bluuebunny/crossref_metadata_2025_split huggingface dataset:
Is Hepatectomy Necessary in Dealing with Left Hepatolithiasis with Intrahepatic Duct Stricture?
Authors: Franco Dominique 
Published: September 2007

Background: Hepatolithiasis with intrahepatic biliary strictures, more common in Southeast Asia than elsewhere, remains a difficult problem to manage. Hepatic resection has recently been advocated as one of the treatment modalities for hepatolithiasis; however, this procedure is not without risk. This study was designed to achieve complete clearance of the stones, eliminate bile stasis, and avoid the potential risks of hepatic resection in the patient with hepatolithiasis and intrahepatic biliary stricture.Methods: In this prospective clinical trial 13 patients with retained left hepatolithiasis and intrahepatic biliary strictures were included. All the patients met the following criteria: (1) initial surgical procedure for hepatolithiasis, (2) normal gross findings of the left liver, and (3) no obvious clinical evidence of an associated intrahepatic cholangiocarcinoma. After the operation they underwent matured T‐tube tract ductal dilatation with percutaneous transhepatic cholangioscopy tube stenting. Choledoschoscopic electrohydraulic lithotripsy was used in five patients after dilatation when impacted or large stones were encountered.Results: Complete clearance of the stones was achieved in these 13 patients. One patient had fevers develop after ductal dilatation, and another patient had mild hemobilia after electrohydraulic lithotripsy. Both recovered uneventfully with conservative treatment. These successfully treated patients remain well, with a mean follow‐up period of 20 months.Conclusions: Postoperative matured T‐tube tract ductal dilatation and stenting, combined with endoscopic electrohydraulic lithotripsy when indicated, is an effective and safe alternative to hepatic resection for selected left hepatolithiasis with intrahepatic biliary stricture.
Postoperative Intravenous Drip Infusion is not Required after Minilaparotomy Cholecystectomy
Authors: Kumar N. , Annudath K. B. , Shukla H. S. , Singh A. , Kumar K. 
Published: September 2007

Objective: To determine if drip infusion should be discontinued after full recovery of the patient from anaesthesia after minilaparotomy cholecystectomy in uncomplicated cases.Design: A randomised controlled clinical trial on 60 patients, from the waiting list, of cholelithiasis/cholecystitis operated by minilaparotomy cholecystectomy between November 1995 to March 1996. 30 patients did not receive postoperative IV drip infusion and in 30 patients 12–24 hours of standard drip transfusion was continued according to the current practice.Setting: Single Surgical Unit, SS Hospital, Banaras Hindu University, Varanasi, India.Main outcome measure: Recognition of clinical indication for continuation of. IV drip infusion after full recovery from anaesthesia.Results: In the cohorts of 30 patients each who were or were not given IV drip infusion after full recovery from anaesthesia following minilaparotomy cholecystectomy the observations on pulse rate, blood pressure, time to first voiding of urine and time to start first oral intake of fluids were identical. However postoperative urinary retention occured in 6 (20%) patients in whom the IV drip infusion was given.Conclusion: There is no clinical indication to continue IV drip infusion after full recovery from anaesthesia in patients operated for minilaparotomy cholecystectomy.
Liver Resection: To Drain or not to Drain?
Authors: Morris David L. 
Published: September 2007

Purpose: A prospective, randomized trial was performed to determine if intra‐abdominal drainage catheters are necessary after elective liver resection.Patients and Methods: Between April 1992 and April 1994, 120 patients subjected to liver resection, stratified by extent of resection and by surgeon, were randomized to receive or not receive operative closed‐suction drainage. Operative blood loss was not an exclusion criteria, and no patient who consented to the study was excluded.Results: Eighty‐seven patients (73%) had resection of one hepatic lobe or more (27 lobectomies, 54 trisegmentectomies, and 6 bilobar atypical resections) and 33 had less than a lobectomy (8 wedge resections or enucleations, 9 segmentectomies, and 16 bisegmentectomies). Eighty‐four patients (70%) had metastatic cancer and 36 patients (30%) had primary liver pathology. There were no differences in outcome, including length of hospital stay (no drain, 13.4 ± 0.9 days; drain, 13.1 ± 0.8 days; P not significant [NS]), mortality (no drain, 3.3%; drain, 3.3%), complication rate (no drain, 43%; drain, 48%; n= NS), or requirement for subsequent percutaneous drainage (no drain, 18%; drain, 8%; P= NS). All infected collections (n= 3) occured in operatively drained patients. Two other complications were directly related to the operatively placed drains. One patient developed a subcutaneous abscess at the drain site, and a second developed a subcutaneous drain tract tumor recurrence as the only current site of recurrence.Conclusion: In the first 50 consecutive resections performed since the conclusion of this trial, only 4 patients (8%) have required subsequent percutaneous drainage. We conclude that abdominal drainage is unnecessary after elective liver resection,
Bile Duct Calculi – The New Challenges
Authors: Stiegmann Gregory V. 
Published: September 2007

Background: Morbidity and mortality after surgical treatment of bileduct stones increase with age and associated diseases. A proposed alternative therapy is endoscopic sphincterotomy (ES) with the gallbladder left in situ, and we elected to compare this option with standard open surgery in high‐risk patients.Methods: 98 patients (mean age 80 years) with symptoms likely to be due to bileduct stones or a recent episode of biliary parcreatitis were randomised to be treated either by open cholecystectomy with operative cholangiography and (if necessary) bileduct exploration (n=48) or by endoscopic sphincterotomy alone (n=50).Findings: The procedure was accomplished successfully in 94% of the surgery group and 88% of the ES group, and there were no significant differences in immediate morbidity (23% vs 16%) or mortality (4% vs 6%). During mean follow‐up of 17 months biliary symptoms recurred in three surgical patients, none of whom underwent repeat surgery, and in 10 ES patients, seven of whom had biliary surgery. By multivariate regression analysis endoscopic sphincterotomy was an independent predictor of recurrent biliary symptoms (odds ratio 6.9; 95% C11.46 to 32.54).Interpretation: In elderly or high‐risk patients, surgery is preferably to endoscopic sphincterotomy with the gallbladder left in situ as a definitive treatment for bileduct stones or non‐severe biliary pancreatitis.
Hepatic Cryotherapy and SubsequentHepatic Arterial Chemotherapyfor Colorectal Metastases to the Liver
Authors: Stubbs Richard S. , Alwan Majeed H. , Booth Michael W. C. 
Published: September 2007

This paper presents an experience of thirty consecutive
patients with hepatic colorectal metastases
who were treated with hepatic cryotherapy and
subsequent hepatic arterial infusion (HAI) chemotherapy
using 5FU.Patients with colorectal metastases confined to the
liver but not suitable for resection, and with liver
involvement of less than 50% were offered the
treatment. Prospective documentation of all patients
was undertaken with data being recorded on a
computerised database.Patients had a median of 6 (2–15) lesions with
sizes ranging from 1–12 cm. There was no 30 day
mortality. Postoperative complications developed in
8 patients but were followed by full recovery in all
instances. Side effects from chemotherapy occured
in 23% of cycles. Twenty seven patients have died.
Median survival from the time of cryotherapy was
18.2 months (7–34), or 23months (9–44) from
diagnosis of liver lesions.Hepatic cryotherapy with subsequent arterial
chemotherapy is safe and well tolerated. The results
suggest survival of patients with colorectal hepatic
metastases can be improved by the use of this
modality of treatment.
Lost Stones During Laparoscopic Cholecystectomy
Authors: Diez J. , Arozamena C. , Gutierrez L. , Bracco J. , Mon A. , Almeyra R. Sanchez , Secchi M. 
Published: September 2007

Background: Gallbladder perforation, with loss of
calculi in the abdomen is frequent during laparoscopic
cholecystectomy. Recent publications report
complications in port sites or in the abdominal
cavity. A study of 3686 laparsocopic cholecystectomies
performed by 6 surgeons was undertaken. In
627 patients, perforation of the gallbladder occurred
and in 254 stones were spilled into the abdominal
cavity. In 214 they were retrieved and in 40 left in the
abdomen. Twelve patients developed complications.
Percutaneous drainage was successful in 2 with
serous collections. Two patients with abdominal
abscesses were reoperated, stones retrieved and the
abdomen drained.One patient developed an intestinal obstruction
due to a stone in the ileum. One patient who had a
cholecystectomy in another hospital developed a
paraumbilical tumor. At reoperation a stone was
retrieved. In another six patients, stones were found
in port sites. Stones lost into the abdomen should be
removed because of their potential morbidity,
especially if they are large or if infection is present
in the gallbladder at the time of initial surgery.
There is no indication for routine conversion to open
surgery when stone spillage occurs, although patients
should be informed to avoid legal consequence,
and to hasten early diagnosis of later
complications.
Left Extended Hemihepatectomy With Preservation ofLarge Inferior Right Hepatic Vein: A Case Report
Authors: Texler M. L. , Jamieson G. G. , Maddern G. J. 
Published: September 2007

For hepatic function to be preserved after an extended
hemihepatectomy adequate venous drainage
of the remaining liver is required. Most metastases
close to the confluence of the superior hepatic veins
are considered unresectable because hepatic venous
outflow after resection would be compromised. In
10–25% of people, the inferior right hepatic vein is
of large calibre. Thus the superior hepatic veins may
be sacrificed and hepatic function preserved if a
large inferior right hepatic vein is present.A patient with involvement of segments 2, 4 and 8
by metastatic colorectal cancer is presented. This
patient had a large inferior right hepatic vein, and so
was able to undergo an extended left hemihepatectomy
with ligation of all superior hepatic veins. Subsequent
quality of life was maintained.This case illustrates that an ‘unresectable’ hepatic
lesion can be actually resectable if an alternative
venous drainage is present. A pre‐operative search
for a prominent inferior right hepatic vein by ultrasound,
computerised tomography, or even magnetic
resonance imaging should be considered in these
cases.
Reoperations for Bleeding Portal Hypertension.Surgical Rescue of Surgical Failures
Authors: Mercado Miguel Angel , Gómez-Méndez Tito José María , Morales-Linares Julio César , Granados Jorge , Chan Carlos , Rojas Gilberto , Orozco Héctor 
Published: September 2007

Background; Surgery for portal hypertension has a
low rebleeding rate. Patients that rebleed can be
grossly divided into those who die as a consequence
of the episode, those who don′t die but develop liver
failure (remaining as Child‐Pugh C) and those who,
in spite of the bleeding episode, retain good liver
function (Child‐Pugh A or B). At our hospital, the
latter group is considered for further surgical
treatment. We report here the results of surgical
rescue of surgical failures.Methods; In a twenty year period, 36 patients (30
Child‐Pugh A, 6 Child‐Pugh B) were reoperated. The
files of these patients were reviewed.Results; Average age was 33 years. Cirrhosis was
present in 31 cases. All patients were electively
reoperated with portal blood flow preserving procedures.
Operative mortality for the whole group
was 12% and for the Child‐Pugh A group 6.6%. Rebleeding
was observed in 5.5%. Postoperative
incapacitating encephalopathy was recorded in one
case (2.7%). Good quality of life was recorded in 84%
of the cases. Survival (Kaplan‐Meier) was 78% at 6
months and 69% at 5 years.Conclusions; Surgical failures in low risk patients
(Child‐Pugh A or B) can be treated by means of
surgery, and a low mortality, re‐bleeding and
encephalopathy rate can be expected. The performance
of a portal blood flow preserving procedure
is recommended.
Selenium Deficiency and Chronic Pancreatitis:Disease Mechanism and Potential for Therapy
Authors: Bowrey David J. , Morris-Stiff Gareth J. , Puntis Malcolm C. A. 
Published: September 2007

Background: It has been suggested that antioxidant
deficiency may play a role in the pathogenesis of
chronic pancreatitis. The aim of this review was to
analyse the evidence for this relationship and to
consider the role of antioxidant supplementation in
the treatment of chronic pancreatitis.Methods: Medline review of all English language
publications for the years 1966–1998.Results and Conclusions: There is evidence that
patients with chronic pancreatitis have enhanced
levels of free radical production, cytochrome P450
induction and antioxidant deficiencies, in particular
selenium. The limited published literature in this
field suggests that dietary antioxidant supplementation
may ameliorate the pain associated with chronic
pancreatitis, diminish the frequency of acute exacerbations
and reduce the requirement for pancreatic
surgery. These findings await confirmation by a large
prospective placebo‐controlled study.
Surgery for Deeply Located Hydatid Cystsof the Liver: A Simple Alternative
Authors: Kjossev Kirien T. , Losanoff Julian E. 
Published: September 2007

Gaining access to deeply located hydatid cysts of the
liver using conventional surgical techniques may be
accompanied by significant intra‐ and postoperative
complications. In addition, obliteration of the cyst
cavity is still a matter of controversy. We developed
a novel method for easy access to deep hydatid cysts
using a water jet dissector (Parenchimotom 01,
TOSA, Pleven, Bulgaria). At pressure of 20 Bar
using a 0.2mm nozzle, a corridor is created through
the liver parenchyma overlying the cyst; vessels and
biliary duct are thus clearly displayed as linear structures
traversing the corridor and are ligated and divided
under direct visual control. The fibrous capsule
of the cyst is spared by the jet. Following endocystectomy
performed in the ordinary manner, the
cyst cavity is filled with gelatin sponge; a passive
tube drain is placed in contact with the liver incision.In allowing for a selective dissection of the liver
parenchyma, the jet makes safe access to deeply located
hydatid cysts possible. On the other hand, the
gelatin sponge induces good fibroblast response
and assists in rapid and effective obliteration of the
residual cavity. This novel technique works well in
our hands but more extensive studies are necessary
before its final acceptance.
Morphine Plus Bupivacaine Vs. MorphinePeridural Analgesia in Abdominal Surgery:The Effects on Postoperative Coursein Major Hepatobiliary Surgery
Authors: Barzoi G. , Carluccio S. , Bianchi B. , Vassia S. , Colucci G. , Mangiante G. L. 
Published: September 2007

Anaesthesia and surgical procedures lead to a
reduction of intestinal motility, and opioids may
produce a postoperative ileus, that might delay
postoperative feeding. The aim of this prospective
randomised study is to test whether or not different
kinds of epidural analgesia (Group A: morphine 0.00
17 mg/kg/h and bupivacaine 0.125% – 0.058 mg/kg/h;
Group B: morphine alone 0.035mg/kg/12h in the
postoperative period) allow earlier postoperative
enteral feeding, enhance intestinal motility a passage
of flatus and help avoid complications, such
as nausea, vomiting, ileus, diarrhoea, pneumonia or
other infective diseases. We included in the study 60
patients (28 males and 32 females) with a mean age
of 61.2 years (range 50–70) and with an ASA score of
2 or 3. All patients had hepato–biliary‐pancreatic
neoplasm and were candidates for major surgery.
We compared two different pharmacological approaches,
i.e., morphine plus bupivacaine (30 patients,
Group A)versus morphine alone (30 patients,
Group B). Each medication was administered by
means of a thoracic epidural catheter for the control
of postoperative pain. In the postoperative course
we recorded every 6 hours peristaltic activity. We
also noted morbidity (pneumonia, wound sepsis)
and mortality. Effective peristalsis was present in
all patients in Group A within the first six postoperative
hours; in Group B, after 30 hours. Six
patients in Group A had bowel motions in the first
postoperative day, 11 in the second day, 10 in the
third day and 3 in fourth day, while in Group B none
in the first day, two in the second, 7 in the third, 15
in the fourth, and 6 in the fifth: the difference
between the two groups was significant (P<0.05
in 1st, 2nd, 4th and 5th days). Pneumonia occurred
in 2 patients of Group A, and in 10 of Group B
(P<0.05).We conclude that epidural analgesia with morphine
plus bupivacaine allowed a move rapid return
to normal gut activity and early enteral nutrition compared
with epidural analgesia with morphine alone.
Tracking Down Duodenopancreatic Malignancy
Authors: Samel-Westerhof Constanze , Samel Stephan , Back Walter , Gaa Jochen , Sturm Jörg 
Published: September 2007

Background Malignant tumours of the duodenum
are rare and often difficult to diagnose. Due to the
small clinical experience with duodenal malignancies
their prognosis is unknown and resection is the
treatment of choice.Case report Adding to a small series of incidental
tumours, we report the case of a 65‐year‐old patient
with primary extranodal (MALT‐) lymphoma of the
duodenum infiltrating the pancreatic head. The
patient was admitted because of anaemia and
epigastric discomfort with a history of Helicobacter‐
pylori associated gastric ulceration. Physical
examination and bloodchemical values were otherwise
normal. Endoscopy revealed duodenal ulceration
but the biopsies taken from the ulceration did
not give any evidence of malignancy or residual
Helicobacter pylori infection. But MRT showed a
circular intramural tumour of the duodenum. On
laparotomy a large duodenal tumour adherent to the
pancreatic head was found and a Whipple procedure
was performed.Conclusion Apart from describing the case of a
rare lymphoproliferative disorder of the duodenum,
this report illustrates the diagnostic difficulties with
uncommon neoplasm′s of the duodenopancreatic
region and the value of MRT prior to resection of a
duodenopancreatic mass.
Treatment Options for Villous Adenomaof the Ampulla of Vater
Authors: Hoyuela C. , Cugat E. , Veloso E. , Marco C. 
Published: September 2007

Introduction: Duodenal villous adenoma arising
from the ampulla of Vater has a high risk of malignant
development. Excluding associated malignant
disease prior to resection of an adenoma of the ampulla
is not always possible. Therefore, the surgical
procedure of choice to treat this rare tumour is still
controversial.Objective: To evaluate retrospectively results of treatment
of villous adenoma arising from ampulla of
Vater with dysplasia or associated carcinoma limited
to the ampulla.Patients and Methods: From 1985 to 1996, eight
patients have been diagnosed with ampullary villous
adenoma suitable for resection. We have reviewed
treatment, morbidity, mortality, follow‐up and final
outcome.Results: Pancreatoduodenectomy (PD) was performed
in 4 patients. Transduodenal ampullectomy and
endoscopic resection was performed in 2 patients
each. There was no perioperative mortality.
None of the patients had biliary, pancreatic or intestinal
leakage but two patients who underwent
PD had minor postoperative complications. The mean
follow‐up was 44 (range: 6–132) months. Villous
adenoma was associated with adenocarcinoma in
50% of the cases (4/8 patients). During the followup
both patients who underwent transduodenal
ampullectomy developed recurrent disease. All patients
initially treated by PD are alive without
evidence of recurrent disease.Conclusions: Treatment of villous adenoma of the
ampulla must be individualized within certain limits.
In our series, PD achieve good results and it appears
to be the procedure of choice in order to treat
villous adenomas with proved presence of carcinoma,
carcinoma in situ or severe dysplasia. Endoscopic
or local resection may be appropriate for small
benign tumours in high risk patients.
Novel Mechanism whereby Nuclear Factor κB Mediates DNA Damage Repair through Regulation of O6-Methylguanine-DNA-Methyltransferase
Authors: Lavon Iris , Fuchs Dana , Zrihan Daniel , Efroni Gilat , Zelikovitch Bracha , Fellig Yakov , Siegal Tali 
Published: September 2007

Abstract
O 6-Methylguanine-DNA-methyltransferase (MGMT) and nuclear factor κB (NF-κB) are two key effectors associated with the development of resistance to alkylating agent–based chemotherapy. This prompted us to hypothesize that NF-κB might be involved in MGMT regulation. Consistent with this hypothesis, we have discovered two putative NF-κB binding sites within the MGMT promoter region and showed a specific and direct interaction of NF-κB at each of these sites. Forced expression of the NF-κB subunit p65 in HEK293 cells induced an increase in MGMT expression whereas addition of the NF-κB super repressor ΔNIκB completely abrogated the induction. We also found a significant correlation between the extent of NF-κB activation and MGMT expression in the glioma cell lines and the human glial tumors tested and showed that it was independent of MGMT promoter methylation. Our results are of potential clinical significance because we show that cell lines with ectopic p65 or high constitutive NF-κB activity are less sensitive to nitrosourea treatment and that suppression of MGMT activity with O6-benzylguanine completely abolishes the chemoresistance acquired by NF-κB. The findings of our study strongly suggest that NF-κB plays a major role in MGMT regulation and that MGMT is most probably the major player in NF-κB–mediated chemoresistance to alkylating agents. [Cancer Res 2007;67(18):8952–9]
Identification and Characterization of Genetic Variation in the Folylpolyglutamate Synthase Gene
Authors: Leil Tarek A. , Endo Chiaki , Adjei Araba A. , Dy Grace K. , Salavaggione Oreste E. , Reid Joel R. , Ames Matthew M. , Adjei Alex A. 
Published: September 2007

Abstract
Folylpolyglutamate synthase (FPGS) catalyzes the polyglutamation of folic acid, methotrexate, and pemetrexed to produce highly active metabolites. To characterize genetic variation in the FPGS gene, FPGS, have resequenced the gene in four different ethnic populations. Thirty-four single nucleotide polymorphisms were identified including five nonsynonymous coding single nucleotide polymorphisms that altered the FPGS protein sequence: F13L and V22I polymorphisms in the mitochondrial isoform of FPGS, and R466/424C, A489/447V, and S499/457F polymorphisms, which exist in both the mitochondrial and cytosolic isoforms. When expressed in AuxB1 cells, the A447V cytosolic variant was functionally similar to the wild-type cytosolic (WT Cyt) allozyme, whereas the R424C and S457F cytosolic variants were reduced by ∼2-fold in protein expression compared with WT Cyt (P &lt; 0.01). The intrinsic clearance of glutamate was reduced by 12.3-fold (R424C, P &lt; 0.01) and 6.2-fold (S457F, P &lt; 0.01), whereas the intrinsic clearance of methotrexate was reduced by 4.2-fold (R424C, P &lt; 0.05) and 5.4-fold (S457F, P &lt; 0.05) in these two cytosolic variants when compared with the WT Cyt isoform. Additionally, the in vitro enzyme velocity at saturating pemetrexed concentrations was reduced by 1.6-fold (R424C, P &lt; 0.05) and 2.6-fold (S457F, P &lt; 0.01) compared with WT Cyt. AuxB1 cells harboring these same cytosolic variant allozymes displayed significant increases in the EC50 for folic acid and in the IC50 values for both methotrexate and pemetrexed relative to the WT Cyt form of FPGS. These observations suggest that genetic variations in FPGS may alter the efficacy of antifolate therapy in cancer patients. [Cancer Res 2007;67(18):8772–82]