bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mini‐Incision Versus Laparoscopic Cholecystectomy
Authors: Yeo Charles J. 
Published: September 2007

Background: We report a prospective randomised comparison between laparoscopic and small‐incision cholecystectomy in 200 patients which was designed to eliminate bias for or against either technique.Methods: Patients were randomised in the operating theatre and anaesthetic technique and pain‐control methods were standardised. Four experienced surgeons did both types of procedure. Identical wound dressings were applied in both groups so that carers could be kept blind to the type of operation.Findings: There was no significant difference between the groups for age, sex, body mass index, and American Society of Anaesthesiologists grade. Laparoscopic cholecystectomy took significantly longer than small‐incision cholecystectomy (median 65 [range 27‐140] min vs 40 [18‐142] min, p<0.001). The operating time included operative cholangiography which was attempted in all patients. We found no significant difference between the groups for hospital stay (postoperative nights in hospital, median 3.0 [1‐17] nights for laparoscopic vs 3.0 [1‐14] nights for small‐incision, p=0.74), time back to work for employed persons (median 5.0 weeks vs 4.0 weeks; p=0.39), and time to full activity (median 3.0 weeks vs 3.0 weeks; p=0.15).Interpretation: Laparoscopic cholecystectomy takes longer to do than small‐incision cholecystectomy and does not have any significant advantages in terms of hostital stay or 13 ostoperative recovery.
Operative vs Non‐Operative Management in Sterile Necrotizing Pancreatitis
Authors: Bradley Edward L. 
Published: September 2007

Background: The clinical management of sterile pancreatic necrosis is still a matter of debate. In this study we analyzed the clinical course and outcome of patients with sterile necrotizing pancreatitis treated surgically versus nonsurgically.Study Design: Between May 1982 and December 1993, 249 patients with necrotizing pancreatitis (NP) entered this study, of which 172 (69 percent) had intraoperatively or fine needle aspiration‐proven sterile NP. One hundred seven of 172 patients underwent surgery (S group) with necrosectomy and continuous postoperative closed lavage and 65 of 172 were treated by nonsurgical means (NS group).Results: Median Ranson and admission APACHE II scores were 4.7 (range, 1 to 10) and 11 (range, 1 to 29) in the S group, significantly higher than those in the NS group with 3.0 (range, 0 to 6) (p=0.022) and 8 (range, 1 to 23) (p=0.036). After 48 hours of intensive care treatment, APACHE II scores persisted at 10.5 (range, 1 to 29) in the S group and decreased to 6 (range, 0 to 15) (p=0.013) in the NS patients. Median Creactive protein (CRP) levels on admission were 179 mg/L and 68.5 mg/L (p=0.023), respectively. Within 72 hours, 61 (94 percent) of 65 NS‐managed patients responded to intensive care therapy, whereas organ complications persisted or increased and thus led to surgery in the S group. Mortality rates were 13.1 percent in the surgically treated patients and 6.2 percent in the nonsurgically treated patients (p=NS).Conclusions: Most patients with limited and sterile pancreatic necrosis respond to intensive care treatment. Indication for surgery in sterile NP should be based on persisting or advancing organ complications despite intensive care therapy. APACHE II scores and adraission CRP levels represent a helpful tool in decision making for surgical or nonsurgical management of NP.
Significance of Liver Size in Hepatic Surgery
Authors: Yanaga K. , Honda H. , Ikeda Y. , Nishizaki A. T. , Yamamoto K. , Sugimachi K. 
Published: September 2007

The purpose of this study was to evaluate the significance of liver volumetry as a parameter for hepatic functional reserve in cirrhotic patients with hepatocellular carcinoma. Liver volume was calculated from preoperative computed tomograms of 44 cirrhotic patients who underwent elective hepatic resections for hepatocellular carcinoma.The liver volume per body weight of non‐alcoholic cirrhotics was significantly smaller than that of alcoholic cirrhotics (20.9 vs. 26.7 cc/kg; p=0.03). The values for alcoholic cirrhotics was comparable with normal values. The liver volume per body weight of the cirrhotic patients demonstrated correlation with the preoperative serum albumin (p<0.01) and indocyanine green clearance (p=0.02). We conclude that the determination of hepatic atrophy by volume try can serve as a parameter for the assessment of hepatic reserve but not as a predictor of postoperative complications in elective liver surgery for cirrhotic patients.
Jejunum or Stomach for the Pancreatic Anastomosis After Pancreaticoduodenectomy
Authors: Warshaw Andrew L. 
Published: September 2007

Objective: The authors hypothesized that pancreaticogastrostomy is safer than pancreaticojejunostomy after pancreaticoduodenectomy and less likely to be associated with
a postoperative pancreatic fistula.Summary Background Data: Pancreatic fistula is a leading cause of morbidity and mortality after pancreaticoduodenectomy, occurring in 10% to 20% of patients. Nonrandomized reports have suggested that pancreaticogastrostomy is less likely than pancreaticojejunostomy to be associated with postoperative complications.Methods: Between May 1993 and January 1995, the findings for 145 patients were analyzed in this prospective trial at The Johns Hopkins Hospital. After giving their appropriate preoperative informed consent, patients were randomly assigned to pancreaticogastrostomy or pancreaticojejunostomy after completion of the pancreaticoduodenal resection. All pancreatic anastomoses were performed in two layers without pancreatic duct stents and with closed suction drainage. Pancreatic fistula was defined as drainage of greater than 50 mL of amylase‐rich fluid on or after postoperative day 10.Results: The pancreaticogastrostomy (n=73) and pancreaticojejunostomy (n=72) groups were comparable with regard to multiple parameters, including demographics, medical history, preoperative laboratory values, and intraoperative factors, such as operative time, blood transfusions, pancreatic texture, length of pancreatic remnant mobilized, and pancreatic duct diameter. The overall incidence of pancreatic fistula after pancreaticoduodenectomy was 11.7% (171145). The incidence of pancreatic fistula was similar for the pancreaticogastrostomy (12.3%) and pancreaticojejunostomy (11.1%) groups. Pancreatisc fistula was associated with a significant prolongation of postoperative hospital stay (36±5 vs. 15±1 days) (p<0.001). Factors significantly increasing the risk of pancreatic fistula by univariate logistic regression analysis included ampullary or duodenal disease, soft pancreatic texture, longer operative time, greater intraoperative red blood cell transfusions, and lower surgical volume (p<0.05). A multivariate logistic regression analysis revealed the factors most highly associated with pancreatic fistula to be lower surgical volume and ampullary or duodenal disease in the resected specimen.Conclusions: Pancreatic fistula is a common complication after pancreaticoduodenectomy, with an incidence most strongly associated with surgical volume and underlying disease. These data do not support the hypothesis that pancreaticogastrostomy is safer than pancreaticojejunostomy or is associated with a lower incidence of pancreatic fistula.
Liver and Pancreatic Resection in the Elderly
Authors: Garden O. J. 
Published: September 2007

Background: Liver resection, or pancreaticoduodenectomy, has traditionally been thought to have a high morbidity and. mortality rate among the elderly. Recent improvements in surgical and anesthetic techniques, an increasing number of elderly patients, and an increasing need to justify use of limited health care resources prompted an assessment of recent surgical outcomes.Methods: Five hundred seventy‐seven liver resections (July 1985–July 1994) performed for metastatic colorectal cancer and 488 pancreatic resections (October 1983–July 1994) performed for pancreatic malignancies were identified in departmental data bases. Outcomes of patients younger than age 70 years were compared with those of patients age 70 years or older.Results: Liver resection for 128 patients age 70 years or older resulted in a 4% perioperative. mortality rate and a 42% complication rate. Median hospital stay was 13 days, and 8% of the patients required admission to the intensive care unit (ICU). Median survival was 40 months, and the 5‐year survival rate was 35%. No difference were found between results for the elderly and those for younger patients who had undergone liver resection, except for a minimally shorter hospital stay fortheyoungerpatients (median, 12 days vs. 13 days p=0.003). Pancreatic resection for 138 elderly patients resulted in a mortality rate of 6% and a complication rate of 45%. Median stay was 20 days, and 19% of the patients required ICU admission, results identical to those for the younger cohort. Long‐term survival was poorer for the elderly patients, with a 5‐year survival rate of 21% compared with 29% for the younger cohort (p=0.03).Conclusions: Major liver or pancreatic resections can be performed for the elderly with acceptable morbidity and mortality rates and possible long‐term survival. Chronologic age alone is not a contraindication to liver or pancreatic resection for malignancy.
Resection of Hilar Cholangiocarcinoma
Authors: Strasberg Steven M. 
Published: September 2007

Objective: Morbidity and mortality involved in the resection of hilar cholangiocarcinoma were reviewed retrospectively. The clinicopathologic and laboratory parameters that might influence the patient′s survival also were re‐evaluated.Summary Background Data: Although much progress has been made in the diagnosis and management of hilar cholangiocarcinoma, long‐term outlook for most patients remains poor. Surgical resection is usually prohibited because of its local invasiveness, and most patients can only be managed by palliative drainage. Recently, many surgeons have adopted a more aggressive resection with varying degrees of success. Several prognostic factors in bile duct carcinoma have been proposed; however, no reports have specifically focused on resected hilar cholangiocarcinoma and its prognostic survival factors using multivariate analysis.Methods: The clinical records and pathologic slides of 49 cases with resected hilar cholangiocarcinoma were reviewed retrospectively. Twenty clinical and laboratory parameters were evaluated for their correlation with postoperative morbidity and mortality, whereas 31 variables were evaluated for their significance with postoperative survival. Variables showing statistical significance in the first univariate analysis were included in the following multivariate analysis using stepwise logistic regression test for factors affecting morbidity and mortality and Cox stepwise proportional hazard model for factors influencing survival.Results: There were 5 in‐hospital deaths, and the cumulative 5‐year survival rate in 44 patients who survived was 14.9%, with a median survival of 14.0 months. Multivariate analysis disclosed that coexistent hepatolithiasis and lower serum asparate aminotransferase levels (90 U/L) had a significant low incidence of postoperative morbidity, whereas a serum albumin of less than 3 g/dL was the only significant factor affecting mortality. Regarding survival, univariate analysis identified eight significant factors: 1) total bilirubin 10 mg/dL, 2) curative resection, 3) histologic type, 4) perineural invasion, 5) liver invasion, 6) depth of cancer invasion, 7) positive proximal resected margin, and 8) positive surgical margin. However, multivariate analysis disclosed total bilirubin ≥ 10 mg/dL, curative resection, and histologic type as the three most significant independent variables.Conclusions: Surgical resection provides the best survival for bilar cholangiocarcinoma. An adequate nutritional support to increase serum albumin over 3g/dL is the most important factor to decrease postoperative mortality. Moreover, preoperative biliary drainage to decrease jaundice and a curative resection with adequate surgical margin are recommended if longer survival is anticipated. Patients with well differentiated adenocarcinoma seem to survive longer compared to those with moderately or poorly differentiated tumors.
The Role of Oxygen Free Radicals in Acute Renal Failure Complicating Obstructive Jaundice: An Experimental Study
Authors: Yüceyar Serdar , Gümüştaş Koray , Ertürk Süphan , Hamzaoğlu Ismail H. , Uygun Nesrin , Ayaz Meltem , Cengiz Ali , Kafadar Yilmaz 
Published: September 2007

Oxydant injury is considered to be an important mechanism in the pathophysiology of acute renal failure. It has been thought that decrease in extracellular and intracellular fluid and endotoxemia seen in obstructive jaundice may cause an increase in production of oxygen free radicals and impairment in antioxydant defense mechanism. This study is designed to investigate the possible role of oxydant injury in renal failure seen in jaundiced patients. In this study, 28 rats were divided into four groups: Control(C) (N=7); Renal ischemia (RI) (N=7); Obstructive jaundice+renal ischemia (OJ+RI) (N=7); Obstructive jaundice (OJ) (N=7). All groups were compared with each other according to renal failure findings and enzyme activities, such as Xanthine oxidase (XOD), Superoxide Dismutase (SOD) and Catalase in renal cortex and Glutathione Peroxidase (GSH‐Px), in blood at 3rd day after ischemia and reperfusion. Renal failure findings monitored by blood urea and creatinine levels, seemed more evident in OJ+RI than RI group (p <0.05). When compared with RI, in OJ+RI group, increase in XOD activity at 3rd day was statistically significant [0.259 ±0.01 U/g (tissue) and 0.362±0.03 U/g (tissue) respectively] (p <0.05). SOD and GSH‐Px activities of each ischemic group at 3rd day were decreased compared to non‐ischemic groups. This fall was significant (p <0.05). But there was no statistical difference between jaundiced and non‐jaundiced groups. Alterations in catalase activities also had no statistical significance.These findings may suggest that the injury induced by oxygen free radicals at re‐oxygenation of tissue after ischemia may also play a role in the pathogenesis of acute renal failure developed in obstructive jaundice.
Changing Therapy for Gastrinoma
Authors: Bornman P. C. , Radebold K. 
Published: September 2007

Objective: The author analyzed potential survival determinants in gastrinoma to characterize a possible uniform staging system and to determine whether complete surgical resection improves expected survival.Summary and Background Data: Gastrinoma is an indolent yet malignant neuroendocrine tumor. The associated gastric acid hypersecretion can be controlled medically. Staging of gastrinoma is inconsistent and the role Of surgical resection controversial.Methods: Seventy‐four patients with gastrinoma with a minimum 5‐year follow‐up were assessed. Cox′s proportional hazards regression model was used to examine the association of risk factors with survival.Results: The following factors had no effect on survival: age at diagnosis, sex, presence of lymph node metastases, associated multiple endocrine neoplasia, and method of ulcer treatment. The three unique determinants of survival were primary tumor size (relative risk 1.534; p<0.0005), liver metastases (relative risk, 2.947; p<0.0209), and complete surgical resection (relative risk 0.163; p<0.0076). On the basis of these risk factors, a uniform staging system is proposed and predictive survival curves developed.Conclusions: The primary determinants of survival in gastrinoma are the size of the primary tumor and liver metastases. Complete surgical resection reduces mortality, regardless of other factors.
An Alternative Technique in the Treatment of Celiac Axis Stenosis Diagnosed During Pancreaticoduodenectomy
Authors: Machado Marcel C. C. , Penteado Sonia , Montagnini André L. , Machado Marcel A. C. 
Published: September 2007

Celiac compression is usually a benign condition, but when surgery necessitates division of collaterals from the superior mesenteric artery, it may cause life‐threatening celiac organ ischemia. Celiac axis obstruction is found in 12.5% to 49.7% of patients during abdominal angiography. In such patients, the arterial blood supply to the stomach, spleen, and liver is sustained through extraordinarily welldeveloped pathways in the pancreas.Though collateral pathways may be sacrificed during pancreaticoduodenectomy, only a small proportion of patients develop hepatic, gastric and splenic ischemia during the procedure. If the appropriate angiographic studies have not been obtained before pancreatic resection, a test occlusion of the gastroduodenal artery, as recommended by Bull et al. [2], should precede its ligation. The hepatic arteries are palpated before and after the test occlusion. In the occasional patient in whom the pulse diminishes during occlusion or if there is evidence of upper abdominal visceral ischemia, revascularization of the celiac circulation may be required. Reestablishment of the celiac circulation may be accomplished by the use of a vein graft between the aorta and the celiac tributaries. This article describes an alternative technique for revascularization of the celiac circulation without the use of a venous graft.
Complete Caudate Lobectomy:Its Definition, Indications, and Surgical Approaches
Authors: Sasada Akinori , Ataka Keiji , Tsuchiya Kazuhiko , Yamagishi Hiroyuki , Maeda Hiromi , Okada Masayoshi 
Published: September 2007

There are three ways to approach and resect the
caudate lobe of the liver, that is; and isolated caudate
lobectomy, a combined resection of the liver overlying
the caudate lobe, and a transhepatic anterior
approach by splitting parenchyma of the liver.We had two patients with neoplasms originating
in the caudate lobe who underwent a complete
caudate lobectomy. Both patients have been doing
well without liver dysfunction. Although after the
transhepatic anterior approach we anticipated an
adverse effect from splitting the parenchyma of the
liver, the postoperative course was uneventful and
similar to that of the right side approach.
Surgical Management of CalcifiedHydatid Cysts of the Liver
Authors: Prousalidis J. , Tzardinoglou E. , Kosmidis Ch. , Katsohis K. , Aletras O. 
Published: September 2007

Hydatid disease of the liver is still a major cause of
morbidity in Greece. Beside the common complications
of rupture and suppuration, calcification of the
hepatic cysts represent a not well studied, less frequent
and sometimes difficult surgical problem. In
the present study 75 cases with calcified symptomatic
liver echinococcosis were operated on in the
1st Propedeutic Surgical Clinic between 1964 to
1996. Twenty‐eight patients were male and 47 female
with ages from 23 to 78 years. The diagnosis was
based mainly on the clinical picture and radiological
studies. In 5 cases the operative method was
cystopericystectomy. We performed evacuation of
the cystic cavity and partial pericystectomy and
primary closure of the residual cavity in 6 cases,
omentoplasty or filling of the residual cavity with a
piece of muscle of the diaphragm in 4 cases and
external drainage by closed tube, in 60 cases. In 12 of
those with drainage, after a period of time, a second
operation with easy, removal of most of the calcareous
wall plaques was performed. The mortality rate
was 2%.Our results could be considered satisfactory. In
the calcified parasitic cysts of the liver the proposed
technique is cystopericystectomy. An alternative
procedure is pericystectomy and drainage with
a “planned” reoperation with a bloodless, due
to intervening inflammation, chiseling of the
calcification.
Results of Surgical Treatment(Modified Sugiura‐Futagawa Operation) of PortalHypertension Associated to CompleteSplenomesoportal Thrombosis and Cirrhosis
Authors: Mercado Miguel Angel , Chan Carlos , Zenteno-Guichard Gustavo , Vásques Moisés , Hernández Jorge , Orozco Héctor 
Published: September 2007

Background Hemorrhagic portal hypertension, secondary
to both intrahepatic and extrahepatic portal
hypertension, is an uncommon entity. In this condition,
the extrahepatic and the intrahepatic obstruction
of the portal vein, due to chronic liver disease,
produce a more severe form of hemorrhagic portal
hypertension that is more difficult to control. The
results of surgical treatment (modified Sugiura‐
Futagawa operation) in this subset of patients is
analyzed.Methods Among 714 patients with a history of
hemorrhagic portal hypertension, 14 cases were
found with histologically proven liver cirrhosis
and complete splenomesoportal thrombosis demonstrated
by means of preoperative angiography.
Patients with incomplete (partial) splenomesoportal
thrombosis were excluded. There were nine males
and 5 females with a mean age of 51 years. Alcoholic
cirrhosis was demonstrated in 50% of the cases, post
hepatitic cirrhosis in 28%, primary biliary cirrhosis
in 7%, and cryptogenic cirrhosis in 14%. There were
nine Child‐Pugh A and 5 B cases. All cases were
treated by means of our modified Sugiura‐Futagawa
procedure.Results Bleeding recurrence from esophagogastric
varices was shown in one case, colonic varices in one
case and hypertensive gastropathy in another of the
survivors. Post operative encephalopathy was
shown in 3 of the cases. The thirty‐six month
survival rate was 30% (Kaplan‐Meier).Conclusions The combination of intrahepatic plus
extrahepatic portal hypertension has a worse prognosis.
Treatment options are limited (sclerotherapy
and/or devascularization), because shunt surgery,
TIPS and liver transplantation have a very restricted
role and postoperative outcome is poor.
The Real Incidence of Extracapsular (Satellite)Cysts of Liver Echinococcus
Authors: Voros Dionysios , Kalovidouris Angelos , Gouliamos Athanasios , Vlachos Lambros , Danias Nickolaos , Papadimitriou John 
Published: September 2007

Background: The presence of extracapsular (Satellite)
cysts in liver echinococcus granulosus is known
for many years. In one of our previous studies of
radiological (CT) material they were found to be
present in 16% of cases.Methods: In the present study the operative findings,
in cases of total capsectomy (cystopericystectomy)
or partial lobectomy are presented.Results: The real incidence of these cysts in
operative specimens was as high as 29,5%. They
were present in 15 out of 51 totally excised cysts.Conclusions: We conclude that satellite cysts are
present more often than they are radiologically
detected. As they can be incriminated as a cause of
recurrence of the disease they must be excised en
block with the main parasitic cysts, by means of
more radical procedures such as cystopericystectomy
or partial hepatectomy, whenever it is feasible.
Mucin Hypersecreting Intraductal PapillaryNeoplasm of the Pancreas
Authors: Kim Anthony W. , Ryan Anna , Millikan Keith W. , Doolas Alexander 
Published: September 2007

Mucin Hypersecreting Intraductal Papillary Neoplasm
is a rare neoplasm that arises from ductal
epithelial cells. This entity is distinct from the more
commonly known Mucinous Cystadenoma or Mucinous
Cystadenocarcinoma. Despite this distinction,
it has been erroneously categorized with these
more common cystic neoplasms. Characteristic clinical
presentation, radiographic, and endoscopic
findings help distinguish this neoplasm from the
cystadenomas and cystadenocarcinomas. Histopathologic
identification is not crucial to the
preoperative diagnosis. This neoplasm is considered
to represent a premalignant condition and, therefore,
surgical resection is warranted. Prognosis,
following resection, is felt to be curative for the
majority of patients.We present two cases of Mucin Hypersecreting
Intraductal Papillary Neoplasm and discuss their
diagnosis and surgical therapy.