bluuebunny/crossref_metadata_2025_split huggingface dataset:
United States trials of adjuvant therapy
Authors: Fisher Bernard 
Published: April 2005

AbstractBeginning in 1958, the first clinical trial of the National Surgical Adjuvant Breast Project compared a brief postoperative course of low dose triethylenethiophosphoramide (TSPA) with no adjuvant therapy or placebo in 826 patients who underwent radical mastectomy for breast cancer. After 5 years, one subset of patients made up of premenopausal women with 4 or more positive axillary lymph nodes had a significantly higher survival rate and longer disease free interval following TSPA therapy than after placebo therapy. After 10 years, these significant differences in survival and incidence of treatment failure between the TSPA‐treated patients and the controls persisted.In 1972, the NSABP initiated a trial comparing prolonged postoperative chemotherapy with 1‐phenylalanine mustard (L‐PAM) with placebo in patients with positive nodes who had undergone radical mastectomy. By 1975 it appeared that premenopausal women who received L‐PAM had a significantly lower incidence of treatment failure than those who received placebo. L‐PAM therapy produced little alteration in the well‐being of the patients.Between February 1975 and March 1976, 700 patients were entered into NSABP Protocol #7 which compares 2 regimens of prolonged postoperative chemotherapy, L‐PAM alone and L‐PAM plus 5‐fluorouracil (5‐FU). In June 1976, NSABP Protocol #8 was initiated to compare another 2 regimens of prolonged postoperative chemotherapy, L‐PAM plus 5‐FU and L‐PAM plus 5‐FU plus methotrexate. It is too early to evaluate the results of these studies. It seems likely that the many trials of adjuvant chemotherapy being conducted throughout the world will provide significant improvement in the curability of breast cancer, provided these trials are carefully planned and thoroughly executed.
Adjuvant combination chemotherapy with CMF in primary mammary carcinoma
Authors: Veronesi Umberto , Rossi Anna , Bonadonna Gianni 
Published: April 2005

AbstractFrom June 1, 1973 to September 11, 1975, 207 patients with clinical stages I and II breast cancer who underwent radical mastectomy and were found to have histologically positive axillary lymph nodes were entered into a clinical trial that compared no further therapy with prolonged, cyclic chemotherapy consisting of cyclophosphamide, methotrexate and 5‐fluorouracil (CMF). A full 12 cycles of CMF therapy has been completed in 124 patients. After observation for 6 to 34 months, the cancer recurrence rate was 29.6% in the control group and 12% in the CMF group. The difference in the relapse curves of the 2 groups was highly significant, irrespective of the number of positive axillary lymph nodes. Short‐term toxicity was frequent but acceptable. Conclusions regarding the effects of CMF therapy on survival await a longer period of observation.
Putative host resistance and long‐term survival in breast cancer
Authors: Fegiz G. , Di Paola M. , Angelini L. , Bertolotti A. , Colizza S. 
Published: April 2005

AbstractLymphocytic infiltration in and around the tumor together with sinus histiocytosis and follicular hyperplasia in regional nodes has been studied in a group of 310 patients with breast cancer treated by standard radical mastectomy. The semiquantitative grading of these particular changes made possible the division of patients into 3 classes of putative host resistance, namely, no or poor reaction, good reaction, and strong reaction. The grading was shown to have a close correlation with prognosis both 5 and 10 years after surgery. More interestingly, the incidence of metastases in the 3 classes was significantly different, i.e. much higher in the non‐responder group, thus supporting the hypothesis that prognosis in breast cancer is closely related to a histological picture of cell‐mediated immunity against the tumor, and that this resistance probably acts as a local barrier to the diffusion of the tumor.
Reconstruction of the esophagus by posterior invagination esophagogastrostomy
Authors: Okada Naniwa , Tagami Yutaka , Morishita Hisashi , Nishimura Osamu , Takimoto Motoyuki , Kodama Ken 
Published: April 2005

AbstractFrom October 1967 to August 1976 posterior invagination esophagogastrostomy in 1 stage without positional change was performed on 84 patients. Since 1971 this method has been extended to include 32 cases of cancer of the upper and middle thirds of the thoracic esophagus. The anastomosis was constructed in the neck in 27 patients, and in the thoracic cavity in 5 patients (1 supra‐aortic, 2 at the level of the aortic arch, and 2 at the level of the inferior margin of the aortic arch). There were no instances of postoperative anastomotic leakage, hemothorax, chylothorax or pyothorax. Six of these patients (18.8%) died of circulatory insufficiency or pulmonary complications within 1 month of operation. Postoperative esophageal stenosis occurred at the site of anastomosis in 4 patients and was relieved by bougienage dilatation or operation under local anesthesia. Of the 32 patients with lesions in the upper and middle thoracic esophagus, 17 survived for 6 months after operation, 6 have lived for at least 3 years, and 4 are still alive after 4 years. Postoperative examinations of autonomic nervous system and cardiopulmonary functions revealed no abnormalities. In the early postoperative period, lipid and Vitamin B12absorption was markedly disturbed but returned to normal levels by the time of the follow‐up studies.
Surgical prophylaxis of gastroduodenal complications associated with renal allotransplantation
Authors: Uhlschmid Georg , Largiadèr Felix 
Published: April 2005

AbstractFrom 1971 to 1975, 226 patients received kidney allografts, and prophylactic ulcer surgery was regularly performed prior to kidney transplantation in those who had a history of previous ulcer, symptoms of peptic ulcer, a demonstrable ulcer on x‐ray or endoscopy, gastric acid hypersecretion, or a temperament conducive to the development of peptic ulcer. The results of this prophylactic program were compared with those of the previous period from 1964 to 1970 when prophylactic ulcer surgery was not used in 77 kidney allograft recipients, and with those of the concurrent period obtained in 194 recipients who did not receive surgical prophylaxis. Initially, the prophylactic operation was truncal vagotomy with pyloroplasty, then it was proximal selective vagotomy (PSV) without pyloroplasty, and finally it was selective gastric vagotomy with pyloroplasty (SGV+P). The incidence of gastroduodenal complications in patients who did not receive prophylactic ulcer surgery was 22.1% during the period 1964–1970, and 15.9% during the period 1971–1975; the mortality rates from gastroduodenal complications were 10.4% and 4.6%, respectively. In contrast, only 1 of 32 renal transplant recipients who underwent prior prophylactic ulcer surgery developed a gastrointestinal complication, and there were no deaths in the prophylactic surgery group. Two patients developed fatal ischemic necrosis of the stomach following PSV, which led to the adoption of SGV+P as the prophylactic operation of choice.
Prevention and management of hyperthyroid storm
Authors: Dobyns Brown M. 
Published: April 2005

AbstractThyroid storm or crisis has become a rare clinical problem but remains a serious emergency when it occurs. The reduction in occurrence rate and deaths is not only attributable to improvements in modern management of severe hyperthyroidism, but also to the inclusion of cases in some series which, by previous standards, would not have been classified as storm in the past. Information from modern research on thyroid pathophysiology is reviewed as a basis for current steps in management of storm. Safeguards in preparation of patients with hyperthyroidism for surgery and recognition of both the potential for storm and the steps required to combat it are reviewed and emphasized.
Graded gastric bypass
Authors: Mason Edward E. , Ito Chikashi 
Published: April 2005

AbstractGastric bypass is an extensive exclusion operation which was developed in 1966 and has been used in over 600 patients for the treatment of morbid obesity. Stomal ulceration has developed in 2% of patients and has usually occurred because the stomach was transected at too low a level. To determine the effect of varying levels of transection and exclusion of the stomach, graded gastric bypass was studied in 2 peptic ulcer models in dogs. With histamine‐in‐beeswax, stomal ulcers occurred whenever there was more than 63% of the stomach located above the gastroenterostomy. With common duct ligation, stomal ulcers were not observed in dogs with 44% or less of the stomach excluded, but when more than 44% of the stomach emptied through the duodenum, duodenal ulcers developed. Stomal ulceration occurred as a result of excessive acid production from large fundic segments stimulated by histamine. Duodenal ulcers resulted from a deficiency in buffering of acid when sufficient stomach was excluded and when an adequate volume of acid entered the duodenum where bile was excluded. These experiments add further emphasis to the importance of high transection of the stomach in gastric bypass, but also suggest that the occurrence of common duct obstruction will introduce the risk of duodenal ulcer in patients who have had gastric bypass for the treatment of obesity.
Five‐year experience with Lillehei‐kaster prostheses in the aortic position
Authors: Mayer John E. , Pyle R. Bradford , Lindsay William G. , Wang Yang , Jorgensen Charles , Nicoloff Demetre M. 
Published: April 2005

AbstractFrom 1972 through 1976, 140 patients underwent aortic valve replacement (AVR) with the Lillehei‐Kaster (LK) prosthesis and 18 additional patients had AVR plus coronary bypass procedures. Follow‐ up information was obtained in 98% of the patients. The operative mortality rate was 7.5% and the actuarial 5‐ year survival rate was, 79%. Two episodes of thromboembolism occurred in 3,645 patient‐months. Prosthesis malfunction or significant hemolysis has not occurred. Postoperative catheterization studies revealed a functional valve area of 0.81 cm2 with the 14A prosthesis; all other valve areas were greater than 1.1 cm2. Continued use of the LK aortic valve prosthesis with warfarin anticoagulation is recommended in sizes greater than 14A.
Whole‐gut transit rates and wet stool weight in an urban Nigerian population
Authors: Ogunbiyi T. A. J. 
Published: April 2005

AbstractThe objective of this study was to test the “dietary fiber theory of Western diseases” in Lagos, an area of relatively low prevalence, by investigating the relationship between fiber in diet, stool weight, and whole‐gut transit rates in a sample of the population on an urban‐type diet. A 5‐day study of fiber in diet and stool weight in 9 normal subjects showed a positive correlation between stool weight and consumed fiber. A second 5‐day study of the diet, whole‐gut transit rates, and wet stool weight in 37 male students revealed that only 15% of the lunches and dinners consisted of staple foods rich in crude fiber, that the mean transit time for first marker was 24.8 hours (SD±10.8) and for 80% of the markers was 48.5 hours (SD±20.9), and that the mean stool weight was 143.3 gram (SD±48.5). There was a negative correlation between transit time and wet stool weight both for first and 80% of markers. The transit time was slower and the stool weight less than figures quoted for rural Africans, but was not significantly different from British figures. The consequences of adopting a sophisticated low fiber diet due to urbanization in rapidly developing urban communities are discussed. It is suggested that in order to prevent an increase in the incidence of colorectal “Western diseases,” a health education drive in urban areas highlighting the qualities of high fiber staple foods be instituted.
Chemical dissolution of bile duct stones
Authors: Allen Bruce L. , Deveney Clifford W. , Way Lawrence W. 
Published: April 2005

AbstractChemical dissolution of retained ductal stone(s) is recommended when mechanical extraction through the formed T‐tube tract fails. Sodium cholate solution has been most widely used for infusion, and two‐thirds of patients can be successfully treated. A new agent, the medium chain glyceride mono‐octanoin, is more potent in vitro and the results of early clinical trials are encouraging. The use of oral longterm chenodeoxycholic acid for treatment of nonobstructing asymptomatic ductal stones has been successful in 50% of a small number of patients.
Results of endoscopic papillotomy: A collective experience from nine endoscopic centers in West Germany
Authors: Reiter Jürgen J. , Bayer Hans P. , Mennicken C. , Manegold Bernd C. 
Published: April 2005

AbstractThis is a report of 1,403 patients who underwent endoscopic papillotomy (EPT) in 9 endoscopic centers in West Germany from 1973 up to April 1, 1977. The main indication for EPT was stones in the bile ducts causing obstructive jaundice. In 79.5% of the patients, a previous surgical operation on the bile ducts had been done, and in 20.5%, the gallbladder was still present. Other indications for EPT were benign and malignant stenosis of the duodenal papilla, and cholangitis in the blind sack syndrome associated with an existing choledochoduodenostomy. The complication rate of EPT was 7.3%. The main complications were pancreatitis, cholangitis, hemorrhage, and perforation. Incarceration of stones or instruments was rare. Most complications could be treated conservatively. The mortality rate at 1.5% was low, and less than that of transduodenal papillotomy. Late complications that occur after transduodenal papillotomy were not found and should not occur after EPT. EPT eliminates the need for laparotomy and represents an alternative for the aged patient in poor general condition.
Follow‐up of 100 patients five to eight years after parietal cell vagotomy
Authors: Jensen Hans‐Eric , Amdrup Erik 
Published: April 2005

AbstractRecurrent ulcer developed in 9 out of 100 patients followed up for 5 to 8 years after parietal cell vagotomy (PCV) for duodenal ulcer. The time of recurrence was often surprisingly late, the latest occurring in the 6th year. Patients with recurrence did not differ significantly from the total group of patients with respect to sex, preoperative age, weight, or gastric acid secretion. Patients with recurrent ulcer were evenly distributed among the surgeons who performed the operations, and showed no obvious difference in reduction in spontaneous or in pentagastrin‐ and insulin‐stimulated acid secretion, compared to the symptom‐free patients. In 3 patients recurrence might have been related to abuse of salicylates and tobacco, and possibly to mental stress. These ulcers healed in response to nonsurgical treatment and the patients have remained symptom free for several years. In 6 patients, antrectomy was required. Sequelae occurred very infrequently, but in 1 patient dumping complaints were severe. An overall clinical assessment by Visick grading placed 72 patients in grade I, 14 in grade II, 4 in grade III, and 10 in grade IV. The failures included 6 patients who required reoperation for recurrent ulcer, 2 who required reoperation for gastric stasis, and the patient with severe dumping.
Surgical treatment of gastroesophageal reflux and its complications
Authors: Woodward E. R. 
Published: April 2005

AbstractAlthough most patients with reflux peptic esophagitis have the sliding type of hiatal hernia, correction of the hernia is incidental and the objective of the surgeon is to reestablish continence of the lower esophageal sphincter (LES). The presence of this crucial closure mechanism between the stomach and esophagus was demonstrated just over 2 decades ago by manometric and cineradiographic studies of the esophagogastric junction. Although the abdominal location of the LES exerts a favorable influence, it is possible to have normal LES function in the supradiaphragmatic position, and the relationship between the sliding hiatal hernia and reflux peptic esophagitis remains unclear. Some patients develop esophagitis in the absence of a hernia.Three surgical methods are in common use today for correcting gastroesophageal reflux: the Belsey cardioplasty, the Nissen fundoplication, and the Hill posterior gastropexy. Results have been analyzed on the basis of clinical, anatomic, and physiologic success. The Nissen fundoplication is the most certain to correct reflux and, as an added advantage, can be performed by either the thoracic or abdominal approach. However, it is associated with the highest incidence of chronic side effects, particularly the “postfundoplication” or “gas‐bloat syndrome.” The Hill procedure can be accomplished only through the abdomen and is associated with a somewhat higher incidence of recurrent esophagitis and recurrent hernia. However, side effects are minimal. The Belsey cardioplasty has the advantage of requiring a minimum of available tissue for its successful accomplishment. However, it can be performed with ease only by the thoracic approach and also has a relatively high incidence of recurrent or persistent esophagitis.For these reasons, we prefer the Hill posterior gastropexy in the medically intractable, but otherwise uncomplicated, patient with reflux peptic esophagitis. The Nissen fundoplication is preferred for cases complicated by prior unsuccessful surgery, stenosis with short esophagus, and marked obesity. The Belsey cardioplasty is most useful in patients who have had extensive prior gastric surgery with loss of available tissue for repair. The combined Thal patch‐Nissen fundoplication is considered the primary treatment of choice in patients with transmural strictures of the esophagus, particularly because it is associated with a low morbidity and mortality.
Operative treatment of recurrence after vagotomy and drainage for duodenal ulcer, gastric ulcer, and acid dyspepsia without ulcer
Authors: Johnson Jon A. , Giercksky Karl‐Erik 
Published: April 2005

AbstractFifty‐two operations were performed on 44 patients with recurrent disease after vagotomy and drainage (38) or vagotomy without drainage (6). The initial vagotomy was done for duodenal ulcer (23), gastric ulcer (17), and acid dyspepsia without ulcer (4). The reoperations were 31 revagotomies, 11 Billroth II gastric resections, 2 gastrojejunostomies, and later 4 gastric resections for another recurrence, 2 gastrojejunostomies for retention, and 2 operations for dumping. After an observation period of 1 to 6 years (mean 2.5 years), the results were good in 22 patients, satisfactory in 20 and unsatisfactory in 2 patients. Of 42 patients with recurrent disease, 41 showed a significant increase of acid output during insulin stimulation before operative treatment of the recurrence. Of 31 revagotomized patients, 26 were insulin‐test negative without later signs of recurrence. Five patients remained insulintest positive, and 4 of these required gastric resection for another recurrence. This series demonstrates the therapeutic significance of complete vagotomy, and emphasizes the value of the insulin test for evaluation of the completeness of the vagotomy.
Dextran in the prophylaxis of pulmonary embolism
Authors: Bergentz Sven ‐Erik 
Published: April 2005

AbstractDextran is a plasma volume expander which has antithrombotic effects. Some of these effects may be nonspecific and due to hemodilution and venous flow improvement. However, dextran also has specific antithrombotic effects that cause a temporary change in the structure and function of Factor VIII (antihemophilic globulin), which results in a decrease in platelet aggregability and thrombus stability. Intravenous dextran therapy has no marked effect on the incidence of small, early postoperative thrombi as detected by125Iodine‐fibrinogen, but it produces a significant decrease in the incidence of thrombi that can be diagnosed phlebographically or clinically. The most marked effect of dextran is on pulmonary emboli, and particularly on fatal pulmonary emboli as seen at autopsy, where it produces about a fivefold decrease in incidence.It is concluded that the antithrombotic properties of dextran are particularly useful in decreasing the incidence of postoperative pulmonary emboli.
Comparative value of tests for the diagnosis of venous thrombosis
Authors: Hirsh Jack , Hull Russell 
Published: April 2005

AbstractThe clinical diagnosis of venous thrombosis lacks sensitivity and specificity. Venography is recognized as the diagnostic reference standard but is invasive and associated with patient morbidity.125I‐fibrinogen leg scanning is sensitive to calf vein thrombosis but is relatively insensitive to femoral vein thrombosis and does not detect iliac vein thrombosis. This test is most useful as a screening test in high‐risk medical and surgical patients. The test may be falsely positive at the site of hematoma, and because of this, it has serious limitations in patients undergoing knee and hip surgery. Leg scanning also has limitations when used to diagnose patients with suspected venous thrombosis because it may take up to 72 hours to obtain a positive result. Impedance plethysmography (IPG), a noninvasive technique, is sensitive and specific for thrombosis involving the popliteal, femoral, and iliac veins. Combined with125Ifibrinogen leg scanning, this test has considerable potential as a screening test in patients undergoing hip surgery. The combined use of IPG and leg scanning has also been shown to be highly accurate for the diagnosis of clinically suspected venous thrombosis, and this approach offers a less invasive alternative to venography in these patients. The Doppler ultrasound flowmeter, like the IPG, is sensitive to popliteal and more proximal vein thrombosis but is relatively insensitive to calf vein thrombosis. The interpretation of the results of this test is more subjective and much more dependent upon the expertise of the examiner than is the IPG. A number of other techniques, including image scanning, and themography, are under investigation but require further evaluation before they can be recommended in the management of patients with venous thromboembolism.
Hemorrhage from the large bowel with special reference to angiodysplasia and diverticular disease
Authors: Welch Claude E. , Athanasoulis Christos A. , Galdabini James J. 
Published: April 2005

AbstractA series of 72 patients with bleeding either from angiodysplasia or diverticular disease of the colon has been studied in the Massachusetts General Hospital. Modern angiographic techniques have dispelled much of the mystery and reduced the mortality of colonic bleeding. In this series 85% of the bleeding originated from the right or transverse colon. Of the 72 patients, 70 survived; there were 52 operations. The 2 deaths occurred in an 81‐year‐old patient after subtotal colectomy and an 84‐year‐old patient after right colectomy, both for diverticular bleeding. After discharge from the hospital, 67 patients have been followed up for a median interval of 22 postoperative months. Late follow‐up of patients with bleeding from either angiodysplasia or diverticula showed that segmental resection was successful in stopping bleeding in 38 of 42 patients (90%); the 10 patients who had subtotal colectomy had no recurrent bleeding.The choice of operation must depend upon many factors that reflect operative risks, which must be balanced against better control of bleeding by subtotal colectomy. Because a right colectomy for angiodysplasia has been followed by recurrent bleeding in 4 of 31 cases, it is suggested that the right half of the transverse colon be included in the right colectomy since this will introduce no greater hazard and may lead to better control of bleeding. Subtotal colectomy is the operation of choice for bleeding from the colon from an unknown source, in good‐risk patients with widespread diverticulosis involving all segments of the colon, and for a combination of angiodysplasia on the right and extensive diverticular disease on the left. In poor‐risk patients, if either angiodysplasia or a single bleeding point has been demonstrated by selective arteriography, a segmentai resection of that area will be the safest procedure.