bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pathology of carcinoma of the gallbladder
Authors: Sumiyoshi Kinjiro , Nagai Eishi , Chijiiwa Kazuo , Nakayama Fumio 
Published: May 2005

AbstractA clinicopathologic study of 40 cases of carcinoma of the gallbladder is presented. Twenty‐six cases resected were assessed retrospectively with respect to the operative procedures employed and the results based on the pathologic findings from the resected specimens.The relationship between clinical features, macroscopic forms of tumor, histological types, liver invasion, and lymph node metastasis were investigated. Papillary, papillary infiltrative and nodular forms were classified as either papillary adenocarcinoma or well‐differentiated tubular adenocarcinoma and invasion of the liver and lymph node metastasis were rare. Frequent lymph node metastasis was encountered in the nodular infiltrative form and invasion of the liver was frequently present in the infiltrative form. Invasion of the liver, lymph node metastasis, and the presence of gallstones were less frequent in papillary adenocarcinoma. In contrast, moderately‐differentiated tubular adenocarcinoma frequently had lymph node metastasis. Invasion of the liver and lymph node metastasis were, however, present regardless of the histologic types and were more related to the extent of subserosal involvement present. A female preponderance was noted in poorly‐differentiated adenocarcinoma. The main reasons for surgery being limited to exploratory laparotomy only or palliative procedures included carcinoma infiltration into the hepatoduodenal ligament, carcinoma extension to the neighboring structures, multiple liver metastases, peritoneal dissemination, large liver invasion, and multiple metastases to the paraaortic lymph nodes.
The effect of acetylsalicylic acid on the outcome after lower limb arterial surgery with special reference to cigarette smoking
Authors: Lassila Riitta , Lepäntalo Mauri , Lindfors Olof 
Published: May 2005

AbstractA prospective controlled study of 144 patients with peripheral obstructive arterial disease was undertaken to evaluate the efficacy of acetylsalicylic acid (ASA) treatment (250 mg daily) on the outcome after lower limb arterial surgery which mainly involved endarterectomy. By random enrollment, 2 groups of 72 patients were formed after the surgery. Patients with ASA treatment for 3 months, starting from the seventh postoperative day, were compared with patients who were not treated with ASA. The patients in both groups had similar characteristics as to sex ratio, age, concomitant diseases, preoperative arm‐ankle systolic blood pressure index, and type and primary success of the reconstruction. Forty‐seven of the ASA‐treated and 48 of the untreated patients reported to continue cigarette smoking. Postoperative ASA‐treatment protected against local adverse events which occurred in 15 patients (21%) of the ASA‐treated group compared with 31 patients (43%) of the untreated group (p<0.01). Among heavy smokers (>15 cigarettes/day) the efficacy of antiplatelet treatment was not detectable. These results imply that, in patients with peripheral arterial disease, ASA prevents platelet interaction to endarterectomized and atherosclerotic lower limb arteries thereby affecting the subsequent risk of occlusion; however, heavy cigarette smoking, which is very common among patients with peripheral arterial disease, counteracts the local antithrombotic potency of ASA.
Should both schistosomal and nonschistosomal variceal bleeders be disconnected?
Authors: Abu‐Elmagd Kareem M. , Ezzat Farouk A. , Fathy Omar M. , El‐Ghawlby Nabih A. , Aly Mohamed A. , El‐Fiky Amgad M. , El‐Barbary Mohsen H. , El‐Ebady Gamal E. , El‐Hak Nabil G. 
Published: May 2005

AbstractSplenopancreatic disconnection (SPD) was conceived and implemented as a technical addition to distal splenorenal shunt (DSRS) to maintain its selectivity and preserve portal perfusion. The proposed hemodynamic and metabolic stability of hepatocytes after DSRS‐SPD should improve survival. In this nonrandomized study, 145 consecutive (Child A/B) variceal bleeders were electively subjected to selective shunt with DSRS in 93 and DSRS‐SPD in 52 patients. The 2 groups were similar before surgery with a mean follow up of 24±12 (DSRS) and 27±14 (DSRS‐SPD) months. DSRS‐SPD had an operative mortality of 3.8%. Postoperative pancreatitis occurred in 7.7% after DSRS‐SPD and 3.2% after DSRS alone, with schistosomal hepatic fibrosis representing 86% of morbid cases. Shunt patency was high and recurrent variceal hemorrhage was low in both groups. Clinical encephalopathy was significantly reduced after DSRS‐SPD (p<0.05). The addition of SPD significantly reduced both the incidence of chronic hyperbilirubinemia in the schistosomal patients (p< 0.05) and the difference between the changes in total serum bilirubin in all patients (p=0.001). Portal perfusion was preserved after DSRS‐SPD in all of the angiographically‐studied patients. The overall survival was 84% after DSRS and 88% after DSRS‐SPD. The schistosomal patients showed an incidence of 95% and 96% survival after DSRS and DSRS‐SPD, respectively. DSRS‐SPD was able to improve survival (92%) better than DSRS (77%) among well‐matched nonschistosomal patients. These data show: (1) DSRS‐SPD still has low operative mortality and a high patency rate with a low incidence of recurrent variceal hemorrhage, (2) DSRS‐SPD maintains portal perfusion, achieves better survival, and reduces the incidence of encephalopathy, especially in patients with nonalcoholic cirrhosis and mixed liver disease, (3) in the schistosomal population, DSRS‐SPD reduces the incidence of chronic hyperbilirubinemia but increases the risk of postoperative pancreatitis.
The influence of surgery on the risk of death in patients with primary hyperparathyroidism
Authors: Hedbäck Gunilla , Odén Anders , Tisell Lars‐Erik 
Published: May 2005

AbstractThe previous finding of an increased risk of premature death in a consecutive series of 896 patients operated on for primary hyperparathyroidism between 1953 and 1982 [1] raised the question of the role that surgery plays in relation to the risk of death. In the present study, undertaken to examine that issue, 3 factors—age, calendar year of surgery, and time passed after surgery—have been found to be significantly related to the risk of death (p<0.001), each factor contributing independently. A correlation was found between a late calendar year of surgery and a low degree of hyperparathyroidism as evaluated by serum calcium and creatinine levels. There was an increased risk of premature death in all age groups. The risk was less among patients operated on in later years. The observed normalization of the increased risk of death with time after surgery also took place sooner in patients operated on in later years. Our finding of improved survival following surgical intervention contrasts favorably with the findings of others in studies of subjects with untreated mild hyperparathyroidism. We have also found that preoperative serum calcium levels affect the risk of death, and that there is an additional factor related to the calendar year of surgery affecting the risk of death. Circumstantial evidence indicates that the duration of hyperparathyroidism contributes to this factor. Our results also show that early surgery decreases the risk of premature death in mild cases of the disease.
Total parenteral nutrition during acute pancreatitis: Clinical experience with 156 Patients
Authors: Robin Arnold P. , Campbell Rebecca , Palani Colathur K. , Liu Katherine , Donahue Philip E. , Nyhus Lloyd M. 
Published: May 2005

AbstractOver a 3‐year period, 156 of 815 patients admitted to a single institution with acute pancreatitis received total parenteral nutrition (TPN) for 2,572 patient days. Seventy had “simple” acute pancreatitis (group I) and 86 (group II) developed local complex disease (pseudocyst, abscess, or necrotic gland). In groups I and II, respectively, days without oral intake (NPO) were 13.6±1.5 (SEM) and 24.0±2.1 (p<0.005), hospital days were 19.8±1.7 and 35.8±3.2 (p<0.005), and duration of TPN was 10.9 ±1.0 and 21.0±2.3 days (p<0.005). Thirty‐three patients in group I and 53 in group II required exogenous insulin. Alteration of standard formulas was necessary in 87 patients, but cessation of therapy was necessary in only one instance. Twenty catheters were removed for suspected sepsis with only 3 confirmed cases. Fat‐based formulas were well tolerated in 15% of patients. During TPN, body weight rose from 95.0±2.4% to 97.4±4.3% of ideal in group I and remained at 90.5±1.8% in group II. Albumin rose from 3.36±0.10 to 3.50±0.08 g/dl in group I and from 3.01±0.07 to 3.35±0.07 g/dl in group II. The entire cohort differed from 10 randomly chosen patients who did not receive TPN in terms of days NPO (2.8±0.3) and hospital days (5.5±0.6). Variables associated with prolongation of hospital stay and time NPO were number of prognostic criteria, local complex disease, and underlying chronic pancreatitis only in select groups. We conclude that during acute pancreatitis, TPN can be administered safely but with careful monitoring and we recommend early aggressive therapy in the subgroups noted above and when underlying malnutrition exists. In the borderline patient, TPN may be administered by peripheral vein until the severity of disease is manifest.
Neonatal necrotizing enterocolitis: Experience with 100 consecutive surgical patients
Authors: Ricketts Richard R. , Jerles Matthew L. 
Published: May 2005

AbstractOne hundred newborns with neonatal necrotizing enterocolitis (NEC) were treated surgically according to a uniform protocol between July, 1980 and June, 1988. The infants (53 females, 47 males) weighed between 600 and 3,800 g, averaging 1,500 g. Twenty‐eight weighed less than or equal to 1,000 g, 38 weighed from 1,001 g to 1,500 g, and 34 weighed more than 1,500 g. Median age at the time of surgery was 14 days. Surgery was performed for pneumoperitoneum in 40, a “positive” paracentesis in 51, and for other reasons in 9 infants. A paracentesis was performed if intestinal gangrene was suspected clinically. Resection of gangrenous bowel with exteriorization was the usual procedure; in only 5 patients was primary closure performed. The hospital survival for the infants was 54% for the group weighing less than or equal to 1,000 g, 74% for the group weighing from 1,001 g to 1,500 g, and 79% for the group weighing more than 1,500 g. Overall hospital survival was 70%; it was 81% for those having a definitive procedure (excluding 14 infants with NEC “totalis”). There were 3 late deaths from causes unrelated to NEC. Significant long‐term complications included failure‐to‐thrive in 23% and stricture formation in 30% of the survivors. Long‐term follow‐up showed gastrointestinal status to be normal in 74%; only 8% have persistent major gastrointestinal dysfunction. Mental and motor development was considered grossly normal in only 53% of the patients.
Coloanal anastomosis after resection of low rectal cancer in the elderly
Authors: Huguet Claude , Harb Joseph , Bona Stefano 
Published: May 2005

AbstractTwenty‐two patients had coloanal anastomoses performed after resection of low rectal tumors (16 adenocarcinomas and 6 large degenerated villous adenomas). The patients had an average age of 72 years (range: 62–85). A hand‐sewn anastomosis was performed between a “J”‐shaped colonic reservoir and the anal sphincter, except in 3 patients who underwent a straight end‐to‐end coloanal suture without pouch. A defunctionalized stoma was made in 18 cases. Mortality within 30 days of operation was 9%. Specific complications occurred in 2 patients (9%). Mean follow‐up in this series was 20.2±11.7 months (± standard deviation). Fifteen patients were alive and free of disease up to 54 months after surgery. One patient was found to have local recurrence at 19 months. The actuarial 3‐year survival rate was 73% in the whole group (operative mortality included). Functional results were good in 16 of 19 patients, with an average 1.8–2.9 stools/24 hours and the continence rate was good. Three patients had complications requiring a permanent colostomy. From these preliminary results, coloanal anastomosis appears to be satisfying in regard to oncologic results and affords good anal function, even in the elderly patient (over 62 years of age).
A new simple test for evaluation of intestinal bacteria
Authors: Takahashi Makoto , Maeda Yorinobu , Tashiro Hirotaka , Eto Takaaki , Goto Takahiko , Sanada Osamu 
Published: May 2005

AbstractWe investigated a newly synthesized conjugate of ursodeoxycholic acid with para‐aminobenzoic acid (PABA) to determine its suitability to evaluate enteric bacteria. This compound, PABA‐UDCA, is deconjugated by cholylglycine hydrolase to release free PABA whereas it is completely resistant to deconjugation by pancreatic and intestinal mucosal enzymes. In bacteriological experiments, almost all of the microorganisms which split glycocholic acid deconjugated this compound. In animal experiments, urinary excretions of PABA were measured for 6 hours following oral administration of 10 mg PABA‐UDCA. Ten control rats excreted 338.5±43.8μg (mean ± SD) of PABA; 10 rats with intestinal bacterial overgrowth due to enteric stagnant loops excreted more (673.6±222.1μgp<0.01), whereas 10 rats in each of 8 groups with intestinal antisepsis by oral administration of various antibiotics excreted significantly less (p<0.001) (ampicillin + doxycycline + fradiomycin: 18.3±16.7, polymixin B + tinidazole: 14.0±8.0, polymixin B: 224.9±74.3, tinidazole: 42.7±27.3, kanamycin: 50.3±18.2, clindamycin: 57.4±23.3, vancomycin: 70.4±27.0, and paromomycin: 160.4±51.9μg). These observations indicate that this compound is likely to offer a simple and rapid method for evaluation of intestinal microorganisms without the use of radioisotopes or expensive, special apparatus.
Pylorus‐preserving duodenopancreatectomy: Long‐term complications and comparison with the Whipple procedure
Authors: Morel P. , Mathey P. , Corboud H. , Huber O. , Egeli R. A. , Rohner A. 
Published: May 2005

AbstractWe have performed 33 pylorus‐preserving duodenopancreatectomies. Twenty patients presented with severe chronic pancreatitis and 13 with periampullary adenocarcinoma. We have no postoperative mortality and a 24% rate of morbidity. Complications include anastomotic leaks (2), surgical bleeding (1), anastomotic ulceration (1), and others (4). We have complete follow‐up for all cases. In the tumor group, 8 (62%) patients are alive with a mean survival time of 20 months (range: 2–46). In the pancreatitis series, all patients are alive after a mean of 34 months (range: 4–66). We have observed 5 cases (15%) of anastomotic ulcerations responsible for stenosis (2) and acute perforation with peritonitis (2) occurring after a mean interval of 18 months. Four cases have been confirmed histologically after resection. The short‐ and long‐term beneficial effects of the pylorus‐preserving operation on patient well‐being and nutritional status were confirmed and compared with the results achieved after a Whipple procedure performed in a series of 18 consecutive patients.
Radical and nonradical hepatic resection for alveolar echinococcosis: Report of 18 cases
Authors: Partensky Christian , Landraud Richard , Valette Pierre‐Jean , Bret Patrice , Paliard Pierre 
Published: May 2005

AbstractThe authors report their experience with 18 patients who underwent liver resection for alveolar echinococcosis of the liver from June, 1982 to January, 1989. Preparation for surgery included transhepatic biliary external‐internal drainage in order to alleviate jaundice in 8 cases and catheterization of infected necrotic cavities in 7 cases. Resection was radical in 9 patients who underwent either right lobectomy (5 cases) or right trisegmentectomy (4 cases) with “en bloc” extension to the bifurcation of the hepatic ducts in 3 cases. Resection was nonradical in another group of 9 patients who had either atypical right hepatectomy (6 cases) or atypical left hepatectomy (3 cases). All patients were submitted to a periodic follow‐up. The 9 patients treated by radical resection are alive and symptom‐free and appear to be disease‐free at radiologic imaging, except for 1 patient who had a small area of parasitic recurrence on computed tomography scan 4 years after operation. Among the 9 patients treated by palliative resection, 3 patients died during the follow‐up period, the cause of the death having been related to the disease in 2 cases and nonrelated in 1 case. The 6 surviving patients had no noticeable growth of the parasitic mass during the period of follow‐up. When feasible, radical liver resection is the best form of therapy. When massive parasitic invasion of both lobes of the liver and the porta hepatis and vena cava precludes radical hepatectomy, palliative resection associated with percutaneous procedures has to be considered before embarking on orthotopic liver transplantation.
Diagnosis of deep vein thrombosis
Authors: Bergqvist David , Bergentz Sven‐Erik 
Published: May 2005

AbstractA wide range of clinical symptoms and signs are observed with venous thrombosis. Nonetheless, clinical diagnosis has been found to be unreliable and accurate diagnostic methods must be used before potent therapy such as anticoagulation is instituted, since the complications of treatment themselves can be life‐threatening.Phlebography is still the basic reference for evaluation of deep venous disease. While it is felt to be the most accurate, there are still limitations relative to difficulty in separating acute from chronic disease, and in obtaining adequate contrast in certain veins such as calf muscles and in the larger intraabdominal veins. Moreover, it is an uncomfortable invasive test, not without complications of its own.The125I‐fibrinogen uptake test is an excellent test for screening for forming thrombi. The sensitivity of this test is high, particularly in the detection of small calf vein thrombi. The primary drawbacks of this technique are that it is falsely positive in cases where there has been bleeding, inflammation, gross edema, arthritis, or leg ulceration. It is not accurate above mid‐thigh because of the high blood flow at the level of the groin and pelvis.Radioactive labeled plasmin which will adhere to the surface of recently formed thrombi can also be used for diagnosis. The limitations are a very short half‐life of the radioactive label so that repeated investigation of a patient cannot be performed unless new injections are given. The diagnostic accuracy is comparable to that of radioactive labeled fibrinogen and has the same advantages and disadvantages.Plethysmographic techniques have been used with various modifications. They have the advantage of being strictly noninvasive. They are most accurate when used in association with venous emptying, but there must be at least 50% occlusion of the vein before the test is positive and large collaterals or duplication anomalies may result in a false‐negative test. Phleborrheography seems to diagnose proximal deep venous disease accurately, but is relatively insensitive to distal deep venous thrombosis. Doppler ultrasound techniques are quick and simple to apply, but interpretation requires substantial experience.Real‐time B‐mode ultrasound has been used in recent years to detect deep venous thrombosis and permit visualization of thrombus within a vessel. With experienced hands, it is possible to differentiate between acute and chronic thrombi.Finally, a combination of 2 or more methods has been found to increase diagnostic accuracy; combining one method which is good at detecting calf vein thrombosis with one detecting hemodynamically significant thrombi in the more proximal veins offers the best combination. Impedance plethysmography combined with radioactive labeled fibrinogen has been found to be nearly as reliable as phlebography with similar cost effectiveness.
Use of plasminogen activators in venous thrombosis
Authors: Hirsh Jack , Turpie A. G. G. 
Published: May 2005

AbstractA major advance in the treatment of thrombosis has been the development of thrombolytic agents. Streptokinase and urokinase have been the standard agents available for many years, but in recent years the most exciting change in the field has been the development of a new generation of plasminogen activators, the principal one being tissue plasminogen activator.The first generation of plasminogen activators—streptokinase and urokinase—do not have fibrin specificity and predictably induce plasma proteolysis when administered systemically in doses which introduce thrombolysis. The second generation of plasminogen activators are much more fibrin‐specific and offer a promise of fewer complications.In a number of major randomized studies, these thrombolytic agents have proved effective clinically. The major complication of thrombolytic therapy, however, is hemorrhage. The risk of hemorrhage increases with the length of infusion and occurs most often from sites of vascular invasion such as needle punctures or cutdown sites from surgical wounds. This can be treated by applying pressure over the wound and discontinuing the thrombolytic agent whose half‐life is measured in hours. It is believed that as more experience is acquired with the second‐generation plasminogen activators, better control of these drugs will result in fewer complications and more effective and wider application of therapy.
Development of the postthrombotic syndrome: Its management at different stages
Authors: Halliday Peter 
Published: May 2005

AbstractThe postthrombotic syndrome consists of clinical features which follow thrombosis of deep venous return of the limb. Patterns of postthrombotic changes remain difficult to predict and once established, difficult to contain and reverse. Following a thrombotic event of the lower limb, 3 clinical stages can be observed which may be followed by intervening quiescent intervals.Stage I, or the early phase, is characterized by the residual obstructive process following acute venous occlusion. This can be manifested by either a bursting type of pain (venous claudication) or edema of the leg. A thrombotic process can involve the calf veins, thigh veins, pelvic veins, or any combination of the three. Specific clinical syndromes develop depending on the venous pump system involved. The venous pump system consists of the plantar calf pump and the thigh pump. These serve to propel blood upward. Involvement of any one or more of the 3 in the thrombotic processes can result in a relative obstruction with a specific pattern of clinical symptoms. Optimally, the venous thrombotic process should be treated during this early phase to prevent the subsequent events which may render the process irreversible.The second stage of the postthrombotic syndrome consists of the development of fat sclerosis. At this stage, the process becomes progressively irreversible as the extravasation of fibrin into the interstitial space results in progressive fibrosis and sclerosis. This results in damage to the skin and subcutaneous tissues which render the process irreversible. Specific treatment, while still introducible at this stage, can halt the progress of the syndrome, but rarely results in complete reversal. Stage 3 process is the advanced postthrombotic limb in which there is extensive damage to the skin usually associated with venous ulceration. By this stage, the development of the syndrome has passed beyond the point where such events can be prevented from recurring, although partial control may be obtained with proper treatment.
Surgical anatomy of the inguinal area
Authors: Skandalakis John E. , Gray Stephen W. , Skandalakis Lee J. , Colborn Gene L. , Pemberton L. Beaty 
Published: May 2005

AbstractThe anatomy of the inguinal region is enigmatic and confusing. Among the many structures involved in hernial repair are the iliopubic tract, the transversus abdominis aponeurosis and the transversalis fascia, the transversalis crura and sling, and the inguinal canal. There is still much disagreement among surgeons and anatomists about the existence, structure, and function of these anatomic entities.