bluuebunny/crossref_metadata_2025 huggingface dataset:
Advances in Perioperative Nutrition: Cancer
Authors: Heslin Martin J. , Brennan Murray F.
Published: August 2002

The role of perioperative nutritional support in the management of cancer patients remains controversial. The benefit of supplemental calories is not the only current issue: in fact, the route of delivery, composition of basic nutrients (carbohydrate, protein, fat), and the role of supplemental additives (arginine, glutamine, omega‐3 fatty acids, nucleotides) in improving immune status and ultimate outcome have been the focus of much discussion. Emerging data suggest that the use of supplemental agents is associated with improvement in immune status in these patients, although there is little clear evidence that this improves outcome. Ongoing studies are aimed at defining the group of patients who would most benefit from nutritional interventions during the perioperative period.
Reuse of Liver Grafts after Early Death of the First Recipient
Authors: González E. Moreno , Gómez R. , Pinto I. Gonzalez , Loinaz C. , Garcia I. , Maffettone V. , Corral M. , Marcello M. , Gonzalez A. , Jimenez C. , Castellon C.
Published: August 2002

Three cases are reported of reuse of a transplanted liver graft after early death of the first recipient due to cerebral hemorrhage. The good condition of the donors; the excellent biochemical evolution of the graft in the first recipients; total ABO compatibility and donor‐recipient crossmatch; the absence of positivity to hepatitis B virus (HBV), hepatitis C virus (HCV), and bacteriologic cultures; and early death made reuse possible. The shortage of donors in relation to patients on the waiting list and the poor clinical condition of the second recipients made it necessary to adopt the decision to reuse the graft in an attempt to save their lives. The evolution of the patients and the reused grafts was satisfactory, and there were no complications that could be attributed to the fact that the graft had been transplanted before.
Clinicopathologic Characteristics and Postoperative Outcome in Japanese and Chinese Patients with Thoracic Esophageal Cancer
Authors: Adachi Wataru , Koike Shoichiro , Nimura Yoshinori , Koide Naohiko , Iida Futoshi , Du Xi Qun , Ping Yu Min , He Ming , Chen Long Qi , Zhang Ming Dao , Zhang He Lin
Published: August 2002

We evaluated the clinicopathologic findings and surgical results of 140 patients with thoracic esophageal cancer treated at Shinshu University, Japan (Shinshu group), and compared them with those from 1164 patients treated at Hebei Medical College, China (Hebei group) to determine if the two groups showed any differences. The Shinshu group had significantly higher incidences of elderly patients (>70 years of age), male patients, and tumors located at the lower esophagus (p< 0.01). In the Hebei group, although the depth of tumor invasion was more advanced, the incidence of nodal metastasis was significantly lower (p< 0.01). Operative death and postoperative complications were more frequent in the Shinshu group. Comparison of the postoperative survival curves revealed significantly longer survival of patients with pT2or pT3tumor in the Hebei group (p< 0.01), but there were no significant differences between the two groups when the lesions were classified by pTNM stage. This study demonstrated several differences between the patients in the two areas in regard to the clinicopathologic characteristics of thoracic esophageal cancer. The most important characteristic of the esophageal cancer in the Hebei group appears to be the low incidence of nodal metastasis.
Cecal‐Colic Adult Intussusception as a Cause of Intestinal Obstruction in Central Africa
Authors: VanderKolk Wayne E. , Snyder C.A. , Figg David M.
Published: August 2002

During a 5‐year experience in Central Africa, the most common cause of 78 adult intestinal obstructions was primary adult cecal‐colic intussusception (n= 43; 55%). The symptom complex of colicky abdominal pain and obstipation was present in 100% of the patients with intussusception. Operative repair in 90% of patients consisted of simple reduction of the intussusceptum. There were no known recurrences. The etiology of adult cecal‐colic intussusception is unknown. Patients typically present with a 3‐ to 4‐day history of abdominal pain, obstipation, and usually a palpable mass. Treatment is surgical reduction. Right colectomy is reserved for intestinal gangrene. We treated 43 cases during a 5‐year period with only one death.
Severity Stratification and Outcome Prediction for Multisystem Organ Failure and Dysfunction
Authors: Zimmerman Jack E. , Knaus William A. , Sun Xiaolu , Wagner Douglas P.
Published: August 2002

Multiple organ system failure or dysfunction (MOSF/MODS) remains a major cause of morbidity and mortality in hospitalized adults. Among intensive care unit (ICU) patients the extent of physiologic derangement, the type of associated disease or injury, increasing age, and life‐threatening comorbid conditions are the major determinants of risk for developing MOSF and for survival during the 1980s. Hospital mortality for patients with a single organ system failure (OSF) lasting more than 1 day approached 40%; and for those with two OSFs hospital mortality increased to 60%. These outcomes did not change over the decade. For patients with three or more OSFs persisting after 3 days of OSF, however, data suggest that between 1982 and 1990 the mortality has been reduced from 98% to 84% (p= 0.0003). Because of variations in the types and combinations of OSFs, associated disease, and extent of physiologic derangement, it is difficult to interpret variations in mortality among patients with one or more OSFs defined using categorical criteria. For this and other reasons, outcome prediction based on a comprehensive assessment of patient risk factors is a more sensitive, specific, useful approach to quantifying MODS than a simple count of the number and duration of OSFs. Because repeated assessment of risk factors during subsequent ICU days reflects complications and response to therapy, daily outcome predictions are even more precise than estimates at ICU admission. The ability to more accurately predict survival from MODS/MOSF can improve our ability to test new therapies, evaluate how outcome has changed over time, and assess the efficacy of supportive therapy for individuals.
Screening by Genomic Linkage Studies and Mutation Analysis of Hereditary Adenomatous Polyposis Coli: Usefulness for Clinical Practice
Authors: Karner‐Hanusch Judith , Wolf Brigitte , Zehetmayer Martin , Wrba Friedrich , Roth Erich , Mannhalter Christine
Published: August 2002

A heterogeneous group of patients suffering from adenomatous polyposis coli (APC) were evaluated by clinical and genetic investigations for the first time in Austria. The patients belonged to eight unrelated APC families. In six families several family members were affected with APC, and linkage analysis with highly informative markers was used to estimate the risk of single individuals in these families to develop APC. All index patients were also tested for the most frequent mutation in the APC gene (mutation cluster region, exon 15). Clinical investigations included ophthalmologic tests for congenital hypertrophy of retinal pigment epithelium and colonoscopy. According to DNA analysis, 5 of 19 at‐risk individuals had to be considered to be at high risk of having inherited the disease. Four of them underwent proctocolectomy, one patient at risk is under colonoscopic surveillance. The predictive value of indirect genotype analyses reached 83.3%; direct mutation analyses allowed risk estimation in 50% of cases. Ophthalmologic investigation was informative in 75% of the families. Direct and indirect genotyping using a panel of highly polymorphic, closely linked microsatellite markers is a valuable, rapid, reliable method for establishing a presymptomatic diagnosis of APC, especially in families in which more than one affected individual is available for analysis. With regard to the onset of APC and extracolonic manifestations, the variability of APC demands clinical investigations in addition to the molecular tests for all patients and their first‐degree relatives.
Endosonography for Preoperative Staging of Specific Nodal Groups Associated with Esophageal Cancer
Authors: Chandawarkar Rajiv Y. , Kakegawa Teruo , Fujita Hiromasa , Yamana Hideaki , Toh Yuji , Fujitoh Hiroyuki
Published: August 2002

The results of endoscopic ultrasonography (EUS), used preoperatively in 74 endoscopically evaluable patients, were compared with the histopathology after subsequent total esophagectomy with radical lymphadenectomy involving a three‐field dissection of the lower cervical, mediastinal, and abdominal nodes. Patients with obstruction to endoscopy were excluded from this study. Overall accuracy, specificity, and sensitivity were 87%, 90%, and 37%, respectively. EUS has an accuracy of more than 80% for detecting metastatic nodes in the cervical paraesophageal, supraclavicular, right recurrent laryngeal, left paratracheal, upper and lower paraesophageal, infraaortic, infracarinal, and lower posterior mediastinal regions. Its sensitivity is highest for cervical and upper thoracic paraesophageal, infracarinal, left paratracheal, and recurrent laryngeal nodes. Accuracy is maximum for periesophageal nodes and varies inversely with the axial distance of the nodes from the esophageal axis. We recommend that EUS be used routinely for preoperative assessment of the cervical and mediastinal nodal status.
Epidermal Growth Factor Receptor Status in Hyperparathyroidism: Immunocytochemical and In Situ Hybridization Study
Authors: Sadler Gregory P. , Morgan John M. , Jasani Bharat , Douglas‐Jones Anthony , Wheeler Malcolm H.
Published: August 2002

The epidermal growth factor receptor (EGFr) family has been increasingly recognized as an important component in the control of normal cell proliferation and the pathogenesis of cancer. We have studied EGFr expression in 104 cases of hyperparathyroidism by immunocytochemistry (ICC) and by in situ hybridization (ISH). Using two different monoclonal antibodies, ICC for EGFr was performed on 66 cryostat sections and 38 wax‐embedded parathyroid glands. ISH was performed on 49 of these glands using a cocktail of three anti‐sense probes to EGFr mRNA and a nonspecific control probe to human HPV‐18 virus. Breast and prostate tumors were employed as positive controls for both ICC and ISH. Controls demonstrated positive EGFr staining. None of the 104 parathyroid glands showed any ICC positivity. ISH displayed positive staining for EGFr mRNA in five of six carcinomas and eight of nine nonrenal hyperplastic glands. Only 3 of 15 adenomas and 3 of 19 renal hyperplastic glands showed positive staining. This difference was statistically significant between adenoma and carcinoma (p< 0.05) and between adenoma and nonrenal hyperplasia (p< 0.01) (Tukey's multiple comparison test). This study demonstrates that EGFr mRNA is present in parathyroid tumors. Expression in carcinoma and nonrenal hyperplasia is significantly different from adenoma and renal hyperplastic glands. In contrast, ICC failed to demonstrate EGFr protein expression. These findings suggest that either receptor numbers are too low to detect by ICC or there is a failure of mRNA translation. More studies are needed to establish whether the EGFr plays a role in the development of parathyroid cancer or hyperplasia.
Prediction of Bone Mass in Renal Hyperparathyroidism by Newly Developed Bone Metabolic Markers: Evaluation of Serum Levels of Carboxy‐Terminal Pyridinoline Cross‐Linked Telopeptide of Type I Collagen and Carboxy‐Terminal Propeptide of Type I Procollagen
Authors: Katagiri Makoto , Fukunaga Masao , Ohtawa Takahiro , Harada Tanekazu
Published: August 2002

Serum levels of the carboxy‐terminal pyridinoline cross‐linked telopeptide of type I collagen (ICTP) and the carboxy‐terminal propeptide of type I procollagen (PICP) were measured in 95 patients with renal hyperparathyroidism who had undergone a total parathyroidectomy and autotransplantation of a small portion of the resected gland. The results were compared with the serum levels of other bone metabolic markers and bone mineral densities in the distal radius (R‐BMD) and lumbar vertebrae (L‐BMD), which were measured by dual energy x‐ray absorptiometry and converted to the percentage of the mean value of sex‐ and age‐matched healthy controls. The preoperative mean values of ICTP and PICP were 142.4 ng/ml and 187.8 ng/ml, respectively. Although the serum levels of PICP levels exceeded the normal range in 42.1% of the patients, those of ICTP exceeded it in all of them. The serum levels of ICTP correlated positively not only with those of tartrate‐resistant acid phosphatase (TRACP), total alkaline phosphatase (ALP), and osteocalcin but also negatively with the values of %R‐BMD and %L‐BMD and seemed to manifest specifically the disturbance of bone metabolism. On the other hand, the serum levels of PICP correlated with those of ALP and TRACP but not with values of %BMDs. After surgery, the serum levels of ICTP decreased gradually, but those of PICP increased immediately up to peak values at 7 days and then decreased gradually after 14 days, reaching the normal range at 3 months. These changes in the bone metabolic markers seemed to reflect the change in bone metabolism that was converting from bone resorption to bone formation. The percent change in the PICP/ICTP ratio at 7 days correlated significantly with the percent change in R‐BMD at 12 months, and it was suggested that postoperative bone gain might be predicted using a combination of postoperative changes in PICP and ICTP.
Incidence of Regional Recurrence Guiding Radicality in Differentiated Thyroid Carcinoma
Authors: Simon Dietmar , Goretzki Peter E. , Witte Jürgen , Röher Hans D.
Published: August 2002

Total thyroidectomy has become the routine procedure for treatment of differentiated thyroid carcinoma. However, the necessity of unilateral or bilateral neck dissection is far less standardized. Our usual procedure has been to perform a routine neck dissection in T4 tumors and in all other tumor stages only in the presence of positive diagnostic or intraoperative findings. The results concerning regional tumor recurrence in cervical lymph nodes subsequent to thyroidectomy are studied and discussed. Between April 1986 and December 1992 a group of 252 patients were operated on for differentiated thyroid carcinoma (DTC) (176 papillary, 76 follicular). Postoperative treatment included radioiodine therapy as a rule in all patients more than stage T1, and follow‐up encompassed thyroglobulin measurements, cervical ultrasonography, and radioiodine scintigraphy. After a mean follow‐up of 6.9 years, 77 (31%) of the patients underwent reoperation because of regional tumor recurrence [46 of 176 (26%) papillary, 31 of 76 (41%) follicular]. In papillary thyroid cancer a significant difference could be demonstrated between patients with thyroidectomy only versus thyroidectomy plus neck dissection in all tumor stages (T2, 13 of 29 (45%) versus 1 of 34 (3%); T3, 10 of 13 (77%) versus 4 of 11 (36%); T4, 6 of 8 (75%) versus 6 of 18 (33%) (p< 0.0001). Similar results could be achieved for follicular thyroid cancer, showing statistical significance with regard to operative procedure (p< 0.009). Our experience demonstrates a positive correlation of regional tumor recurrence with increasing tumor stage for both histologic tumor types. The high rate of regional recurrence justifies a more radical approach, including neck dissection at the initial operation. The impact on survival, however, must be proved by further evaluation.
Resuscitation of Ischemically Damaged Pancreas by the Two‐Layer (University of Wisconsin Solution/Perfluorochemical) Mild Hypothermic Storage Method
Authors: Matsumoto Shinichi , Kuroda Yoshikazu , Fujita Hirofumi , Tanioka Yasuki , Kim Yongsik , Sakai Tetsuya , Hamano Mitsuaki , Suzuki Yasuyuki , Ku Yonson , Saitoh Yoichi
Published: August 2002

We have shown that 24‐hour preservation by a two‐layer [University of Wisconsin solution (UW)/perfluorochemical (PFC)] cold storage method at 4°C allowed tissue ATP synthesis and resuscitated canine pancreases subjected to 90 minutes of warm ischemia. The purpose of this study was to examine whether the two‐layer (UW/PFC) mild hypothermic storage method at 20°C could shorten a preservation period for recovery of ischemically damaged pancreas and clarify changes of tissue adenine nucleotide metabolism and tissue perfusions. After 90 minutes of warm ischemia, canine pancreas grafts were preserved by the two‐layer method and then autotransplanted. Tissue adenine nucleotide levels at the end of preservation and tissue perfusions after reperfusion were measured. Pancreas grafts subjected to 90 minutes of warm ischemia did not survive (0 of 5), without preservation. During a 5‐hour preservation by the two‐layer cold storage method the grafts did not synthesize enough ATP to repair damaged cell, although tissue perfusions were maintained after reperfusion. Consequently, ischemically damaged pancreases were not resuscitated (0 of 3). However, during 5‐hour preservation by the two‐layer mild hypothermic storage method, the grafts supplied enough ATP for processes that repair damaged cells, and tissue perfusions were maintained after reperfusion. As a result, ischemically damaged grafts were resuscitated (5 of 5). We conclude that 5‐hour preservation by the two‐layer mild hypothermic storage method accelerates ATP synthesis, which is essential for repairing damaged cells and protects the vascular microcirculation. This method can resuscitate ischemically damaged pancreas faster and holds promise for pancreas‐kidney transplantation from cardiac arrest donors.
Emergency Surgery in Hematologic Patients
Authors: Gold Michael S. , Dietz Patrick A. , Heneghan Steven J. , MacMillan Roger W. , Moglia Robert M. , Rudnicki Marek
Published: August 2002

Patients at risk for clinically significant bleeding and who require urgent or emergent surgical procedures are encountered. Usually local causes are responsible, but a generalized hematologic defect may be uncovered. Quickly and effectively distinguishing the cause may be critical to rapid treatment and survival. A careful history, appropriate use of laboratory tests (e.g., partial thromboplastin time, prothrombin time, and platelet count), and knowledge of possible causes are key to prompt diagnosis and treatment. Bleeding from multiple sites, spontaneous bleeding, or unexpectedly severe bleeding suggests a systemic process. Immunocompromised or suppressed patients or systemically ill patients with chronic hepatic renal, lymphatic, and hematologic disorders are seen with urgent surgical problems. The key is rapid diagnosis and effective systemic and local therapy to counter the problem. The syndrome of diffuse “medical bleeding” frequently confronts the surgeon treating a patient who has received transfusions of more than 1.5 times blood volume. The coagulation defect is almost always associated with hypothermia and acidosis. Treatment consists in control of large‐vessel bleeding by appropriate surgical techniques, blunt packing, and tamponade of diffuse bleeding, rapid rewarming of the patient, and adequate resuscitation for shock. Transfusion of platelets and fresh frozen plasma is empiric initially and subsequently guided by the clinical and laboratory coagulation profiles of the patient.
Late outcome after acute pancreatitis: Functional impairment and gastrointestinal tract complications
Authors: Fernández‐Cruz Laureano , Navarro Salvador , Castells Antoni , Sáenz Alejandro
Published: August 2002

Functional and morphologic changes that take place in the pancreatic gland after an episode of acute pancreatitis have been the subject of discussion among experts in recent years. At the present time there are enough studies to support the fact that for a certain time if not permanently after acute pancreatitis a variable number of patients continue to show morphologic pancreatic changes in the pancreas and exocrine functional impairment. These changes are clearly seen to be related to the severity and alcoholic etiology of the pancreatitis. There are also indications of possible progression from acute alcoholic pancreatitis to chronic pancreatitis, related to severity and recurrence. It is more probable that it is the first instance of pancreatitis in a pancreas that has previously suffered asymptomatic alcohol‐induced impairment. The vascular and gastrointestinal tract complications that make a late appearance after acute pancreatitis, although infrequent, on occasion confronts the patient with a high risk of mortality, especially in cases of perforation and hemorrhage.
Laparoscopic Highly Selective Vagotomy: Technical Considerations and Preliminary Results in 119 Patients with Duodenal Ulcer or Gastroesophageal Reflux Disease
Authors: Awad William , Csendes Attila , Braghetto Italo , Yarmuch Julio , Loehnert T. Rodolfo , Burdiles Patricio , Diaz Juan Carlos , Schutte Hans , Maluenda Fernando
Published: August 2002

The technical considerations and preliminary results of 119 patients submitted to laparoscopic highly selective vagotomy are presented. There were 33 with duodenal ulcers, 31 with duodenal ulcers plus gastroesophageal reflux, and 55 with gastroesophageal reflux. Operating time varied from 120 to 160 minutes. Six complications occurred: four perforations of the gastric fundus and two bleeding episodes. Conversion to open surgery was done in four cases and reoperation in one case. No deaths occurred, and the mean hospital stay was 3 days. The mean follow‐up was 16 months, being 94% of the cases with Visick I or II and 6% with Visick III or IV. This technique is completely feasible by laparoscopic procedure and reproduces exactly what has been done with the laparotomy approach.
Prognostic Value of Flow Cytometric DNA Analysis in Non‐Small‐Cell Lung Cancer: Rationale of Sequential Processing of Frozen and Paraffin‐Embedded Tissue
Authors: Mugüerza José M. , Díez Manuel , Torres Antonio J. , López‐Asenjo José A. , Picardo Antonio L. , Gómez Ana , Hernando Florentino , Cayón Roberto , Granell Javier , Balibrea José L.
Published: August 2002

The objective of this study was to determine the prognostic information provided by flow cytometric DNA analysis in non‐small‐cell lung cancer. Lung samples of 132 consecutive patients submitted to surgery were prospectively processed. When no aneuploid populations were detected in fresh frozen samples, the process continued as a second step in paraffin‐embedded tissue, consuming all the tumor available. The influence of ploidy on the postoperative outcome was studied by both a univariate and a multivariate analysis. Aneuploidy was found in 81 patients (61.4%). Fourteen patients showed no aneuploidy in fresh frozen samples; and only after further analysis in paraffin‐embedded tissue was abnormal DNA detected. Overall, the 36‐month survival was 69% for the diploid group and 24% for the aneuploid group (p= 0.0006). Including subjects submitted to complete tumor removal (stages I, II, and IIIA) in a multivariate analysis adjusted for TNM stage and histologic type, bearers of aneuploid tumors exhibited a higher risk of relapse (hazard ratio 2.65; CI 95% 1.5–4.66;p= 0.004) or death (hazard ratio 2.17; CI 95% 1.08–4.39;p= 0.032) than patients with diploid tumors. DNA ploidy resulted an independent prognostic factor of survival and tumor relapse in completely resected non‐small‐cell lung cancer. Sequential analysis of fresh and paraffin‐embedded samples can help avoid the bias due to intratumoral DNA content heterogeneity. DNA ploidy could be an useful parameter in any future multifactorial analysis of outcome in such tumors.
Treatment of Primary Multiple Early Gastric Cancer: From the Viewpoint of Clinicopathologic Features
Authors: Takeshita Kimiya , Tani Masao , Honda Tooru , Saeki Ichiro , Kando Fumio , Saito Naoya , Endo Mitsuo
Published: August 2002

The treatment of multiple early gastric cancer was investigated through the clinicopathologic assessment of 61 cases of primary multiple early gastric cancer (82 accessory lesions) treated by surgical resection over a 15‐year period. These cases accounted for 11.7% of all cases of early gastric cancer resected during the same period. The 61 patients included 48 men (mean age 64 years) and 13 women (61 years). Of the 82 accessory lesions, 41 (50%) were located in the same region as the main lesion. The most frequent combination of macroscopic types of the main lesion and the accessory lesion was depressed type/depressed type (28 cases). The main lesion was of the well differentiated type in 39 (64%) of the 61 cases; the accessory lesion was also well differentiated in 37 of the 39 cases. Of the 82 accessory lesions, 29 (35%) had been overlooked preoperatively; most of them were located in the middle third of the stomach and included 17 depressed and 10 flat lesions, most of which measured no more than 1 cm. Cases of multiple early gastric cancer are characterized by the predominance of male patients of advanced age (>60 years), a combination of the same macroscopic type of the main and accessory lesions, and well differentiated carcinoma. Lymph node metastasis and vascular invasion are equally or less frequent than in cases of solitary early gastric cancer. The postoperative crude survival rate in patients with multiple gastric cancer is similar to that in those with solitary gastric cancer. Therefore we believe that multiple early gastric cancer does not require extended operative procedures. Endoscopic treatment may be indicated if each lesion fits the criteria for treatment and careful follow‐up is ensured.
Complement Activation, Its Consequences, and Blockade by Gene Transfer
Authors: Carrington Christine A. , Richards Andrew C. , van den Bogaerde Johan , Tucker Alexander W. , White David J.G.
Published: August 2002

The success of xenotransplanting vascularized pig organs into humans is limited owing to the immediate immune reaction, termed hyperacute rejection (HAR). This reaction is primarily mediated by naturally occurring xenoreactive antibodies binding to the graft and activating the complement system, resulting in organ dysfunction. Pig membrane‐bound complement regulatory proteins efficiently control autologous complement only and are unable to protect against human complement‐mediated damage. One line of current research to overcome HAR of pig organs involves the expression of human complement regulatory proteins by pig cells. In vitro data have demonstrated that pig endothelial cells expressing human regulators of complement activation (RCAs) are resistant to human complement‐mediated attack, which has led to the successful production of pigs transgenic for human RCAs. Ex vivo perfusion studies using fresh human blood with organs from these animals has shown an improvement in graft function and survival through expression of human RCAs compared to that of nontransgenic pig organs. Similar results have been observed in primate models, where expression of human RCA proteins on the pig donor organ has resulted in protection against HAR and prolongation of graft survival. The initial complement‐mediated immunologic barrier of HAR has been overcome through this genetic incorporation of human RCAs into pigs, and it is now possible to study the subsequent mechanisms of xenograft rejection in the pig‐to‐human combination.
Baboon Bone Marrow Transplantation in Humans: Application of Cross‐Species Disease Resistance
Authors: Exner Beate G. , Neipp Michael , Ildstad Suzanne T.
Published: August 2002

Xenotransplantation is a newly evolving field. A renewed interest has emerged coincidentally with the shortage of donor organs for transplantation. Bone marrow (BM) chimerism has been suggested as a potential strategy to induce tolerance to xenografts and control the immune response across a species barrier. Bone marrow transplantation (BMTx) displays unique features compared to solid‐organ transplantation or transplantation of other cellular grafts. To achieve engraftment of the pluripotent hematopoietic stem cell, which generates all lineages of the hematolymphopoietic system, conditioning of the recipient (usually a combination of irradiation and cytoablative chemotherapy) is required. Once engraftment is achieved, graft function is stable and rejection does not occur, even without immunosuppression. On the other hand, the graft itself is able to generate an immune response against the host, resulting in graft‐versus‐host disease (GVHD). A newly recognized advantage to xenotransplantation is species‐specific disease resistance. In terms of BMTx, important questions arise: Can xenogeneic BM generate a competent immune response across species barriers? Will cross‐species GVHD occur? What are the possible applications to humans? This review addresses these questions. Problems emerging from xenogeneic BMTx are summarized and strategies for their solution discussed.
Surgery for Nonalcoholic Chronic Pancreatitis
Authors: Sharma Atul K. , Pande Girish K. , Sahni Peush , Nundy Samiran
Published: August 2002

There are few reports on operations in patients with nonalcoholic pancreatitis. Between 1985 and 1995 we operated on 58 such patients, 38 of whom were male and 20 female with a mean age of 35 years (range 5–72 years). The indications for operation were pain (n= 49), biliary obstruction (n= 12), duodenal obstruction (n= 10), portal hypertension (n= 11), cysts (n= 14), and pancreatic ascites (n= 3). Thirty‐four patients with a dilated pancreatic duct underwent pancreaticojejunostomy; cysts were drained internally in eight, and biliary and duodenal obstruction was bypassed. Ten patients also underwent surgery for portal hypertension. Four (7%) patients died during the postoperative period. Of the remaining 54 patients, 48 (89%) were followed up for a median period of 63 months (range 6 months to 10 years). Six died: four of pancreatic cancer, one of cerebrovascular accident, and one of malnutrition. Of the 34 surviving patients operated for pain, 30 (88%) felt better, of whom 24 (71%) had complete relief of pain; 14 (41%) recorded a weight gain. Pancreatic decompression results in immediate and lasting pain relief in most patients with nonalcoholic chronic pancreatitis.
Assessment of Risk Factors for Pancreatic Resection for Cancer
Authors: Crucitti Francesco , Doglietto Giovanni Battista , Viola Gabriele , Frontera Domenico , De Cosmo Germano , Sgadari Antonio , Vicari Donatella , Rizzi Alfredo
Published: August 2002

A series of 101 consecutive patients undergoing pancreatic resection for cancer was retrospectively analyzed to define factors that may affect the immediate postoperative outcome. Overall morbidity and mortality were 28.7% and 10.9%, respectively, although these figures were greatly reduced during the last years; the complication rate dropped from 55.6% (1981–1987) to 20.0% (1993–1995) and the mortality from 16.7% to 6.7%. At univariate statistical analysis the patient characteristics (sex, age, American Society of Anesthesiologists [ASA] class, nutritional status, jaundice), tumor characteristics (site, size, TNM stage, and grading), and type of surgery were found not to affect postoperative morbidity and mortality. In contrast, a significantly lower rate of complications was observed in patients not undergoing gastric resection, in those who received 3 units or less of blood intraoperatively, and in subjects operated more recently (after 1990). At multivariate analysis the period when the operation was performed was the only independent variable that affected the immediate postoperative outcome. Among the examined factors, only the experience acquired over time regarding the intra‐ and perioperative treatment of these patients seems able to lower the rate of postoperative complications.
Use of the Scalp as a Donor Site for Large Burn Wound Coverage: Review of 150 Patients
Authors: Chang Li‐Yen , Yang Jui‐Yung , Chuang Shiow‐Shuh , Hsiao Cheng‐Wei
Published: August 2002

The characteristics of rapid wound healing and multiple harvest capacity make the scalp an important donor site when dealing with large and deep burn wounds. This paper reports the results of a retrospective analysis of 150 patients treated for large burn wounds. The findings indicated that bleeding during graft skin harvest could be limited to 50 ml by intradermal injection of epinephrine (1:2,000,000), high‐concentration epinephrine‐soaked gauze compression (1:20,000), and temporary porcine skin coverage. Use of a scalp graft also carried a low risk of complications, with only four (2.7%) major complications including three cases (2.0%) of visible alopecia and one case (0.7%) of hair transplantation. There were no hypertrophic scars, even in the patient who had the largest number (11) of repeat harvests.
Transcylindrical Cholecystectomy: New Technique for Minimally Invasive Cholecystectomy
Authors: Grau‐Talens Enrique Javier , García‐Olives Francisco , Rupérez‐Arribas María Pilar
Published: August 2002

Minilaparotomy cholecystectomy presents exposition difficulties, and laparoscopy requires expensive equipment and additional training. Laparotomy is more painful, causes trauma to the abdominal wall, and requires a longer convalescence; it is also less aesthetic. We present a new technique for minilaparotomy cholecystectomy, transcylindrical cholecystectomy (TC), based on the introduction of a 3.8‐ or 5.0‐cm diameter cylinder (10.0 cm long). The cylinder serves the purpose of separating and isolating the hepatocystic triangle from the surrounding structures, thereby providing a stable surgical field and adequate vision of the hepatocystic triangle so the technique can be performed safely. Patients who have been diagnosed with symptomatic cholelithiasis, who are convalescent from biliary pancreatitis, or who have acute cholecystitis have been treated consecutively by TC. We have carried out the procedure on 116 occasions, 94 using the 3.8‐cm cylinder and 28 with the 5.0‐cm cylinder; both cylinders were used in 6 cases. The indications for using the 5.0‐cm cylinder were mainly cholecystitis, pancreatitis, choledocholithiasis, and difficulty with the 3.8‐cm cylinder. The result is a 4.5‐ or 7.0‐cm incision. We had difficulty recognizing the anatomy in 11 dissections so we had to enlarge the incision. We have not had accidents related to placement of the cylinder, hemorrhage, or bile duct injuries. The median operating time was 43 minutes, and the mean postoperative stay was 1.8 days. Postoperative FVC and FEV1 reductions were 21.7% and 27.4%, respectively. The technique has proved fast, safe, and practicable using conventional material. The cost of TC is $701 (US).
Induction of Heat Shock Response: Effect on the Rat Liver with Carbon Tetrachloride‐induced Fibrosis from Ischemia‐reperfusion Injury
Authors: Shimabukuro Takashi , Yamamoto Yuzo , Kume Makoto , Kimoto Syuji , Okamoto Ryoji , Morimoto Taisuke , Yamaoka Yoshio
Published: August 2002

The role of heat shock pretreatment in the induction of tolerance for ischemia‐reperfusion injury was investigated in rat livers with fibrosis produced by carbon tetrachloride (CCl4) injected subcutaneously. The control group (group C,
n= 56) received no pretreatment except anesthesia, and the heat shock group (group HS,n= 56) were exposed to heat shock (42°C) for 15 minutes. After a 48‐hour recovery all rats were subjected to 30 minutes of warm ischemia. Western blotting analysis was employed for heat shock protein (HSP) 72 detection. The adenine nucleotide levels in liver tissue and the liver enzyme levels in serum were measured before and after ischemic intervention (seven animals were used at each of six time point measurements in both groups). HSP72 was induced in group HS at greater intensity than in group C. The survival rate on postoperative day 7 in group C (3/14) was significantly poorer than that in group HS (14/14) (p < 0.01). The higher survival rate in group HS was accompanied by more rapid recovery of the adenosine triphosphate level and lower serum levels of liver enzymes after reperfusion (p < 0.01 vs. group C). Heat shock preconditioning induces HSP72 in the rat liver with fibrosis and provides significantly increased tolerance of warm‐ischemia reperfusion injury.
Overexpression of nm23 Protein Assessed by Color Video Image Analysis in Metastatic Colorectal Cancer: Correlation with Reduced Patient Survival
Authors: Berney Christophe R. , Yang Jia‐Lin , Fisher Richard J. , Russell Pamela J. , Crowe Philip J.
Published: August 2002

The function and prognostic significance of the nm23 gene is controversial in colorectal cancer (CRC). The aim of this study was to determine if nm23 protein expression correlated with the subsequent development of liver metastasis. Paraffin‐embedded sections of 30 metastasizing CRC primaries and their subsequently resected liver secondaries were compared with those of 28 nonmetastasizing CRCs, 20 adenomas, and 20 cases of normal colonic mucosa. Expression of nm23 protein, assayed by immunohistochemistry, was measured using a standard semiquantitative scaling system and compared with a microcomputer‐based color video image analysis (VIA). There was good correlation between color VIA and semiquantitative evaluation of nm23 immunoreactivity, confirming the validity of quantitative analysis (Pearson's r= 0.88; p < 0.001). Metastasizing CRC primaries and secondaries overexpressed nm23 protein when compared with the other clinical groups, particularly nonmetastasizing CRC (Student'st‐test, p < 0.001). Furthermore, more nm23 immunoreactivity was associated with a higher risk of death from CRC (log‐rank test, p= 0.002). These results suggest that overexpression of nm23 is highly associated with liver metastases from CRC and reduced survival.
Preoperative and Intraoperative Topographic Diagnosis of Insulinomas
Authors: Kuzin Nikolay M. , Egorov Aleksey V. , Kondrashin Sergey A. , Lotov Aleksey N. , Kuznetzov Nikolay S. , Majorova Julia B.
Published: August 2002

Altogether 120 patients with organic hyperinsulinism underwent clinical examination and treatment (38 male, 82 female, mean age 44.2 ± 4.6 years). The cause of hyperinsulinism was benign insulinomas in 96 (80.0%), malignant tumors in 9 (7.5%), and hyperplasia of beta cells in 6 (5.0%). In 9 (7.5%) patients the origin of hyperinsulinism was not diagnosed. The tumor was localized in the head, body, and tail of the pancreas in 31.8%, 36.4%, and 31.8% of cases, respectively. Intraoperative ultrasonography (IOUS) was undertaken in 37 patients, and in 83 cases only intraoperative palpation was done. Arterial stimulated venous sampling (ASVS) was performed in 17 patients (blood was sampled from the right hepatic vein for determination of the insulin level after arterial stimulation by calcium gluconate in different parts of the pancreas). The sensitivity of ultrasonography (US) was 29.5%, computed tomography (CT) 24.2%, angiography 55.9%, superselective angiography (branches of the celiac trunk) 72.2%, and intraoperative palpation 90.0%. ASVS showed an accuracy of 90.0%. Combining angiography with ASVS gave an exact diagnosis of hyperinsulinism in 100% of cases, and IOUS revealed tumors in 100% of cases. Hyperplasia of beta‐cells was diagnosed only by means of ASVS. A total of 117 patients underwent surgery, including distal resection of pancreas (n= 39), enucleation of tumor (n= 70), and laparotomy (n= 8). The postoperative mortality associated with insulinomas was 7.7%. The frequency of postoperative complications was 43.6%. Benign insulinomas recurred at a rate of 5.4%. Patients with malignant insulinomas had a 5‐year survival of 66.0%. The diagnosis of insulinomas was achieved by a combination of selective angiography, ASVS, and IOUS.
Anaplastic Giant Cell Carcinoma of the Thyroid Gland: Treatment and Survival Over a 25‐Year Period
Authors: Nilsson Ola , Lindeberg Johan , Zedenius Jan , Ekman Eva , Tennvall Jan , Blomgren Henric , Grimelius Lars , Lundell Göran , Wallin Göran
Published: August 2002

Anaplastic giant cell carcinoma of the thyroid is a rare but highly malignant tumor. At the Karolinska Hospital in Stockholm, surgery, chemotherapy, and radiotherapy have been used separately or in various combinations in 81 patients admitted with this diagnosis during 1971–1997. In this study, we present the various multimodality treatment regimens and their changes over the years and the subsequent differences in survival and local tumor control. Overall, eight patients (10%) survived more than 2 years. All survivors were treated with combinations of chemotherapy, radiotherapy, and surgery. Among the patients who died, local tumor control was achieved by the therapy given in many cases. The results suggest that our current strategy with a combination of preoperative hyperfractionated accelerated radiotherapy, doxorubicin pre‐ and postoperatively, and debulking surgery whenever possible results in better local tumor control and an increased chance of survival.
Liposuction: Procedure for Focal Volume Reduction and Body Contour Remodeling
Authors: del Campo Antonio Fuente , Allegretti Eustacio Rojas , Filho Jose Amandio Fernandes , Gordon Christopher Burnside
Published: August 2002

Liposuction is the most commonly used procedure for focal reduction of body fat deposits and remodeling the body contour. The procedure consists in aspirating fat from lamellar deposits using a vacuum source connected to a cannula that is passed bluntly through fatty tissue. Adjuncts to the procedure include infiltration of solutions to aid in fat removal or to limit blood loss and the application of ultrasonic energy to lyse fat cells before suction aspiration. Surgical history, theory, procedures, indications, potential complications, and guidelines are discussed herein.
Second Step: Testing—Outcome Measurements
Authors: Lorenz Wilfried , Troidl Hans , Solomkin Joseph S. , Nies Christoph , Sitter Helmut , Koller Michael , Krack Walter , Roizen Michael F.
Published: August 2002

Despite worldwide enthusiasm for endoscopic surgery, this new technology is now on the top of McKinlay's “product life circle curve.” Critical questions are being asked about its benefits and burdens, but the concepts applied and the methodologies used for technology assessment are in a similar position as endoscopic surgery and need a critical evaluation. (1) There are incorrect and outdated concepts for the scientific basis of surgery (surgical theory) including the basic sciences involved; biomedicine still dominates, but assessment of outcome after operations is no longer possible without clinical epidemiology and social psychology. (2) Based on an outdated scientific theory for surgery, an outdated concept of disease is still propagated. It is denoted as mechanical and is based solely on biomedicine. Human subjects are reduced to biologic machines, and outcomes measurement excludes most dimensions of functioning and well‐being. To achieve a valid result for outcome measures, a hermeneutic approach must be combined with the mechanical approach. (3) Based on an outdated model of disease, the outcomes used in endoscopic surgery rely too much on traditional measures, such as mortality rate, complication rate, hospital stay, and especially an endless list of biochemical mediators. Their alterations during the perioperative period have not yet been shown to be related to clinical or hermeneutic outcomes. A new method of assessment for clinical trials in endoscopic surgery and for other surgical problems is outlined, such as for surgical infections and for surgical oncology. It includes an index of recovery and objective health status assessed by the doctor, a quality‐of‐life self‐report by the patient, and the true endpoint concept as a critical weighting of both types of outcome by patients and doctors.
Current Surgical Therapy for Bronchiectasis
Authors: Ashour Mahmoud , Al‐Kattan Khaled , Rafay Mohamad A. , Saja Khalid F. , Hajjar Waseem , Al‐Fraye Abdul Rahman
Published: August 2002

The ideal classification system for bronchiectasis continues to be debated. As an alternative to the present morphologic classification, a hemodynamic‐based functional classification is proposed. This study examines the rationale for and outcome of surgery based on this classification in patients with unilateral or bilateral bronchiectasis. Between July 1987 and January 1997 the morphologic and hemodynamic features in 85 bronchiectatic patients were examined: 18 with bilateral bronchiectasis and 67 with unilateral disease. A policy of unilateral lung resection of the nonperfused bronchiectasis and preservation of the perfused type was adopted in all patients. The mean age at operation was 29.4 ± 9.7 years (range 6–55 years) with a mean follow‐up period of 45.2 ± 21.0 months (range 2–120 months). Left‐sided predominance of bronchiectasis was evident in this series both in frequency and severity. In those with unilateral disease, bronchiectasis was left‐sided in 49 (73.1%) patients and right‐sided in 18 (26.9%). The left lung was totally bronchiectatic in 11 (16.4%) patients and the right in 3 (4.4%). Moreover, among the patients with bilateral bronchiectasis, 14 of 18 (77.7%) patients had the left lung more severely involved. Based on the morphologic and hemodynamic features in the investigated patients, two types of bronchiectasis were recognized: a perfused type with intact pulmonary artery flow and a nonperfused type with absent pulmonary artery flow. Lobectomy was performed in 55 patients, basal segmentectomy and preservation of the apical segment in 16, and pneumonectomy in 14. There was no mortality in this series. Altogether 63 patients (74.1%) achieved excellent results, 19 (22.4%) scored good results, and 3 (3.5%) patients had not benefited from surgery at last follow‐up. In the face of the general criticism of the traditional morphologic classification, the proposed classification not only predicts whether the involved lung will have a measure of respiratory function with regard to gas exchange but reflects the degree of severity of the disease process. Thus the question of which side to resect and which to preserve is defined more precisely. This classification was found to be logical, physiologically sound, and of proven benefit.