may be the treatment of choice for acute steroid‐resistant rejection.
Effects of Platelet‐Activating Factor Antagonist E5880 on Intrahepatic and Systemic Metabolic Responses to Transient Hepatic Inflow Occlusion and Reperfusion in the Rabbit
Authors: Nakatani Toshio , Sakamoto Yoshimasa , Ando Hirofumi , Kobayashi Kunio
Published: August 2002

We investigated the effects of pretreatment with a potent platelet‐activating factor (PAF) receptor antagonist (E5880) on the changes in hepatic and systemic metabolism induced by transient hepatic ischemia and reperfusion. Sixty‐five rabbits were assigned to four groups that either did or did not undergo a period of hepatic ischemia and reperfusion with or without pretreatment. E5880 was administered intraportally 1 minute prior to inflow occlusion. Twenty minutes of warm ischemia was followed by 30 minutes of reperfusion. Blood gas analyses and measurements of levels of arterial pyruvate, lactate, and ketone bodies, arterial and portal ammonia and endotoxin, and intrahepatic adenine nucleotide, pyruvate, and lactate were performed. Results were analyzed by either ANOVA or chi‐square analysis. Hepatic tissue ATP and energy charge levels were significantly increased and the AMP level was significantly decreased after 30 minutes of reperfusion in the pretreatment group compared to those without pretreatment. At the same time, parameters reflecting hepatic mitochondrial function, such as the arterial ketone body ratio and arterial ammonia level, improved, although they were not statistically significant. No difference was observed for parameters reflecting systemic changes, such as arterial blood gas values and pyruvate and lactate levels. PAF is thought to mediate metabolic changes after hepatic ischemia and reperfusion. PAF released in the liver may exert local effects, which appear to be attenuated by pretreatment with E5880. Systemic metabolic changes seen after hepatic ischemia and reperfusion may be mediated by factors other than PAF.
What Is New in the Prophylaxis and Treatment of Venous Thromboembolism?
Authors: Bergentz Sven‐Erik
Published: August 2002

Deep venous thrombosis continues to be a frequent complication of surgery and trauma. The topic is controversial with regard to diagnosis, indication for prophylaxis, and suitable methods for prophylaxis and therapy. We review some of the highlights of the extensive literature in this field during the last few years. Particular emphasis is given to new trends in diagnostic methods, newly discovered genetic factors for thrombophilia, and the use of heparins for prophylaxis and therapy of thromboembolic disease.
Changes in gallbladder surgery: Comparative study 4 years before and 4 years after laparoscopic cholecystectomy
Authors: Cervantes Jorge , Rojas Guillermo , Anton Jorge
Published: August 2002

Operative procedures on the gallbladder and biliary ducts have undergone a profound transformation since the introduction of laparoscopic techniques in general surgery. As the benefits of minimally invasive procedures become universally known, patients are seeking surgery at an earlier stage, resulting in an increased number of cases for elective surgery and a considerable reduction in emergency operations, morbidity, need for intraoperative cholangiography (IOC), fewer common bile duct (CBD) explorations, shortened hospital stay, and reduced overall costs. The early criteria for IOC and the need for CBC explorations must be reevaluated in view of the observed changes and appropriate modifications made. Looking at the present trends, it seems that the routine use of IOC is not justified in the average patient who presents for laparoscopic cholecystectomy with no history of jaundice or pancreatitis, normal liver function tests, and a normal‐size CBD on ultrasonography. Under those conditions, the chance of leaving an unsuspected stone in the CBD is less than 1%; and if it happens the stone can be easily retrieved by endoscopic sphincterotomy as an outpatient procedure.
Prognostic markers for colorectal cancer: Expression of P53 and BCL2
Authors: Pereira Hermínia , Silva Salete , Julião Rui , Garcia Palla , Perpétua Fátima
Published: August 2002

P53 is a tumor suppressor gene that has been implicated in the pathogenesis of a wide range of tumor types including colorectal cancers. bcl2 is a proto‐oncogene that inhibits apoptosis. Immunostaining for P53 and BLC2 protein product was performed in a retrospective series of 80 colorectal carcinomas with a minimum follow‐up of 5 years. The aim of the study was to evaluate the prognostic significance of P53 and BCL2 protein expression and their correlation with clinicopathologic variables such as pathologic disease stage (Dukes system), histologic grade, and vascular invasion. The patients were 41 to 76 years of age, and the follow‐up ranged between 5 and 10 years. Among the 80 cases, 30 were Dukes stage A and 50 stage B. We found vascular invasion in 21.2%. P53 and BCL2 expression was detected, respectively, in 30.0% and 8.8%. We concluded that the P53 and BCL2 expression detected by immunohisto‐chemistry in routinely processed, paraffin‐embedded tissues: (1) has no prognostic significance; and (2) was not correlated with pathologic disease stage, histologic grade, or vascular invasion. Nevertheless, the number of patients in our study was small, and we believe that investigation of a larger series of patients is indicated.
Endoscopic Diagnosis and Treatment of Early Colorectal Cancer
Authors: Kudo Shin‐ei , Kashida Hiroshi , Nakajima Takashi , Tamura Satoru , Nakajo Kazuo
Published: August 2002

Colorectal adenomas and early cancers are grossly classified into three groups: protruded, flush or slightly elevated (so‐called flat adenomas), and depressed. Protruded lesions and flat adenomas are not invasive until they are rather large, whereas depressed lesions can invade the submucosa even when very small. It is not difficult to detect protruded and flat adenomas, but depressed carcinomas are often overlooked. Keys to the detection of depressed carcinomas are a slight color change, bleeding spots, interruptions of the capillary network pattern, slight deformation of the colonic wall, shape change of the lesion with insufflation and deflation of air, and interruption of the innominate grooves by the lesion. Spraying of indigo carmine dye helps to clarify the lesions. Pit pattern analysis with magnifying colonoscopy is useful for diagnosis of early colorectal cancer. Pit pattern analysis and histologic examination suggest that depressed carcinomas probably have arisen de novo, without going through an adenomatous step. Some adenomas appear at first to have a depression, but such cancer‐mimicking adenomas with pseudodepression must be distinguished from depressed carcinomas because they are quite different in nature. Protruded and flat adenomas can usually be removed with polypectomy or hot biopsy techniques. Depressed carcinomas are treated with an endoscopic mucosal resection (EMR) technique; but when they massively invade the submucosa, surgical resection is indicated. Some neoplastic lesions, which we call laterally spreading tumors, extensively and circumferentially spread along the colonic wall, although they are short in height. They tend to have a rather benign nature despite their large size; therefore EMR or a piecemeal EMR method is indicated.
Long‐Term Prognosis of Patients with Surgical Wound Infections
Authors: Poulsen Kjeld B. , Gottschau Adam
Published: August 2002

This study examined if surgical wound infections (SWI) result in a severe prognosis regarding general health and increase the consumption of social resources. A group of 1301 patients were interviewed by self‐administered questionnaires during 1993–1994, while operated during hospitalization in seven Danish hospitals. These patients were followed up at least once by similar questionnaires at a median time of 5.5 and 10.0 months postoperatively. The consequences of surgically diagnosed SWI were analyzed in a hospital cohort of 58 infected patients and 648 controls. Postdischarge infections were analyzed in a patient cohort of 263 cases and 767 controls. Changes in health was measured by the General Health Questionnaire, Activities of Daily Living index, and self‐assessed health. Consumption of resources were estimated by reliance on assistance from family and friends, use of home services, and contacts to doctors. It was found that the long‐term prognosis of general health was unaffected by SWIs. However significantly increased social dependence was found for patients with SWIs compared to uninfected patients. Almost one‐fourth of the operations were complicated by an SWI. Most of the infections were recognized only after discharge and were thought to be of minor importance, which may explain why no chronic impairment of the health was found for patients with an SWI. A bias toward no‐effect may have been introduced if patients with severe SWIs abstained from participation. The societal cost of care for patients with minor infections seems to be large. The causal relation between outcome and SWI needs to be further investigated.
Genetic Engineering as an Approach to Xenotransplantation
Authors: Bach Fritz H.
Published: August 2002

A discordant organ xenograft, such as a heart or kidney transplanted from pig to human, is rejected within 1 to 2 hours by a process called hyperacute rejection (HAR) caused in large or full measure by preexisting host xenoreactive natural antibodies (XNAs) and complement. HAR can be averted by blocking either complement or XNAs; but the xenograft is then rejected at 3 to 4 days by a process called delayed xenograft rejection (DXR), which can occur without the presence of T cells. DXR involves type II endothelial cell (EC) activation (the phase of activation that includes up‐regulation of proinflammatory genes in the EC), infiltration into the graft of host monocytes and natural killer cells (both of which appear to be activated), and a complex cytokine picture. We discuss in this paper various approaches that might help prevent DXR, after which we assume that one would still have to deal with a xenograft counterpart of the T cell‐mediated allograft rejection response. The approach to avoiding DXR focuses largely on genetic engineering of the ECs in the graft.
Tolerance Induction for Xenotransplantation
Authors: Sykes Megan , Zhao Yong , Yang Yong‐Guang
Published: August 2002

The transplantation of donor hematopoietic tissue prior to organ xenografting has the potential to induce lasting T cell tolerance and, possibly, tolerance of natural antibody‐producing B cells. However, the development of specific and nontoxic methods of overcoming the immunologic and physiologic barriers to xenogeneic marrow engraftment is a major challenge that must be met before this goal can be achieved. A greater understanding of the species specificity of molecular interactions important for hematopoiesis and cell homing is a first step toward transcending these physiologic barriers. Perhaps most promising is the potential associated with the use of nonprimate xenogeneic donors genetically engineered to make donor tissues more readily capable of surviving and, in the case of hematopoietic cells, competing with host tissues for survival in a human environment.
Genetically Modified Animal Organs for Human Transplantation
Authors: Squinto Stephen P.
Published: August 2002

The major barrier to successful discordant xenogeneic organ transplantation is the phenomenon of hyperacute rejection (HAR). Hyperacute rejection results from the deposition of high‐titer preformed antibodies that activate serum complement on the luminal surface of the vascular endothelium, leading to vessel occlusion and graft failure within minutes to hours. Here we describe our strategy to overcome HAR in the pig‐to‐primate transplant setting, which includes the genetic incorporation into transgenic organs and high level expression of both a novel human bifunctional complement inhibitor and a human blood group enzyme. The expression of the human blood group enzyme is designed to reduce significantly the natural antibody reactivity to the discordant pig tissue, whereas expression of the complement inhibitor results in inhibition of complement‐mediated cell activation and lysis. High‐level cell surface expression of the complement inhibitor and high‐level expression of the human blood group enzyme in vascular endothelium effectively eliminate both the antibody and complement components of the massive inflammatory response to the xenogeneic tissue. Elimination of HAR will establish inroads into understanding the cellular immune response toward the discordant tissue. It is conceivable that standard immunosuppressive regimens routinely practiced with allotransplantation can also be effective drug therapies for xenotransplantation. Therefore it is critical to develop a system that tests these possibilities in order to solve an ever‐growing need for donor organs.
Physiologic Effects of Cisapride on Gastric Emptying after Pylorus‐Preserving Gastrectomy for Early Gastric Cancer
Authors: Tomita Ryouichi , Takizawa Hidehiro , Tanjoh Katsuhisa
Published: August 2002

Pylorus‐preserving gastrectomy (PPG) has been considered reasonable reduction surgery. However, even patients in whom more than 1 year passed after surgery frequently have a feeling of gastric fullness after meals and long‐term retention of foods in the residual stomach. To treat this syndrome, cisapride has been administered. We studied the emptying time of a semisolid diet (radioisotope method using 99mTc‐tin colloid‐labeled rice gruel) and the emptying time of a fluid diet (acetaminophen method with orange juice) before and after oral administration of cisapride (15 mg/day for 1 month) in 14 patients (10 men, 4 women; 32–70 years old, average 60.6 years) who underwent PPG (Billroth I procedure, D2 lymph node dissection, curability A) for treatment of early gastric cancer. Ten healthy volunteers without gastrointestinal symptoms and digestive diseases (7 men, 3 women; 28–61 years old, average 49.8 years) were enrolled as controls. The results showed obviously delayed emptying time of the semisolid diet before administration of cisapride in patients with PPG compared with that of the control group, whereas the emptying curves for the fluid diet showed an almost normal pattern. One month after the start of cisapride administration the emptying time of the semisolid diet was improved, and the emptying curves were close to the patterns in the control group. Emptying of the fluid diet was slightly accelerated compared with that before administration of cisapride, and the emptying curves showed almost the same pattern as in the control group. A postgastrectomy symptom, “gastric fullness,” after PPG was alleviated by cisapride. These results showed that cisapride improved delayed emptying of a semisolid diet after PPG and prevented the feeling of gastric fullness after meals due to retention in the residual stomach.
Surgical and Radiologic Treatment of Primary Budd‐Chiari Syndrome
Authors: Pisani‐Ceretti Andrea , Intra Mattia , Prestipino Francesco , Ballarini Carlo , Cordovana Andrea , Santambrogio Roberto , Spina Gian Paolo
Published: August 2002

Budd‐Chiari syndrome (BCS) is an uncommon form of portal hypertension caused by obstruction of the hepatic venous outflow. From 1969 to 1997 we treated 19 patients (7 men, 12 women; mean age 37.6 years) affected by primary BCS. In most of the cases no etiologic factors were identified; in the remaining cases the etiology was associated with polycythemia vera, use of oral contraceptives, presence of endoluminal membranes, and repeated episodes of sepsis. Three patients with membranous occlusion of the major hepatic veins were treated by percutaneous placement of a self‐expanding metallic stent inserted via a transjugular or transhepatic approach. The remaining 16 patients underwent a side‐to‐side portacaval shunt, which required interposition of a graft in five cases. In two patients with a significant caval obstruction, a metallic vascular stent was placed in the narrowed tract of the inferior vena cava, before shunting, by means of a transfemoral venous approach. One patient died within the first 30 postoperative days. The 18 survivors were followed for a mean of 66.7 months. The 5‐year survival was 83%. Primary BCS requires different therapies depending on the stage of the disease. The fulminant or chronic forms with irreversible hepatic damage require definitive treatment, such as orthotopic liver transplantation. For the acute or subacute forms, characterized by reversible hepatic injury, a portasystemic shunt represents the most effective treatment. The patients at poor hepatic risk can be treated by interventional radiology. In both cases preliminary caval stenting is necessary if the syndrome is complicated by significant obstruction of the inferior vena cava.
Laparoscopic Cholecystectomy for Cholelithiasis during Infancy and Childhood: Cost Analysis and Review of Current Indications
Authors: Jawad Akram J. , Kurban K. , El‐Bakry Abdulkarim , Al‐Rabeeah Abdullah , Seraj Mohammed , Ammar Adel
Published: August 2002

Eleven consecutive laparoscopic cholecystectomies (LCs) were performed between January 1994 and June 1996 compared with seven open cholecystectomies (OCs) performed previously at King Khalid University Hospital. The comparison included surgical, clinical, and economic factors, together with a review of the literature. In the laparoscopic group the main indication for cholecystectomy was symptomatic gallstones. Other indications include mucocele of the gallbladder and chronic cholecystitis. A total of eight children in both group had sickle cell disease. The first two LCs were performed in the presence of an experienced laparoscopic surgeon. There is a learning curve to pass through with LC. The operating time for LC ranged between 65 and 135 minutes (mean ± SD 89.81 ± 21.89 minutes). There was no major morbidity or mortality. The average postoperative parenteral analgesia required for LC (50.45 ± 24.57 mg) was significantly less than for OC (135.14 ± 62.02 mg), and the mean length of hospitalization for LC was significantly shorter than that for OC (1.68 ± 0.46 vs. 6.07 ± 0.30) days. Although the average operative cost per LC (2522 SR) was significantly more expensive than for OC (350 SR), the ultimate cost of LC was significantly less than for OC (5790.00 ± 787 vs. 12,343 ± 139 SR) because the total period of hospitalization was much shorter. In conclusion, LC is safe, effective, and less expensive than OC and therefore is the approach of choice for cholecystectomy in children.
Selective Gut Decontamination in Intensive Care and Surgical Practice: Where Are We?
Authors: Ramsay Graham , van Saene Rick H.K.F.
Published: August 2002

Selective decontamination of the digestive tract (SDD) has been widely studied in the intensive care setting. Despite the publication of more than 50 controlled trials, it remains a controversial subject, with widely disparate views on the role of SDD. This article reviews the use of SDD primarily by examining the areas of controversy. The published data seem to show clear evidence that SDD can reduce acquired infection during intensive care. Most individual studies have shown no effect on mortality, but meta‐analyses suggest a 10% overall reduction in mortality. Despite the large number of publications to date, there remain several aspects worthy of further study.
Intraoperative Assessment of Intestinal Viability by Laser Doppler Flowmetry for Surgery of Ruptured Abdominal Aortic Aneurysms
Authors: Redaelli Claudio A. , Schilling Martin K. , Carrel Thierry P.
Published: August 2002

Ischemic colitis is a well known complication following surgery of ruptured abdominal aortic aneurysms, occurring in up to 60% of these patients. It is caused by failure to restore adequate blood flow to the watershed areas of the sigmoid colon. The purpose of this prospective study was to investigate erythrocyte flux to defined areas of the colon immediately after repair of ruptured abdominal aortic aneurysms using laser Doppler flowmetry (LDF) and to determine the critical level of erythrocyte flux below which revascularization of the colon is indicated. A group of 22 patients with a ruptured infrarenal aortic aneurysm in whom the inferior mesenteric artery was ligated at surgery were studied prospectively. Multiple LDF measurements of bowel blood flow (four per bowel segment) were performed on 103 intestinal segments intraoperatively using a Periflux 4001 Master with a PF 415:1 probe. In addition, histologic findings of ischemically injured intestine biopsied at routine postoperative endoscopy or postmortem examination were compared with the LDF records. There was a 41% incidence (9/22 patients) of postoperative colonic ischemia with a significant decrease in colonic erythrocyte flux below 50 perfusion units (PU) intraoperatively in all nine patients (100%). Four patients had transmural colon necrosis, and two patients died, for an overall mortality of 27%. Five patients were identified as having mild or moderate intestinal ischemia and were treated conservatively. Another 14 patients had no clinical or endoscopic signs of ischemic colitis. Erythrocyte flux in those colonic segments were > 50 PU. An intraoperative LDF recording of < 50 PU achieved a sensitivity of 100% (32/32 colon segments) and a positive prediction value of 100% in patients who developed ischemic colitis after surgery for ruptured abdominal aortic aneurysms. The results of this study demonstrate that LDF is a sensitive guide to and feasible method for evaluating critical colonic blood flow during repair of ruptured abdominal aortic aneurysm. The critical level of microvascular perfusion of the colon wall was found to be around 50 PU, below which revascularization of the colon should be considered to reduce the risk of subsequent ischemic colitis.
Palliative Operation for Cancer of the Head of the Pancreas: Significance of Pancreaticoduodenectomy and Intraoperative Radiation Therapy for Survival and Quality of Life
Authors: Ouchi Kiyoaki , Sugawara Tohoru , Ono Hidemaro , Fujiya Tsuneaki , Kamiyama Yasuhiko , Kakugawa Yoichiro , Mikuni Junichi , Yamanami Hideaki
Published: August 2002

The benefits of a palliative operation and intraoperative radiation therapy (IORT) for survival and quality of life (QOL) of patients with cancer of the head of the pancreas are not clear. Survival and hospital‐free survival (HFS), which are considered to be objective indicators of QOL, were studied in 13 patients who underwent palliative pancreaticoduodenectomy (PD) and 32 patients who underwent surgical bypass. Although there was no significant difference in the survival of patients who underwent PD or bypass (median survivals of 9 months and 7 months, respectively), HFS for 3 months or longer was achieved in 84.6% of the patients who underwent PD, which was significantly higher than that of the 53.1% in patients who underwent surgical bypass (p < 0.05). Among TNM stage III patients, a significant difference in survival was observed between surgical bypass associated with IORT and bypass alone (p < 0.05); the median survival time of the IORT group was 10 months, whereas that of the control group was 5 months. In addition, HFS of 3 months or longer was achieved in 83.3% of patients who underwent bypass with IORT but in only 25.0% of the patients who underwent surgery alone (p < 0.01). The addition of IORT to palliative PD neither prolonged survival nor improved HFS. These results show the beneficial effect of palliative PD on QOL, and the efficacy of IORT for survival and QOL was proved in cases with stage III pancreatic cancer who underwent surgical bypass. For patients subjected to palliative PD, however, IORT is not thought to be beneficial for either survival or QOL.
Effect of Pneumoperitoneum Induced by Carbon Dioxide and Air on Tumor Load in a Rat Model
Authors: Lundberg Owe , Kristoffersson Anders
Published: August 2002

Laparoscopic surgery for malignant disease is highly controversial mainly due to the large number of abdominal wall metastases being reported. Previous experimental studies have particularly studied CO2 pneumoperitoneum and its effect on tumor development. The purpose of this study was to compare CO2‐ and air‐induced pneumoperitoneum with regard to intraperitoneal tumor growth. Altogether 39 rats were injected intraperitoneally with 105 colonic tumor cells and randomly allocated into three groups: 13 rats had a pneumoperitoneum created with CO2, 13 with air, and 13 served as controls. Tumor development was determined semiquantitatively by a peritoneal cancer index scale after 12 days. CO2 and air pneumoperitoneum equally increased intraperitoneal tumor growth compared to controls. Pneumoperitoneum induced by CO2 and air seems to increase tumor load, but the mechanisms are not established. This finding supports the hypothesis that insufflation not only by causing tumor cell movements but in fact pneumoperitoneum per se and the used gas are involved in the development of abdominal wall metastases after laparoscopic surgery.
2‐Methoxyisobutylisonitrile Probe during Parathyroid Surgery: Tool or Gadget?
Authors: Bonjer H. Jaap , Bruining Hajo A. , Pols Huib A.P. , de Herder Wouter W. , Proye Charles A.G. , Carnaille Bruno M.L. , Mohammedamin Robert S.A. , Steyerberg Ewout W. , Breeman Wout A.P. , Krenning Erik P.
Published: August 2002

The success of parathyroid surgery is determined by the identification and removal of all parathyroid tumors. Parathyroid tumors accumulate and retain 2‐methoxyisobutylisonitrile (MIBI) labeled with technetium‐99m. Intravenous injection of this radiopharmacon prior to parathyroid surgery allows identification of parathyroid tumors with a hand‐held gamma detector. To assess the value of this technique, a case–control study was performed with 62 patient having nuclear‐guided parathyroidectomy and 60 patients having conventional parathyroid explorations. The sensitivity rates of the MIBI probe in single and multiple gland disease were 84.6% and 63.0%, respectively. Rates of success, temporary and permanent hypoparathyroidism, and injury of the recurrent laryngeal nerve were similar in patients who underwent probe‐guided surgery and those who had conventional surgery. In conclusion, although the MIBI probe appears to be a valuable tool in parathyroid surgery, its use has not improved the outcome of such surgery at our institution.
Laparoscopic versus Open Posterior Adrenalectomy: Comparison of Acute‐phase Response and Wound Healing in the Cushingoid Porcine Model
Authors: Kollmorgen Christine F. , Thompson Geoffrey B. , Grant Clive S. , van Heerden Jon A. , Byrne John , Davies Edward T. , Donohue John H. , Ilstrup Duane M. , Young William F.
Published: August 2002

This prospective randomized study examined the acute‐phase response and wound healing, comparing laparoscopic (LA) and open posterior (PA) adrenalectomy in a cushingoid porcine model. Repository corticotropin gel was given to 40 pigs for 21 days. Biochemical and tissue parameters of Cushing syndrome were confirmed. The pigs were randomized to undergo LA or PA. In addition to operating time and morbidity, the acute‐phase response was compared by measuring the postoperative white blood cell count, fasting glucose, C‐reactive protein, and nitrogen balance. Wound healing was assessed by (1) scored (1–4) gross appearance at 48 hours and 1 and 2 weeks; (2) histologic examination; and (3) tensile strength. There was no difference in operating time (mean ± SD) (36 ± 9 minutes open vs. 37 ± 7 minutes laparoscopic), perioperative mortality, degree of leukocytosis, fasting glucose, or C‐reactive protein (p > 0.05). Nitrogen balance, wound scores, and tensile strength at 24 hours and 1 week were more favorable in the LA group than in the PA group (p < 0.05). In the cushingoid porcine model, laparoscopic adrenalectomy was less catabolic and was associated with fewer wound complications than the open posterior adrenalectomy. These findings provide support for continued pursuit of laparoscopic methods for adrenalectomy in the clinical setting.
Vitamin D Receptor Gene Polymorphism and Parathyroid Calcium Sensor Protein (CAS/gp330) Expression in Primary Hyperparathyroidism
Authors: Carling Tobias , Ridefelt Peter , Hellman Per , Juhlin Claes , Lundgren Ewa , Åkerström Göran , Rastad Jonas
Published: August 2002

Calcitriol, via its receptor (VDR), inhibits parathyroid hormone (PTH) secretion and cell proliferation. Physically linked polymorphic VDR alleles denoted b,a, and T, comprise a novel risk factor for postmenopausal primary hyperparathyroidism (pHPT) by their presumed coupling to reduced VDR expression. This study examines VDR gene polymorphisms, parathyroid calcium‐regulated cytoplasmic calcium concentrations ([Ca2+]i) and parathyroid expression of a calcium sensor protein (CAS/gp330). Genomic DNA was obtained from 66 postmenopausal women with pHPT and 66 age‐matched female controls. Polymorphic VDR alleles were detected after polymerase chain reaction (PCR) and restriction digestion. Cryosections of pathologic parathyroid glands from 41 of the patients were immunostained with a monoclonal anti‐CAS/gp330 antibody. Homozygosity for the VDR alleles b, a, and T was overrepresented in pHPT (p < 0.01–0.05) but did not couple to ED50 for calcium‐regulated [Ca2+]i. The enlarged parathyroid glands possessed heterogeneous down‐regulation of CAS/gp330. This down‐regulation was the least conspicuous in the BBgenotype, and these few patients generally had larger parathyroid lesions (p < 0.05). The VDR haplotype baTis a risk factor for pHPT possibly by hampering the regulatory actions of calcitriol. In contrast the BAt haplotype seems to be underrepresented in pHPT and to couple to larger parathyroid lesions as well as less deranged CAS/gp330 expression and parathyroid cell function. HPT in these individuals may relate to genetic events principally altering the regulation of cell proliferation, rather than calcium sensing of the parathyroid cells.
Intraperitoneal Normal Saline Infusion for Postoperative Pain after Laparoscopic Cholecystectomy
Authors: Tsimoyiannis Evangelos C. , Siakas Philipos , Tassis Andreas , Lekkas Epameinondas T. , Tzourou Helen , Kambili Maria
Published: August 2002

After laparoscopic surgery carbon dioxide remains within the peritoneal cavity for a few days, commonly causing pain. This prospective randomized study was performed to determine the efficacy of intraperitoneal infusion of normal saline on postoperative pain after laparoscopic cholecystectomy. Altogether 300 patients were randomly assigned to one of five groups of 60 patients each. Group A: control group, no peritoneal infusion, no subhepatic drain. Group B: no peritoneal infusion but a subhepatic closed drain was left for 24 hours. Group C: normal saline 25 to 30 ml/kg body weight at a temperature of 37°C was infused under the right hemidiaphragm and left in the peritoneal cavity. Group D: normal saline in a room temperature was infused under the right hemidiaphragm and suctioned after the pneumoperitoneum was deflated. Group E: normal saline was infused and suctioned as in group D, but a subhepatic closed drain was left for 24 hours. Postoperatively, analgesic medication usage, nausea, vomiting, and pain scores were determined at 2, 6, 12, 24, 48, and 72 hours (during hospitalization and at home). Postoperative pain was reduced significantly (p < 0.001) in the patients of groups C, D, and E versus controls, whereas no difference was observed between groups A and B. Among groups C, D, and E, group E (p < 0.01) had the best results followed by group D and then group C. Intraperitoneal normal saline offered a detectable benefit to patients undergoing laparoscopic cholecystectomy. The beneficial effect was better when the fluid was suctioned after deflation of the pneumoperitoneum and even better when a subhepatic closed drain continued fluid suction during the first postoperative hours.
Excising the Reexcision: Stereotactic Core‐Needle Biopsy Decreases Need for Reexcision of Breast Cancer
Authors: Kaufman Cary S. , Delbecq Ronald , Jacobson Leslie
Published: August 2002

There is debate regarding use of the stereotactic core‐needle biopsy (SCNB) for highly suspicious mammographic lesions. This study compares a serial group of mammography‐detected breast cancer patients treated before and after the use of SCNB. We studied 113 consecutive nonpalpable breast cancers between 1994 and 1996. Altogether 47 patients were diagnosed by wire‐localized breast biopsy (wire group) and the next 66 consecutive breast cancer patients by SCNB (stereo group). Negative margins were found more often in the stereo group than in the wire group (77% vs. 38%, p < 0.001). Reexcision was required more frequently in the wire group than in the stereo group (68% vs. 21%,p < 0.001), and one‐staged surgical procedures were done more often in the stereo group than the wire group (79% vs. 21%,p < 0.001). The volume of the initial wide excision was much larger in the stereo group than in the wire group (p= 0.002). Those in the wire group required 50% more operations per patient (1.8 vs. 1.2) than the stereo group. A significant cost savings can be estimated in the stereo group compared with the wire group. The use of SCNB was associated with breast excisions of larger volume, negative margins, and decreased need for reexcision. Simultaneous adjunct procedures resulted in one‐stage operations, improving cost savings. The use of SCNB for nonpalpable breast cancer benefits the patient, the surgeon, and the payor. It should be undertaken prior to the first surgical procedure.
Arterial Reconstruction: Justified for Patients with Intermittent Claudication?
Authors: Fujioka Kentaro , Esato Kensuke , Zempo Nobuya , Katoh Tomoe , Fujimura Yoshihiko , Yoshimura Koichi
Published: August 2002

The objective of this study was to evaluate the effects of arterial reconstruction in patients with intermittent claudication. A total of 243 patients (305 limbs) underwent lower extremity vascular reconstruction at our institution from 1979 to 1995. They were assessed by physical examination, pulse volume recordings, segmental pressure, Duplex ultrasonography, and intravenous subtraction arteriography to evaluate the effects of arterial reconstruction. Surviving patients (220 limbs) were enrolled for evaluation of outcome during the follow‐up period. There were 59 deaths during the follow‐up period. The cumulative life‐table 5‐year patency rates were 90% ± 3%, 73% ± 6%, and 74% ± 10% for aortoiliac, infrainguinal, and aortofemorodistal arterial reconstructions, respectively. Among 129 repairs in the aortoiliac region, Fontaine stages I, II, and III were found in 109 limbs (84.5%), 17 limbs (13.2%), and 2 limbs (1.5%), respectively. There was one (0.7%) minor amputation. There was Fontaine stage I in 50 limbs (76.9%), Fontaine stage II in 14 limbs (21.5%), and Fontaine stage III in 1 limb (1.5%) for repairs in the infrainguinal region. Among the 26 aortofemorodistal repairs, there was Fontaine stage I in 21 limbs (81%) and Fontaine stage II in 5 limbs (19%). There was a statistically significantly higher incidence of Fontaine stage I than Fontaine stage II or III in aortofemoral, infrainguinal, and aortofemorodistal arterial reconstructions (p < 0.0001). Arterial reconstruction for patients at Fontaine stage II offered benefits and improved quality of life at follow‐up. Arterial reconstruction for patients at Fontaine stage II offers benefits and improved quality of life at follow‐up. It was concluded that the significant improvement in quality of life after arterial reconstruction warrants continued use of the procedure in patients with intermittent claudication.
Genetic and Biochemical Screening for Endocrine Disease
Authors: Goretzki P.E. , Höppner W. , Dotzenrath C. , Clark O.H. , Simon D. , Cupisti K. , Schulte H. , Röher H.D.
Published: August 2002

The development of biochemical and genetic screening tests for inherited endocrine diseases has dramatically changed our approach to surgical patients with endocrine tumors. Among more than 1800 patients with endocrine tumors and a possible inherited disease operated on between 1986 and 1997, there were 6.1% to 7.3% who were found to have a familial disease associated with familial medullary thyroid cancer, (MTC), multiple endocrine neoplasia type IIa (MEN‐IIa), MEN‐IIb, or MEN‐I. Genetic testing for the
RET proto‐oncogene is therefore recommended for all patients with MTC, and testing for the MEN‐I gene is recommended in patients with suspected MEN‐I and in specific clinical subgroups with an increased probability of endocrine tumor heredity. Early treatment based on early diagnosis by genetic testing appears to improve survival and to decrease morbidity in these patients.
Effects of Laparoscopic and Conventional (Open) Cholecystectomy on Human Leukocyte Antigen‐DR Expression in Peripheral Blood Monocytes: Correlations with Immunologic Status RID="" ID="" This International Society of Surgery (ISS)/Société Internationale de Chirurgie (SIC) article was presented at the 37th World Congress of Surgery International Surgical Week (ISW97), Acapulco, Mexico, August 24–30, 1997.
Authors: Carlei Francesco , Schietroma Mario , Cianca Giovanni , Risetti Alberto , Mattucci Sandro , Ngome Enang Gerard , Simi Mario
Published: August 2002

It is well known that surgery significantly decreases immune responses. Laparoscopic cholecystectomy
(LC) is a “miniinvasive” surgical procedure; and on the basis of this consideration we have investigated if and how the immune response is modified in patients after laparoscopic cholecystectomy compared to patients who underwent open cholecystectomy. Immune activity
[neutrophils, total lymphocytes count, lymphocytes subpopulations, human leukocyte antigen‐DR (HLA‐DR)] was evaluated in 53 patients 1 day before surgery and respectively, 1, 3, and 6 days after surgery; 26 patients underwent “open” cholecystectomy and 27 LC. A day after surgery, patients with open cholecystectomy showed a significant increase (p < 0.05) in plasma neutrophils, while they were almost unchanged in LC patients. Monocyte antigen HLA‐DR was reduced in patients with “open” cholecystectomy. We recorded two cases (7.6%) of respiratory tract infection in the “open” group. In conclusion, LC strongly reduces postoperative (p.o.) pain and hospitalization, and it promotes earlier recovery and return to normal activity, avoiding p.o. immunosuppression, mostly due to conservation of HLA‐DR activity, with less p.o. morbidity compared to that seen with open surgery.RID="" ID="" Correspondence to: F. Carlei, M.D.
Pregnancy: A Contraindication?
Authors: Holthausen Ulla H. , Mettler Liselotte , Troidl Hans
Published: August 2002

According to David L. Sackett evidence‐based medicine is the conscientious, explicit, and judicious use of current best evidence when making decisions about the care of individual patients. It means integrating individual clinical expertise with the best available external evidence from systematic research. On the basis of this idea in medicine the following communication summarizes and evaluates current statements and literature on laparoscopic surgery during pregnancy. The topic is an example for excellent individual clinical performance on one hand, as gynecologists have perform laparoscopic procedures during pregnancy for decades. On the other hand, pregnancy is considered to be a contraindication for laparoscopic surgery by clinicians, because no excellent external evidence from systematic research is available. To find an answer to the question of whether pregnancy is a contraindication for laparoscopic surgery we performed a literature search and gained information by conducting interviews with several experts in gynecology and endoscopic operations. We concluded that there are almost no “scientific” data about endoscopic surgery during pregnancy, but gynecologists representing the “real world” seem to have no fear of the procedure for their patients. Between the two extremes, performing laparoscopic operations during pregnancy might be advantageous for maximal patient‐friendly surgery, but considering pregnancy as a contraindication for the laparoscopic approach might be the safer treatment. The reader may decide that the subject on endoscopic surgery in pregnancy is still open.
Development of Clinical Practice Guidelines: Surgical Perspective
Authors: Brouwers Melissa C. , Browman George P.
Published: August 2002

Clinical practice guidelines (CPGs) are systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances. The implications of this definition are that: the methodologic perspective and operations for systematic development must be specified, a strategy is needed to account for the patient's perspective in the CPG development process and the clinical decision, and a mechanism is required to determine how appropriateness ought to be conceptualized and defined. Addressing these issues, we review models of CPG development, outline challenges to evidence‐based approaches to CPG development, address unique factors relevant to the development of guidelines for the surgical community, introduce an Ontario practice guidelines strategy that uses complementary methods of CPG development, and summarize the feedback provided by the surgical community regarding the practice guidelines produced in Ontario's cancer system.
Effects of Early Eschar Excision En Masse at One Operation for Prevention and Treatment of Organ Dysfunction in Severely Burned Patients
Authors: Huang Yuesheng , Yang Zongcheng , Chen Faming , Crowther Roger S. , Li Ao
Published: August 2002

We sought to determine whether early eschar excision en masse (EEE) at one operation would be effective in the prevention and treatment of postburn organ dysfunction (OD) and multiple organ dysfunction syndrome (MODS). A total of 60 patients, with total body surface burned area over 35% and a third degree burn area over 20% were studied and divided into two groups, the EEE group (35 cases) and the group treated with repeated escharectomies by stages (repeated escharectomy group, 25 cases). Other than the different operations undertaken, the patients in both groups received identical conventional treatment. Before, during, and after operation the hemodynamic and blood gas indices, plasma levels of endotoxin and tumor necrosis factor (TNF), and the injurious effects of burn patients' sera on endothelial cells in vitro were determined in patients of the EEE group. The incidence of OD and MODS was decreased significantly (11.4%) in patients of the EEE group, and the cure rate increased greatly (85.7%). The cardiac output dropped to 77.8% of its preoperative level at the end of escharectomy but began to rise at 2 hours and returned to its baseline levels at 24 hours after operation. Plasma levels of endotoxin and TNF and levels of lactic dehydrogenase and 6‐keto‐prostaglandin F1|ga in the endothelial cell culture media were all reduced profoundly. The cultured endothelial cells maintained their original morphology. The findings substantiate the hypothesis that eschar excision en masse at one operation is feasible and effective in preventing and treating early postburn OD and MODS, mainly by alleviating systemic inflammatory response syndrome and endothelial cell injury.