bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk and Outcome of Bowel Resection in Patients with Incarcerated Groin Hernias: Retrospective Study
Authors: Kurt Necmi , Oncel Mustafa , Ozkan Zeynep , Bingul Sadik 
Published: January 2004

AbstractThe goal of this retrospective study was to evaluate factors that increase the risk of bowel necrosis and document the outcome of bowel resection in patients with strangulated hernias. We identified 102 patients (60 men, 42 women) who underwent surgical treatment for an incarcerated hernia at the Kartal Education and Research Hospital Emergency Unit between April 1997 and April 2001. Patients in group 1 required intestinal resection (n = 16), and patients in group 2 did not (n = 86). The median age of the patients was 53 years (range 3–96). Demographic and surgical data were obtained from the patients’ charts and compared between the two groups. Women required bowel resections more often than men (p < 0.05). Patients older than 65 years and those with femoral or epigastric hernias required resection more often than patients younger than 65 years and those with inguinal, umbilical, or incisional hernias (p < 0.05 for all). Group 1 patients had a longer hospitalization and experienced more overall complications and wound infections than group 2 (p < 0.05 for all). In conclusion, incarcerated hernias are more common in men, but intestinal resection is required more often in women. The risk of intestinal resection is higher for patients with femoral hernias and those older than 65 years. Patients who undergo intestinal resection have a higher overall complication rate related to wound infections but not an increased risk of other complications or mortality.
Physiologic Studies on Nitric Oxide in Rat Small Bowel Isografts
Authors: Tomita Ryouichi , Fujisaki Shigeru , Park Eichi , Kimizuka Kei 
Published: January 2004

AbstractThe enteric nervous system (ENS), especially the nonadrenergic noncholinergic (NANC) inhibitory nerves, is an important factor in intestinal peristalsis. Recently, it was established that nitric oxide (NO) is released after stimulation of NANC inhibitory nerves. Inhibitory nerves such as NANC inhibitory nerves in the ENS are more easily damaged than excitatory nerves by reperfusion or ischemic injuries during small bowel transplantation (SBT). To evaluate the effects of reperfusion and ischemic injuries to the ENS in the transplanted small bowel, we examined the ENS responses, including the effects of NO in the isografted rat jejunum, using the nontransplanted jejunum as a control. To avoid potentially confounding immune phenomena, we used syngeneic Lewis (LEW) rats. Orthotopic entire SBT with portocaval drainage was performed from LEW rats to LEW rats. Isografted muscle strips were obtained from 8 LEW rats 130 days after SBT (n = 24). As controls, normal muscle strips of the jejunum were obtained from 20 nontransplanted LEW rats (n = 60). A mechanograph was used to evaluate in vitro jejunal responses to electrical field stimulation of the adrenergic and cholinergic nerves before and after treatment with various autonomic nerve blockers, Ng‐nitro‐l‐arginine (L‐NNA), and l‐arginine. The results indicated that excitatory nerves, especially NANC excitatory nerves, were more dominant in the isografted jejunum than in the normal jejunum (p < 0.01). NANC inhibitory nerves were found to act on the normal jejunum and to a lesser extent on the isografted jejunum (p < 0.05). NO mediates the relaxation reaction of NANC inhibitory nerves in the normal jejunum and to a lesser extent in the isografted jejunum. These results indicated that the intrinsic intestinal innervation contains excitatory and inhibitory nerves and that the former, especially NANC excitatory nerves, are more dominant in the isografted jejunum than in the normal jejunum. In addition, reduction of the action of NANC inhibitory nerves such as that by NO may be largely related to impaired motility in the isografted jejunum. Thus over a long period of time (more than 130 days after SBT) transplanted small bowel dysmotility may be influenced by reperfusion or ischemic injury to the ENS (especially NANC inhibitory nerves) via NO in the transplanted jejunum after syngeneic SBT.
Transthoracic versus Transabdominal Surgical Approach for Echinococcal Cysts Located over the Superoposterior Aspect of the Right Lobe of the Liver
Authors: Smyrniotis Vassilios E. , Kostopanagiotou Elias K. , Farantos Charalampos I. , Katis Constantinos I. , Kostopanagiotou Georgia G. 
Published: January 2004

AbstractA retrospective study of 80 patients operated on for hydatid cysts located on the superoposterior aspect of the right lobe of the liver (segments VI, VII, VIII) is presented. Right thoracotomy was performed in 30 patients, and 50 patients were operated on through bilateral subcostal incisions. The two approaches were compared in terms of radicality and morbidity. The transabdominal approach produced superior results and fewer postoperative complications, resulting in a shorter hospital stay (11 ± 5 vs. 18 ± 8 days). Total cystopericystectomy was feasible in 30% of patients operated on transabdominally and in 6% of those approached transthoracically. The rest of the patients were offered partial pericystectomy, except three in the thoracotomy group who underwent simple drainage of the cavity. We recommend that the transabdominal approach be the first choice for treatment of liver hydatid cysts irrespective of their location and size. We abandoned the transthoracic approach for cysts located on the superoposterior aspect of the right liver lobe in 1996. The transabdominal approach enables the surgeon to treat liver hydatidosis in a more radical, safer manner than does the transthoracic approach.
Chromoendoscopic Evaluation of Gastric Mucosa after Partial Gastrectomy by Use of Modified Endoscopic Congo Red Test
Authors: Tóth Ervin , Sjölund Kristina , Thorlacius Henrik 
Published: January 2004

AbstractThe need for partial gastrectomy has decreased as a result of reduced incidence and improved endoscopic and medical treatment of peptic ulcer disease. Nonetheless, several patients with resected stomach remain in the population, and it is well known that important pathological changes can occur in the gastric remnant. We evaluated the morphological and functional status of the gastric stump by use of modified endoscopic Congo red test (MCRT). For this purpose, 87 partially gastrectomized (Billroth I and II) patients referred for elective gastroscopy were consecutively enrolled. We found a high prevalence of severe chronic atrophic fundal gastritis (CAFG) (67%) in the gastric remnant. We also observed, however, that one‐third of the patients had almost unaffected gastric acid production even as long as 26 years after partial gastrectomy. Moreover, the accuracy, sensitivity, and specificity of routine gastroscopy in diagnosing CAFG in the gastric stump were found to be 55%, 50%, and 84%, respectively. The presence of bile reflux correlated well with the degree of CAFG. Importantly, we observed that more than 71% of the patients receiving acid‐suppressing therapy had no or very little capacity to produce gastric acid. Taken together, our study has demonstrated that MCRT is a simple and well‐tolerated method providing important morphological and functional information about the mucosa of the resected stomach. Furthermore, MCRT was superior to routine gastroscopy in diagnosing CAFG in the gastric stump. Outcome studies should define the clinical benefit of MCRT in the management of patients with resected stomach.
Pathophysiological Studies on the Relationship between Postgastrectomy Syndrome and Gastric Emptying Function at 5 Years after Pylorus‐preserving Distal Gastrectomy for Early Gastric Cancer
Authors: Tomita Ryouichi , Fujisaki Shigeru , Tanjoh Katsuhisa 
Published: January 2004

AbstractPylorus‐preserving distal gastrectomy (PPG) has frequently been performed on patients with early gastric cancer in Japan to prevent the postgastrectomy syndrome seen after conventional distal gastrectomy (CDG). The long‐term postoperative quality of life (QOL) and gastric emptying function in patients after PPG has not been assessed in detail. To clarify the usefulness of PPG for treating early gastric cancer we investigated the relation between postgastrectomy syndrome and gastric emptying function 5 years after PPG and then compared the results with those 5 years after CDG. Altogether, 32 patients who underwent curative gastrectomy at our clinic for early gastric cancer (submucosal cancer without lymph node metastasis) were studied. Ten subjects who underwent PPG with D2 lymphadenectomy without preserving the hepatic and pyloric branches of the vagal nerve [group A: eight men, two women; age 33–70 years (mean 60.7 years)] were interviewed and asked about appetite, weight loss, epigastric fullness, reflux esophagitis, and early dumping syndrome. They were compared with patients after CDG [group B: 36–72 years (mean 63.6 years)]. Esophagogastric endoscopy, abdominal ultrasonography, and gastric emptying function were also studied. The gastric emptying time of a semisolid diet was measured with a radioisotope method using 99mTc‐labeled rice gruel; the gastric emptying time of a liquid diet was measured with the acetaminophen method using orange juice. The control subjects (group C) consisted of 18 healthy volunteers (10 men, 8 women) without gastrointestinal symptoms aged 38 to 68 years (mean 60.8 years). The following results were obtained: PPG (group A) alleviated postoperative gastrointestinal symptoms such as appetite loss, reflux esophagitis, early dumping syndrome, lost body weight, endoscopic reflux esophagitis, endoscopic gastritis in the remnant stomach, and postogastrectomy cholecystolithiasis better than did CDG (group B). The only weak point with the PPG procedure was that it produced a feeling of epigastric fullness. The pattern of the gastric emptying curve for the semisolid diet was almost the same among groups A, B, and C, although delayed gastric emptying was clearly more frequent in group A than in group B or C (p < 0.05). Gastric emptying with the liquid diet in group B was significantly faster than that in groups A and C (p < 0.01). Gastric emptying in groups A and C was similar. These results showed that PPG improved the postoperative QOL, but the delayed emptying of semisolid diet after PPG led to a feeling of epigastric fullness after meals due to retention of contents in the residual stomach. Epigastric fullness after meals continued in many patients after PPG. Thus the only disadvantage of the PPG procedure is the sensation of epigastric fullness and gastric stasis due to delayed gastric emptying of a semisolid diet.
Risk Factors and Management of Bile Leakage after Hepatic Resection
Authors: Nagano Yasuhiko , Togo Shinji , Tanaka Kuniya , Masui Hidenori , Endo Itaru , Sekido Hitoshi , Nagahori Kaoru , Shimada Hiroshi 
Published: January 2004

AbstractThe aim of this study was to identify the perioperative risk factors for postoperative bile leakage after hepatic resection and to propose a treatment strategy for such leakage when it does occur. Between 1992 and 2000 a total of 313 hepatic resections without choledocojejunal anastomosis were performed at our institute. Risk factors related to bile leakage were identified with univariate analysis, and strategies were evaluated in relation to the findings of postoperative fistulography. Postoperative bile leakage developed in 17 patients (5.4%). Univariate analysis identified high risk factors as advanced age, a wide surface area of the incision (bile leakage group versus no bile leakage group: 102.1 vs. 66.4 cm2, p < 0.05), and exposure of Glisson’s sheath at the cut surface (e.g., central bisegmentectomy, S4, S8 subsegmentectomy). Groupings of patients by their postoperative fistulography results showed that patients with involvement of the proximal bile duct were slower to heal than those with no demonstrable bile duct involvement. The one patient whose fistulogram demonstrated peripheral bile duct involvement had uncontrollable leakage and required reoperation. Hepatectomies with a wide surface area and those that expose the major Glisson’s sheath present serious risk factors for bile leakage. When the fistulogram shows proximal bile duct involvement, endoscopic nasobiliary tube drainage is necessary; when the fistulogram shows peripheral bile duct involvement, reoperation is needed.
Diagnosis and Treatment of Inferior Vena Caval Invasion by Hepatic Cancer
Authors: Okada Yoshito , Nagino Masato , Kamiya Junichi , Yamamoto Hideo , Hayakawa Naokazu , Nimura Yuji 
Published: January 2004

AbstractHepatectomy with concomitant resection of the inferior vena cava (IVC) has become common for hepatic malignancies involving the IVC. However, diagnosing IVC invasion and the procedure of choice have yet to be standardized. Medical records of nine patients with liver cancer (five metastatic tumors from colorectal cancer and four intrahepatic cholangiocarcinomas) believed to have directly invaded the IVC wall were retrospectively abstracted for data on preoperative radiologic studies, surgical procedures, histology of the resected specimen, and treatment outcome. All nine patients underwent hepatectomy: Five did not undergo IVC resection because the IVC could be isolated from the tumor; the remaining four underwent combined IVC resection (wedge and segmental resections in two each). The segmentally resected IVC was reconstructed using an external iliac vein graft. Total hepatic vascular exclusion, venovenous bypass, and the ex vivo technique were not used. Interestingly, the tumor was smaller and the percentage of the IVC circumference in contact with tumor as seen on computed tomography (CT) was less in patients with IVC invasion than in those without it (40 ± 11 vs. 134 ± 61 mm, p < 0.05; 30% ± 8% vs. 60% ± 20%, p < 0.05). The length of the IVC compressed by tumor on cavography was similar in the two patient groups (47 ± 9 vs. 55 ± 8 mm). All patients were discharged from the hospital in good condition: Seven died of cancer recurrence, and the remaining two are currently alive and disease‐free 15 and 73 months after surgery, respectively. In conclusion, imaging modalities demonstrating caval deformation, such as CT and cavography, are unreliable for diagnosing direct invasion of the IVC wall. Even when IVC invasion is strongly suggested by conventional radiologic studies, the surgeon should endeavor to peel the tumor from the IVC. This strategy is important to avoid unnecessary resection of the IVC, use of a prosthetic graft, or ex vivo hepatectomy.
Carl Gussenbauer: Pioneer in Pancreatic Surgery
Authors: Schnelldorfer Thomas , Kitvarametha Yan Y. , Adams David B. 
Published: January 2004

AbstractCarl Gussenbauer (1842–1903), known for many contributions to surgery, should also be noted prominently in the list of pioneers of pancreatic surgery. His successful performance of external drainage for a pancreatic cyst in 1882 was the first planned pancreatic operation. Although pancreatic surgery had been developed in animal models during the seventeenth century, surgery of the human pancreas was practically nonexistent owing to the dismal results seen with incidental pancreatic operations done early in the nineteenth century. Gussenbauer’s procedure was a significant advance, representing a safe and effective solution to the pancreatic cyst problem. Gussenbauer’s external drainage procedure remained the gold standard for treating pancreatic cysts until the 1920s and was still a widely practiced therapeutic option until the 1950s. With his discipline, insight, and innovative thought, Gussenbauer initiated the modern era of pancreatic surgery.
Change in Mitochondrial Membrane Potential in Peripheral Blood Lymphocytes, Especially in Natural Killer Cells, Is a Possible Marker for Surgical Stress on the Immune System
Authors: Takabayashi Arimichi , Kanai Michiyuki , Kawai Yasuhiro , Iwata Shingo , Sasada Tetsuro , Obama Kazutaka , Taki Yoshiro 
Published: January 2004

AbstractThere is accumulating evidence that surgical stresses cause impairment of systemic immune responses, which may promote susceptibility to infection as well as growth of remnant cancer cells in cancer patients. Although alterations in numbers, populations, and functions of lymphocytes have been extensively studied to assess modulation of the immune system, the precise mechanisms of immunosuppression caused by surgical stresses have not been identified, nor have methods been developed to estimate the magnitude of surgical stresses on the immune system. In the present study, to evaluate the effects of surgical procedures on the immune system, the mitochondrial membrane potential (ΔΨm) of peripheral blood lymphocytes (PBL) from 25 patients who underwent various types of operation was measured by flow cytometry using 3,3′‐dihexiloxacarbocyanine iodide (DiOC6(3)) on the day before operation and on postoperative day (POD) 1, POD 3, and POD 7. The ΔΨm in PBL, especially in natural killer (NK) cell population, was reduced after major surgery. In particular, the reduction of ΨΔm in NK cells appeared to be proportional to the severity of the surgical procedures and reflected the impairment of cellular function. Interestingly, the ΔΨm in NK cells was also negatively correlated with the level of plasma noradrenaline after major surgery, suggesting that the reduction of ΔΨm in NK cells induced by surgical stresses may bemediated, at least in part, by the accompanying increase in plasma noradrenaline. Monitoring of ΔΨm in PBL after operation may be one of the useful markers for estimating the magnitude of surgical stresses on the immune system.
Plastic Iodophor Drape during Liver SurgeryOperative Use of the Iodophor‐impregnated Adhesive Drape to Prevent Wound Infection during High Risk Surgery
Authors: Yoshimura Yasuko , Kubo Shoji , Hirohashi Kazuhiro , Ogawa Masao , Morimoto Ken , Shirata Kumiko , Kinoshita Hiroaki 
Published: January 2004

AbstractWe retrospectively investigated factors associated with wound infection after liver resection for hepatocellular carcinoma (HCC), with special reference to use of a plastic adhesive drape impregnated with iodophor. The subjects were 296 patients undergoing liver resection for HCC. Wound infection was defined as purulent drainage from the superficial incision with or without laboratory confirmation. One or more of the following signs was required: pain or tenderness, localized swelling, or redness or heat. Wound infection developed in 25 patients. Regression analysis indicated that low body mass index (BMI), smoking, long preoperative hospital stay, and nonuse of iodophor drapes were risk factors for wound infection. Wound infection was significantly less likely with the use of iodophor drapes (3.1%) than for surgery without iodophor drapes (12.1%). By multivariate regression analysis, BMI, smoking, and lack of drape use were independent risk factors. Most of the bacteria isolated were skin bacteria, including Staphylococcus aureus and Staphylococcus epidermidis. In conclusion, low BMI, smoking, a long preoperative hospital stay, and the lack of iodophor drape use were risk factors for wound infection after liver resection for HCC. The drapes presumably prevented contamination from the skin during the operation.
Diagnosis and Management of Primary Aldosteronism
Authors: Wheeler Malcolm H. , Harris Dean A. 
Published: January 2004

AbstractIdentifying primary aldosteronism within the hypertensive population is an important clinical challenge, as most patients with a unilateral source of excess aldosterone secretion are amenable to surgical cure. At least 20% of patients with primary aldosteronism have normal serum potassium levels. Therefore, screening tests should not be based on recognition of hypokalemia alone. Rather, the diagnosis should depend on identifying renin suppression and measuring the ratio of plasma aldosterone concentration to plasma renin activity. The diagnosis may be confirmed by performing an aldosterone suppression test after oral salt loading. Once primary aldosteronism has been established, it is necessary to exclude glucocorticoid‐remediable aldosteronism and then proceed to localization studies. Detecting a unilateral source of aldosterone, usually due to an adenoma (Conn syndrome), is achieved by postural hormonal testing and confirmed by selective venous sampling (SVS) with measurement of aldosterone concentrations (expressed as the aldosterone/cortisol ratio) in each adrenal vein. SVS is enjoying a revival in many institutions as it is more sensitive and specific than either cross‐sectional imaging or scintigraphy and has the potential to influence significantly both the diagnosis and clinical decision‐making. Patients with unilateral disease are ideally treated by laparoscopic adrenalectomy. Patients in whom localization is not achieved usually have bilateral adrenal hyperplasia and are treated medically.
Temperature-dependent fractionation of stable oxygen isotopes in otoliths of juvenile cod (Gadus morhua L.)
Authors: Høie Hans , Otterlei Erling , Folkvord Arild 
Published: January 2004

Abstract
Analysis of stable oxygen isotopes in otoliths is a promising technique for estimating the ambient temperature experienced by fish, but consistent equations relating temperature and fractionation of stable oxygen isotopes in otoliths among different fish species are lacking. Juvenile cod were reared at constant temperatures from 6 to 20°C and the sagittal otoliths were analysed for oxygen isotope values. We determined that temperature-dependent fractionation of oxygen isotopes in the otoliths was close to that reported for inorganic aragonite at low temperatures, but there were deviations from oxygen isotope fractionation equations for otoliths of other species. The linear relationship between oxygen isotope value in the cod otoliths and temperature was determined to be: 1000 Ln α = 16.75(103 TK−1) − 27.09. Temperature estimates with 1°C precision at the 95% probability level require a sample size of ≥5 otoliths. Only an insignificant amount of the variance in the data was due to variance between left and right otolith, and due to repeated measurements of otolith subsamples. This study confirms that stable isotope values of cod otoliths can give precise and accurate estimates of the ambient temperature experienced by fish.