bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reconstructive Surgery for Treatment of Urogenital Tuberculosis: 30 Years of Observation
Authors: Mochalova Tatiana P. , Starikov Igor Y. 
Published: February 2006

AbstractTuberculosis has continued to be a public health problem around the world. The urogenital tuberculosis clinic in
the Russian Scientific Research Institute of Phthisiopulmonology was
founded in 1950. The development of reconstruction operations for those
with urogenital tuberculosis began in 1960. Since then 4298 patients
with urogenital tuberculosis have been treated, and 2364 operations
have been performed: 885 to remove an organ, 531 to preserve an organ, and 948 for reconstruction. The cases of extrapulmonary tuberculosis in
recent years have increased to 6.0%. Surgery for urogenital
tuberculosis is performed after specific medical therapy has been
tried, but it is difficult, particularly if it is a reconstruction. The
clinical features and results of various ureteral neoimplantation
procedures using intestinal transplants (ileocystoplasty, sigmoidocystoplasty, cecocystoplasty) are discussed.
Selective Treatment of Differentiated Thyroid Carcinoma
Authors: Gemsenjäger Ernst , Heitz Philipp U. , Martina Benedict 
Published: February 2006

AbstractOver a period of 20 years 84 papillary and 82 follicular carcinomas operated on by one surgeon and examined by
one pathologist were documented prospectively, treated selectively, and
followed for 1 to 20 years (median 7 years). Tumors with a low risk of
recurrence or incurable disease—i.e., papillary carcinoma pT1–3 N0 M0
(n= 56) and minimally invasive follicular carcinoma (n= 37)—were treated by a limited‐radicality
hemithyroidectomy or total thyroidectomy without radioiodine in 79 of
the 93 cases (85%). No unfavorable course was observed, and only one
curable recurrence (1.3%) developed contralaterally after
hemithyroidectomy for papillary cancer. Of the remaining 73 patients, including 100% of those with nodal involvement, 65 (89%) underwent
total thyroidectomy with radioiodine. Total thyroidectomy was achieved
in 34% of the cases by completion thyroidectomy, based on definitive
histologic examination. No instance of a serious, potentially incurable
recurrence and no tumor‐related death was observed in patients with a
papillary TNM stage I + II or with a minimally invasive follicular
carcinoma. Five of the patients (6%) with papillary carcinoma, all
with TNM stage III or IV, and seven of the patients (8.5%) with
follicular carcinoma, all grossly invasive and pT3 or pT4, had
tumor‐related deaths following total thyroidectomy in all and with
remnant ablation in 10 cases. A potentially curable node recurrence
occurred in two patients 1 and 10 years, respectively, after primary
treatment. Permanent hypoparathyroidism (n= 4)
(2.4%) and permanent recurrent laryngeal nerve palsy
(n= 2) (1.2%) were observed only in patients with a
grossly invasive follicular carcinoma and concomitant benign recurrent
goiter. We conclude that (1) hemithyroidectomy or total thyroidectomy
without radioiodine is adequate for papillary carcinoma pT1–3 N0 and
minimally invasive follicular carcinoma; (2) there were no nodal
recurrences in tumors recognized as node‐negative; and (3)
extracapsular excision of one or both lobes can be carried out
technically with low morbidity. The study confirms the prognostic value
of age‐related TNM classification for papillary carcinoma;
classification of follicular thyroid carcinoma as minimally invasive or
grossly invasive proved to be useful.
Muscle Force and Bone Mineral Density after Parathyroidectomy and Subcutaneous Autotransplantation for Secondary Hyperparathyroidism
Authors: Chou Fong‐Fu , Lee Chiang Hsuan , Lee Chien Te 
Published: February 2006

Abstract.The object of this study was to determine the muscle force and bone mineral density (BMD) of patients with secondary hyperparathyroidism before and 3 months after operation. Thirty‐nine patients with secondary hyperparathyroidism and regular dialysis were operated. Their ages were 47 ± 12 (mean ± SD) years and duration of dialysis was 70.5 ± 35.8 months. The clinical symptoms included bone pain in 23 patients (59%), skin itching in 21 (53.8%), general weakness in 13 (33.3%), conscious disturbance in 2, chest tightness in 1, and failure to thrive in 1. Total parathyroidectomy and autotransplantation of 60 mg of parathyroid gland into subcutaneous tissue was done routinely. BMD was measured in the lumbar spine (L2–L4) and left proximal femur, expressed as grams per square centimeter and as fracture risk. The extension force of the quadriceps muscle was measured at 60 degrees of right knee flexion, expressed as newtons (N) in a peak force and an average force. Three months after operation the BMD of the study group increased (in g/cm2) from 1.063 ± 0.181 to 1.148 ± 0.149 (p < 0.001) in L2–4 (n= 25), from 0.792 ± 0.14 to 0.875 ± 0.161 (p < 0.001), in femoral neck (n= 25), from 0.672 ± 0.171 to 0.754 ± 0.21 (p < 0.001) in Ward's triangle (n= 25), and from 0.69 ± 0.149 to 0.738 ± 0.143 (p < 0.001) in trochanter (n= 25). Fracture risk also was reduced significantly 3 months after operation at L2–4 (p= 0.003), femoral neck (p= 0.001), Ward's triangle (p= 0.003), and trochanter (p= 0.005). Muscle force (in newtons) increased from 264.8 ± 110.5 to 326 ± 110.9 (p= 0.023) in peak force (n= 18) and from 195.3 ± 90.4 to 258 ± 99 (p= 0.012) in average force (n= 18). The patients with general weakness had improved muscle force more prominently than those without general weakness. In addition to skin itching, bone pain, and soft tissue calcification, general weakness that causes disability is an indication for surgery in secondary hyperparathyroidism. After parathyroidectomy and autotransplantation, the muscle force tends to increase, especially in those with general weakness. An increment of BMD and reduction of fracture risk are also found after surgery.
Quality of Life following Radical Surgical Treatment of Gastric Carcinoma
Authors: Thybusch‐Bernhardt Anja , Schmidt Christian , Küchler Thomas , Schmid Andreas , Henne‐Bruns Doris , Kremer Bernd 
Published: February 2006

Abstract.Quality of life (QOL) in patients with gastric cancer who underwent total gastrectomy has so far not been studied using the EORTC QLQ‐C30 (Quality of Life Core Questionnaire of the European Organization for Research and Treatment of Cancer) as a standardized European QOL instrument. The aim of this study was to evaluate the effect of radical procedures such as extensive lymph node resection and combined resection of adjacent organs on patients' QOL. From 1992 to 1996, 152 patients underwent total gastrectomy. All patients alive on July 1, 1996 were included in the study (77/152). For assessing QOL, the EORTC QOL questionnaire QLQ‐C30 version 2.0 and a validated gastric cancer module were sent home to the patients for self‐completion. The response rate was 91%. It was possible to evaluate the questionnaires of 62 patients who had undergone resection with curative intent including 13 extended gastrectomies (21%). Of the 62 resections, 50 were combined with D2 lymphadenectomy (80.6%). The global health status was not negatively influenced by D2 lymphadenectomy and extended gastrectomy. Patients with splenectomy were more affected by treatment than patients without splenectomy. Radical gastrectomy combined with D2 lymphadenectomy is the treatment of choice for gastric cancer patients, concerning not just survival but QOL as well.
Rectal Cancer Surgery in a District General Hospital: Controlled Follow‐up Study
Authors: Schütz Gaston , Aleksic Marko , Ulrich Bernward 
Published: February 2006

Abstract.Local recurrence after curative surgery of rectal cancer indicates failure of the initial treatment. In recent years reported local recurrence rates have steadily decreased. In this study 364 patients treated for rectal cancer were analyzed retrospectively to determine if it is still justified to treat this disease in small nonspecialized hospitals. An overall local recurrence rate of 9.7% was found for all operation methods used. Local recurrence rates were 11.6% for patients treated by low anterior resection, 8.4% for the patients who sustained an amputation of the rectum, and 7.1% for the patients treated by transanal tumor resection. None of the patients in whom we performed a total mesorectal excision has developed local recurrent disease during the observation period. Careful surgical technique and close follow‐up of the patients being prerequisites, the results of this study justify continuing to treat rectal cancer in nonspecialized centers.
Malnutrition: Organic and Functional Consequences
Authors: Mora Rafael J.F. 
Published: February 2006

Abstract.Malnutrition in its various forms is without doubt the commonest disease. Acute malnutrition resulting from a total lack of ingestion clearly shows that not only are water and electrolytes a priority for survival but also energy reserves. It also shows that the maximum wasting that the lean body mass can withstand is around 40% before the organism collapses and death occurs. Malnutrition is more often the results of insufficient ingestion, and the term protein‐calorie malnutrition has been suggested for the most frequently occurring type. This can give rise to confusion because the deficiency in these patients is not limited to these macronutrients but extends, rather, to micronutrients, which are equally important to the functioning of the body. A useful approach for the surgeon is to analyze how the various organs and systems have been affected. The effects on the gastrointestinal tract, the immunologic system, and formation of scar tissue are reviewed.
Postoperative Protein Sparing
Authors: Wilmore Douglas W. 
Published: February 2006

Abstract.Postoperative nitrogen sparing refers to a therapy that decreases net nitrogen loss from the body following an operation. Protein sparing has long been regarded as a surrogate marker for improved outcome, but a critical review of the evidence indicates that this relation is difficult to establish, especially in the short term. Thus, specific endpoints that evaluate outcome are needed to determine the efficacy of a specific therapy that spares protein. Cost effectiveness must also be considered. A variety of therapies were evaluated using protein‐sparing, efficiency, and cost criteria. Evidence was reviewed for glucose, amino acids, parenteral nutrition, enteral nutrition, growth hormone, and glutamine administered during the perioperative period. Only three areas could be identified that spared nitrogen and provided efficacy: (1) preoperative total parenteral nutrition (TPN) for 7 to 10 days before operation in a depleted patient (≤15% body weight loss); (2) the use of growth hormone with nutritional support to promote wound healing (especially in burns) and possibly to enhance muscle strength (particularly in the elderly); and (3) the use of glutamine‐supplemented TPN in severely ill surgical patients to decrease mortality. The issue of early tube feeding in trauma patients is still confusing. This therapy must be evaluated by an appropriate study in trauma patients that compares a tube‐fed group with an unfed control group. Only by demonstrating improved outcomes and enhanced cost saving with our protein‐sparing therapy can we continue to enhance the care of our surgical patients.
Postoperative Total Parenteral Nutrition
Authors: Waitzberg Dan L. , Plopper Caio , Terra Ricardo M. 
Published: February 2006

Abstract.Surgical trauma induces complex physiologic changes that lead to catabolism and loss of body cell mass. This reaction is usually mild but can be exacerbated by previous malnutrition and postoperative complications. To avoid severe metabolic distress, nutritional therapy may be prescribed, using the enteral route whenever possible. Postoperative total parenteral nutrition (TPN) is indicated for patients already receiving TPN preoperatively, those severely malnourished prior to major surgery, those unable to eat satisfactorily for 7 days, or patients presenting with severe complications. Postoperative TPN should last for at least 7 days. The total energy requirements are between 30 and 35 kcal/kg/day. About 50% to 70% should be provided in the form of carbohydrates, and 20% to 30% in the form of lipids. The optimal input rates for glucose and lipids are 4 to 5 g/kg/day and 80 mg/kg/hr, respectively. The ideal nitrogen administration is 250 to 300 mg/kg/day, and the optimal calorie/nitrogen ratio is 150 to 200. Some specific amino acids can be added as intravenous dipeptides. An adequate follow‐up must include clinical and biochemical parameters. Several trials evaluated the impact of TPN in postoperative patients, but further well designed, controlled clinical trials are still necessary to address a great number of unanswered questions.
Perioperative Nutrition Support for Patients Undergoing Gastrointestinal Surgery: Critical Analysis and Recommendations
Authors: Torosian Michael H. 
Published: February 2006

Abstract.There is a high incidence of malnutrition in hospitalized patients undergoing gastrointestinal surgery. Malnutrition is clearly associated with increased morbidity and mortality after major gastrointestinal surgery. The efficacy of perioperative nutrition support to reduce surgical complications and mortality significantly has been an area of active clinical investigation over the past three decades. From multiple prospective, randomized trials, significant benefit from perioperative nutritional support has been demonstrated in severely malnourished patients undergoing major surgery. Results of the prospective, randomized trials studying the effects of perioperative nutrition support on patients undergoing gastrointestinal surgery are reviewed and critically analyzed.
Artificial Nutritional Support in Patients with Gastrointestinal Fistulas
Authors: Dudrick Stanley J. , Maharaj Ashwin R. , McKelvey Alicia A. 
Published: February 2006

Abstract.Gastrointestinal (GI) fistulas allow abnormal diversions of GI contents, digestive juices, water, electrolytes, and nutrients from one hollow viscus to another or to the skin, potentially precipitating a wide variety of pathophysiologic effects. Mortality rates have decreased significantly during the past few decades from as high as 40% to 65% to 5.3% to 21.3% largely as a result of advances in intensive care, nutritional support, antimicrobial therapy, wound care, and operative techniques. The primary causes of death secondary to enterocutaneous fistulas have been, and continue to be, malnutrition, electrolyte imbalances, and sepsis, especially in high‐output fistulas, which continue to have a mortality rate of about 35%. Priorities in the management of GI fistulas include restoration of blood volume and correction of fluid, electrolyte, and acid‐base imbalances; control of infection and sepsis with appropriate antibiotics and drainage of abscesses; initiation of GI tract rest including secretory inhibition and nasogastric suction; control and collection of fistula drainage with protection of the surrounding skin; and provision of optimal nutrition by total parenteral nutrition (TPN) or enteral nutrition (EN) (or both). The role of nutrition support in the management of enterocutaneous fistulas as either TPN or EN is primarily one of supportive care to prevent malnutrition, thereby obviating further deterioration of an already debilitated patient. It has been shown in several studies that TPN has substantially improved the prognosis of GI fistula patients by increasing the rate of spontaneous closure and improving the nutritional status of patients requiring repeat operations. Moreover, other studies have shown that nutritional support decreases or modifies the composition of the GI tract secretions and is thus considered to have a primary therapeutic role in the management of fistula patients. Finally, if a fistula has not closed within 30 to 40 days, or if it is unlikely to close because of a variety of collateral or compounding pathophysiologic conditions, consideration must be given to operative resection of the fistula while continuing to maintain the previous nutritional and metabolic support. The morbidity and mortality rates in such unfortunate patients remain high despite the many recent advances in surgical and metabolic technology.
Laparoscopic Assisted Cystectomy and Lymphadenectomy for Bladder Cancer: Initial Experience
Authors: Denewer A. , Kotb S. , Hussein O. , El‐Maadawy M. 
Published: February 2006

Abstract.This study discusses our initial experience in the field of laparoscopic management of bladder carcinoma. Ten patients with invasive bladder tumors of variable histology and ranging from stage T2 to T3b were submitted to this procedure. Intraoperative assessment, lateral dissection, posterior dissection, anterior dissection, and urethral transection were achieved laparoscopically. The specimen retrieval and continent pouch construction was performed through a limited abdominal incision. This new regimen allows precise radical lymphadenectomy, early postoperative mobility, fewer wound complications, and shorter hospital stay. The early postoperative results of this procedure are encouraging. Modification and continuous refinement of the technique is still ongoing.
Gastrointestinal Disease following Heart Transplantation
Authors: Mueller Xavier M. , Tevaearai Hendrick T. , Stumpe Frank , Hurni Michel , Ruchat Patrick , Fischer Adam P. , Seydoux Charles , Goy Jean‐Jacques , von Segesser Ludwig K. 
Published: February 2006

Abstract.With advances in heart transplantation, a growing number of recipients are at risk of developing gastrointestinal disease. We reviewed our experience with gastrointestinal disease in 92 patients undergoing 93 heart transplants. All had follow‐up, with the median time 4.8 years (range 0.5–9.6 years). During the period of the study we progressively adopted a policy of low immunosuppression aiming toward monotherapy with cyclosporine. Nineteen patients (20.6%) developed 28 diseases related to the gastrointestinal tract. Thirteen patients required 18 surgical interventions, five as emergencies: closure of a duodenal ulcer, five cholecystectomies (one with biliary tract drainage), a sigmoid resection for a diverticulitis with a colovesical fistula, a colostomy followed by a colostomy takedown for an iatrogenic colon perforation, appendectomy, two anorectal procedures, and six abdominal wall herniorrhaphies. At the onset of gastrointestinal disease, 8 patients were on standard triple‐drug immunosuppression, all of them within 6 months of transplantation; 13 were on double‐drug immunosuppression; and 7 were on cyclosporine alone. All the patients with perforations/fistulas were on steroids. Among the 11 infectious or potentially infectious diseases, 10 were on triple‐ or double‐drug immunosuppression. One death, a patient who was on triple‐drug immunosuppression, had a postmortem diagnosis of necrotic and hemorrhagic pancreatitis. Except for an incisional hernia following a laparoscopic cholecystectomy, there was no morbidity and, importantly, no septic complications. We concluded that a low immunosuppression policy is likely to be responsible for the low morbidity and mortality of posttransplant gastrointestinal disease, with a lower incidence of viscous perforation/fistula and infectious gastrointestinal disease.
Nonembolic Predictors of Stroke Risk in Coronary Artery Bypass Patients
Authors: Pompilio Giulio , Lotto Attilio A. , Agrifoglio Marco , Antona Carlo , Alamanni Francesco , Spirito Rita , Biglioli Paolo 
Published: February 2006

Abstract.The aim of this study was to identify and stratify the most important nonembolic risk factors for stroke after coronary bypass grafting. From June 1994 to June 1997 a series of 1532 patients (pts) underwent isolated myocardial revascularization on cardiopulmonary bypass (CPB). A retrospective chart review selected 1417 pts in whom the presence of aortic calcification or left ventricular mural thrombi was not detectable by echocardiogram, angiogram, and intraoperative records. Univariate and multivariate analyses were conducted to identify nonembolic variables independently correlated to postoperative stroke. A predictive model of stroke probability was then constructed by means of a mathematic method with the variables selected from logistic regression analyses. The global incidence of stroke was 1.8%. Univariate analysis revealed that, among 29 preoperative and operative variables, age, vasculopathy, emergency operation, previous cerebrovascular accident (CVA), CPB, and aortic cross‐clamping times were factors strongly associated with postoperative stroke (p < 0.01). A first logistic regression analysis (LRA) selected as independent predicting variables (p < 0.05) age [odds ratio (OR) 1.07/year], vasculopathy (OR 4), previous CVA (OR 7.2), CPB time (OR 1/year), and emergency operation (OR 4.2). In a second stepwise LRA, age and CPB time were subdivided into cohorts as follows: age ≤ 65 years, > 65 but < 75 years, ≥ 75 years; CPB time ≤ 120 minutes, > 120 but < 180 minutes, ≥ 180 minutes. Both age ≥ 75 years (p= 0.024; OR 3.3) and CPB time ≥ 180 minutes (p= 0.002; OR 4.2), were found to be predictors of postoperative neurologic damage. Finally, a probability table of stroke risk was obtained with the logistic regression coefficients. A lower stroke probability (0.7%) was calculated in the absence of risk variables and a higher one in the presence of all of them (83.3%). Between these extremes, a total of 158 combinations of stroke probabilities were obtained. We concluded that previous CVA, vasculopathy, emergency operation, and age > 75 years are variously associated with a high risk of nonembolic stroke after myocardial revascularization. A duration of CPB longer than 3 hours strongly increases the probability of neurologic damage in the presence of the aforementioned variables.
Perioperative Blood Transfusion as a Prognostic Indicator in Patients with Hepatocellular Carcinoma
Authors: Asahara Toshimasa , Katayama Kouji , Itamoto Toshiyuki , Yano Masatsugu , Hino Hiroshi , Okamoto Yuzo , Nakahara Hideki , Dohi Kiyohiko , Moriwaki Katsufumi , Yuge Osafumi 
Published: February 2006

Abstract.We studied the relation of perioperative blood transfusion and the outcomes in 175 patients with hepatocellular carcinoma (HCC) who underwent hepatic resection from 1986 to 1994 in our hospital. Hepatectomy was performed in 23 (13.1%) patients with and 152 (86.9%) without blood transfusions. The cumulative cancer‐free survival rates for patients who had received blood transfusion was significantly lower than that for patients who had not received blood transfusions (p= 0.003). Further examinations revealed a significant difference in cancer‐free survival rates for stage I–II patients (n= 75) of HCC (p= 0.02) but not for stage III–IV patients (n= 56) (p= 0.06). Cox regression analysis for recurrence revealed that blood transfusion was the most significant prognostic indicator (p= 0.001) for recurrence in stage I–II patients but not in stage III–IV patients (p= 0.99). These results suggest that a perioperative blood transfusion may be a significant prognostic indicator for patients with HCC who had underwent hepatectomy, especially in stage I–II patients of HCC.