bluuebunny/crossref_metadata_2025 huggingface dataset:
The Dardik biograft in reconstructive arterial surgery: Report on a five‐year experience in 94 cases
Authors: Raithel Dieter , Schweiger Hans
Published: May 2005

Since March 1977, there have been 94 peripheral vascular reconstructions performed using the Dardik biograft, i.e., the glutaraldehyde‐tanned human umbilical vein. The indication for operation was limb salvage in 88.3%. In 74.5% only one or no crural vessels was patent. In 50 patients previous bypass grafting had failed. The distal anastomosis was placed below the knee in 91.5%, and in 53.2% a tibial or peroneal revascularization was performed. The accumulated graft patency rate at 5 years was 47.4%. Poor results were obtained when the umbilical vein was combined with other graft materials. It is concluded that the human umbilical vein cord is the graft of choice in below‐knee reconstructions when the autogenous saphenous vein is not available.
What is new in Sweden? Changing pattern of general surgery
Authors: Bergentz Sven‐Erik
Published: May 2005

The results of recent studies on the development of general and vascular surgery in Sweden have been analyzed. Among the findings were the following:

There was a marked decrease in the number of cholecystectomies performed. Related findings seem to indicate a decline in the incidence of gallstone disease.

A slight but continuous decrease in the number of appendectomies performed has occurred over the last decade.

There was a decrease in the number of gastric resections performed for gastroduodenal ulcer since 1970 and a considerable total decrease in the number of surgical interventions for this disease since 1977.

Arterial reconstructive surgery has increased considerably during the last decade.

The decline in the number of surgical procedures being performed concomitant with an increase in the number of surgeons may have significant impact on departments of surgery throughout Sweden in the near future.
Malignant jaundice: Results of diagnostic and therapeutic endoscopy
Authors: Soehendra N. , Grimm H. , Berger B. , Nam V. C.
Published: May 2005

Direct cholangiography plays an important role in the diagnosis of malignant obstructive jaundice. Endoscopic retrograde cholangiopancreatography is gradually gaining ground over percutaneous transhepatic cholangiography. Endoscopy can determine the exact location and extent of the obstruction. Typical changes of the ducts are often helpful in interpreting the causes of obstructive jaundice. Representation of the bile and pancreatic duct systems is successful in 95% of cases in the hands of an expert. Acute pancreatitis is a complication occurring in about 1% of cases. Immediate drainage can usually prevent septic complications. Endoscopic drainage is a palliative measure for inoperable patients. Compared to biliodigestive anastomoses, catheters are subject to clogging in the lessrisky, nonsurgical method. Blockage causes late cholangitis which can only be recognized and remedied by regular aftercare of the patient. Endoscopic placement of the prosthesis has an 85% rate of success. The rate of complications related to the procedure is 2%. The mortality rate is 1%.
Biliary concrements: The endoscopic approach
Authors: Rosseland Arne R. , Osnes Magne
Published: May 2005

Since 1970, endoscopic retrograde cholangiopancreaticography (ERCP) has received much attention as a diagnostic method in pancreaticobiliary disease. The information given by ERCP is of great value in the management of patients with symptoms after biliary tract surgery and especially in patients with suspected obstructive jaundice. In patients with symptoms highly suggestive of cholelithiasis, ERCP examination should be considered for definitive diagnosis despite a negative oral cholecystogram and ultrasound finding.

Endoscopic papillotomy is a major advance in the treatment of many elderly and high‐risk patients with common bile duct stones. It should replace surgery in most of these patients with retained or recurrent stones and appears justified in many patients who have not yet undergone cholecystectomy, either in the hope of avoiding biliary surgery altogether or to defuse an acute clinical situation. The rule of endoscopic treatment in the young and fit has yet to be established.
Emergency colonoscopy
Authors: Rossini Francesco Paolo , Ferrari Arnaldo , Spandre Mauro , Cavallero Mariella , Gemme Carlo , Loverci Carlo , Bertone Alberto , Pintor Marco Pinna
Published: May 2005

Different diagnostic techniques for massive active lower gastrointestinal hemorrhage are reviewed. According to data in the literature and personal experience in 409 emergency endoscopic examinations of the large bowel, emergency colonoscopy is a valuable diagnostic tool in cases of massive colorectal bleeding.
Teaching surgical endoscopy of the gastrointestinal tract
Authors: Dent Thomas L. , Kukora John S. , Leibrandt Thomas J.
Published: May 2005

Surgical endoscopy, or the utilization of endoscopic techniques in the diagnosis and treatment of surgical disease, is an integral part of the practice of modern gastrointestinal surgery and the training of surgical residents. In addition to information crucial to preoperative evaluation and postoperative surveillance, endoscopy offers alternative therapeutic and complementary intraoperative options.

Surgical endoscopy can be taught as part of an integrated residency experience, a separate endoscopy rotation, a postresidency fellowship, or an individually‐arranged preceptorship. Each method of teaching has relative advantages and disadvantages. The 3 surgical endoscopy training programs with which the authors have been associated include an integrated experience, a separate endoscopy rotation followed by an integrated experience, and a preceptorship followed by an integrated experience.
A clinicopathological study of gastric cancer with special reference to age of the patients: An analysis of 1,630 cases
Authors: Mitsudomi Tetsuya , Matsusaka Toshimitsu , Wakasugi Kenzo , Takenaka Masaharu , Kume Kazuhiro , Fujinaga Yutaka , Teraoka Hiroaki , Iwashita Akinori
Published: May 2005

A series of 1,630 patients with gastric cancer was reviewed with special reference to their ages. The overall resectability rate was 84.6%. With increasing age, there was also an increase in: the male‐to‐female ratio, the frequency of tumors located in the distal third of the stomach, and the degree of differentiation of the carcinoma (p<0.01). There was no age‐related association to: tumor size, early gastric cancer of 30–40%, macroscopic classification, histological staging, or symptomatology. The 5‐year survival rates did not differ significantly among the various age groups. From 1980 to 1984, clinical characteristics were evaluated in 58 patients under 40 years of age and in 39 patients 80 years of age and older. Preexisting medical illnesses and postoperative complications were more frequent in the aged group; however, there were no operative deaths in either group. In conclusion, although there are several distinct properties depending on the age of the patients, very elderly as well as young patients can be successfully treated.
The use of blood components in surgical transfusion therapy
Authors: Högman Claes F. , Bagge Lars , Thorén Lars
Published: May 2005

Blood components can be prepared either by separation of ordinary whole blood units or, selectively, by apheresis techniques. In recent years, new methods for improvement of quality and length of storage have been developed. The additive solution approach is now being applied increasingly. Its advantages and the difference between some available systems are described. Blood component therapy must be integrated into the patients' water/electrolyte balance and nutrition schedule. An outline is given of the role of blood components in the treatment of shock. The question of excessive bleeding, the possibilities of making the diagnosis of its cause(s) in the individual case, and the use of blood components is described. Coronary pulmonary bypass is used as an example of a complicated situation that can be handled effectively by a limited number of diagnostic and therapeutic tools.
Acute limited normovolemic hemodilution: A method for avoiding homologous transfusion
Authors: Martin Eike , Hansen Ernil , Peter Klaus
Published: May 2005

Preoperative normovolemic hemodilution was introduced for clinical application by Messmer and co‐workers. Preoperative blood withdrawal of 1,500–2,000 ml by an isovolemic exchange with colloids or crystalloids (3 times the volume of blood withdrawn), in order to maintain a constant circulating volume, is offset by an adequate increase of cardiac output and an unchanged systemic oxygen transport capacity despite a decreased oxygen content. Patients lose fewer red cells and more plasma intraoperatively. The retransfusion of autologous blood follows in the reverse order of collection after hemostasis is restored. The procedure is a safe and feasible method, which is not beset with the logistical problems of autologous blood predeposit and has the added advantage that fresh autologous blood is available at once for retransfusion. Provided that the contraindications are observed, the technique helps to reduce or even avoids the risks of homologous blood transfusion. The need for stored blood can be reduced by 20% to 90%, depending on the surgical procedure.
Intraoperative autotransfusion
Authors: Glover John L. , Broadie Thomas A.
Published: May 2005

Intraoperative autotransfusion was done only sporadically until equipment, modified from cardiac surgery, became available in the 1970's. Use has increased because of the availability of cell‐washing techniques and the increased demand for blood associated with complex operations, such as liver transplantation and resection of thoracoabdominal aneurysms. There is a lack of agreement about the use of anticoagulation with autotransfusion, and there are several factors that limit widespread applicability. More studies are needed regarding infusion of activated clotting factors, and blood contaminated with bacteria or tumor cells. Although a significant administrative commitment is required, implementation of a program of autotransfusion is useful in trauma, vascular surgery, and any procedure that involves large amounts of blood loss.
The appropriate role of frozen‐stored red blood cells in transfusion practice
Authors: Chaplin Hugh
Published: May 2005

Frozen‐stored red blood cells (FS‐RBC) held great promise when the product was introduced 35 years ago. They appeared to offer sufficient logistical and clinical advantages to predict wide application in component transfusion therapy in the years ahead. Yet, in 1986, FS‐RBC account for < 1% of RBC product usage. Quantitative, operational, and logistical characteristics of FS‐RBC are reviewed in order to explain their seemingly paradoxical “unpopularity.” The limited indications for FS‐RBC usage in contemporary transfusion practice are defined.
The use of plasma substitutes with special attention to their side effects
Authors: Messmer K. F. W.
Published: May 2005

Plasma protein fraction and human serum albumin are suitable for plasma replacement; however, they are in short supply and extremely expensive. Fresh‐frozen plasma should not be used for volume replacement, but for documented coagulation protein deficiencies and for patients who require massive blood transfusions. Artificial colloids are free from the risk of transmitting diseases and easy to provide at low costs. The intravascular volume effect of colloid solutions based on dextran, gelatin, or hydroxyethyl starch depends on the physicochemical characteristics of the polymer solution. For the given colloid, the half‐life varies from 2 to 8 hours. In addition to the volume effect, dextran provides specific antithrombotic properties. None of the colloids are free from the risk of untoward effects, such as anaphylactoid/anaphylactic reactions. The low frequency of these reactions and the possibility to prevent and to treat them justifies the use of artificial colloids on a routine basis for shock treatment, volume support, and perioperative hemodilution.
Recent developments in the area of massive transfusion
Authors: Collins John A.
Published: May 2005

In 2 previous reviews of the subject of massive transfusion, this author noted that one of the most distressing complications of massive transfusion, pathological diffuse bleeding, was poorly understood, but was almost certainly not something induced by the transfusions themselves. Much better evidence is now available relating to the development of coagulopathies during transfusion, and these studies will be reviewed here. In both the prior reviews, the author also noted that one of the potentially most important aspects of massive transfusion was the effect on immunologic defenses, but that this was almost entirely ignored. This situation has now changed dramatically, and most of this review will deal with the rapidly emerging data on this aspect of transfusion. Most of the other aspects of massive transfusion have not changed substantially since the previous reviews.
Blood transfusion: Yesterday, today, and tomorrow
Authors: Rudowski Witold J.
Published: May 2005

The evolution of blood transfusion practice into modern transfusion medicine is reported. The impact of great wars on the technique of blood storage and organization of blood supply is discussed. The progress of immunotechnology and fractionation of plasma contributed greatly to contemporary transfusion medicine and the implementation of blood and plasma component therapy. Three basic indications for use of blood in surgery are summarized: restoration of acute loss of circulating blood volume, improvement of oxygen transport, and delivery and correction of coagulation disorders. Some factors arising from storage lesion of blood (citrate intoxication, 2,3‐DPG depletion, cellular aggregates) are described. The recent research in blood transfusion refers particularly to red cell substitutes. The oxygen‐carrying solutions, perfluorocarbons, stroma‐free hemoglobin, and current research on artificial red cells are discussed. The in vitro culturing, recombinant DNA technology, and the practical application of monoclonal antibodies in clinical practice are emphasized. The advent of great technological advances in transfusion medicine makes it possible to predict several future developments. Blood will be substituted by oxygen carriers, human protein and cells by biotechnological and genetic engineering. The education of tomorrow's surgeons must be adapted to the recent progress and advances of transfusion medicine.
Vagal regeneration after parietal cell vagotomy: An experimental study in dogs
Authors: Cuesta Valentin M. A. , Doblas Dominguez M. , Rodriguez Alonso M. , Bengoechea Gonzalez E.
Published: May 2005

The gradual increase with time of the insulin‐stimulated acid output, after a well‐performed parietal cell vagotomy (PCV), has been thought to be produced by regeneration of the vagus nerves. A genuine regeneration of the gastric branches of the vagus connected to the intramural plexus has yet to be confirmed. Experiments have been carried out in dogs to determine if this type of regeneration takes place after PCV.

The animals were divided into 3 groups (A, B, and C) of 4 mongrel dogs each. In all dogs, a PCV was performed and the Grassi test was used intraoperatively to check the completeness of vagotomy. During the experiments, an insulin stimulation test and a macroscopic and microscopic study of the esophagus and stomach were obtained at several points in time (in group A, at operation and after 2 weeks; in group B, after 6 months; and in group C., after 2 1/2 years).

We found, 2 weeks after PCV, a complete degeneration pattern of the vagal branches in the gastric serosa. After 6 months, and more completely after 2 1/2 years, many nerve fibers are seen, macroscopically, crossing from the vagus nerves and the branches of Latarjet to the esophagus and the lesser curvature through the old ligatures. This regeneration can be confirmed microscopically. These pathological changes in the nervous system of the stomach were found to correlate with recovery of gastric secretion. It is suggested that the recovery of acid secretion after a well‐performed PCV is accounted for by vagus nerves regeneration.
Comparison of selective and nonselective single‐dose antibiotic cover in biliary surgery
Authors: Ambrose N. S. , Morris D. L. , Burdon D. W. , Alexander‐Williams J. , Keighley M. R. B.
Published: May 2005

A prospective randomized trial has compared 2 policies of single‐dose antibiotic prophylaxis in biliary surgery. Patients were randomly allocated to 1 of 2 regimens: in group A, all patients received a single dose (2 g) of mezlocillin; in group B, patients were only given a single dose (2 g) of mezlocillin if they could be identified as “high‐risk.” The high‐risk criteria used in group B patients were: emergency surgery, jaundice, age over 70, recent cholangitis, choledocholithiasis, or previous biliary surgery. Eighty‐five patients were randomized (random numbers) to group A and 84 patients to group B. Only 34 (40%) of the 84 patients in group B were high‐risk patients and these were the only patients who qualified for antibiotic cover. Septicemia occurred in 1 patient in each group. Wound sepsis occurred in 11 (13%) of the 84 patients in group B compared with only 2 (2.3%) of those in group A (p<0.02). These findings indicate that it is more advisable to provide single‐dose antibiotic prophylaxis to all patients having biliary tract surgery than to adopt a policy of “selective” antibiotic cover to high‐risk cases only.
Tuberculous mastitis: A continuing problem
Authors: Banerjee S. N. , Ananthakrishnan N. , Mehta R. B. , Parkash S.
Published: May 2005

Eighteen patients with tuberculosis of the breast are presented. The disease was prevalent in young female patients. The most common presentation was a lump, with or without sinuses, in the upper, outer quadrant of the breast, with matted axillary lymphadenopathy. One‐third of the patients were lactating at the time of presentation. In 1 patient the disease was associated with carcinoma of the breast. The majority were treated by excision biopsy of the mass or a biopsy from a sinus for histological confirmation of the diagnosis, followed by standard antituberculous chemotherapy. Two patients required a sector mastectomy and 1 patient required a radical mastectomy for associated malignancy.

This article stresses the need for a high index of suspicion in making the diagnosis (especially in developing countries), in establishing the diagnostic criteria, and in the overlapping of clinical presentation with malignancy of the breast as well as the possibility of a coexisting carcinoma. The role of surgery is mentioned both in diagnosis and for treatment of residual masses.
The hyperfunctioning intrathyroidal parathyroid gland: A potential pitfall in parathyroid surgery
Authors: Wheeler M. H. , Williams E. D. , Wade J. S. H.
Published: May 2005

The details of 7 patients with hyperparathyroidism in whom 8 intrathyroid hyperfunctioning parathyroid glands were located are presented. Seven of the 8 glands were inferior parathyroids and this observation is discussed in the light of current embryological teaching. The intrathyroidal hyperfunctioning parathyroid is considered to be a potential cause of failed parathyroid surgery and, therefore, when an inferior parathyroid gland is missing, it is recommended that the lower pole of the thyroid be incised and, if necessary, a thyroid lobectomy performed.
Identification and antibiotic prophylaxis of high‐risk patients in elective colorectal surgery
Authors: Törnqvist A. , Forsgren A. , Leandoer L. , Ursing J.
Published: May 2005

High‐risk patients undergoing elective colorectal surgery were identified by culturing irrigation fluid samples taken peroperatively, and the effect of supplementary antibiotics in this group was evaluated. All patients (n =267) got 600 mg doxycycline intravenously as a preoperative prophylaxis. The day after operation the high‐risk patients could be identified by a count of bacteria cultured from the irrigation fluid. They were randomly allocated either to group A (n=40), no further antibiotics, or to group B (n=45), combination of cefuroxime and metronidazole. The rate of postoperative septic complications was 20% in group A and 4.4% in group B (p<0.05). It is concluded that high‐risk patients undergoing elective colorectal surgery can be identified by culturing the irrigation fluid taken peroperatively. With supplementary antibiotic prophylaxis, the postoperative complication rate can be lowered significantly.
Duodenal carcinoid in neurofibromatosis: A calcitonin‐ and amyloid‐containing tumor
Authors: Posalaky Zoltan , Mulholland Michael , Kasperson Elmer , Posalaky Irene P.
Published: May 2005

A patient with neurofibromatosis was found to have a malignant periampullary carcinoid tumor. Electron microscopic and immunohistochemical studies demonstrated calcitonin‐producing tumor cells and the presence of extracellular amyloid. The association of neurofibromatosis and duodenal carcinoids is rare. Cases found in the literature are reviewed and possible pathogenic implications are discussed.
Bacteria, toxins, and the peritoneum
Authors: Hau Toni
Published: May 2005

Intraperitoneal infections are caused by members of the gastrointestinal flora, mainlyEscherichia coli, enterococci, Klebsiella, Enterobacter, Proteus, Bacteroides, anaerobic cocci, Clostridia, and Fusobacteria. The Gram‐negative aerobic bacteria exert their pathogenic potential mainly through endotoxin which acts by way of mediators, causing systemic septic response and, initially, the local response of the peritoneal cavity. The main virulence factors of anaerobic bacteria are exoenzymes and capsular polysaccharides. Peritoneal infections are truly synergistic infections. The most important synergistic mechanisms are protection against host defense and creation of a suitable environment by one member of the flora for another. Aside from bacteria, certain adjuvant substances, i.e., bile, gastric juice, blood, and necrotic tissue, play a role in the pathogenesis of peritonitis. The peritoneum deals with an infection in 3 ways: first, the direct absorption of bacteria into the lymphatics via the stomata of the diaphragmatic peritoneum; second, the local destruction of bacteria through phagocytosis by either resident macrophages or polymorphonuclear granulocytes attracted to the peritoneal cavity; and third, the localization of the infection in the form of an abscess.
Systemic and peritoneal host defense in peritonitis
Authors: Christou Nicolas V.
Published: May 2005

Most of the work of host defense has been carried out in mixed patient populations. It is now clear that elective preoperative surgical patients have totally different host defense capabilities as compared to posttrauma patients or those suffering from peritonitis. Specific cell‐mediated immune studies need to be repeated in these 2 patient groups as well. What will contribute clinical relevance to these studies will be the means to correct the defects. If these defects or—more correctly termed—abnormalities of host defense are, indeed, important and contribute to an increased sepsis rate and mortality from sepsis in affected patients, then correcting them should reduce these complications. This hypothesis can only be tested when such means become available. The issues of most interest in the next few years will be the significance of serum albumin in host outcome, the role of immunomodulators, the involvement of cytokines in the overall process of host defense, and the use of specific nutritional support regimens targeted to the immune system.
Intraabdominal infections and gut origin sepsis
Authors: Offenbartl Karsten , Bengmark Stig
Published: May 2005

Intraabdominal postoperative or posttraumatic infections remain a major threat to life in spite of generation after generation of increasingly effective antimicrobial drugs indicating the importance of immunological host defense failure following major trauma or surgical complications. The spectrum of infectious postoperative or posttraumatic complications can, in part, be explained by pathogenic factors inherent to the methodology of modern surgical intensive care and techniques. This report presents a survey of the historical background as well as current concepts of the multiple systems organ failure syndrome as related to postoperative or posttraumatic intraabdominal infectious complications. The pathophysiology of nosocomial infectious complications in the intensive care unit setting is analyzed. The concept of “gut origin sepsis” is presented and possible preventive and therapeutic actions discussed. A judicious use of antimicrobial drugs on strict indications is emphasized as is the importance of increased knowledge of the interactions between the gut flora, antibiotics, and absence of enteral nutrition.
Intraabdominal infection: Pulmonary failure
Authors: Runcie C. , Ramsay G.
Published: May 2005

Since its first description in 1967, the mortality of the adult respiratory distress syndrome (ARDS) has remained unchanged despite the increasing sophistication of supportive techniques. Few patients now die of refractory hypoxemia, the majority succumbing to the multiple systems organ failure syndrome, commonly due to sepsis. Sepsis is both the most common cause of ARDS, usually involving the abdomen, and the most frequent complication, usually affecting the lungs. ARDS is, thus, increasingly seen as the pulmonary component of multiple systems organ failure, triggered by the systemic response to sepsis.

In critically ill patients, impairment of hepatic function and of the barrier function of the gut mucosa allows translocation of endotoxin derived from the aerobic Gram‐negative bacteria within the gut. This releases mediators which are responsible for the activation of cellular and humoral cascades, resulting in the pathological changes seen in ARDS. This sequence of events underlines the importance of therapies directed at abnormal colonization of the gastrointestinal tract and elimination of the gut endotoxin pool. Selective decontamination of the digestive tract is attractive in that it attacks the problem from 2 sides: first, by eliminating colonization, it appears effective in preventing secondary infection and, second, it may also play a role in reducing the enteric endotoxin pool.

Recent descriptions of pathological oxygen supply dependency in both ARDS and septic patients emphasize the similarity of pathophysiological abnormalities in the 2 conditions. Intensive supportive therapy to achieve adequate oxygen transport and aggressive investigation and surgical management of septic foci are the cornerstones of management of the established syndrome.
Imaging intraabdominal abscesses and nonoperative drainage procedures
Authors: Haaga John R.
Published: May 2005

With state‐of‐the‐art imaging and interventional techniques, the diagnosis and management of intraabdominal abscesses have improved. Radionuclide scanning, ultrasound, and computed tomography are very accurate for the diagnosis and staging of intraabdominal abscesses, permitting the use of percutaneous drainage methods. Percutaneous abscess drainage (PAD) has gained wide acceptance and applications now include not only curative drainages but also certain palliative ones. Although some controversy exists relative to results and palliative procedures, PAD is now accepted as an effective alternative to operative drainage.
Nonoperative antiinfective treatment of intraabdominal infections
Authors: Pollock Alan V.
Published: May 2005

There are many causes of peritonitis. Primary peritonitis is rare, but may complicate cirrhosis of the liver or may, in developing countries, be caused byMycobacterium tuberculosis.It is occasionally iatrogenic, particularly as a complication of continuous ambulatory peritoneal dialysis. It is, however, most frequently the result of perforation of a hollow viscus, caused by either trauma or disease. Its most lethal form follows breakdown of an intestinal anastomosis.

Primary and iatrogenic peritonitis should be treated with antibiotics, and localized abscesses can sometimes be cured by percutaneous aspiration. Secondary peritonitis requires resuscitation, antibiotics, and operation. When there is gross microbial invasion, it is wise to avoid suture of the hollow viscus. If there is a strong chance of recurrence of intraabdominal abscesses, nonclosure of the abdomen is theoretically desirable and allows frequent reexploration. This is particularly applicable to pancreatic abscesses.
Is closure of the peritoneal layer necessary in the repair of midline surgical abdominal wounds?
Authors: Hugh Thomas B. , Nankivell Charles , Meagher Alan P. , Li Bei
Published: May 2005

This study describes a prospective randomized controlled trial to evaluate whether suture of the peritoneal layer is necessary as a separate step in the closure of midline abdominal surgical wounds. Consecutive patients undergoing abdominal operation—elective and emergency surgery—through a midline abdominal wound were randomized to have the peritoneal layer closed with continuous catgut, or to have this step omitted. The linea alba was closed with interrupted stainless steel sutures, and the skin approximated with staples. Patients were evaluated for wound sepsis, wound dehiscence, and subsequent incisional hernia development. Postoperative pain was assessed by a self‐administered visual analogue score, and by measuring narcotic requirements. There was no significant difference in narcotic requirements, pain scores, or wound complications between the 2 groups. Single‐layer closure of the abdominal wall is quicker, less costly, and theoretically safer than layered closure, and it is recommended that separate suture of the peritoneum be abandoned.
Percutaneous control of a portacaval H‐graft: Description of a new device and its initial clinical application
Authors: Smith Ross C. , Brown Alastair R. , Spencer Peter C. , Gill Robert W. , Griffiths Kaye A. , Lane Rodney J. , Reeve Thomas S.
Published: May 2005

A percutaneously‐controlled inflatable cuff which can change the diameter of a portacaval H‐graft has been developed and used in 10 patients. When inflated, the cuff narrows the H‐graft to increase portal pressure and reduce shunting. Use of the cuff has been of clinical significance in 3 of 7 long‐term surviving patients. Narrowing the shunt improved the clinical state in 2 patients with encephalopathy, and reopening a closed shunt improved ascites in the third patient. Duplex ultrasound and deep Doppler have demonstrated an alteration of hepatic portal blood flow following inflation of the cuff after 6 months. It is concluded that further development of this controlled portacaval H‐graft is warranted.
Six‐year results of annual colonoscopy after resection of colorectal cancer
Authors: Juhl Greg , Larson Gerald M. , Mullins Richard , Bond Sheldon , Polk Hiram C.
Published: May 2005

Colonoscopy is an important diagnostic and therapeutic tool that may also be useful in the surveillance of patients after curative resection of colorectal cancer. The yield of colonoscopy and the frequency with which it should be performed after operation, however, have not been clearly defined. Over the past 10 years, we have examined these patients annually with colonoscopy or barium enema. This study evaluates the results of a specifically designed protocol that followed 174 patients.

Counting all sites, colorectal cancer recurred in 57 of 174 patients, three‐quarters within the first 24 months. Nine anastomotic recurrences were detected in the 12–30 month interval; none was reoperated for cure; however, 4 metachronous colon cancers were found and resected for cure. In addition, 30 polyps larger than 1 cm in size and 7 villous adenomas were removed in 30 patients. Combined, these findings represent an interval yield of 3–5% per year. Based on these results and other reports, we recommend that patients undergo colonoscopy annually at least for the first 6 years postresection of colorectal cancer. The detection of new primary tumors and possibly predisposing lesions becomes more important in these patients than detection and cure of recurrent disease.
Acute and perforated appendicitis: Current experience with ultrasound‐aided diagnosis
Authors: Schwerk Wolf B. , Wichtrup Britta , Rüschoff Joseph , Rothmund Matthias
Published: May 2005

The clinical value of high‐resolution real‐time sonography for the diagnosis of acute and complicated appendicitis was prospectively investigated in 857 patients admitted with suspected appendicitis. The ultrasound findings were correlated with history and physical examination on admission. Sonography was able to make the diagnosis of appendicitis with a sensitivity of 89.7%, a specificity of 98.2%, an overall accuracy of 96.3%, and a positive and negative predictive value of 93.6% and 97%, respectively. Routine use of ultrasound before making therapeutic decisions has reduced the rate of unnecessary laparotomies from 20.3% to 11.3%. In 48 (24.7%) of 194 patients with proven appendicitis, the disease had progressed to perforation at laparotomy. History and clinical findings on admission classified 30 (62.5%) of these patients as “highly suspect;” however, 9 (18.8%) were classified as “equivocal” and 9 (18.8%) as “very unlikely.” Only half (48%) of the patients with appendiceal rupture had white blood cell counts higher than 13,000/mm3 or fever above 38°C (50%). Sonography enabled the visualization of the inflamed appendix and/or appendicular abscess in 44 (91.7%) patients with perforation. In 47 of 48 patients with appendiceal rupture, the ultrasoundaided diagnosis was made on hospital admission. Thus, the incidence of complicated appendicitis (24.7%) in our study population must be attributed to disease progression before admission and preclinical diagnostic delay.
Cellular physiology and pathophysiology of the parathyroid glands
Authors: Åkerström Göran , Rastad Jonas , Ljunghall Sverker , Ridefelt Peter , Juhlin Claes , Gylfe Erik
Published: May 2005

This report provides insight into parathyroid gland physiology and the pathophysiology of hyperparathyroidism (HPT). Increases in the extracellular calcium concentration constitute the primary physiological signal for inhibition of parathyroid hormone (PTH) release. Transduction of the external signal into a cellular response involves activation of a cation receptor mechanism on the plasma membrane with rapid rise in the cytoplasmic calcium concentration of the cells. This recently discovered parathyroid calcium receptor has been characterized as a glycoprotein of unusually high molecular weight, which may play a key role in calcium homeostasis since it is also expressed in the kidney and placenta. Binding of external calcium to the receptor is associated with mobilization of intracellular calcium as well as calcium influx into the cells and phosphoinositol hydrolysis. These events rapidly interfere with the release process through essentially unknown mechanisms and probably also at sustained stimulation inhibit PTH gene transcription. The relative calcium insensitivity of the PTH release in HPT is associated with a deranged regulation of cytoplasmic calcium within pathological parathyroid cells. The molecular basis for this disturbance comprises down regulation of the cation receptor, whereby external calcium is translated into abnormally low levels of cytoplasmic calcium and insufficient inhibition of PTH release. Studies on expression of the functionally important cation sensing glycoprotein and its associated cellular signal systems may provide novel means for interference with the pathophysiological derangements of HPT.
Surgical treatment of primary hyperparathyroidism: An institutional perspective
Authors: van Heerden Jon A. , Grant Clive S.
Published: May 2005

Three hundred and eighty‐four consecutive patients with primary hyperparathyroidism (HPT) were surgically treated at a single institution during the 2 year period 1983 through 1984. Two patients were found to have benign familial hypocalciuric hypercalcemia and a single patient had parathyroid carcinoma. In the remaining 379 patients, the cure rate was 99.5%, the operative mortality 0.3%, persistent vocal cord paralysis 0.8%, and permanent hypocalcemia 0.3%. This data supports a liberal policy regarding cervical exploration in patients with HPT and questions any policy of observation without surgical intervention.
Pre‐Operative localization and interventional treatment of parathyroid tumors: When and how?
Authors: Miller Donald L.
Published: May 2005

A variety of diagnostic tests are currently used for parathyroid localization. In patients who have not had previous surgery, none of these are as sensitive or specific for the localization of abnormal parathyroid glands as an experienced surgeon. In these patients, no pre‐operative localization procedures are normally needed.

Patients who have had previous thyroid or parathyroid surgery require pre‐operative localization. Noninvasive imaging procedures (ultrasound, scintigraphy, computed tomography, magnetic resonance imaging) should be performed until an abnormal gland is identified in the same location on at least 2 examinations. The order in which these studies are performed is not important. In the 50% to 70% of patients in whom noninvasive studies are inconclusive, suspicious lesions may be aspirated or biopsied with imaging guidance. If this cannot be done or is nondiagnostic, angiography and, if necessary, parathyroid venous sampling should be done. Intra‐operative ultrasound examination of the neck is helpful during re‐operations.

In selected patients, parathyroid tumors may be ablated by injection of contrast material through an angiographic catheter into the artery supplying the gland, or by percutaneous injection of alcohol into the gland itself. Angiographic ablation is best used for mediastinal glands supplied by the internal thoracic artery or by a descending branch of the inferior thyroid artery. Percutaneous alcohol injection may injure the recurrent laryngeal nerve permanently and should be limited to the rare patient with a neck lesion who has a prohibitive surgical risk. Neither technique is as effective as surgery.
Management of patients with persistent or recurrent primary hyperparathyroidism
Authors: Carty Sally E. , Norton Jeffrey A.
Published: May 2005

The surgical management of patients with persistent or recurrent primary hyperparathyroidism is reviewed. The several factors allowing the surgeon to formulate a correct working diagnosis and to successfully remove all abnormal parathyroid tissue are individually discussed and recent results of re‐operative parathyroid surgery are presented. In particular, direct surgical exploration based on aggressive pre‐operative localization studies, the use of intra‐operative ultrasound to facilitate intra‐operative dissection, cryopreservation of excised parathyroid tissue with potential for delayed autograft to avoid permanent hypoparathyroidism, and the use of intra‐operative monitoring of urinary cyclic adenosine monophosphate levels in patients with parathyroid hyperplasia in whom the surgeon is uncertain whether all abnormal parathyroid tissue has been removed, each contribute to a high rate of successful management (>95%) for patients with the difficult problem of persistent or recurrent primary hyperparathyroidism.
Asymptomatic primary hyperparathyroidism
Authors: Harrison Barnard J. , Wheeler Malcolm H.
Published: May 2005

The criteria used in selecting patients with asymptomatic hyperparathyroidism (HPT) for surgery remain controversial. Do patients with asymptomatic HPT have less severe disease (smaller glands and less derangement of biochemistry) than those with symptoms? We studied a consecutive series of 111 patients with HPT surgically treated and compared the symptomatic patients (n=83) and asymptomatic patients (n=28). There were no significant differences between the two patient groups with respect to age, serum calcium, PTH (intact 1–84), and excised gland weights (adenomas). Hypercalcemia was cured in all patients. The natural history of mild or asymptomatic HPT is unknown, but we summarize the current knowledge relating to mortality, cardiovascular/ renal disease, psychiatric and neuromuscular disorders, and bone disease. Symptoms of HPT do not correlate with the degree of biochemical and pathological derangement. Furthermore clinical assessment does not predict severity of disease and should not be the sole basis of selection for surgery. The results of surgery for primary HPT permit us to advocate a liberal approach to the selection of asymptomatic patients for operation.
Management of hyperparathyroid patients with grave hypercalcemia
Authors: Tisell Lars‐Erik , Hedbäck Gunilla , Jansson Svante , Lindstedt Göran , Zachrisson Bo‐Fredrik
Published: May 2005

During recent years the total number of patients undergoing surgery for hyperparathyroidism has markedly increased, but the annual number of cases with substantial hypercalcemia has remained unchanged. Parathyroid carcinoma and water clear cell hyperplasia cause more severe hypercalcemia than other kinds of hyperparathyroidism. Grave hypercalcemia due to hyperparathyroidism is more common among the elderly, but can occur during pregnancy and also among children. Occasionally, a patient with hyperparathyroidism can also have another cause of the hypercalcemia and does not become normocalcemic until adequately treated for both. The suspicion of grave hypercalcemia should arise due to its clinical features. Determination of serum calcium and intact parathyroid hormone concentrations establishes the diagnosis. The basic treatment of grave hypercalcemia is to rehydrate the patient and to restore the sodium losses. To further lower the serum calcium value we have found bisphosphonates to be very effective. The definitive treatment of grave hypercalcemia due to hyperparathyroidism is surgery. As a last resort, frail patients with grave hyperparathyroidism can undergo surgery under local anesthesia. Repeat operations can improve the prognosis of patients with metastatic parathyroid carcinoma. Selective venous catheterization with blood sampling for determination of intact parathyroid hormone can be helpful in localizing recurrent disease.
The molecular biology of parathyroid disease
Authors: Backdahl Martin , Howe James R. , Lairmore Terry C. , Wells Samuel A.
Published: May 2005

Advances in molecular genetics have shed important new light on the understanding of the basis for human tumors. The application of these methods has allowed for characterization of endocrine neoplasms at a level of resolution that was not previously possible. A variety of molecular techniques have been apph'ed to the study of parathyroid tumors at the DNA level. Studies of the clonal derivation of adenomas and hyperplasia suggest that these entities arise through fundamentally different mechanisms. The gene for parathyroid hormone (PTH) has been cloned and mapped within the human genome. In a small subset of parathyroid tumors, a rearrangement of the PTH gene has been described which may have contributed to their pathogenesis. A separate gene has been identified which appears to be responsible for the humoral hypercalcemia of malignancy. Chromosomal deletions which appear to be involved in the pathogenesis of multiple endocrine neoplasia type 1 have also been found in sporadic parathyroid adenomas. Characterization of tumors at the DNA level may make it possible to correlate specific genetic abnormalities with the biologic behavior of different parathyroid neoplasms and may be useful in distinguishing between adenoma, hyperplasia, and carcinoma.
A new technique of “Marlex®‐peritoneal sandwich” in the repair of large incisional hernias
Authors: Matapurkar B. G. , Gupta Arun Kumar , Agarwal Anil Kumar
Published: May 2005

Repair of a large abdominal wall incisional hernia is a difficult surgical problem with recurrence being a common complication. In addition, other complications such as hematomas, seromas, and sinus formation result from the use of foreign material. A new technique to obviate these complications was used in 60 patients with large incisional hernias repaired over the last 15 years. Marlex® polypropylene mesh was used for repair, sandwiched between 2 layers of peritoneum of the overstretched hernia sac. There was no operative mortality and no recurrence in follow up from 3 years to 7 years. Postoperative complications encountered could be managed conservatively, without necessitating any major surgical procedure or mesh removal.
Prognostic factors in primary gastrointestinal leiomyosarcoma: A retrospective study
Authors: Kimura Hironobu , Yonemura Yutaka , Kadoya Naotaka , Kosaka Takeo , Miwa Kouichi , Miyazaki Itsuo , Sawa Toshiharu , Yoshimitsu Sotohiro , Nishida Yoshio , Kamata Touru , Hirono Teisuke , Takayanagi Nobutatsu
Published: May 2005

Thirty‐six patients who were admitted for surgical resection of leiomyosarcomas of the gastrointestinal tract to the Department of Surgery II, Kanazawa University Hospital, Kanazawa, Japan and its affiliates are included in the study. Follow‐up data on survival is available for 32 patients. The clinico‐pharmacologic variables, such as tumor site, tumor size, cellularity, mitotic index, and DNA ploidy pattern were analyzed and the results proved to correlate with the prognosis. Thirteen (41%) of the patients presented with distant metastases and/or recurrences, with hematogenous metastasis being the predominant type of recurrence. Local recurrences and/or distant metastases were significantly correlated with survival (p<0.001), as was tumor site (p<0.03), tumor size (p< 0.04), surgical treatment (p=0.05), and DNA ploidy pattern (p=0.06). Neither the mitotic index nor the cellularity proved to be significantly correlated with survival. Furthermore, some of the patients with local recurrences or distant metastases survived long after resection of recurrent tumors. In view of the results, aggressive surgical resection may be an efficient treatment of recurrences.
Cytogenetic studies in patients with gastric cancer
Authors: Abarbanel Joseph , Shabtai Fiorella , Kyzer Shlomo , Chaimof Chaim
Published: May 2005

Banded Cytogenetic studies of gastric carcinoma are still relatively scarce, comprised of only a small number of patients. This study was performed on peripheral blood lymphocytes and malignant cells of 16 patients with gastric carcinoma. The lymphocytes were analyzed by standard techniques. All patients had a normal constitutional karyotype; 90% of the patients presented an increased breakage rate and nonrandom chromosomal instability mainly in the heterochromatic regions of chromosomes 1, 9, and 16. Decreased response to phytohemagglutinin was observed in 6 (38%) patients. The tissue specimens were analyzed using direct techniques. Normal ploidy was observed in only one patient, 3 tumors were near‐diploid, 4 hyperdiploid, 4 near‐triploid, and 4 near‐tetraploid. Those with the near‐triploid or near‐tetraploid constitution were in a more advanced pathological stage, most of them with a more complex Cytogenetic profile. Particular involvement was found for chromosomes 1 to 4, 7 to 9,17, and 20, but the more specific nonrandom changes seemed to involve chromosomes 7, 8, 9, and 17.
Foreign body ingestion: Management of 167 cases
Authors: Barros J. L. , Caballero A. , Rueda J. C. , Monturiol J. M.
Published: May 2005

We reviewed the management of 167 patients with foreign body ingestion from 1980 to 1986. Two patients (1.1%) refused treatment. Nonoperative management was attempted in 14 (8.4%) patients. Endoscopy was performed on 117 patients with an overall success rate of 85.5% and a complication rate of 1.7%. Surgical treatment was required in 51 (30.0%) patients, 14 of whom had previous unsuccessful endoscopy.