bluuebunny/crossref_metadata_2025_split huggingface dataset:
Occupational risk to surgeons of unrecognized HIV infection in a low‐prevalence area
Authors: Evrard Serge , Meyer Pierre , van Haaften Korinne , Christmann Daniel , Marescaux Jacques 
Published: May 2005

AbstractData are available on the occupational risk to surgeons of the human immunodeficiency virus (HIV) for areas of high HIV prevalence but not for low‐risk areas and particularly for unrecognized HIV infection. The 40‐year cumulative occupational risk to surgeons caring for patients with unknown HIV serologies in a low‐prevalence area was estimated. From May 1989 to May 1991, 4119 consecutive patients with unknown HIV status, hospitalized in our department, were proposed for testing; 100% complied. Acquired immunodeficiency syndrome (AIDS) patients and known seropositive patients operated on during this period were excluded from the study. The prevalence of unknown HIV infection was 0.07%. Taking into account the rate of parenteral injuries, the rate of contamination after an infected parenteral injury, and the total number of operations performed during a 40‐year career, we estimated the cumulative risk of unknown HIV infection in our area to be 1%. This risk must be added to those of caring for known infected patients. In high‐risk areas (cumulative risk 10%), a high standard of infection control is required for every surgical procedure, even if it is expensive or of doubtful efficacy. It is unrealistic to apply this standard in a low‐risk area. HIV testing with informed consent of the patient is an imperfect guard against infection but has the advantage of alerting the surgeon to the risk of contamination on a case‐by‐case basis; it also offers the seropositive patient the best possibility for a longer life expectancy.
Appendicitis diagnosis today: Clinical and ultrasonic deductions
Authors: John Hubert , Neff Urs , Kelemen Milos 
Published: May 2005

AbstractA total of 111 patients referred with a diagnosis of suspected “appendicitis” were entered into a prospective study. The surgeon and radiologist in charge of ultrasonography made separate diagnoses, and their findings were then combined and discussed as indications for surgery. Clinically, a history of pain migration proved to be reliable (p < 0.0001) as a diagnostic indicator, in contrast to nausea and initial irregularity of bowels. The duration of symptoms was significantly shorter in patients with proved appendicitis than among patients with negative findings (median 24 hours compared with 41 hours,p<0.04). Among patients with perforated appendicitis, the symptomatic history was prolonged (not significantly) by 3 hours. Peritoneal signs such as pain on percussion, rebound tenderness, guarding, and a leukocytosis of more than 13,000/mm3 were indicative of appendicitis (p=0.0001 for each sign). Lively bowel sounds excluded the possibility of appendicitis (p=0.001). Scanty bowel sounds, rectal tenderness, axillorectal temperature difference, and a left shift in leukocytes were of no diagnostic significance. The doctor's “clinical experience” is significant at the level ofp<0.03. On ultrasonography, the following signs were indicative of appendicitis: periappendicular infiltration (p=0.0003), a visible “cockade,” and an appendix larger than 12 mm in diameter (p=0.04). For 75% of the patients the surgeon was sure of his own clinical diagnosis and did not allow himself to be influenced by the sonographic findings. In 12% of doubtful cases ultrasonographic results decisively favored operation, and in 4.5% (n = 5) it prevented an unnecessary laparotomy in the presence of positive clinical symptoms. Among the patients without appendicitis (n = 56) the diagnosis could be definitely excluded by ultrasonography in 45% (n = 25); for the other patients without appendicitis ultrasonography did not provide a conclusive diagnosis. We deduce from our results that clinical examination is still the most important basis for decision making regarding the diagnosis of appendicitis but that it may be successfully supplemented by ultrasonography in doubtful cases.
Neoadjuvant chemotherapy for high‐grade advanced gastric cancer
Authors: Yonemura Yutaka , Sawa Tosiharu , Kinoshita Kazuo , Matsuki Nobuo , Fushida Sachio , Tanaka Sigehiro , Ohoyama Shigekazu , Takashima Tooru , Kimura Hironobu , Kamata Tooru , Fujimura Takashi , Sugiyama Kazuo , Shima Kouzou , Miyazaki Itsuo 
Published: May 2005

AbstractFifty‐five patients with high‐grade advanced gastric cancer in whom the presence of stage IV was confirmed by preoperative diagnostic imaging were treated with PMUE therapy by a combined use of cisplatin (CDDP) 75 mg/m2, mitomycin C (MMC) 10 mg/body, etoposide 150 mg/body, and UFT (a combination of 1‐(2‐tetrahydrofuryl)‐5‐fluorouracil and uracil in a molar ratio of 1∶4) 400 mg/day. CDDP and MMC was administered intravenously on the first day, followed by etoposide 50 mg/day on the 3rd, 4th, and 5th days. All the patients had measurable lesions that were evaluated by computed tomography scanning before and after the treatments. These patients were allocated randomly to two groups. Of these cases, 29 belonged to the neoadjuvant chemotherapy (NAC) group to whom PMUE therapy was given preoperatively; the remaining 26 patients underwent operation first and received PMUE thereafter (control group). Background factors did not differ significantly between the two groups. The response rate was higher in the NAC group than in the control group (62% in the former versus 35% in the latter). The resectability rates were 79% and 88% in the NAC and control groups, respectively. However, the rate of potentially curable cases was higher in the NAC group than in the control group (38% in the former versus 15% in the latter). Among the nonresection cases, the prognosis was highly unfavorable in both groups. In the resection cases, however, the survival rate was significantly better in the NAC group than in the control group. These results may indicate that in patients with high‐grade, advanced gastric cancer initial chemotherapy (neoadjuvant chemotherapy) and then surgery should be considered.
Adenomas and hyperplastic polyps in screening studies
Authors: Bech Karsten , Kronborg Ole , Fenger Claus 
Published: May 2005

AbstractA survey is given of colorectal polyps detected in a prospective randomized screening study with the fecal occult blood test. It is demonstrated that colonoscopy in persons with positive Hemoccult‐II tests results in detection of and removal of a higher number of adenomas than among controls. The strategy may, therefore, possibly be followed by a reduction of the incidence of colorectal cancer. Screen‐detected adenomas were most often in males and were larger than among controls; they were most often in the sigmoid colon, whereas the rectum was the most frequent location for adenomas in controls. Eight percent of persons with screen‐detected adenomas had some symptoms, which could be referred to adenomas, in contrast to 50% among controls.Hyperplastic polyps served as markers for adenomas in persons with positive Hemoccult‐II as well as in controls with adenomas detected by colonoscopy; however, most persons with adenomas had no hyperplastic polyps.Endoscopic polypectomy did not result in any severe complications, but surgical removal in 2 of 22 patients proved fatal.The results presented are compared with those of other prospective randomized trials. The optimistic view—that the incidence of cancer may be reduced by polypectomy in persons with positive Hemoccult‐II tests—stresses the importance of securing optimal colonoscopy service.
Endoscopic treatment of adenomas
Authors: Waye Jerome D. 
Published: May 2005

AbstractThe endoscopic removal of colon polyps can be safely and efficiently accomplished when established principles of colonoscopy and electrosurgery are followed. This technique requires the proper equipment, a skilled endoscopy assistant, and a well‐trained, experienced endoscopist. Complete mastery of basic colonoscopy is essential along with an understanding of the concepts of electrocautery and knowledge concerning the structural configurations of polyps.
Surgical treatment of adenomas
Authors: Nicholls R. John 
Published: May 2005

AbstractSurgical treatment of adenomas may become necessary when the base of the polyp is too wide for snaring, increasing the risk of incomplete removal or perforation of the bowel wall. Suspicion of malignancy may also indicate surgery. Multiple adenomas not controlled by snare polypectomy can be treated by colectomy. The different approaches of surgical treatment are described.
Follow‐up after polypectomy
Authors: Winawer Sidney J. 
Published: May 2005

AbstractProgress in understanding the biology, natural history, and relationship to colorectal cancer has provided the basis for a rational approach to patients with adenomas. Pathological assessment of polyps is essential for initial management; only adenomas require search for synchronous neoplasia. A finding of a 30%–50% synchronous rate has been observed. After clearing of the colon of all adenomas, follow‐up examination will reveal a 30%–50% rate of metachronous adenomas, but usually with unimportant pathology. Patients with no special concerns at initial polypectomy can have surveillance at intervals of approximately 3 years, while those with an incompletely cleared colon, numerous polyps, or large sessile or malignant adenomas need individualized surveillance. Working guidelines can be provided at this time pending observations in ongoing trials. It is expected but not yet proven that control of colonic adenomas will reduce the incidence and mortality from colorectal cancer. Further research into the biology of adenomas and cancer will undoubtedly provide a clear understanding of susceptibility for colorectal adenomas and more selective control strategies.
Treatment of carcinoma in adenomas
Authors: Muto Tetsuichiro , Sawada Toshio , Sugihara Kenichi 
Published: May 2005

AbstractInvasive carcinomas in polyps removed during endoscopy are described. Most of them can be treated adequately by polypectomy alone, but some need additional surgical treatment. Incomplete excision, poorly‐differentiated carcinoma, and lymphatic invasion are associated with increased risk of residual carcinoma and lymph node metastases, making colorectal resection more attractive; however, in elderly patients and poor‐risk patients, the risks of surgery should be balanced against the possible advantage of curative surgery. Rectal polyps may be large but sphincter preservation can usually be achieved by different types of local excision. Recently described flat adenomas may contain carcinoma, but may also be treated by polypectomy using snare or hot biopsy.
Management of acute volvulus of the sigmoid colon: A new approach by percutaneous deflation and colopexy
Authors: Salim Aws S. 
Published: May 2005

AbstractForty‐one consecutive patients with acute sigmoid volvulus were prospectively randomized into 2 groups to compare percutaneous deflation prior to emergency tube decompression followed electively by colopexy with banding (n=20) versus emergency tube decompression followed electively by sigmoid colectomy (n=21). Of 21 patients subjected to tube decompression, the procedure was successful in 15 (71%). Emergency sigmoid colectomy was done in the remaining 6 patients and 3 of them died postoperatively. Percutaneous deflation enabled all patients (n=20) to have successful tube decompression without complications. Two of the patients (13%) who underwent elective sigmoid colectomy died postoperatively and another 2 developed wound infections, whereas colopexy by banding caused no mortality and only 1 patient (5%) developed a wound infection. Disconnection of the intravenous line, consumption of solid food, and discharge from the hospital were each effected at significantly (p <0.001) earlier postoperative times with colopexy than with sigmoid colectomy. Both of these elective procedures were equally effective in preventing recurrence of the volvulus. During 1 year of follow‐up, colopexy was not observed to cause any abdominal pain or alteration in bowel habits.This study shows that percutaneous deflation of acute sigmoid volvulus is a rapid and safe method which enables successful sigmoidoscopic decompression with avoidance of emergency surgery and its high mortality rates. The study also shows that colopexy by banding is a simple elective procedure which overcomes the limitations of mesenteropexy and resectional surgery.
Sequential abdominal reexploration with the zipper technique
Authors: Cuesta M. A. , Doblas M. , Casta∼neda L. , Bengoechea E. 
Published: May 2005

AbstractFrequently, several multiple abdominal reexplorations are needed in patients with acute necrotizing hemorrhagic pancreatitis (ANP) or with persistent intraabdominal sepsis (PIAS). Residual undrained necrotic and septic foci lead to multiple organ failure. To provide wide‐open drainage of the abdominal cavity, since 1985 we have performed sequential abdominal reexploration with the zipper technique (SARZT) in 24 patients.Apache II score was used to evaluate expected mortality. In the pancreatic necrosis group, with a mean Apache II score of 31, the expected and the observed mortality were 70% and 29%, respectively. In the PIAS group, with a mean Apache II score of 30, the expected and observed mortality were 60 and 28%, respectively. These results are attributed to the sequential reexploration of the abdominal cavity that permits excision and drainage of necrotic and septic foci.
Primary jejunoileal tumors: A review of 45 cases
Authors: Desa L. A. J. , Bridger J. , Grace P. A. , Krausz T. , Spencer J. 
Published: May 2005

AbstractWe reviewed 45 patients who underwent surgery for primary jejunoileal tumors over a 15‐year period. There were 16 benign and 29 malignant tumors, which included 13 lymphomas, 7 adenocarcinomas, 7 carcinoid tumors, and 2 leiomyosarcomas. Eighteen patients, 13 of whom had benign tumors, presented with intestinal bleeding and 5 tumors were found incidentally at laparotomy. Benign lesions were more frequently sited in the jejunum while malignant lesions were more common in the ileum (p<0.001). Lesions presenting with hemorrhage were more likely to be benign than malignant (p<0.001) and were more commonly sited in the jejunum than in the ileum (p<0.05). Visceral perforation (31%), intestinal obstruction (21%), and an abdominal mass (17%) were other presenting features in patients with malignant tumors. In spite of a wide variety of investigations, the correct diagnosis was reached preoperatively in only 31% of patients. Surgical management included either limited bowel resection or segmental resection with regional lymphadenectomy. Operative mortality was 13% and morbidity was 36%. Actuarial 5‐year survival for all malignant tumors was 24%, being 64% at 5 years for carcinoid tumors, 20% at 30 months for adenocarcinomas, and 10% at 42 months for lymphomas. These results reemphasize the need for a high index of suspicion and early laparotomy in patients with obscure intestinal symptoms if the prognosis of small bowel tumors is to improve.
Falls in hemoglobin saturation during ERCP and upper gastrointestinal endoscopy
Authors: Al‐Hadeedi S. , Leaper D. J. 
Published: May 2005

AbstractFiberoptic endoscopy is practiced everyday in the field of gastroenterology and, for diagnostic purposes, carries a risk of complications and an estimated mortality of 1∶5,000, which is multiplied several times during interventional procedures. Half of these complications have a cardiopulmonary origin which may be anticipated by the use of pulse oximetry to measure hemoglobin saturation (SaO2).We studied 132 patients undergoing diagnostic or procedural endoscopic retrograde cholangiopancreatography (ERCP) under sedation, and 51 undergoing esophagogastroduodenoscopy (EGD) without sedation. In the ERCP group, SaO2fell from 95.7±2.4% (mean ±standard deviation) to 88.9±6.4% (p<0.001) with a corresponding rise in pulse from 95±19 to 116±18/min (p<0.001) followed by recovery. The largest falls followed positioning of the endoscope (rather than following administration of the sedative or the procedure), particularly during introduction of the endoscope within 1 minute of administering diazemuls (diazepam). The EGD group also had a fall in SaO2(97.3±1.9% to 93.9±3.3%,p<0.001), although the patients were younger and undergoing shorter examinations. Again, the largest falls occurred 1 minute after introduction of the endoscope.In subgroups of patients undergoing ERCP, analysis of respiratory patterns using spectral techniques and electrocardiogram during endoscopy (n=25), or peripheral perfusion using transcutaneous oximetry and laser Doppler velocimetry (n=12) was undertaken. No correlations were found in relation to changes in SaO2.The cause of the fall in SaO2during endoscopy is multifactorial. It is known to be related to a fall in blood pressure and, although we could not demonstrate any obvious change in peripheral perfusion, this may still be occurring and affecting pulse oximetry readings which are less accurate in poor perfusion states. We recommend its use, however, during endoscopy and, after intravenous sedation, it might be safer to wait 2 minutes and document that the SaO2is satisfactory before introducing the endoscope.
Surgical treatment of severe postshunt hepatic encephalopathy
Authors: Dagenais Michel H. , Bernard Denis , Marleau Denis , Morgan Stephen , Tassé Daniel , Wassef Ramsès , Villeneuve Jean‐Pierre , Pomier‐Layrargues Gilles , Willems Bernard , Lavoie Pierre 
Published: May 2005

AbstractHepatic encephalopathy is a major complication of portal‐systemic shunts with an incidence ranging up to 52%. A small fraction of these patients are refractory to medical therapy. Shunt ligation and colonic procedures are the main surgical approaches. The goal of the latter is to diminish the colonic absorption of nitrogenous substances which are involved in the pathophysiology of hepatic encephalopathy. Six patients, whose average age was 55.7±2.6 years, were operated for severe postshunt encephalopathy requiring 4.3±0.9 admissions for a total duration of 76±26 days over 1–11 years. One patient had undergone a splenoral shunt and 5 had a portacaval shunt. One ligation of the shunt and 5 colon exclusions were performed. The average postoperative hospital stay was 21.5±3.9 days. The mean follow‐up was 47±20 months. The patient with the shunt ligation remains free of encephalopathy 94 months after the procedure and has not bled from his esophageal varices. Among the 5 colon exclusion patients, there were 1 death and 3 complications. Three patients were completely relieved of their hepatic encephalopathy. One of those 3 died of a subarachnoid hemorrhage 28 months after the surgery. The fourth still needs medication to control a persistent, although improved, encephalopathy that required 2 further hospitalizations. Colon exclusion is a useful intervention in very selected cases. It has a lower operative mortality than total colectomy and the advantage over shunt ligation of not reestablishing hypertension in the portal system.
Prospective randomized double‐blind trial of branched chain amino acid enriched versus standard parenteral nutrition solutions in traumatized and septic patients
Authors: Vente Johannes P. , Soeters Peter B. , von Meyenfeldt Maarten F. , Rouflart Margriet M. J. , van der Linden Cees J. , Gouma Dirk J. 
Published: May 2005

AbstractThe addition of branched chain amino acids (BCAA) to total parenteral nutrition (TPN) solutions of balanced aminoacid composition has been reported to result in improved nitrogen balance, preservation of plasma protein levels, and improved immune function; however, only a few large clinical studies have been performed, yielding conflicting results. We, therefore, studied in a prospective, randomized double blind trial, the effects of BCAA enrichment of an otherwise isonitrogenous and isocaloric TPN solution on plasma protein levels in 101 traumatized and septic patients.TPN‐derived nitrogen intake was similar in both study groups. Nitrogen balances in the BCAA group (n=49) were not different from those in the standard group (n=52). Plasma total protein levels increased significantly in the standard group resulting in a significant difference between study groups on day 7. Pre‐albumin levels increased significantly in the BCAA group and in the standard group. The number of neutrophils (rods) was significantly lower in the standard group compared to the BCAA group on day 7. Lymphocytes increased significantly in the standard group as did the number of platelets, resulting in a significant difference between study groups on day 7.We conclude that BCAA enrichment of standard TPN solutions does not result in more efficient nitrogen metabolism in septic or traumatized patients.
Complicated pneumothorax: Short‐ and long‐term results of endoscopic fibrin pleurodesis
Authors: Hauck Herwig , Bull Philippe G. , Pridun Nestor 
Published: May 2005

AbstractComplicated pneumothorax is defined as a recurrent or persistent air leak in the pleural interspace beyond 5 days despite adequate tube drainage. Up to now, this disorder could only be corrected by open thoracotomy. Endoscopic fibrin pleurodesis is shown to be a method that could obviate, in most cases, the need for thoracotomy. In the last 6 years, 138 of 153 patients presenting with complicated spontaneous pneumothorax were treated with this method. The fibrin sealant consists of 2 components: fibrinogen, factor XIII, and albumin dissolved in aprotinin (3,000 KIU/ ml), and a thrombin calcium chloride solution, which is applied through the working channel of a thoracoscope and vaporized with nitrous oxide. In this observation period, 6 (4.4%) recurrences were observed, which were subsequently treated with thoracotomy; a second attempt at fibrin pleurodesis was not undertaken. In all cases, endoscopic sealing was followed by prompt reexpansion of the collapsed lung. Long‐term follow‐up was satisfactory, pulmonary function tests showed no signs of restrictive dysfunction, and pleural fibrosis was not observed on x‐ray as reported in other modes of treatment. Following these results, it is concluded that this method is useful in cases of persistent, therapy‐resistant, complicated spontaneous pneumothorax; its effects are durable and it has a low rate of recurrence. It produces a physiological healing process without damage to the pleura.
Unresolved surgical issues in the management of patients with Zollinger‐Ellison syndrome
Authors: Norton Jeffrey A. , Jensen Robert T. 
Published: May 2005

AbstractIn the last 10 years, there have been a number of major advances that have markedly changed the management of patients with Zollinger‐Ellison syndrome. These advances have been described recently in a number of excellent reviews [1–3]. After reading each of these reviews, including our own, one is left generally with the impression that most of the important problems and particularly those involving surgery in the treatment of this disease have been resolved; however, in considering the possible problems to address in protocols in the coming years in our patients with Zollinger‐Ellison syndrome followed at the National Institutes of Health, it became apparent to us that not only will surgery play an increasingly important role in the management of this disease, but that there are a number of major questions in which various aspects involving surgery are not resolved. Furthermore, resolution of a number of these areas will have applicability to the surgical treatment of other islet cell tumors. The purpose of this article is to call attention to these questions with the hope that other investigators may also consider these and specifically attempt to address some of these issues in the surgical treatment of Zollinger‐Ellison syndrome in prospective studies.