bluuebunny/crossref_metadata_2025 huggingface dataset:
Sepsis and asepsis in large bowel cancer surgery
Authors: Hughes E. S. R. , McDermott F. T. , Polglase A. L. , Johnson W. R. , Pihl E. A.
Published: May 2005

A patient undergoing surgery for carcinoma of the large bowel has 2 hurdles to negotiate before claiming a cure. The first is postoperative complications and the second, recurrence of the tumor. Recurrence of the tumor will occur almost always within the first 5 years. Postoperative complications are mainly related to infection. Infection on its own is rarely responsible for the death of the patient, but by damaging the vascular endothelium may predispose to arterial or venous thrombosis. More commonly, sublethal sepsis is the cause of considerable morbidity whether within the abdominal wound or the intraperitoneal cavity. One or more of 3 basically different methods are employed to control infection in large bowel surgery: (1) reduction in the number of microorganisms in the large bowel; (2) reduction in the number of microorganisms contaminating the wound, whether within or without the peritoneal cavity; and (3) destruction of microorganisms contaminating the wound.

The authors have relied on reducing the number of microorganisms contaminating the wound by strict attention to wound protection and aseptic surgery, and the destruction of microorganisms that actually reach the wound. To this end, excellent results with antibiotics have been obtained by combining meticulous aseptic surgery with the use of cefazolin and metronidazole administered a short time prior to surgery.
Experiences with intestinal antisepsis
Authors: Cohn Isidore , Bornside George H.
Published: May 2005

From 1955 through 1964, the authors were actively engaged in experimental and clinical studies concerned with intestinal antisepsis, a form of antimicrobial prophylaxis used by the surgeon to lower the high rate of infectious complications following colorectal operations. Controversy has existed regarding the protective action of antibacterial agents and whether such a regimen has significant advantage over simple mechanical cleansing. Animal studies and clinical trials of 50 drugs, drug combinations, and drug dosage schedules are cited in support of intestinal antisepsis. Kanamycin was selected as the intestinal antiseptic of choice on the basis of studies in 967 patients.
Intestinal antisepsis: Rationale and results
Authors: Condon Robert E.
Published: May 2005

The intensive, short‐term, low‐dose neomycin‐erythromycin preparation regimen we have reported is effective in both microbiologic and clinical terms. The evidence establishing the efficacy of neomycin and erythromycin base in elective resections of the colon and rectum is reviewed. The concentration of bacteria in the lumen of the bowel is reliably decreased at the time of operation; emergence of resistant organisms has not been noted. Clinically, the incidence of all forms of septic complications is significantly reduced.

In comparison with other effective regimens of oral antimicrobial bowel preparation, we continue to prefer neomycin‐erythromycin because it is less expensive, the drugs administered are less toxic, and emergence of resistant organisms has not been noted. Neomycin‐erythromycin remains the “gold standard” regimen against which other regimens of both oral and systemic bowel preparation should be compared directly in future clinical trials.
Plasma clearance of bromsulphalein® (BSP) in children with biliary atresia and other hepatobiliary disorders
Authors: Bianchi Adrian , Baker Peter R.
Published: May 2005

Bromsulphalein® (BSP) plasma clearance has been studied in 17 infants with hepatobiliary disorders, including 9 with biliary atresia. A total of 26 clearance studies were made, 24 of which were analyzed by means of a modified 2‐compartmental model to provide quantitative data on hepatocellular function.

The initial BSP plasma clearance curve indicated an absence of biliary excretion in 13 patients, including all 9 patients with biliary atresia. The presence of an excretory phase appears, therefore, to exclude a diagnosis of biliary atresia. Of the 4 other patients, 3 had biliary tract disorders and 1, severe neonatal hepatitis.

The “atretic” type curves were analyzed by a modification of the usual technique, which enabled quantitation of hepatocellular function in the absence of biliary excretion. The equivalent liver volume (ELV), which is an estimate of the functional liver cell mass, was less than 400 ml/kg in 5 of the 6 patients with biliary atresia who are now dead or not thriving and icteric, whereas all 3 patients currently thriving and anicteric, and who had undergone hepatic portoenterostomy, had ELV values greater than 500 ml/kg.

Transhepatic cholangiography and bile drainage in a patient with inspissated bile syndrome with an “atretic” type BSP clearance curve prior to operation resulted in restoration of biliary excretion and a marked and progressive improvement in all aspects of liver function.

Quantitative analysis of BSP plasma clearance is a simple technique which may be of value in the differential diagnosis of biliary disorders, and as a means of evaluating the progression of hepatic disease and the success of surgical management of biliary atresia.
Free perforation of the small bowel in Crohn's disease
Authors: Abascal Javier , Diaz‐Rojas Fernando , Jorge José , Sanchez‐Vegazo Inmaculada , Escartin Pedro , Abreu Luis , Chantar César
Published: May 2005

Three patients with an uncommon complication of Crohn's disease are presented. A free perforation of the diseased terminal ileum was found at laparotomy in all patients. Pneumoperitoneum was not seen on x‐ray. They all under‐went emergency surgery with a tentative diagnosis of acute appendicitis and/or generalized peritonitis. The surgical management is described.

The literature was reviewed regarding free perforation of the small bowel in Crohn's disease. The clinical and radiological findings of this condition are described. Simple suture of the perforation should be avoided because of the high mortality (33%) and complications rates (44%) recorded in the literature with this surgical procedure. According to the limited world experience, resection of the diseased bowel is the treatment of choice in these patients.
The value of revisional surgery for the treatment of postoperative alkaline reflux gastritis
Authors: Lygidakis N. J.
Published: May 2005

Twenty‐eight patients with postoperative alkaline reflux gastritis from a series of 2,437 operations carried out for gastroduodenal ulcer are presented. The incidence of this complication was significantly higher after Polya gastrectomy (2.1%). In all 28 cases, the diagnosis was endoscopically and histologically documented. Revisional surgery proved to be safe and efficacious. There were no deaths, no serious complications, and the results obtained proved to be impressive in both the short and long term. None of our patients required reoperation. The follow‐up was 100% and from 6 months to 10 years.
Motor and electrical activity of the gastroduodenal junction before and after submucosal pyloroplasty
Authors: Reiser S. B. , Holle G. E.
Published: May 2005

In 5 mongrel dogs, motor and electrical activity of the gastroduodenal wall was measured before and after submucosal pyloroplasty using 5 transducers and 5 bipolar serosal electrodes. The significant increase in the motility index (MI) by 105% (p<0.05), as well as the contractile activity by 231% (p<0.01), in the antrum preoperatively after feeding was not demonstrated postoperatively. In spite of this, gastric emptying was accelerated postoperatively by 15 minutes, to a total time of about 2 hours by radiological check with solid meal. Disturbances of motor and electrical patterns in the distal antrum and the duodenal cap that are seen after Finney and Heinike‐Mikulicz pyloroplasty were not observed in the present study in which submucosal pyloroplasty was performed. Since the submucosal pyloroplasty protects the hypomuscular zone of the gastroduodenal junction, the reflex inhibition of the duodenal cap during large antrat contractions is not disturbed postoperatively.
Follow‐up evaluation of thyroid function after thyroidectomy for thyrotoxicosis
Authors: Harada Tanekazu , Shimaoka Katsutaro , Arita Seizaburo , Nakanishi Yuri
Published: May 2005

One hundred fifty‐seven patients with hyperthyroidism treated by subtotal thyroidectomy 2–8 years previously were followed up with serum T3, T4, and TSH determinations. There was some difficulty in distinguishing the various groups of patients by thyroid function tests. However, it was determined that the percentages of patients with hyperthyroidism, euthyroidism, and hypothyroidism, based on T3 values, were 3.2%, 89.7%, and 7.1%, respectively, whereas 5.8%, 41.6%, and 53.1% were hyperthyroid, euthyroid, and hypothyroid by TSH criteria. Subclinical hypothyroidism, that is, increased TSH levels but normal T3 and T4 levels, accounted for the major discrepancy in these results. Subclinical hypothyroidism is more sensitive to disclosure by the TRH stimulation test. However, the incidence and severity of hypothyroidism after thyroidectomy are lower and milder than after131I treatment. The recurrence rate is less than that after the administration of antithyroid drugs, and postoperative complications are rare. Surgical treatment, therefore, plays an important role in the treatment of patients with hyperthyroidism. Those patients with sustained subclinical hypothyroidism after subtotal thyroidectomy should receive supplemental thyroid hormone.
Biological characteristics of adenomatous nodules, adenomas, and hyperfunctioning nodules as defined by adenylate cyclase activity and TSH receptors
Authors: Thomas C. G. , Combest W. , McQuade R. , Jordan H. , Reddick R. , Nayfeh S. N.
Published: May 2005

This study was designed to examine the functional characteristics of thyroid adenomas, adenomatous (colloid) nodules, hyperfunctioning nodules, and normal thyroid parenchyma with respect to the presence of TSH receptors, levels of adenylate cyclase, and the responsiveness of adenylate cyclase to specific stimuli, e.g., NaF (sodium fluoride), GTPγS [guanosine 5′‐0‐(3‐thiotriphosphatate)], PGE1, and TSH. Aliquots of specimens from patients undergoing thyroidectomy [11 normal thyroids, 7 adenomas, 8 adenomatous (colloid) nodules, 5 hyperfunctioning nodules] were immersed in liquid nitrogen and stored at 90°C. Studies were performed on partially purified plasma membranes. Receptor binding of125I‐TSH was quantitated and analyzed according to Scatchard. Adenylate cyclase activity was assayed in the same tissue fraction by conversion of (α‐32P) ATP to cAMP.

High‐ and low‐affinity TSH receptors were present in adenomatous (colloid) nodules, hyperfunctioning nodules, and normal thyroid parenchyma. The thyroid adenomas had high‐affinity receptors in normal quantities; low‐affinity receptors were present at normal or decreased levels. The basal adenylate cyclase activity was slightly increased in thyroid adenomas. All groups had adenylate cyclase response to NaF with the thyroid adenomas being 60% more responsive than normal thyroid parenchyma (p <0.005). All tissues responded to PGE1, with normal thyroid parenchyma being twice as responsive as thyroid adenomas. The adenylate cyclase response of adenomatous (colloid) nodules and hyperfunctioning nodules was distinct from that of adenomas and comparable to that of normal thyroid parenchyma. The adenylate cyclase response to TSH was fourfold in thyroid adenomas and twofold in adenomatous (colloid) nodules compared to normal thyroid parenchyma.
Evaluation of various types of needle biopsies of the thyroid
Authors: Esselstyn Caldwell B. , Crile George
Published: May 2005

Thyroid needle biopsy has been used at the Cleveland Clinic since 1948 in more than 2,000 instances without serious complications. In the years 1979 and 1980, there were 481 needle biopsies performed, and the patients have been followed from 1 to 3 years. One hundred fourteen needle biopsies were with the 18‐gauge needle, 119 were with the fine needle, and 248 were Tru‐cut® biopsies. One hundred fourteen of the patients had 2 kinds of biopsies at the same time, usually Tru‐cut® and fine needle. The Trucut® needle biopsy gave the highest percentage of success in obtaining diagnostic material with only a 4% failure in the hands of the surgeon using it most often. Aspiration with an 18‐gauge needle and fixing the aspirate to form a cell block was found to be a safe and satisfactory way of obtaining material from cysts or nodules too small to be safely and easily sampled by a Tru‐cut® technique. The fine‐needle (ABC) biopsy is safe, simple, and economical and provides material sufficient to diagnose all types of thyroid cancer except the low‐grade follicular type. This limits to some extent the usefulness of the ABC biopsy. Even with Tru‐cut® core biopsies, it is often impossible to distinguish between cellular adenomas and low‐grade adenocarcinomas. Since approximately one‐third will prove to be malignant, surgery is adviced for these patients.

The most significant accomplishment of the routine use of needle biopsy in the diagnosis of thyroid nodules has been the diagnosis of malignancy in more than 5% of the patients with nodules. This has permitted us to avoid surgery in 87% of all patients with thyroid nodules. As a result, in the time period reviewed, 21 of the 46 patients (47%) who had thyroid surgery had malignant tumors.
A prospective controlled study of fine‐needle aspiration and Tru‐cut® needle biopsy of dominant thyroid nodules
Authors: Boey John , Hsu C. , Collins Robert J. , Wong John
Published: May 2005

In order to evaluate the relative merits of fine‐needle aspiration (FNA) and Tru‐cut® needle biopsy (TNB), we conducted a prospective controlled trial in 384 patients who had dominant thyroid nodules. FNA had a slightly higher diagnostic yield and fewer complications than TNB. Definitive confirmation of the biopsy diagnoses was obtained in 41.1% of the patients. Both techniques achieved a very high degree of overall accuracy, and false‐positive errors among non‐follicular lesions occurred only in cases labeled as possibly malignant. However, neither method could reliably distinguish between a benign and malignant follicular neoplasm. Including follicular neoplasms as suspicious for malignancy, the individual sensitivity rates for cancer were 86.5% and 91.9% for FNA and TNB, respectively. The combined use of FNA and TNB, however, detected 97.3% of the 37 malignancies.

Rather than demonstrating any overwhelming relative advantage, this study would support the use of both FNA and TNB to investigate dominant nodules. When combined with clinical information and imaging studies, needle biopsy can reduce the number of unnecessary operations without seriously compromising the removal of thyroid cancers.
Prognostic value of nuclear DNA content in papillary thyroid carcinoma
Authors: Cohn Kenneth , Bäckdahl Martin , Forsslund Gun , Auer Gert , Lundell Göran , Löwhagen Torsten , Tallroth Eva , Willems Jan ‐Silvester , Zetterberg Anders , Granberg Per ‐Ola
Published: May 2005

The prognostic value of nuclear DNA content in papillary thyroid carcinoma was studied retrospectively in 90 patients. Eighty survived for at least 10 years, and 10 died, of papillary thyroid carcinoma, between 6 months and 12 years after diagnosis. Clinical data as well as morphological tumor characteristics were examined. DNA measurements in morphologically identified single tumor cells were performed either on fine‐needle aspiration material or on histologic sections. The tumors of the survivors were composed of cells with a DNA content comparable to that of normal cells, whereas the tumors of the non‐survivors had significantly higher DNA values. The data suggest that DNA measurements in papillary thyroid carcinoma offer a valuable adjunct to standard clinical and microscopic analysis.
Measurement of nuclear DNA content in thyroid diagnosis
Authors: Bengtsson Allan , Malmaeus Jan , Grimelius Lars , Johansson Henry , Pontén Jan , Rastad Jonas , Åkerström Göran
Published: May 2005

The nuclear DNA content in thyroid cell imprints was determined in 94 patients with different thyroid diseases by single‐cell cytophotometry. Sixty‐three of the patients had benign thyroid lesions and 31 had different thyroid malignancies. The WHO tumor classification was used. The DNA values are presented in frequency histograms according to the ploidy and degree of proliferation. The histograms were classified into 6 groups: I, II, II +, III, IV, and IV +. The patients have been followed up for up to 6 years.

With the exception of 1 case of thyrotoxicosis, the DNA values in benign thyroid lesions fell into group I–II or II +. Apart from 4 patients with small nodules of medullary carcinoma, the values in all patients with differentiated or anaplastic carcinomas were classified as group III, IV, or IV+.

Determination of the DNA content may be a valuable adjunct in the differentiation between benign and malignant thyroid lesions. The presence of aneuploid cells seems to indicate a malignancy and in our material there was a clear difference in DNA content between follicular adenomas and follicular carcinomas.
Prevalence of C‐cell hyperplasia and medullary thyroid carcinoma in a consecutive series of pheochromocytoma patients
Authors: Jansson Svante , Hansson Göran , Salander Håkan , Stenström Gunnar , Tisell Lars ‐Erik
Published: May 2005

During a 27‐year period (1956–1982), 64 patients were treated surgically for pheochromocytoma. There was no kinship among any of these subjects. The true prevalence of C‐cell disease of the thyroid in this series was searched for by performing serum calcitonin determinations after provocation with pentagastrin. Postoperative follow‐up of the pheochromocytoma disease was performed by blood pressure measurement and determination of urinary excretion of catecholamines and metabolites. Ten individuals (15.6%) were found to have C‐cell disease indicating that they had multiple endocrine neoplasia type II (MEN II) syndromes. Seven of these patients had been diagnosed before the time of follow‐up evaluation, 4 because of symptoms and 3 because of the screening procedure. At the systematic follow‐up, 3 “new” cases of C‐cell disease were diagnosed. As a result of the screening procedure, we found 4 “new” MEN II kindreds. After unilateral adrenalectomy, 7 of the 10 MEN II patients have been followed for more than 7.7 years without signs of recurrent adrenal disease.

Our results suggest that the prevalence of MEN II syndromes among pheochromocytoma patients is higher than previously reported. Removal of only grossly evident pheochromocytomas and careful follow‐up is a good alternative to routine bilateral adrenalectomy in MEN II patients with pheochromocytoma.
Ultrasonic localization and cytologic identification of parathyroid tumors
Authors: Rastad Jonas , Johansson Henry , Lindgren Per G. , Ljunghall Sverker , Stenkvist Björn , Åkerström Göran
Published: May 2005

Ultrasonic examination of the parathyroid glands was performed in 55 consecutive patients with subsequent surgically verified hyperparathyroidism. Ultrasound located 26 of 37 parathyroid adenomas in the neck. Eleven of 48 hyperplastic glands in the neck were visualized by ultrasound in 16 patients with primary or uremic hyperplasia. A parathyroid adenoma was revealed in all 3 patients with hypercalcemic crisis and in all 5 patients with an adenoma and a previously unsuccessful exploration of the neck. Two of 3 glands were visualized by ultrasound prior to secondary explorations in 3 patients with primary hyperplasia associated with the multiple endocrine neoplasia syndrome type I. Undetected parathyroid glands were generally small and located in regions of the neck difficult to detect by ultrasound. It was often difficult to unequivocally establish that identified lesions represented a parathyroid gland. Nodules and cysts of the thyroid and lymph nodes were misinterpreted for parathyroid lesions. Ultrasonically guided fine‐needle biopsies were obtained from 8 parathyroid lesions, 7 thyroid tumors, and 2 lymph nodes. By cytologic examination these tissues could be discriminated after a differential staining of the aspirates.
Assessment of parathyroid graft function after autotransplantation of fresh and cryopreserved tissue
Authors: Rothmund Matthias , Wagner Peter K.
Published: May 2005

Experience in autotransplantation of fresh and cryopreserved parathyroid tissue is reported. In 100 patients autografting of fresh tissue was combined with total parathyroidectomy (TPX + AT). Cryopreserved parathyroid glands were grafted after reoperation for primary (p) and secondary (s) hyperparathyroidism (HPT) in 4 patients (3p and 1s), and in 3 with TPX + AT for sHPT after the fresh tissue grafted during initial surgery failed to function.

One to seven years after TPX + AT, nearly 90% of 65 patients presented with normal graft function, 7.7% were hypocalcemic, and 3% exhibited graft‐dependent hypercalcemia. In only 31% of all patients could a PTH‐gradient—grafted versus non‐grafted arm—be demonstrated. All 3 patients with pHPT who received cryopreserved autologous tissue showed normal function 6–34 months later. In 2 of 4 patients with sHPT the autografted cryopreserved tissue secretes enough PTH to maintain a normal calcium level. The results of autotransplantation of cryopreserved tissue do not depend on the length of cryopreservation but on accurate freezing and thawing technique.
Successful resection of intrathoracic metastases from two patients with parathyroid carcinoma
Authors: Dubost C. , Jehanno C. , Lavergne A. , Le Charpentier Y.
Published: May 2005

Patients with functioning parathyroid carcinoma (PTC) may develop local or distant metastases many years after primary surgical resection. Such lesions are sometimes very difficult to localize, even with current investigative methods (including computed tomographic scanning, scintiscan, angiography, and selective venous catheterization with PTH radioimmunoassay). Unfortunately, radiation therapy, antineoplastic chemotherapy, and medical therapy aimed at reducing the hypercalcemia are generally unsuccessful. Surgical excision is, in fact, the only hope of controlling the disease, as illustrated by our 2 cases of successful resection of intrathoracic metastases. The first patient had a single intrapulmonary metastatic nodule 12 years after resection of a primary tumor. Two years after the thoracic operation, the serum calcium was normal. Following resection of a primary parathyroid carcinoma, the second patient had resection of a local recurrence (3 years later) and subsequently an intramediastinal metastasis (5 years later). He is hypocalcemic 1 year after the last surgery.
MEN I pancreas: A histological and immunohistochemical study
Authors: Thompson Norman W. , Lloyd Ricardo V. , Nishiyama Ronald H. , Vinik Aaron I. , Strodel William E. , Allo Maria D. , Eckhauser Frederic E. , Talpos Gary , Mervak Tim
Published: May 2005

The spectrum and extent of islet cell histopathological findings in patients with multiple endocrine neoplasia, type I (MEN I) syndrome has never been clearly defined. Although some patients have discreet tumors causing clinically evident syndromes, others may have no symptoms until metastatic islet cell carcinoma is apparent. Whether diffuse islet cell disease occurs in all patients with grossly apparent tumors is not known. This study is an attempt to define both the functional and anatomical extent of islet cell disease and its relationship with the clinical course of patients with MEN I syndrome.

The resected specimens of pancreas from 14 patients with MEN I syndrome were evaluated for hyperplasia, nesidioblastosis, multiple tumors, and evidence of malignancy. In 12 cases, specimens consisted of distal pancreas and, in 2 cases, the entire pancreas was available. Multiple sections were taken from each specimen. Immunoperoxidase staining was done for gastrin, pancreatic polypeptide, glucagon, serotonin, VIP, somatostatin, and neuron‐specific enolase in sections of 24 tumors from 10 patients. Five of the 10 patients with Zollinger‐Ellison syndrome underwent total gastrectomy and 3 others underwent only pancreatic procedures to control their acid hypersecretion.

The following is concluded. All MEN I patients with pancreatic neoplasms have diffuse islet cell involvement consisting of nesidioblastosis, micro‐ and macronodular hyperplasia. Some tumors produce multiple hormones and these patients are at risk to develop new tumors, but complete excision of grossly apparent tumors may result in long‐term control of the endocrinopathy present. This is particularly true for patients with insulinoma and hypoglycemia. Selected patients with gastrinoma may also be considered for excision of their islet cell tumor(s) without concomitant gastrectomy, especially if transhepatic venous sampling demonstrates a single site of excess gastrin production. However, if transhepatic venous sampling demonstrates diffuse sources of hypergastrinemia, a local pancreatic procedure will invariably be unsuccessful. Total pancreatectomy in MEN I patients with disease localized to the pancreas is the only curative surgical procedure but is rarely indicated.
Prevalence of diffuse pancreatic beta islet cell disease with hyperinsulinism: Problems in recognition and management
Authors: Harrison Timothy S. , Fajans Stefan S. , Floyd John C. , Thompson Norman W. , Rasbach Dennis A. , Santen Richard J. , Cohen Cynthia
Published: May 2005

Among 77 patients with endogenous hyperinsulinism seen in 2 medical centers, diffuse islet cell disease accounted for 17 (22%) patients. Since diffuse islet cell disease poses special problems in management, its prevalence is emphasized in this report.

Among these patients with diffuse islet cell disease, there were 11 patients with adenomatosis, 4 with nesidioblastosis, and 2 with islet cell hyperplasia. Six of the 77 patients were found in multiple endocrine neoplasia, type I kindreds; diffuse islet cell disease was documented in 4 of these patients.

We outline principles of management in patients with diffuse islet cell disease. Frozen section microscopy failed to identify nesidioblastosis or islet cell hyperplasia.
Islet autotransplantation in the pancreatectomized dog: Effect of time on graft function
Authors: Alderson D. , Farndon J. R. , Alberti K. G. M. M. , Phil D. , Path M. R. C. , Johnston I. D. A.
Published: May 2005

Pancreatic transplants in large experimental diabetic animals maintain fasting euglycemia, but do not achieve normal glucose tolerance. This and other hormonal and metabolic defects influence the efficacy of these grafts to control or reverse the complications of diabetes. The aim of this study was to see if such defects exist, and how they might alter with time.

Twelve dogs were studied 1 and 3 months after receiving intrasplenic autotransplants of collagenase‐dispersed pancreatic fragments. Thirty‐three normal animals acted as controls. Blood glucose, lactate, pyruvate, alanine, glycerol, 3‐hydroxybutyrate, cholesterol, free fatty acids, dinsulin, glucagon, and cortisol were determined in the fasting state and following an intravenous glucose load. At 1 month, glucose clearance (K) was reduced and there were elevated fasting levels of glycerol, cholesterol, free fatty acids, and 3‐hydroxybutyrate. At 3 months, significant improvements in K had occurred and intermediary metabolism returned to normal. There was a significant increase in glucosestimulated insulin output measured in peripheral blood between 1 and 3 months. Profiles for glucagon and cortisol were normal throughout the study.

Unlike segmental pancreatic transplants, the pancreatic islet graft demonstrates functional improvement with time, a feature of considerable importance for future clinical studies.
The effects of transplant mass on insulin release by collagenase‐dispersed pancreatic fragments in the diabetic dog
Authors: Alderson Derek , Farndon John R.
Published: May 2005

The abnormal glucose tolerance seen in experimental diabetic animals receiving pancreatic transplants has been assumed to be due to a reduced functional islet mass.

Collagenase‐dispersed autografts were prepared following total pancreatectomy. Six dogs received 100%, and 6 received 50% of the tissue so formed. Blood glucose, lactate, pyruvate, alanine, glycerol, 3‐hydroxybutyrate, cholesterol, free fatty acids, insulin, glucagon, and cortisol were determined in the fasting state and following an intravenous glucose load (IVGTT). Glucose clearance (K) was calculated. Fasting euglycemia was achieved and insulin levels were the same in both groups. Similar reductions in K, with elevated fasting levels of glycerol, and 3‐hydroxybutyrate, were present in both groups 1 month after transplantation. Glucose‐stimulated insulin output was both quantitatively and qualitatively defective with similar levels being achieved in peripheral blood in both groups. This abnormal insulin response exposed elevated levels of free fatty acids and alanine during the IVGTT, although suppression of glucagon was normal in both groups.

The results suggest that a simple relationship between transplant mass and insulin secretion does not exist. This may be important in regard to the future clinical application of free transplantation in the treatment of diabetes.
Wound infections in appendicitis: Effective prophylaxis
Authors: Gaffney Peter R.
Published: May 2005

Wound infections following appendectomy continue to occur at a surprisingly high rate. Individual prophylactic methods have been shown to reduce the incidence but are unlikely to eliminate infections owing to the multifactorial nature of their etiology. No study in which multiple methods were used has yet been reported. In this study 100 consecutive cases of appendicitis were treated by multiple methods including good surgical technique, protective wound packs, avoidance of drains, and systemic antibiotics (penicillin, gentamicin, and clindamycin), in appendicitis associated with perforation, gangrene, or abscess formation. By using these methods a 1% wound infection rate was achieved, the lowest rate yet reported for 100 consecutive cases of appendicitis.
Twenty‐five years after Billroth II gastrectomy for duodenal ulcer
Authors: Fischer Anders B.
Published: May 2005

One thousand twenty‐five patients underwent a Billroth II resection for duodenal ulcer between 1948 and 1956. The operative mortality rate was 2.4%. At follow‐up between 22 and 30 years later, 522 had died and 423 patients were traced. Recurrent ulcer appeared in 2.6% of the cases. Postgastrectomy symptoms occurred with the following frequency: dumping 10%, diarrhea 5%, vomiting 7%, and pain 4%. Anemia developed in 18%, hypoalbuminemia and hypocalcemia in 40 and 15%, respectively. Eleven percent had lost more than 10 kg in weight. Tuberculosis was found in 3% of the cases. While 90% of the patients were satisfied with the result, 10% were failures. The overall mortality rate was significantly increased because of suicide. Gastric carcinoma was the cause of death no more often than expected.
Proximal gastric vagotomy in dyspeptic patients without an ulcer
Authors: Aase Steinar T. , Liavåg Ivar , Roland Magne
Published: May 2005

Proximal gastric vagotomy (PGV) was performed in 40 patients who had suffered from dyspepsia for several years, but who did not have any demonstrable ulcer. Great care was taken to obtain a thorough history of the disease. Patients with symptoms not likely to be caused by gastric hypersecretion were not treated surgically. There was a distinctive reduction of both basal and pentagastrin‐stimulated acid secretion after the operation. The decrease in acid output was accompanied by a marked relief of symptoms. Most patients noted the improvement within 3 months after surgery. Thirty patients were interviewed after 5 years. Of these, 23 were either completely cured of dyspepsia or were at least much better than before the operation. Only 1 person reported no relief 5 years after PGV. It is concluded that surgical treatment may be of value in patients with chronic dyspepsia even in the absence of a peptic ulcer.
Compression of the common hepatic duct by the right hepatic artery in intrahepatic gallstones
Authors: Tsuchiya Ryoichi , Eto Toshifumi , Harada Noboru , Yamamoto Kensuke , Matsumoto Teiji , Tsunoda Tsukasa , Yamaguchi Takashi , Noda Takatoshi , Izawa Kunihide
Published: May 2005

Two cases of intrahepatic gallstones with stenosis of the common hepatic duct caused by overriding of the right hepatic artery are described. The probable diagnosis of the compression of the bile duct by the artery was obtained by superimposing a direct cholangiogram on an angiogram. The final diagnosis was made at operation. The first patient was successfully treated by resection of the compressed common hepatic duct with Roux‐en‐Y hepaticojejunostomy anterior to the right hepatic artery. In the second patient, lateral segmentectomy and cholangiojejunostomy were performed.
The incidence and significance of common bile duct dilatation in biliary calculous diseases
Authors: Lygidakis N. J.
Published: May 2005

To assess the significance of common bile duct dilatation in biliary lithiasis, we studied 3,802 patients who underwent surgery for biliary calculous disease. It has been shown that there is a higher incidence of common bile duct dilatation in patients of advanced age, in those with a long history of symptoms, and in those who have undergone previous biliary surgery. Furthermore, it has been noted that common bile duct dilatation is associated with a high incidence of bile infection of primary common bile duct stones and of pathological changes on the biliary tree histology. These findings support the view that common bile duct dilatation should be considered as an end result of advanced biliary tree disease and it may well predict a high potential for recurrent choledocholithiasis.
Residual pancreatic exocrine function before and after pancreaticoduodenectomy for periampullary cancer
Authors: Kodama Motomu , Tanaka Tsuneo
Published: May 2005

In 25 patients with periampullary cancer receiving pancreaticoduodenectomy (PD), residual function of the exocrine pancreas was assessed by the pancreatic function diagnostant test (PFT) to investigate functional variations during the postoperative course. The volume of excretion of p‐aminobenzoic acid (PABA) in urine for 6 hours before the operation was significantly lower than that in the control group (p<0.01). The 6‐hour excretion level within 2 months after the operation was the same as preoperatively; however, the 6‐hour excretion level 12 months postoperatively was higher than that before the operation (p<0.01) and within 2 months after the operation (p<0.01). An analysis of the urinary excretion pattern of PABA was useful to suggest the status of the pancreatic duct. It may be concluded that the lower level of the PFT before PD resulted from obstruction of the pancreatic duct, that the lower level within 2 months after PD was the result of maldigestion and malabsorption, and that the level of the PFT beyond 12 months after PD was improved to the same level as the control group.
Pancreatic abscess management by subtotal resection and packing
Authors: Stone H. Harlan , Strom Priscilla R. , Mullins Richard J.
Published: May 2005

A 20‐year experience in management of 57 patients with pancreatic abscess was reviewed. Ages ranged from 17 to 91 years (average 46). Males outnumbered females 39 to 18. A prior episode of pancreatitis had been documented in 31 patients, trauma in 23, and no known cause in 3. All patients had fever (> 39°C), abdominal pain and/or tenderness, and absent peristalsis. A draining wound, abdominal mass, oliguria, (< 20 ml/hr), and shock (BP<100/60) were other prominent findings. Either leukocytosis (> 12,000/mm3) or leukopenia (<5,000/mm3) was noted in 56 patients. Elevation of the serum amylase (> 200 u/100 ml) and jaundice (bilirubin > 2 mg/100 ml) were reported less frequently. Bacteremia was found in all patients not receiving parenteral antibiotics at the time blood cultures were drawn and in half despite such therapy. Plain abdominal x‐rays and, more recently, the computed tomography scan revealed retroperitoneal gas bubbles and/or a mass in 52 of the patients and proved to be the most useful diagnostic tests.

Treatment with antibiotics alone or plus drainage led to survival in only 3 of 18. Five of 14 managed by open packing and 2 of 3 managed by distal resection with drainage died. However, when the wound following subtotal pancreatectomy was packed open, with daily pack changes, only 2 of 22 failed to survive. Deaths were primarily due to hemorrhagic (9) or septic (8) shock or some complication of these states (3).
A controlled trial of synthetic salmon calcitonin in the treatment of severe acute pancreatitis
Authors: Martínez Enrique , Navarrete Francisco
Published: May 2005

Thirty‐one patients suffering severe acute pancreatitis entered a protocol designed to evaluate the therapeutic value of synthetic salmon calcitonin. All 31 patients were submitted to standardized treatment and, in addition, 14 received daily 300 MRCU of calcitonin for 15 days. The parameters evaluated were: mortality rate, effectiveness of conservative treatment, pleural effusion, date of return to oral feeding, days of hospitalization, pain, abdominal distention, peristalsis, fever, pulse rate, serum and urinary amylase, serum calcium, hematocrit level, and leukocyte count. Significant differences were not found between the 2 groups. Therefore, the conclusion is that synthetic salmon calcitonin is of no benefit in the treatment of severe acute pancreatitis.
Results of surgical treatments of primary hepatocellular carcinoma: Some aspects to improve long‐term survival
Authors: Okamoto Eizo , Tanaka Nobutaka , Yamanaka Naoki , Toyosaka Akihiro
Published: May 2005

From 1973 through 1982 we have treated 226 patients with primary hepatocellular carcinoma, including 103 by hepatectomy and 93 by hepatic artery ligation. Most were associated with cirrhosis or related liver diseases and one‐third with esophageal varices. As in other Japanese and Asian series, our long‐term overall results for the 90 patients who survived hepatectomy were poor in comparison with Western series dealing with non‐cirrhotic patients. However, the actuarial survival rate at 3 years was 90% in patients with carcinomas smaller than 3 cm in diameter (n = 18). The 5‐year survival rate was 70.8% in the 25 patients whose carcinoma had a curative resection, and 100% at 3 years in the 16 patients in whom a tumor smaller than 5 cm had been resected. Eighty‐four patients survived hepatic artery ligation; in 50 of them the area of ischemia was thought to include all the neoplastic lesions within the liver. The survival rate of these 50 patients was superior to that of the patients who had undergone noncurative hepatic resection.

We conclude that early detection and curative resection is the best way to improve the long‐term results in cirrhotic patients with hepatocellular carcinoma and that hepatic artery ligation is better than incomplete (noncurative) resection.
The pituitary before and after adrenalectomy for Cushing's syndrome
Authors: Manolas Konstantinos J. , Farmer Helen M. , Wilson H. Kenneth , Kennedy A. Laurence , Joplin Graham F. , Montgomery Desmond A. D. , Kennedy Terence L. , Welbourn Richard B.
Published: May 2005

Seventy‐nine patients underwent subtotal or total adrenalectomy for pituitary‐dependent Cushing's syndrome (1953–1980); 76 survived the operation and 75 were followed for 1 to 27 (mean 11) years. Pigmentation, plasma ACTH, and sellar X‐rays were assessed at intervals.

Pigmentation developed in 37 (5 before and 32 after operation), most frequently after total adrenalectomy. The sella was definitely enlarged in 6 of 65 patients before the operation and in 14 of 65 after it. Enlargement was more common in pigmented than in non‐pigmented patients. The plasma ACTH concentration rose after adrenalectomy. It was significantly higher in pigmented than in non‐pigmented patients. It was also higher after total than after subtotal adrenalectomy.

Pituitary tumors were confirmed histologically in 15 patients. The tumors presented at the same time as the Cushing's syndrome in 8 and after adrenalectomy in 7. They were malignant and fatal in 6. Pigmentation, present in 11 of these patients, developed only after adrenalectomy. In 9 other patients with benign lesions and 21 with clinically probable but histologically unconfirmed tumors, 7 were treated by hypophysectomy with or without irradiation (4 cured, 3 improved), and 4 by irradiation alone: external 3, internal 1 (all improved).
One‐hand racquet grip for Tru‐cut® thyroid biopsy
Authors: Boey John , Collins Robert J.
Published: May 2005

Numerous studies attest to the reliability and safety of Tru‐cut® needle biopsy of thyroid nodules. We describe a simple method in which the biopsy needle may be controlled with one hand, thereby freeing the other hand to fix the thyroid nodule in position. Attention to the site of needle entry and the trajectory of the biopsy plane will minimize complications while ensuring a satisfactory yield in approximately 90% of nodules, irrespective of their location within the thyroid gland. Obtaining multiple biopsies along different planes will further reduce geographical sampling errors. It is suggested that this easily adopted method should complement fine‐needle aspiration in the management of dominant thyroid nodules.
Loop ileostomy: A superior diverting stoma in colorectal surgery
Authors: Fasth S. , Hultén L.
Published: May 2005

In a consecutive series of 99 patients, we have evaluated the safety of the loop ileostomy employed for diversion and/or decompression. We have recorded the complications after construction and subsequent closure and any associated difficulties with stoma care have been evaluated. The results indicate that a loop ileostomy, when properly constructed and managed by modern appliances, presents no more problems than a conventional end ileostomy. Closure of a loop ileostomy is associated with few complications. A loop ileostomy appears superior to a transverse colostomy as a temporary diversion of the fecal stream and should be used where possible.
Abrogation of the beneficial blood transfusion effect in dogs by splenectomy
Authors: Marquet R. L. , Heineman E. , Tank B. , Obertop H. , Niessen G. J. C. M. , Bijnen A. B. , Westbroek D. L. , Jeekel J.
Published: May 2005

The role of the spleen in the manifestation of the transfusion phenomenon was studied in beagle dogs. Beagles were transfused 3 times with 100 ml blood from different mismatched mongrel dogs, at 4, 3, and 2 weeks before mongrel kidney transplantation or splenectomy. Seven transfused dogs were splenectomized 1 week before transplantation, 9 transfused animals were not splenectomized, and a group of 9 kidney allografted controls was neither transfused nor splenectomized. All recipients were given postoperative immunosuppression, which consisted of azathioprine and prednisolone.

As with earlier demonstrations it was found that 3 pretransplant blood transfusions in the nonsplenectomized group led to a significant prolongation of kidney graft survival. All transfused animals survived for more than 3 weeks, a period in which more than 50% of the kidneys in the control group were rejected. Four out of 9 transfused dogs became long‐term survivors. In the transfused‐splenectomized group, 70% of the recipients rejected their kidney acutely within 3 weeks, and only one animal became a long‐term survivor. The absence of a transfusion effect in most of the splenectomized dogs suggests that, under the experimental conditions employed, the spleen plays a crucial role for the induction and manifestation of the transfusion phenomenon.
Radiographic parenchymal patterns in Japanese females as a risk factor for breast carcinoma
Authors: Kojima Osamu , Majima Takashi , Uehara Yasuo , Ikeda Eito , Ahn Tatsuyuki , Fujita Yoshihiro , Tamura Yukio , Majima Susumu
Published: May 2005

Wolfe has reported that his classification of xerographic parenchymal patterns of the breast was of value in screening programs. However, there has been no attempt to confirm his work in Japan. Therefore, we investigated the relationship of breast parenchymal patterns to breast carcinoma prevalence in Japanese females. In the cancer patients, the P2 pattern was the most dominant pattern (49.4%), followed by the DY pattern (23.6%), the P1 pattern (14.0%), and the N pattern (13.0%). In the group without carcinoma, the dominant pattern was the N pattern (45.2%), followed by the P1 pattern (26.9%), the P2 pattern (21.3%), and the DY pattern (6.7%). The DY pattern was associated with 31% of breast carcinomas that occurred in women under 50 years of age, whereas it was associated with only 13% of breast carcinomas in women older than 50 years. Conversely, the P2 pattern was associated with 58% of the breast carcinomas occurring in women over age 50 years compared to 41% of those occurring in women younger than age 50. More than 70% of the patients with breast carcinoma who were between 30 and 59 years of age demonstrated the P2 and DY patterns. In the patients with breast carcinoma who were over 60 years of age, the incidence of these patterns was somewhat lower (55.6%).

The present results demonstrate that the classification proposed by Wolfe is of value in the screening programs for breast carcinoma in Japanese females.
Mucormycosis: A fatal case bySaksenaea vasiformis
Authors: Patiño José Félix , Mora Rafael , Guzmán Miguel A. , Rodríguez‐Franco Eduardo
Published: May 2005

A fatal case of mucormycosis in a previously healthy 26‐year‐old woman who developed a progressive necrotizing lesion is presented. Histopathological and mycological studies revealed the presence of a Zygomycete, which after several cultures proved to beSaksenaea vasiformis. No underlying pathological condition was detected. This case might prove to be the first one of fatalSaksenaea vasiformis infection reported in Latin America, and only the 4th one in the world literature. The relevance of mucormycosis in the diagnosis and management of necrotizing cellulitis is stressed.
Use of selective arterial secretin injection test to guide surgery in patients with Zollinger‐Ellison syndrome
Authors: Imamura Masayuki , Takahashi Kiyoyuki
Published: May 2005

It is often difficult to localize gastrinomas in patients with Zollinger‐Ellison syndrome (ZES). We have developed a new useful method, the selective arterial secretin injection test (SASI test), for localizing gastrinomas in patients with ZES. The SASI test first determines the arteries feeding the gastrinomas and then locates the gastrinomas. In 12 patients with ZES, the SASI test clearly localized the gastrinomas, while results obtained with computed tomography or portal venous blood sampling had a positive predictability of less than 10%. Following localization with the SASI test, curative resection of gastrinomas was successfully performed on 7 patients who consented to the operation. Each of 3 patients had one duodenal submucosal microgastrinoma and one or more metastatic lymph node; the other 4 patients had 2 to 10 microgastrinomas or large gastrinomas in the duodenum or the pancreas. All 7 patients, who exhibited negative responses with a postoperative secretin test, have been completely cured from 3 months to 4 years postoperatively. The usefulness of the SASI test for preoperative evaluation is demonstrated by the fact that it gives a 100% positive predictability rate as well as a 100% negative predictability rate. Hence the SASI test precisely locates functioning gastrinomas.