bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does New Technology Increase or Decrease Health Care Costs? The Treatment of Peptic Ulceration
Authors: Murphy Shaun 
Published: January 2017

Objectives: To determine whether new technology increases or decreases formal health care costs, with reference to the diagnosis and treatment of peptic ulcers. Methods: A costing method has been devised which is designed to investigate directly the way in which the costs to formal health services of diagnosing and treating an individual illness have changed with changes in technology. Results: The cost of diagnosis has increased almost entirely as a result of the high cost of endoscopy compared with X-ray examination. The introduction of H2-receptor antagonist drugs increased the cost of treatment compared with the earlier phases of surgical treatment. Subsequently, Helicobacter pylori eradication treatment has reduced the cost of treatment compared with all earlier phases of technology. Conclusions: A method has been devised that allows the impact of changes in medical technology on formal health care costs to be investigated for individual illnesses. In the treatment of peptic ulceration, the current technology, H. pylori eradication, has lower treatment costs than all previous technologies. The evidence from previous studies and this study is insufficient to support the assertion that new technology in general leads either to an increase or to a decrease in health care costs.
Liver Operations in Sweden in 1987–99
Authors: Jersenius U. , Granath F. , Arvidsson D. , Blomqvist P. 
Published: January 2017

Background and Aims: Liver surgery is developing with new techniques and treatment modalities. The aim of this study is to describe liver surgery over a long period of time in a country with a public health care system. Patients and Method: A register study including adult patients admitted for liver resection in Sweden (population 8.8 million) selected from the Inpatient Register 1987–99. Additional data were collected from the Swedish Cancer Register and the Cause of Death Register. Analyses of the patients, indications, mortality and causes of death are presented. Results: 2,405 operations were performed (21 per million per year). The most frequent indication was colorectal metastases (27 %). The 5-year survival after an operation for primary liver cancer and colorectal liver metastases was 27 % and 26 %, respectively. Conclusions: Few patients were admitted for liver operations compared to expected figures. The survival rates are in conformity with those previously published. With an increasing awareness of the relatively favourable prognosis and the introduction of new methods, the volume of liver operations will probably increase in Sweden.
Pneumatosis Intestinalis — A Pitfall for Surgeons?
Authors: Braumann C. , Menenakos C. , Jacobi C. A. 
Published: January 2017

Pneumatosis intestinalis (PI) is characterized by multiple gas cysts in the wall of the gastrointestinal tract. Primary PI is extremely rare. In most of the cases PI is due to an underlying disease (traumatic and mechanical, inflammatory and autoimmune diseases, infectious and pulmonary diseases, drug induced, immunosuppression, transplantation, or neoplasm). A 69-year-old woman was treated with mixed connective tissue disease and PI twice operatively and once conservatively in our department. Review of the english literature showed 13 more cases of PI with underlying mixed connective tissue disease. Most published cases of pneumatosis intestinalis with radiological finding of pneumoperitoneum were treated conservatively and should have not been considered as a reason for surgery. Therefore, the treatment of PI can present as a major dilemma for the surgeon.
Etiology and Outcome of Burns in Tabriz, Iran an Analysis of 2963 Cases
Authors: Maghsoudi H. , Pourzand A. , Azarmir G. 
Published: January 2017

Background and aims: Burn injuries still produce a significant morbidity and mortality in Iran. A 3-year retrospective review of burn victims hospitalized at a major burn center was conducted to determine the etiology and outcome of patients in Tabriz. Material and Methods: Two thousand nine hundred sixty + three patients were iden tified and stratified by age, sex, burn size, presence or absence of inhalation injury, cause of burn. There is one burn center in the East Azarbygan province serving 3.3 million people over an area of 47,830 sq.km. Results: The overall incidence rates of hospitalization and death were 30.5 % and 5.6 % per 100000 person years. The mean patient age was 22 years, and the male: female ratio was 1.275. There were 555 deaths altogether (18.7 %). The highest incidence of burns was in the 1–9 age group (29.2 %). Patients with less than 40 percent of burned surface constituted 79.8 % of injuries. The most common cause of burns was kerosene accident in adults and scald injuries in children. The mean length of hospitalization was 13 days. The mean body surface area burned was larger with higher mortality in females than in males (p < 0.001). Inhalation injuries were strongly associated with large burns and were present in all flame-burn fatalities. Conclusion: In our opinion, social factors are the main drive leading to an unacceptably high rate of burn injuries in our societies. Most of the burn injuries were caused by domestic accidents and were, therefore, preventable; educational programs might reduce the incidence of burn injuries.
Major Amputation Incidence Decreases Both in Non-Diabetic and in Diabetic Patients in Helsinki
Authors: Eskelinen E. , Eskelinen A. , Albäck A. , Lepäntalo M. 
Published: January 2017

Background and Aims: The aim of the study was to assess the changes in diabetes-related lower extremity amputations and to compare it with the development of amputations for critical leg ischaemia in patients without diabetes. Material and Methods: Clinical records of 1094 patients undergoing major lower limb amputations for vascular disease in the town of Helsinki during 13 years from 1990 to 2002 were analyzed retrospectively. Data concerning patient factors, diagnosis, existence of diabetes and amputation level were recorded. The study period was divided into three parts (1990–1994, 1995–1998 and 1999–2002) and results were compared between diabetic and nondiabetic vascular amputees during these time periods. Results: From 1990 through 2002, 561 of patients undergoing major lower limb amputation had diabetes mellitus. The overall incidence of major amputations of diabetics reduced from the first time period to the last period by 23%. At the same time, the incidence of amputations in non-diabetic patient group decreased 40%. If the incidence rate for amputations is expressed per million individuals with diabetes, 33% decrease was observed during the study period. Conclusions: The decrease in major amputation rates among diabetic as well as non-diabetic patients can be attributed to the increased interest in amputation prevention, with a contribution by vascular surgeons being made in both groups.
Growth Hormone is a Stimulating but Not An Essential Factor in Healing of Colon
Authors: Tei T. M. , Kissmeyer-Nielsen P. , Flyvbjerg A. , Christensen H. 
Published: January 2017

Background: Growth hormone (GH) has been implicated as an important factor in the healing and previous studies showed significant strength acceleration of experimental intestinal anastomoses. Aim: To study the healing of experimental colonic anastomoses in GH-deficient rats and to study the potential physiological effects of GH-substitution on healing parameters. Conclusion: Exogenous rhGH treatment started 7 days prior to surgery and continued until day 4 postoperatively accelerates the strength development of the experimental colonic anastomoses in dwarf rats indicating a potent role of growth hormone in colonic healing. However, GH is not essential in the healing process, since anastomotic healing in GH-deficient dwarf rats is like rats with normal pituitary function.
Adjuvant Intraperitoneal Chemotherapy for Advanced Primary Gastric Cancer
Authors: Sugarbaker P. H. 
Published: January 2017

Background: For gastric cancer dissemination to the peritoneal cavity is a large part of the natural history. Also, cancer dissemination caused from the trauma of cancer resection can release viable cancer cells into the free peritoneal cavity; these cells implant and then progress as peritoneal carcinomatosis. Methods: From the medical literature a compilation of the results of adjuvant treatment of gastric cancer were reviewed and critically analyzed. A surgical rationale for integrating intraperitoneal chemotherapy into the management of advanced primary gastric cancer was sought. Results: A theoretical basis for the application of cytotoxic effects of cancer chemotherapy within the peritoneal cavity as a part of the primary management of gastric cancer was explored. Numerous manuscripts suggested that there was an increased morbidity and mortality with perioperative intraperitoneal chemotherapy but the added number of complications was manageable. These data suggest that intraperitoneal chemotherapy is of benefit in an adjuvant setting in gastric cancer patients who have a complete resection but who are at high likelihood of local-regional recurrence. Summary: Adjuvant intraperitoneal chemotherapy for advanced primary gastric cancer has a strong rationale. Numerous reports have established benefit. Wider application of this treatment modality is necessary through education, through additional clinical trials, and through continued publications from peritoneal surface malignancy treatment centers around the world.
Operation for Primary Hyperparathyroidism: The New versus the Old Order
Authors: Aarum S. , Nordenström J. , Reihnér E. , Zedenius J. , Jacobsson H. , Danielsson R. , Bäckdahl M. , Lindholm H. , Wallin G. , Hamberger B. , Farnebo L.-O. 
Published: January 2017

Background and Aims: In patients with primary hyperparathyroidism (PHPT), parathyroid imaging is nowadays routinely used for the purpose to perform a focused unilateral minimally invasive operation. The outcome of this new strategy has, however, not been established in randomised trials. Material and Methods: Patients were randomised to either preoperative localisation with sestamibi scintigraphy and ultrasonography (group I) or no preoperative localisation (group II). In group I, a minimally invasive parathyroidectomy was performed in patients in whom both localisation studies were consistent with a single pathological gland, whereas a conventional bilateral neck exploration was performed in cases with negative localisation findings. In group II all patients underwent conventional bilateral neck exploration. Primary outcome measure was normocalcaemia at 6 months postoperatively. Results: In the preoperative localisation group (group I) 23/50 (46%) of the patients could be operated on with the focused operation whereas 26/50 (52%) were operated on by bilateral neck exploration. All patients in the no localisation group (group II; n=50) were operated on with the intended bilateral neck operation. Normocalcaemia was obtained in 96% and 94% in group I and II, respectively. Total (localisation and operative) costs were 21% higher in group I. Conclusions: Routine preoperative localisation, with the intention to perform minimally invasive parathyroidectomy, is not cost effective if concordant results of scintigraphy and ultrasonography are a prerequisite for the focused operation. Less than half of the patients were successfully managed with this strategy, at a higher cost and without obtaining a more favourable clinical outcome.
Minilaparotomy Cholecystectomy as a Day Surgery Procedure: A Prospective Clinical Pilot Study
Authors: Harju J. , Pääkkönen M. , Eskelinen M. 
Published: January 2017

Background and Aims: In some studies minilaparotomy cholecystectomy (MC) has been shown to be as good as laparoscopic cholecystectomy (LC) in the surgical treatment of cholecystolithiasis. To our knowledge, the MC operation is rarely considered as a day surgery procedure. Patients and Methods: Thirty elective symptomatic non-complicated patients were included in the study during the end of the year 2004 to June 2005. The mean age of patients was 52 years (range 27–68), the mean body mass index 29 kg/m2 (range 19–41). Gallstones were confirmed with ultrasound and the pre-operative liver laboratory tests were normal in all patients. A five (+/-2) centimetre-long incision was used avoiding to split the rectus abdominis muscle. All patients were re-evaluated four weeks postoperatively with the follow-up letter. Results: The average operating time was 51 minutes (range 30–105 minutes). Day surgery was possible in 25 cases (83%). Five patients (17%) stayed over night at the hospital. There were four (13%) conversions to conventional cholecystectomy. The average postoperative sick leave was 16 days (range 14–30). Two patients returned to hospital. One patient had wound pain, but no complication was found, and the patient was not admitted. One patient had a wound infection and spent 6 days in the hospital. Twenty-nine (97%) patients were satisfied with the operation and were ready to recommend it for other patients. Conclusions: The results of this study support the suitability of MC as a day surgery procedure, but a prospective randomised trial is needed to evaluate the relative advantages of MC and LC.
Multidisciplinary Approach for the Management of Complex Hepatic Injuries AAST-OIS Grades IV—V: A Prospective Study
Authors: Asensio J. A. , Petrone P. , Garcí-Núñez L. , Kimbrell B. , Kuncir E. 
Published: January 2017

Background: Complex hepatic injuries grades IV—V are highly lethal. The objective of this study is to assess the multidisciplinary approach for their management and to evaluate if survival could be improved with this approach. Study Design: Prospective 54-month study of all patients sustaining hepatic injuries grades IV—V managed operatively at a Level I Trauma Center. Main outcome measure: survival. Statistical analysis: univariate and stepwise logistic regression. Results: Seventy-five patients sustained penetrating (47/63%) and blunt (28/37%) injuries. Seven (9%) patients underwent emergency department thoracotomy with a mortality of 100%. Out of the 75 patients, 52 (69%) sustained grade IV, and 23 (31%) grade V. The estimated blood loss was 3,539±-3,040 ml. The overall survival was 69%, adjusted survival excluding patients requiring emergency department thoracotomy was 76%. Survival stratified to injury grade: grade IV 42/52–81%, grade V 10/23–43%. Mortality grade IV versus V injuries (p <0.002; RR 2.94; 95% CI 1.52–5.70). Risk factors for mortality: packed red blood cells transfused in operating room (p=0.024), estimated blood loss (p<0.001), dysryhthmia (p<0.0001), acidosis (p=0.051), hypothermia (p=0.04). The benefit of angiography and angioembolization indicated: 12% mortality (2/17) among those that received it versus a 36% mortality (21/58) among those that did not (p=0.074; RR 0.32; 95% CI 0.08–1.25). Stepwise logistic regression identified as significant independent predictors of outcome: estimated blood loss (p=0.0017; RR 1.24; 95% CI 1.08–1.41) and number of packed red blood cells transfused in the operating room (p=0.0358; RR 1.16; 95% CI 1.01–1.34). Conclusions: The multidisciplinary approach to the management of these severe grades of injuries appears to improve survival in these highly lethal injuries. A prospective multi-institutional study is needed to validate this approach.
Hormonal Stress Response and Hemodynamic Stability in Patients Undergoing Endovascular vs. Conventional Abdominal Aortic Aneurysm Repair
Authors: Kataja J. , Chrapek W. , Kaukinen S. , Pimenoff G. , Salenius J.-P. 
Published: January 2017

Background and Aims: To investigate the effect of two different surgical techniques with different anesthetic modes on intraoperative and postoperative hormonal stress response, hemodynamic stability, fluid loading and renal function in patients scheduled for elective infrarenal abdominal aortic aneurysm (AAA) repair. Materials and Methods: Forty consecutive patients scheduled for elective infrarenal AAA repair were allocated without randomizing into two groups: an endovascular (EVAR, n=20) and a conventional (CAR, n=20) aneurysm repair group according to aneurysm morphology as determined by pre-operative computed tomography and angiography. The EVAR group were operated under spinal anesthesia and the CAR group using general anesthesia with epidural blockade. Results: Patients undergoing CAR showed lower intraoperative mean arterial pressure and significantly higher plasma norepinephrine before aortic cross-clamping and significantly higher lactate after aortic declamping and postoperatively than patients in the EVAR group. Postoperatively, vasopressin and serum cortisol were also significantly higher in the CAR group. Fluid loading and estimated blood loss were more excessive in the CAR group. Conclusions: Stress response was lower and hemodynamic stability and lower body perfusion superior and renal function also better maintained in patients undergoing EVAR under spinal anesthesia as compared to those undergoing CAR using general anesthesia with epidural blockade.
Bioactive Glass Granules as Extender of Autogenous Bone Grafting in Cementless Intercalary Implant of the Canine Femur
Authors: Keränen P. , Itälä A. , Koort J. , Kohonen I. , Dalstra M. , Kommonen B. , Aro H. T. 
Published: January 2017

Background and Aims: Ceramic bone graft substitutes have a potential to be used as replacement of allogeneic bone grafting and, under optimal distribution of particle size, they may even provide mechanical support. The current study examined the efficacy of bioactive glass granules as an extender of autogenous bone grafting in a segmental bone replacement model of the canine femur. Material and Method: A 16 mm long segment of the femur shaft was bilaterally replaced with an intercalary titanium implant in eight animals. The implant had cementless grooved proximal and distal stems. In one leg, the peri-implant space was packed with composite graft consisting of a mixture of bioactive glass granules and autogenous bone graft in proportion of 50:50. In the opposite leg, the peri-implant space was treated with autogenous bone graft alone. After surgery, unlimited functional loading was allowed. The outcome was evaluated at three months. Results: Eight out of sixteen autografted implants and seven out of sixteen composite-grafted implants were radiographically incorporated and clinically stable at three months. In the paired comparison, the proximal components of composite-grafted implants showed lower maximum load under torsional testing (p=0.068), less new bone in the longitudinal grooves of the stems (p=0.036) and lower affinity of new bone to implant surface (p=0.046). The distal components of the two sides showed a similar trend for less new bone in the grooves and lower bone affinity of new bone in the distal composite-grafted components. Conclusions: The current study suggests that supplementation of periprosthetic bone graft with bioactive ceramic particles may not help to promote healing of cementless implants under high dynamic loading conditions.
Heredity and Familial Tendency of Acute Appendicitis
Authors: Ergul E. 
Published: January 2017

Background: Although inflammatory disease of the vermiform appendix has been recognized as such for more than 100 years, its etiology remains a subject of controversy. The notion that appendicitis is familial, is not only important for understanding the etiology of the condition but might contribute substantially to the diagnosis and thus provide an indication for early surgical intervention. Methods: An extensive Medline search, textbooks, scientific reports and scientific journals are the data sources. Conclusions: In the light of past studies, we can suggest that almost half of the variability in risk of acute appendicitis is due to genetic factors. A positive family history increases the relative risk of being acute appendicitis nearly 3 times.
Natural Course of Incisional Hernia and Indications for Repair
Authors: Nieuwenhuizen J. , Halm J. A. , Jeekel J. , Lange J. F. 
Published: January 2017

Background: Incisional hernias and incisional hernia repair can be a significant challenge for both surgeon and patient. Despite the growing amount of literature describing various methods of surgical techniques, little has been published the natural course of an incisional hernia and regarding indications for incisional hernia repair. Methods: An internet database search was performed to identify articles describing symptoms presented by patients and indications for incisional hernia repair. Results: Various symptoms and indications regarding incisional hernia repair and the natural course of an incisional hernia are mentioned in the literature. Nevertheless, published data accurately describing these symptoms and indications are rare. Conclusion: A prospective trial monitoring incisional hernias as well as comparing conservative treatment with repair should be performed.
Predictors for the Immediate and Long-Term Outcome of Avascular Surgical Procedure
Authors: Virkkunen J. , Venermo M. , Saarinen J. , Salenius J. 
Published: January 2017

Background and Aims: The ability to predict post-operative mortality reliably will be of assistance in making decisions concerning the treatment of an individual patient. The aim of this study was to test the GAS score as a predictor of post-operative mortality in vascular surgical patients. Material and Methods: A total of 157 consecutive patients who underwent an elective vascular surgical procedure were included in the study. The Cox proportional hazards model was used in analyzing the importance of various preoperative risk factors for the postoperative outcome. ASA and GAS were tested in predicting the short and long-term outcome. On the basis of the GAS cut-off value 77, patients were selected into low-risk (GAS low: GAS < 77) and high-risk (GAS high: GAS > = 77) groups, and the examined risk factors were analyzed to determine which of them had predictive value for the prognosis. Results: None of the patients in the GAS low group died, and mortality in the GAS high group was 4.8% (p = 0.03) at 30 days' follow-up. The 12-month survival rates were 98.6% and 78.6% (p = 0.0001), respectively, with the respective 5-year survival rates of 76.7% and 44.0% (p = 0.0001). The only independent risk factor for 30-day mortality was the renal risk factor (OR 20.2). The combination of all three GAS variables(chronic renal failure, cardiac disease and cerebrovascular disease), excluding age, was associated with a 100% two-year mortality. Conclusions: Mortality is low for patients with GAS<77. For the high-risk patients (GAS> = 77), due to its low predictive value for death, GAS yields limited value in clinical practice. In cases of patients with all three risk factors (renal, cardiac and cerebrovascular), vascular surgery should be considered very carefully.