bluuebunny/crossref_metadata_2025_split huggingface dataset:
Etappenlavage: Advanced diffuse peritonitis managed by planned multiple laparotomies utilizing zippers, slide fastener, and Velcro® analogue for temporary abdominal closure
Authors: Wittmann Dietmar H. , Aprahamian Charles , Bergstein Jack M. 
Published: May 2005

AbstractEtappenlavage is defined as a series of planned multiple operative procedures performed at a 24‐hour interval. It includes a commitment to reexplore the patient's abdomen at the initial corrective operation. This is a report of a prospective study of 117 patients treated by etappenlavage for severe advanced suppurative peritonitis in 2 institutions. Etappenlavage was performed in 15% of all patients with operations for peritonitis. In these patients, the abdominal infection had progressed to an advanced stage of severe functional impairment. A total of 669 laparotomies were performed and the abdomen closed temporarily utilizing retention sutures (n=45), a simple zipper (n=26), a slide fastener (n=29), and Velcro® analogue (n=17). An average of 6.1 procedures were necessary to control the infection. In 57% of the patients, additional complications were recognized and repaired after the initial operation. Patients were artificially ventilated for an average of 17 days. The median duration of therapy was 33 (range, 3–183) days. Twenty‐eight patients died between days 3 and 71 (median, 9) after initiation of therapy. In 88%, uncomplicated wound healing was observed after wounds were closed definitely. In the last 17 patients, no complications were attributable to the use of 2 adhesive sheets of polyamide plus nylon or perlon for temporary abdominal closure (Velcro®‐like artificial burr). APACHE II scoring predicted a median mortality of 47%. The actual mortality was 25%. Overall, the mortality of advanced diffuse peritonitis was reduced from a predicted 34–93% (APACHE II/SIS scoring) to 24%. Velcro® analogue (artificial burr) was the most practical device for temporary abdominal closure.
Herniorrhaphy and concomitant peritoneovenous shunting in cirrhotic patients with umbilical hernia
Authors: Belghiti Jacques , Desgrandchamps François , Farges Olivier , Fékété François 
Published: May 2005

AbstractFrom 1981 to 1987, a total of 40 cirrhotic patients with umbilical hernia were treated either by conventional herniorrhaphy (26) or by herniorrhaphy and concomitant insertion of a peritoneovenous (PV) shunt (14). The aim of concomitant PV shunt insertion was to reduce postoperative complications of herniorrhaphy in those patients with intractable ascites, or in whom difficulty to control postoperative ascites was contemplated. In the group of patients with PV shunt, 8 were class B and 6 were class C according to Child's classification; 7 patients had complicated hernia including 2 patients with skin ulceration, 4 with rupture, and 1 with incarceration. In the group with standard herniorrhaphy, 5 patients were class A and 21 were class B; 13 patients were operated on electively for uncomplicated hernia without ascites, 6 had incarceration, and 7 had skin ulceration. The technical procedure of concomitant PV shunting and hernia repair included: insertion of the valve, surgical repair of the hernia, and insertion of the venous tube. In that order, in‐hospital mortality was nil. Postoperative complications included sepsis in 2 patients who had concomitant insertion of a PV shunt, and massive ascitic fluid production in 5 patients treated by conventional herniorrhaphy, resulting in ascitic leak from the surgical wound in 1 case. Recurrence of the hernia was observed in 6 patients treated by conventional herniorrhaphy, and in none who had a patent PV shunt. We conclude that concomitant insertion of a PV shunt should be considered in cirrhotic patients whose ascites does not respond to medical treatment or in patients with complicated hernia requiring an emergency procedure in whom poor liver function anticipates difficult management of postoperative ascites.
Evaluation of hemodynamics and hepatic mitochondrial function on extrahepatic portal obstruction in the rat
Authors: Omokawa Susumu , Asanuma Yoshihiro , Koyama Kenji 
Published: May 2005

AbstractAn animal model resembling clinical cases with extrahepatic portal vein obstruction was developed. The changes in hepatic mitochondrial function and the hepatic hemodynamics including hepatic regional blood flow, portal venous pressure, and portogram were evaluated to assess the effect of portal vein obstruction in the model.Portal vein ligation in this model was a simple and easy maneuver and could produce collateral veins to the liver—cavernomatous transformation—which were obviously seen in clinical patients with extrahepatic portal obstruction. Hepatic blood flow was significantly decreased until 5 days after portal vein ligation; however, hepatic blood flow was gradually increased and reached the normal value at 3 weeks after portal vein ligation due to the formation of the collateral veins to the liver. Respiratory parameters of mitochondria were gradually decreased and reached the lowest levels at 5 days after portal vein ligation, while they recovered to normal values in accordance with increasing hepatic blood flow at 3 weeks after portal vein ligation.In extrahepatic portal obstruction, although the liver is temporarily deteriorated by portal vein obstruction such as portal vein thrombosis, hepatic blood flow and the liver functions are to be normally improved with the formation of collateral veins to the liver.
Bleeding peptic ulcer: A prospective evaluation of risk factors for rebleeding and mortality
Authors: Branicki Frank J. , Coleman S. Y. , Fok Peter J. , Pritchett Christopher J. , Fan Sheung‐tat , Lai Edward C. S. , Mok Francis P. T. , Cheung Wai‐lam , Lau Peter W. K. , Tuen Henry H. , Lam Shiu‐kim , Hui Wai‐mo , Ng Matthew M. T. , Lam David K. H. , Tang Alan P. K. , Wong John 
Published: May 2005

AbstractClinical, endoscopic, and laboratory data were collected prospectively in 701 patients with bleeding peptic ulcer. The overall rebleeding rate was 16.1% and increased the risk of a fatal outcome by 17 fold (1.2% versus 20.6%,p< 0.001). Rebleeding was documented in more than 75% of the group who did not survive following initial conservative management. Rebleeding was more likely (24.1% versus 14.2%,p< 0.02) when shock was present on admission and the risk of a rebleed was doubled in patients over 60 years of age (22.1% versus 10.9%,p< 0.001). Ulcers greater than 1 cm in size carried twice the risk of rebleeding (23.9% versus 12.4%,p< 0.002).Concomitant medical illness had a significant adverse effect on outcome (p< 0.05). Shock on admission was associated with a doubling of mortality figures (9.5% versus 3.7%,p< 0.01). The identification of endoscopic stigmata of recent hemorrhage (ESRH) tripled the risk of mortality (7.5% versus 2.4%,p< 0.002), ESRH were more frequently encountered when ulcer size was larger than 1 cm (61.4% versus 39.8%,p< 0.001). Respective mortality rates for ulcers less than or equal to 1 cm and greater than 1 cm in size were 1.6% and 12.5% (p< 0.001), corresponding mortality figures for patients over 60 years of age being 4.4% and 16.4% (p< 0.002). The risk of a rebleed tripled (6.7% versus 2.6%,p< 0.02) when ESRH were evident. There was a 6‐fold increase in mortality following emergency surgery when compared with conservative management of patients in whom no surgical intervention was necessary (2.6% versus 14.9%,p< 0.001). In summary, age over 60 years, previous medical illness, shock on admission, large ulcer size, and ESRH were each associated with an increased risk of rebleeding and mortality.
Primary hyperparathyroidism: Epidemiology, diagnosis and clinical picture
Authors: Ljunghall Sverker , Per Hellman  , Rastad Jonas , Åkerström Göran 
Published: May 2005

AbstractPrimary hyperparathyroidism (HPT) is a common disorder that mainly afflicts elderly women. It can be diagnosed in at least 1% of all postmenopausal females and autopsy studies indicate an even higher frequency. Although the widespread use of automated serum calcium analyses has increased the awareness of HPT, only 10% of all cases seem to be identified. The diagnosis relies on the demonstration of an inappropriately elevated serum concentration of parathyroid hormone (PTH) relative to the serum calcium value, which need not be markedly raised. Measurements of intact PTH with immunometric methods have considerably improved the diagnostic precision but it is still difficult to evaluate patients with only marginal hypercalcemia. Few patients with diagnosed HPT are completely without symptoms. Symptoms commonly encountered are psychiatric and neuromuscular disturbances. Subclinical bone disease might be relevant but there is insufficient information about its importance in otherwise asymptomatic individuals. Various cardiovascular risk factors appear more commonly in patients with HPT and untreated disease is associated with an increased risk of premature death.
Management of primary hyperparathyroidism caused by multiple gland disease
Authors: Goretzki P. E. , Dotzenrath Cornelia , Roeher H. ‐D. 
Published: May 2005

AbstractMultiple gland parathyroid disease is the pathological finding in primary hyperparathyroidism (HPT) in about 10% to 20% of all patients and in approximately a third of all patients with persistent or recurrent disease. The variability of multiple gland disease spans from 2 adenomas to diffuse hyperplasia in patients with multiple endocrine neoplasia type 1. This variability calls into question the proposed common pathophysiologic background in all of these cases. As primary treatment of multiple gland primary HPT, subtotal parathyroidectomy and thymectomy or total parathyroidectomy and heterotopic autotransplantation including thymectomy can be equally advocated. Recurrent hyperparathyroidism frequently occurs in cases of diffuse parathyroid hyperplasia. This must be considered especially in patient follow up and before each surgical procedure. Thus, a defined but adaptable therapeutic regimen might prevent permanent hypoparathyroidism and persistent hyperparathyroidism.
The role of the pathologist in diagnosis and surgical decision making in hyperparathyroidism
Authors: Grimelius Lars , Åkerström Göran , Bondeson Lennart , Juhlin Claes , Johansson Henry , Ljunghall Sverker , Rastad Jonas 
Published: May 2005

AbstractHyperparathyroidism has been diagnosed with increasing frequency in recent decades. The concomitant awareness that the disease may be the cause of a concealed morbidity and even an increased mortality has resulted in more liberal indications for surgery. Many patients currently undergo surgery on the grounds of only mild hypercalcemia and in the absence of any apparent clinical symptoms. This policy of early surgical treatment has emphasized the importance of a histopathological parathyroid diagnosis, since many of these patients exhibit chief cell hyperplasia and minimal glandular enlargement. Light microscopic examination of frozen sections stained with hematoxylin‐eosin and with stains for demonstration of cytoplasmic fat in the parathyroid chief cells, and appropriate weight estimates of the parathyroid glands, constitute the conventional, intra‐operative basis for the diagnosis. The use of specific antiparathyroid antibodies is an important new tool in the histopathological parathyroid examination, mainly because of the ability to demonstrate the cause of increased parathyroid hormone release from the pathological parathyroid tissue. A careful histopathological examination in combination with gross inspection of the parathyroid glands by an experienced eye should contribute to adequate surgical treatment and minimize errors in operative management in patients with hyperparathyroidism.
Diagnosis and treatment of patients with parathyroid carcinoma: An update and review
Authors: Obara Takao , Fujimoto Yoshihide 
Published: May 2005

AbstractParathyroid carcinoma is a rare cause of primary hyperparathyroidism. However, to our best knowledge, at least 163 cases of functioning parathyroid carcinoma appeared in the English literature from 1981 to 1989. We summarize the available information obtained from the reports of those patients and compare it with previous descriptions of the disease. The etiology of parathyroid carcinoma is usually obscure, but the possibility of a radiation‐induced malignant change in the parathyroid gland became evident in a few patients. Clinical manifestations, including age, sex, symptoms, and biochemical findings in this review were comparable to those in previous reviews. Noninvasive localization studies such as ultrasonography may offer a diagnostic clue to parathyroid carcinoma. Measurement of DNA content is a useful adjunct for making the histologic diagnosis of parathyroid carcinoma and prediction of the clinical outcome. Since the initial operation offers the best chance for cure, preoperative suspicion and intra‐operative recognition of the parathyroid cancer are essential. The initial operation should been bloc resection of the tumor, avoiding rupture of the tumor capsule and spillage of tumor cells. As parathyroid carcinoma is a slow‐growing but tenacious malignancy, repeated resection of local recurrent tumors or even distant métastases is effective for palliation of recurrent hypercalcemia and occasional cure. When hypercalcemia is refractory to surgical therapy or no recurrent tumor can be identified, other modalities of therapy must be considered. New drugs to control hypercalcemia by inhibiting bone resorption may hold promise in patients with recurrent parathyroid carcinoma.
Subtotal parathyroidectomy versus total parathyroidectomy and autotransplantation in secondary hyperparathyroidism: A randomized trial
Authors: Rothmund Matthias , Wagner Peter K. , Schark Claudia 
Published: May 2005

AbstractIn a randomized study subtotal parathyroidectomy (sPTX) was compared with total parathyroidectomy and autotransplantation of fresh tissue (PTX+AT) in 40 patients with severe secondary hyperparathyroidism (HPT). After surgery both groups were followed at 19±6 months (PTX +AT) and 19±7 months (sPTX) and at 43±9 months (PTX+AT) and 40±7 months (sPTX). There were 17 patients alive in each group at the time of the second follow‐up. After sPTX, 2 patients required re‐operation because of recurrent disease originating from the remaining parathyroid gland in the neck and another 2 patients were hypercalcemic at follow‐up. After PTX + AT both serum calcium and alkaline phosphatase normalized significantly more often (p <0.03) than after sPTX. Re‐operations were not required in this group. Radiological signs also improved significantly more after PTX+AT, as did clinical signs like pruritus (p< 0.005) and muscle weakness (p<0.04). These results and the fact that in recurrent disease a re‐operation at the autograft in the forearm is simpler than a re‐operation in the neck, lead to the recommendation that PTX+ AT should be considered as the method of choice in the surgical treatment of secondary HPT.
Replantation of cryopreserved human parathyroid tissue
Authors: Wagner Peter K. , Seesko Hinrich G. , Rothmund Matthias 
Published: May 2005

AbstractTwenty‐five patients with permanent postoperative hypoparathyroidism received cryopreserved parathyroid autografts. Twelve patients had undergone cervical re‐operations due to persistent or recurrent hyperparathyroidism and 10 patients had malfunction of a fresh autograft after total parathyroidectomy. Hypoparathyroidism occurred in 2 patients after subtotal parathyroidectomy and in 1 after the resection of a solitary adenoma following previous thyroid resection. The viability of the tissue was examined histologically prior to replantation in 22 patients and the amount of tissue needed for transplantation was determined by the ratio of necrotic cells vs. viable cells in the material. The patients were examined between 6 months and 125 months (median: 40 months) after replantation. Pre‐operatively each patient required high doses of calcium and vitamin D metabolites to establish normocalcemia. This medication was reduced postoperatively, with 16 patients requiring no supplemental treatment. Nine patients still needed low doses of calcium and/or vitamin D. At follow‐up all patients were free of hypocalcemic symptoms. Our results demonstrate that replantation of autologous cryopreserved parathyroid tissue is safe and effective therapy for permanent postoperative hypoparathyroidism. Thus, we regard it as an essential part of today's parathyroid surgery.
Complications associated with heal pouch‐anal anastomosis
Authors: McMullen Kevin , Hicks Terry C. , Ray John E. , Gathright J. Byron , Timmcke Alan E. 
Published: May 2005

AbstractSeventy‐three patients underwent total colectomy, rectal mucosectomy, creation of J or S ileal reservoir, and ileal pouch‐anal anastomosis from 1982 to 1989. Mean follow‐up was 38 months, with a minimum of 3 months in 15 patients being followed long‐term at another institution. Forty‐eight (66 %) patients had histologically proven ulcerative colitis and 25 (34%) patients had familial polyposis. Thirty‐eight J reservoirs and 35 S reservoirs were constructed. There were no perioperative deaths. The failure rate (loss of pouch) was 3%. Thirty‐six complications in 34 (47%) patients were reported, 14 (19%) patients required surgery. Bowel obstruction was the most common postoperative complication (16%), followed by pouchitis (15%), and cuff infection (5%). Seventy‐eight percent of the complications were associated with the J pouch. Average stool frequency at 1 year was 4 per 24‐hour period. Other complications included postoperative pneumonia (1), peroneal nerve palsy (1), and temporary sexual dysfunction (1). Seven of 15 complications requiring surgical intervention occurred in the first 2 years of the study period, illustrating the learning curve associated with the procedure. Blood loss, transfusion requirements, and length of operation were not associated with higher complication rates. Use of the J pouch and experience of the individual surgeon affected morbidity.
Progress in the treatment of congenital malformations of the hand
Authors: Buck‐Gramcko Dieter 
Published: May 2005

AbstractTreatment of congenital malformations of the hand and forearm has progressed not only from new procedures, but especially due to a new technique, namely microsurgery. Microsurgery enables skilled hand surgeons to operate on the tiny hands of babies without damaging the anatomical structures. The optimal time for the correction of many deformities is during the first 2 years of life. This gives excellent adaptation of the corrected structures to their altered function, especially in combination with a long period of further growth. Several new procedures are described which have been made possible only since the introduction of microsurgery, either by microvascular anastomoses or by meticulous dissection technique (toe transplantation, proximal toe phalanx transplantation, nail wall formation in complex syndactyly, transposition of digital parts in polydactyly and radial club hand).
Reconstruction of traumatically acquired defects of the phallus
Authors: Horton Charles E. , Dean John A. 
Published: May 2005

AbstractTrauma to the male phallus may be treated in a systematic approach to achieve aesthetically and functionally pleasing results. Isolated burns should be treated early with excision and preputial flap or skin graft closure. Avulsion injuries are closed primarily or skin grafted. Subtotal loss can be treated with penile lengthening techniques. Total loss is treated with reimplantation or microvascular free tissue transfer phalloplasty. There are reconstructive surgical options, instead of penectomy, in patients with penile malignancies.
Breast reconstruction: Progress in the past decade
Authors: Elliott L. Franklyn , Hartrampf Carl R. 
Published: May 2005

AbstractThere have been numerous advances in breast reconstruction techniques of the past decade. The disappearance of the radical mastectomy along with the increased frequency of smaller tumor detection have contributed significantly to these changes. Furthermore, reliable studies have shown that breast reconstruction does not interfere with extirpative surgery or delay postoperative adjuvant therapy if indicated. Studies such as these have led increasing numbers of women to elect immediate breast reconstruction as opposed to delaying that reconstruction for months or even years after the tumor extirpation.The advent of successful breast reconstruction using autogenous tissue provided the most radical change to reconstructive techniques over the past 10 years. The TRAM (transverse rectus abdominis myocutaneous) flap was the first of these techniques to be introduced and has rapidly assumed a position of prominence among those techniques chosen for breast reconstruction. The LTTF (lateral transverse thigh flap) and the buttock flap, while requiring microsurgical technique, are important alternatives for those patients who choose autogenous tissue breast reconstruction and should be presented to women during the discussion of alternatives for breast reconstruction.Implant technology has continued to improve with the introduction of the tissue expander, the most important addition in the past decade. Investigations are currently underway to provide a long‐term tissue expander that does not have to be removed and replaced by a permanent implant. The ultimate end result would be to create a more normal breast shape without firmness. And the use of stacked or directional expanders may allow more freedom in creation of the new breast shape to conform to the opposite side.Finally, nipple areola reconstruction has improved significantly as the tissues of the breast mound itself are used for the new nipple and areola, thereby avoiding the transfer of grafts from distant sites which do not generally maintain their size or projection over time.
Progress in flap surgery: Greater anatomical understanding and increased sophistication in application
Authors: Lamberty B. George H. , Chir B. , Cormack G. C. , Chir B. 
Published: May 2005

AbstractAn introduction summarizes the history of the development of flap surgery and puts the discovery of the fasciocutaneous flaps into historical perspective. The anatomical work underlying this discovery is presented and the way in which it has led to improved designs of flaps on the limbs is then described. Finally, the increased refinement and sophistication in the application of all types of flaps is demonstrated by a description of recent advances in the use of microsurgical free tissue transfer in 3 key areas of reconstructive surgery.
Dynamic properties of blood flow and leukocyte mobilization in infected flaps
Authors: Feng Lu‐Jean , Price David C. , Mathes Stephen J. , Hohn David 
Published: May 2005

AbstractTwo aspects of the inflammatory response to infection—blood flow alteration and leukocyte mobilization—are investigated in the canine model. The elevation of paired musculocutaneous (MC) and random pattern (RP) flaps allowed comparison of healing flaps with significant differences in blood flow (lower in random pattern flaps) and resistance to infection (greater in musculocutaneous flaps). Blood flow changes as determined by radioactive xenon washout were compared in normal skin and distal flap skin both after elevation and following bacterial inoculation. Simultaneous use of In‐111 labeled leukocytes allowed determination of leukocyte mobilization and subsequent localization in response to flap infection. Blood flow significantly improved in the musculocutaneous flap in response to infection. Although total leukocyte mobilization in the random pattern flap was greater, the leukocytes in the musculocutaneous flap were localized around the site of bacterial inoculation within the dermis. Differences in the dynamic blood flow and leukocyte mobilization may, in part, explain the greater reliability of musculocutaneous flaps when transposed in the presence of infection.