bluuebunny/crossref_metadata_2025_split huggingface dataset:
An Easier Technique for End to End Pancreatlcojejunostomy
Authors: Pedrazzoli Sergio , Sperti Cosimo , Pasquali Claudio 
Published: September 2007

Breakdown of the pancreaticoenterostomy is responsible for a number of complications and for the
high mortality associated with pancreaticoduodenectomy. Although in recent years the postoperative
mortality has dropped to less than 10% and in some to less than 5%, pancreatic fistula remains
the most common and troublesome complication.Various procedures, such as duct ligation or occlusion, resection of the pancreatic stump or
pancreaticogastrostomy, have been proposed to treat the pancreatic stump when it is considered
unsuitable for jejunal anastomosis. A little trick permitted us to perform 41 consecutive end to end
pancreaticojejunostomies, irrespective of the conditions of the pancreatic stump, with only 3
pancreatic fistulas (7%) and without fistula related deaths.
Two Cases of Spontaneous Liver Rupture and Literature Review
Authors: Cozzi P. J. , Morris D. L. 
Published: September 2007

Spontaneous liver rupture is uncommon, difficult to diagnose and carries a universally high mortality. It
has been well documented to occur as a complication of primary or secondary hepatic malignancy.
Similarly, there are 28 cases of ruptured haemangiomata described in the world literature. It is also well
described in severe pregnancy‐induced hypertension and is said to carry a mortality of 18% for patients
treated by packing and drainage of the haematoma and 75% for patients treated with liver resection.Two female patients aged 60 and 61 presented to our accident and emergency department. One had a
history of hypertension only and the other a history of a bleeding diathesis from the lupus anticoagulant.
Both presented with hypotension and abdominal pain and both were diagnosed by abdominal CT scan.
One was treated with hepatic artery ligation and tamponade and the other with liver resection and
correction of the coagulopathy. Neither had any evidence of a ruptured haemangioma or tumour at
laparotomy or on histological examination, and both are alive and well.The conclusions to be drawn from this review and our own recent experience is that the treatment of
choice for ruptured haemangiomata is liver resection and, for rupture during pregnancy, is tamponade
with packs and evacuation of the haematoma. Hepatic arteriography and embolisation, if possible, is a
useful adjunct. Correction ofany coagulopathy is essential. We can only speculate that the aetiology in our
patients was uncontrolled hypertension in one and coagulopathy in the other.
Prophylactic Sclerotherapy: Yes or No!
Authors: Burroughs A. K. 
Published: September 2007

Controlled trials of endoscopic sclerotherapy for the prevention of the first variceal
hemorrhage have given controversial results. We continued a previously reported study
and randomly assigned 141 patients with esophageal varics and no prior gastrointestinal
bleeding to either prophylactic sclerotherapy (n=70) or no treatment (n=71). Sclerotherapy was performed until complete eradication of the varices was achieved; recurrent
varics were treated with repeat sclerotherapy. The groups were well balanced in terms of
demographic and clinical characteristics. Patients in both groups who bled from varices
received sclerotherapy whenever possible.During a median follow‐up of 56 months, variceal bleeding occurred in 7% in
sclerotherapy patients and 44% on control patients (p < 0.01). In the sclerotherapy
group 59% died, and in the control group 51% (n.s.). In both groups, the mortality rate
increased with the severity of liver function impairment. Sclerotherapy was not found to
improve survival in patients, irrespective of the etiology of cirrhosis (alcoholic or
nonalcoholic) or variceal size (low‐grade or high‐grade). We conclude that sclerotherapy
is a suitable method to reduce the occurrence of the first variceal hemorrhage, but it does
not appear to have an effect on survival.
Primary Extrahepatic Bile Duct Carcinoids
Authors: Belli Giulio , Rotondano Gianluca , D′Agostino Alberto , Marano Ines 
Published: September 2007

Biliary tact carcinoids are extremely rare: only ten cases have been reported up to now. The
Authors describe a successfully treated carcinoid tumour ofthe proximal bile duct and review the
literature about these rare malignancies.Despite extensive preoperative work‐up, including ultrasound, CT scan and ERCP, a definite
diagnosis is hardly possible prior to histologic examination of the operative or necropsy
specimen.Due to the slow‐growing nature and the non‐aggressive behaviour of these malignancies,
surgical resection followed by biliodigestive anastomosis should be the treatment of choice.
Choledochoduodenostomy in the Management of Common Duct Stones or Associated Pathology – An Obsolete Method?
Authors: de Almeida António Castro Mendes , dos Santos Noel Medina , Aldeia Fernando José 
Published: September 2007

Choledochoduodenostomy (CDD) has been reported as a more effective treatment of CBD stones than T‐tube drainage but it is regarded as a last resort or obsolete therapeutic method due to fears of higher mobidity, cholangitis, “sump” syndrome and liver dysfunction. We aimed to assess the aforementioned issues analyzing prospectively our experience from 1976 through Dec.92.Methods: CDD was performed in 89 females and 36 males, aged 60.2±8.7 years, 26 during repeat surgery. Duct stones were the indication in 94, Sphincter of oddi (SO) dysfunction in 23 and obstructive pancreatitis nodule in 8. Peroperative liver biopsies were obtained in 44 patients. The “follow‐up” schedule (> 2.5 years in 110) included clinical interview and LFT′s on an yearly basis. Ultra sound (USG) was obtained every one or two years. ERC was done in 10 symptomatic patients and in 25 others for protocul purposes. Liver
biopsies were taken four to nine years post surgery in 11 patients‐five at relaparotomy for non‐biliary causes and six percutaneously by fine needle. Ductal mucosa biopsy could safely be performed in one patient 10 years after surgery. The long‐term results were classified as excellent, good, fair or poor. Poor meant the need for further invasive therapy (resurgery or EST).Results: There were two operative deaths (1.6%). The long‐term results (123 survivors) were considered excellent in 89, good in 22, fair in 9 and poor in three. Three patients died from unrelated causes and eight others ceased the “follow‐up” evaluation three to five years post surgery. All of them were considered as having excellent or good results. A widely patent anastomosis of approximately 20 mms without mucosal inflammatory changes was documented in every patient assessed via ERC. food “debris” was detected within the distal duct of four patients yet it was easily flushed through the stoma. Normal tissue patterns were observed in all long‐term liver biopsies. Likewise the ductal mucosa biopsy failed to reveal any acute or chronic inflammatory changes.Conclusions: 1) CDD is ahighly effective short and long‐term treatment of CBD lithiasis.2) It does not lead to bacterial or “chemical” cholangitis, to “sump” syndrome or to hepatic dysfunction, provided a wide anastomosis is accomplished.3) CDD should only be considered as obsolete after extensive, long‐term, prospective, randomized assessments of laparoscopic or combined laparoendoscopic approaches have been shown to be as effective as or superior to CDD.
“A New Reconstructive Method after Pancreaticoduodenectomy: the Triple Rouxon a “P” Loop. Rationale and Radionuclide Scanning Evaluatlon.”
Authors: Pescio Gianluigi , Cariati Erminio 
Published: September 2007

We propose a method of reconstruction after pancreaticoduodenectomy consisting of a double Roux en Y
on the same jejunal loop without interruption of the mesentery and a third anatomical Roux en Y to
reconstitute the alimentary tract.The construction of the double Roux en Y draining pancreas and bile ducts separately, requires a linear
Stapler 3‐4 centimeters from the biliary anastomosis. In this way, by employing the same loop without
mesenteric interruption, two functional excluded loops will be ’obtained. The rationale of the suggested
model is based on the separation of biliary and pancreatic secretions. This makes it possible to avoid a
stagnant cul‐de‐sac coinciding with the pancreaticojejunal anastomosis and to obtain in the case of
leakage, a pure biliary and/or pancreatic fistula as far as is possible.99mTc HIDA scans demonstrated the efficiency, of the biliopancreatic limbs of the reconstruction,
showing normal emptying time for the gastric remnant and the absence of radionuclide stagnation or any
alkaline enterogastric reflux.
Are Hepatic Adenomas Premalignant?
Authors: Nagorney David M. 
Published: September 2007

Objective: To investigate clinical experience with the apparent malignant transformation of benign liver cell adenomas.Design: Retrospective review of personal experience and literature.Setting: University hospital and affiliated community hospitals.Patients: All patients diagnosed with liver cell adenomas over a 30‐year period.Interventions: Liver resection and/or tumor biopsy.Main Outcome Measures: Gender, age, drug associations, alpha‐fetoprotein levels, response to treatment, and survival.Results: Thirteen patients from personal experience and 26 patients from the reports of others had liver cell adenomas that were not resected. Five of these patients subsequently developed hepatocellular carcinoma.Conclusions: Malignant transformation of a liver cell adenoma is a rare phenomenon, but it does occur. Alphafetoprotein levels may be more helpful in diagnosis than expected from previous reports. Solitary benign adenomas should be resected whenever possible. Patients with diffuse multiple tumors should be observed closely over a long period.
Prospective Randomized Trial Comparing Endoscopic Sphincterotomy Followed bySurgery with Surgery Alone in Good Risk Patients with Choledocholithiasis
Authors: Kapoor R. , Kaushik S. P. , Saraswat V. A. , Choudhuri G. , Sikora S. S. , Saxena R. , Kapoor V. K. 
Published: September 2007

Background: Role of endoscopic sphincterotomy (ES) in high risk patients with choledocholithiasis is established but its role in good risk patients is unclear.Design: A prospective randomized trial of endoscopic sphincterotomy followed by surgery (ES + S) versus surgery alone (SA) in good risk patients with choledocholithiasis.Setting: A tertiary level referral hospital in north India; July 1991 to October 1993.Patients and methods: Thirty three out of 60 patients with choledocholithiasis were found suitable for
randomization‐16 were randomised to ES+S group and 17 to SA group.Results: Common bile duct clearance was achieved in 11/13 (85%) patients in ES+S group and in 13/15 (87%) in SA group. Major complications occurred in 4/13 (31%) patients in ES+S group and 3/16 (19%) patients in SA group. These differences were not statistically significant, but patients in ES+S group were exposed to morbidity twice, procedure related morbidity of ES being 23%. No significant differences were observed in hospital stay and cost of treatment.Conclusions: Results of this trial do not support use of precholecystectomy ES in good risk patients with choledocholithiasis, since it did not offer any advantage over surgery alone.
Effects of Endothelin‐1 on Hepatic Blood Flow
Authors: Unneberg Kjetil , Mjaaland Marianne , Helseth Elin , Revhaug Arthur 
Published: September 2007

Endothelin‐1 belongs to a family of potent vasoconstrictors, recently isolated from endothelial cells.
Endothelin‐1 has a variety of hepatic effects and hepatic clearance from the circulation is important.
Elevated plasma concentrations of Endothelin‐1 are found after orthotopic liver transplantation and in
cirrhosis with ascites.This study in piglets on hepatic bloodflow was designed to compare differences in effects between central
venous and intraportal injection of endothelin‐1, and to evaluate effects of repeated injections. Central
venous injection of endothelin‐1 caused a larger reduction in portal vein flow, while intraportal injection
caused a larger increase in portal vein pressure. Repeated injections resulted in a reduction in portal vein
flow and an increase in portal vein vascular resistance.
Successful Control of External Biliary Fistula by Using SMS 201‐995 in a Child
Authors: Bakhotmah Mohamad Abid 
Published: September 2007

Somatostatin is a potent inhibitory hormone, it′s synthetic analogue is more potent and has a prolonged
action. It has a wide range of actions in the gastrointestinal system; among which is an anticholeritic action
on bile secretion.The use of Sandostatin in the management of a case of complicated biliary fistula is reported; it
controlled the fistula reducing its daily output from 200 ml to less than 5 ml per day.
Surglcel ® Reinforced Resection Lines in Left‐sided Hepatectomy with Linear Stapling Device. An Experimental Study on Pigs
Authors: Zilling Thomas , Holmin Torsten 
Published: September 2007

Fourteen pigs underwent left‐sided hepatectomy. The resection was performed with a linear
stapling device and the pigs were randomised to either Surgicel ® reinforced resection lines or not.
The median time required for resection was 25 min (range 17‐30) in the Surgicel® reinforced
group compared to 30 min (range 21‐41) in the stapled group. This difference was, however, not
statistically significant (p=0.053).The postoperative haemoglobin value was lower in the stapled group compared to the
Surgicel® reinforced group 69 g/1 (range 42‐85) versus 82 g/1 (range 78‐90) (p=0.018). The
estimated blood losses by weighing the compresses were 287 ml (range 166‐379) for the stapled
group and 204 ml (range 152‐264) for the Surgicel® reinforced group (p=0.053).
The median number of additional haemostatic sutures in the Surgicel® reinforced group was
7 (range 3‐11) and in the stapled group 10 (range 5‐15) (p=0.038).The haemoglobin value was similar in the two groups week postoperatively; 100 g/1 (range
87‐104) and 102 g/1 (range 95‐114), p=0.27, in the stapled group and the Surgicel® reinforced group, respectively. In the stapled group reinforced with the Surgicel® there was one postoperative death. In the solely stapled group there was no postoperative death (p=0.5). Four out
of six pigs in the Surgicel® group had massive adhesions to the resection lines. One of these six
pigs was sacrificed postoperatively as it was ill and had small bowel obstruction secondary to
Surgicel® induced adhesions. On the other hand, no adhesions were seen in the solely stapled pigs
(p=0.09). At this point, we can not recommend the use of Surgicel® to reinforce resection lines at stapled liver resection in the clinical situation, because of the high frequency of adhesions this
material creates.
The Relationship between Portal Venous and Hepatic Arterial Blood Flow. I. Experimental Liver Transplantation
Authors: Jakab F. , Sugár I. , Ráth Z. , Nágy P. , Faller J. 
Published: September 2007

The relationship between the changes in portal venous and hepatic arterial blood flows, in the liver is a much disputed question, it has tremendous significance in the practice of transplantation, and an explanation has been available since 1981, when Lautt published the so‐caled “adenosine washout theory”. According to our earlier observations the decrease of portal pressure or flow consistently led to an increase in hepatic artery flow. At the same time changes in hepatic artery flow or pressure seemed to produce only inconsistent effects on the portal circulation. In the present experiments liver transplantation (OLTX) was carried out on mongrel dogs by Starzl′s method. Electromagnetic flow probes were placed on the hepatic artery and the portal vein before removal of recipient’s liver, and after completion of all vascular anastomoses to the newly inserted liver, during the recirculatory phase of OLTX. The flow probes were connected to a Hellige electromagnetic flowmeter, portal venous and systemic arterial pressures were also recorded.The control HAF was 241±23 ml/min, the average PVF was 517±47 ml/min before removal of the recipients′s liver. In the recirculatory phase the HAF increased, by 71±12% (p < 0.001). The PVF decreased in most animals after OLTX. The decrease was in average –40.2±3.5% (p < 0.001). The THBF calculated by adding the HAF and PVF showed a small, but not significant decrease during recirculation.The systemic arterial pressure decreased slightly and portal vein pressure rose in most animals after OLTX. There was a substantial increase in portal inflow resistance and prehepatic arteriolar resistance and a decrease in hepatic artery resistance. The decrease of PVF after OLTX can be explained by progressive fluid accumulation in the liver parenchyma and increased sinusoidal and portal inflow resistance. The prolonged and continuous increase in hepatic artery flow during the recirculatory phase of OLTX may be due to the decrease of portal flow. The exact mechanism, by which a change in portal flow leads to arteriolar dilatation, can be most probably explained by the “adenosine washout theory” of Lautt.
Improved Results for Resection of Periampullary Adenocarcinoma
Authors: Obertop H. , Gouma D. J. 
Published: September 2007

Background: This study evaluates the indications for and effects of pancreaticoduodenectomy (102 patients) or total pancreatectomy (15 patients) with extensive lymph node dissection performed upon 117 patients for treatment of periampullary adenocarcinoma.Study Design: Presenting symptoms and postoperative morbidity and mortality rates were recorded. Cumulative survival rates were evaluated in relation to origin, size, and staging of tumor. Postoperative follow‐up of clinical symptons was done after one year.Results: The postoperative mortality rate after Whipple’s operation was 8 percent (eight patients). The median survival period was 1.1 year and the overall five year survival rate was 15 percent (confidence limits, 5 to 25 percent). The five year survival rate for patients without tumor extension beyond the pancreas was 25 percent (confidence limits, 5 to 50 percent), and in patients with adenocarcinoma of the ampulla of Vater, 34 percent (confidence limits, 3 to 65 percent). The median survival rate in patients with adenocarcinoma of the ampulla of Vater was 3.3 years, which was significantly longer than in the other patients. Fifty‐nine patients with distant spread could be divided into 14 patients with para‐aortic lymph node metastases who had a significantly shorter survival period than 45 patients without para‐aortic lymph node metastases (p=0.004). Most patients surviving more than one year were doing well, although 60 percent needed exocrine pancreatic substitution therapy.Conclusions: Resection of periampullary carcinoma provides a better palliation and survival rate than nonoperative biliary drainage or bypass operation. An improved preoperative verification of para‐aortic metastases could restrict resection to patients with a prognostic five year survival rate of more than 25 percent and a postoperative mortality rate of less than 5 percent.
Pancreatic Serous Cystadenomas Report of 8 Cases with a Mean Follow up of 7 Years
Authors: Fabiani Alejandro , Delía Gonzalo J. , De Rosa Roberto , Pombo María T. , Molfino Oscar , Ferraina Pedro , Laffaye Horace A. 
Published: September 2007

Serous cystadenoma of the pancreas are rare tumors and have little or no malignant potential.We report our experience in the management of eight casses of these tumors in the last 22 years. All the
patients were women with a mean age of 59 years. All the cysts caused symptoms. Ultrasound and CTscan
were useful in the diagnosis of the pancreatic cystic tumor out not in determining the nature of these
lesions clear. FNA‐biopsy was performed in 6 cases but in only one c se was the diagnosis confirmed. All
tumors were resected. Four radical pancreatoduodenectomies, two distal pancreatectomies and two
cystectomies were performed. Mean followup was 83.5 months. All patients are alive and with no signs of
recurrence. Complications include an external pancreatic fistula, an acute cholangitis and a case of
delayed gastric emptying. In all cases the histological diagnosis was serous cystadenoma of the pancreas.
We conclude that resection of these tumors is mandatory although they are supposed to be benign, in
order to avoid complications and because malignant transformations has been related to nonresective
treatment.
Stent or Surgery for Malignant Low Bileduct Obstruction?
Authors: Ihse Ingemar , Hansson Lars , Hammarström Lars-Erik , Lindström Eva 
Published: September 2007

The development of non‐surgical techniques for the relief of malignant low bileduct obstruction has cast doubt on the best way of relieving jaundice, particularly in patients fit for surgery whose life expectancy is more than a few weeks.We did a randomised prospective controlled trial comparing endoscopic stent insertion and surgical biliary bypass in patients with malignant low bileduct obstruction. 204 patients were randomised (surgery 103, stent 101); 3 subsequently proved to have benign disease and were excluded, leaving 101 surgical and 100 stented patients for assessment. Technical success was achieved in 94 surgical and 95 stent patients, with functional biliary decompression obtained in 92 patients in both groups. In stented patients, there was a lower procedure‐related mortality (3% vs 14%, p=0.01), major complication rate (11% vs 29%, p=0.02), and median total hospital stay (20 vs 26 days, p=0.001). Recurrent jaundice occurred in 36 stented patients and 2 surgical patients. Late gastric outlet obstruction occurred in 17% of stented patients and 7% of the surgical group. Despite the early benefits of stenting there was no significant difference in overall survival between the two groups (median survival: surgical 26 weeks; stented 21 weeks; p=0.065).Endoscopic stenting and surgery are effective palliative treatments with the former having fewer early treatment‐related complications and the latter fewer late complications.
Should the Distal Splenorenal Shunt be Combined with Gastric Disconection and Transection?
Authors: Henderson J. Michael 
Published: September 2007

Background: This study was aimed at evaluating advantages of distal splenorenal shunt (DSRS) with splenopancreatic and gastric disconnection (DSRS‐SPGD) over DSRS with splenopancreatic disconnection (DSRS‐SPD) and standard DSRS (S‐DSRS).Methods: DSRS‐SPGD, DSRS‐SPD, and S‐DSRS were performed on 62, 7, and 55 patients, respectively, from 1970 to 1992. Comparison was performed in the following aspects: (1) long‐term results in ratio of rebleeding, survival rate, and quality of life and (2) portal hemodynamics evaluated by preoperative and postoperative angiography. Portal blood flow was assessed by the ratio of the diameter of portal vein (PV) to superior mesenteric vein (SMV), and shunt selectivity was evaluated by selectivity grade.Results: Incidence of rebleeding was significantly lower in patients who underwent DSRS‐SPGD than in those who underwent S‐DSRS (p< 0.05). Grade 0 and I performance status was better in patients who underwent DSRS‐SPGD. Accumulated survival ratio for 5 and 7 years was 78.3% and 70.5% in patients who underwent DSRS‐SPGD, 59.7% and 44.1% in patients who underwent S‐DSRS, and 75% and 75% in patients who underwent DSRS‐SPD. Hemodynamic evaluation showed significantly lower PV/SMV ratio and degree of change in PV/SMV ratio of patients who underwent S‐DSRS and DSRS‐SPD. Many patients who underwent S‐DSRS and DSRS‐SPD exhibited loss of shunt selectivity at grades II and III. In contrast, patients who underwent DSRS‐SPGD maintained satisfactory PV/SMV ratio and selectivity grade.Conclusions: DSRS‐SPGD clearly showed advantages in decrease of rebleeding and improvement of quality of life resulting from maintenance of shunt selectivity and portal blood flow.