bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Pennsylvania State University paracorporeal ventricular assist pump: Optimal methods of use
Authors: Gaines Wayne E. , Pierce William S. , Donachy James H. , Rosenberg Gerson , Landis Donald L. , Richenbacher Wayne E. , Waldhausen John A. 
Published: May 2005

AbstractA ventricular assist device (VAD) has been developed for clinical use at The Pennsylvania State University that can be inserted with standard surgical technique, is capable of completely supporting either the systemic or pulmonary circulation, and does not require anticoagulation. Since 1976, this device has been used in 29 patients following cardiac surgical procedures who were not able to be weaned from cardiopulmonary bypass (CPB) with conventional techniques. From 1976 through 1979, we used ventricular assist pumping in 14 patients. Four of these patients were weaned from the assist pump and 2 were discharged from the hospital, yielding a 14% survival rate. From 1980 to the present, 16 patients required use of the assist pump from which 9 patients were weaned and 7 patients were discharged yielding a 44% survival rate. During the 8 years of clinical experience with this device, a program designed to optimize results has evolved with respect to patient selection, insertion technique, and postoperative care that has resulted in significant improvement in patient survival.
Temporary and permanent left ventricular bypass: Laboratory and clinical observations
Authors: Bernhard William F. , Clay Warren , Gernes David , Hougen Thomas , Sherman Craig , Burke David , Schoen Frederick J. , Poirier Victor L. 
Published: May 2005

AbstractTemporary circulatory support with a pneumatic, axisymmetric, paracorporeal ventricular assist device (VAD) has been undertaken in 22 postcardiotomy patients. During VAD function, 9 patients demonstrated hemodynamic improvement (group I), and eventually, 8 of these stabilized sufficiently to permit device removal. Three remain alive and well up to 5 years postoperatively. The clinical course of 13 others (group II) was complicated by severe postoperative bleeding and abnormalities in renal function, leading to lack of hemodynamic improvement and death. In group I, the duration of cardiopulmonary bypass (CPB) ranged from 4.3 to 9.0 hr (mean 6.0 hr), and in group II, from 3.7 to 10.0 hr (mean 5.9 hr). The duration of VAD function was 125 hr (mean) in group I, and 25 hr (mean) in group II. Major hematologic abnormalities (secondary to prolonged CPB) included thrombocytopenia, abnormal platelet function studies, severe hypofibrinogenemia, and low levels of fibrinogen/fibrin degradation products. Efforts to develop a permanent, electrically powered ventricular assist system (VAS) for patients with irreversible cardiomyopathy and end‐stage coronary artery disease are also progressing. In a recent series of animal experiments, 2 components of the VAS, an electromechanical energy converter and pusher‐plate blood pump (stroke volume 85 ml) were evaluated (9 calves, 30–149 days). The bloodcontacting surfaces of the device consisted of textured fibrils to attract a fibrin coagulum. Conversion of this layer to a collagenous membrane was achieved by preliminary seeding of the pump with cultured, bovine fetal fibroblasts (5 calves). These were compared with 4 non‐cell‐seeded devices (controls), and functioned for longer periods without thromboembolic complications.
Evaluation of surface‐bound heparin and platelet inhibition in a centrifugal pump left ventricular assist system
Authors: Musial Jacek , Gluszko Piotr , Edmunds L. Henry 
Published: May 2005

AbstractFollowing the discovery of thrombi attached to polycarbonate connectors in a patient successfully perfused for 46 hr with a centrifugal pump‐left ventricular assist system, the combination of platelet inhibition and surface‐bound heparin was tested in vitro. Fresh citrated human blood to which calcium and prostaglandin E1was added was recirculated for 3 hr in a centrifugal pump‐left ventricular assist system. Circuits with ionically bound heparin and circuits with cross‐linked ionically bound heparin were compared to uncoated circuits to which low‐dose (0.15 U/ml) and high‐dose (0.5 U/ml heparin) had been added. Fibrinopeptide A concentrations progressively increased during 3 hr of recirculation, but were significantly higher with low‐dose heparin control than in either of the surface‐bound heparin circuits. Plasma heparin concentrations were significantly less in the heparinized circuits than in the low‐dose heparin control group. There were no significant differences between cross‐linked and non‐cross‐linked tridodecylmethyl ammonium chloride (TDMAC) heparinized circuits. The combination of platelet inhibition and ionically bound heparin in centrifugal pump‐left ventricular assist circuits reduces the rate of thrombus formation beyond that caused by heparin leached from the surface.
Successful treatment of profound left ventricular failure by automatic left ventricular assist system
Authors: Takano Hisateru , Taenaka Yoshiyuki , Nakatani Takeshi , Akutsu Tetsuzo , Manabe Hisao 
Published: May 2005

AbstractWe have developed an automatic left ventricular assist device (LVAD) system which can maintain the normal circulation irrespective of severity of the LV failure (LVF) and can restore the failing heart by decreasing the bypass flow (BF) through the LVAD as the heart recovers. The main parts of our control‐drive unit are an automatic ECG synchronization system and an automatic level control system for left atrial pressure (LAP) and total flow (TF). Profound LVF was induced by complete interception of blood supply (myocardial infarction: MI) to the extent of 50% (5 goats), 70–80% (6 goats), and 80–90% (3 goats) of the LV free wall. The air‐driven, diaphragm‐type pump was implanted between the left atrium and aorta. At the beginning of LVAD pumping, BF tended to be high to keep LAP at the preset level (0–5 mm Hg) and to maintain TF at a somewhat higher level (100–130 ml/kg per min). During the recovering stage from LVF, the preset level of LAP was gradually raised. When cardiac output exceeded 90–100 ml/kg per min, LVAD was removed. The 50% MI group recovered between 17 hr and 3 days, the 70–80% MI group between 6 and 16 days after the onset of LVAD pumping. However, the 80–90% MI group could not recover because of intractable ventricular fibrillation. This LVAD system was applied in 1 patient who fell into postcardiotomy profound LVF. The patient's entire circulation was maintained at normal levels by the LVAD during a 14‐day period. The failed heart gradually recovered and the pump was successfully removed. We believe that the decompression of LV at the beginning will prevent overextension of impaired myocardium and simultaneously accelerate the solid scar formation. Gradual increase of LV work will promote the compensation ability of the residual myocardium.
Status of the artificial heart program in Berlin
Authors: Bücherl E. S. , Hennig E. , Baer P. , Frank J. , Lemm W. , Zartnack F. 
Published: May 2005

AbstractThe artificial organs program in Berlin started more than 20 years ago. The main emphasis in the circulatory assist and replacement devices program was and still is on the development of an electro‐pneumatic total artificial heart (TAH) system. Additionally, a temporary assist system and investigations in the field of biomaterials are included in the research activities. Topics of the program are: interactions between natural and artificial materials, blood pump development and in vitro fatigue testing, driving units and energy transmission, measurement equipment needed for the surveillance and automatic control of the TAH system, in vivo studies of the response of the circulatory system and the organs, in vivo reliability, and training of the staff for clinical readiness. The joint efforts of engineers of different disciplines and medical doctors, working together in the department of experimental surgery, supported in the past by industrial partners, resulted after extensive in vitro and in vivo investigations in the clinical application of temporary assist devices and the realization of a percutaneous portable, electro‐pneumatic total artificial heart system.
Experimental results and future prospects for a nonpulsatile cardiac prosthesis
Authors: Yozu Ryohei , Golding Leonard A. R. , Jacobs Gordon , Harasaki Hiroaki , Nose Yukihiko 
Published: May 2005

AbstractReplacing the heart function by means of a nonpulsatile blood pump is a great challenge to nature, which evolved pulsatile blood circulation. Some years ago, we hypothesized that mammalian physiology was capable of adapting to chronic nonpulsatile blood flow and maintaining normal organ function. The methodology of complete circulatory replacement with nonpulsatile flow has been established in awake calf experiments in our institution. To date, 5 animals have lived with nonpulsatile blood perfusion with near normal physiology for up to 3 months. Our studies on nonpulsatile biventricular animals have shown that immediately following surgery there is an adaptation phase which lasts approximately 7 to 10 days. This phase is characterized by increased total systemic vascular resistance (SVR), which appears to correlate with an increase in the circulating catecholamines. After this phase, these animals showed normal values of SVR, renal, biochemical, and endocrine function. Our data show that nonpulsatile blood flow is not a limiting factor to maintain mammalian life.
Intrathyroidal epithelial thymoma: An entity distinct from squamous cell carcinoma of the thyroid
Authors: Miyauchi Akira , Kuma Kanji , Matsuzuka Fumio , Matsubayashi Sunao , Kobayashi Akira , Tamai Hajime , Katayama Shoichi 
Published: May 2005

AbstractWe report 3 cases of intrathyroidal epithelial thymoma, a clinicopathologic entity distinct from squamous cell carcinoma of the thyroid. Two patients are long‐term survivors among 5 postoperative patients with squamous cell carcinoma of the thyroid. One has been free from the disease for 17 years, and the other with local recurrence died of an unrelated disease 18 years after the surgery. The diagnosis in these 2 was corrected to intrathyroidal epithelial thymoma following a review of the histological findings. These 2 tumors consisted of tumor cell nests resembling poorly differentiated squamous cell carcinoma surrounded by many lymphocytes. Features discriminating thymoma from squamous cell carcinoma included the lack of foci of anaplastic carcinoma and papillofollicular tumor, which are seen in squamous cell carcinoma of the thyroid. Two of the 3 patients with squamous cell carcinoma died within 1 year. We have found recently another case of thymoma.The present observations indicate that: thymoma can arise in the thyroid gland presumably from aberrant thymic tissue, mimicking squamous cell carcinoma; and the prognosis of thymoma is favorable. Therefore, it is important to discriminate thymoma from squamous cell carcinoma of the thyroid, which is usually fatal.
Microwave surgery: Hepatectomy using a microwave tissue coagulator
Authors: Tabuse Katsuyoshi , Katsumi Masaharu , Kobayashi Yasuhito , Noguchi Hiroyuki , Egawa Hiromu , Aoyama Osamu , Kim Hideo , Nagai Yugo , Yamaue Hiroki , Mori Kazunari , Azuma Yoshinori , Tsuji Takeshi 
Published: May 2005

AbstractThe microwave tissue coagulator has been applied clinically with satisfactory results. In our system, 2,450‐MHz microwaves for medical use are generated and transmitted to a monopolar‐type needle electrode. This electrode is thrust directly into the liver tissue and this is repeated along the line where incision is anticipated. Between July 1980, and May 1983, this device was used in 60 patients having major hepatic resections for a variety of conditions. The average amounts of blood loss and blood transfusion were 860 ml and 416 ml, respectively. Seventeen patients did not need blood transfusions, and all cases were free from postoperative bleeding from the resected liver stump. Besides the complications similar to those occurring with other major operations, pyrexia and abdominal pain developed in some cases 2–3 weeks after this surgical procedure. These symptoms were thought to be ascribed to the microwave surgery. However, they remitted soon and the subsequent course was uneventful. All patients with benign or inflammatory diseases had a satisfactory postoperative course, and are well. Of the patients subjected to liver resection for malignant diseases, 4 (6.7%) died within a month after the operation. These findings led us to conclude that this new operative technique can be utilized safely, surely, and easily in the field of hepatic surgery.
Surgical treatment of liver injuries by application of Fibrinkleber
Authors: Giakoustidis E. , Drosinopoulos P. , Agouridakis K. , Galanis N. 
Published: May 2005

AbstractThe combination of highly concentrated fibrinogen, thrombin, clotting factor XIII, and fibrinolytic inhibitor aprotinin represents a new biological hemostatic, and adhesive system, known as “Fibrinkleber.” Liver injuries and injuries of parenchymatous organs, with the difficulties inherent in their surgical repair, are a suitable field of application for the new substance. In our experimental work, standardized sharp liver injuries in 29 rabbits were treated only by application of Fibrinkleber. In all cases, this procedure resulted in a complete control of bleeding as well as in a stable and lasting closure of wounds. Five of these animals died from causes unrelated to the liver trauma but rather to parasitosis. During the postoperative observation period, from 2 days to 2 months, microscopic and histological examination showed ideal repair of the glued wounds. In the control group, 5 rabbits were kept without application of Fibrinkleber. Three of the rabbits with liver injuries and all of the control group histological examinations showed separation of the wounds with minimal healing.
Indication for operation of patients with autonomously functioning thyroid tissue in endemic goiter areas
Authors: Goretzki P. E. , Wahl R. A. , Branscheid D. , Joseph K. , Tsuchiya A. , Röher H. D. 
Published: May 2005

AbstractFour hundred thirty‐nine patients with autonomously functioning thyroid tissue (AFTT), 26% of all patients with AFTT diagnosed at the University of Marburg between 1970 and 1982, underwent thyroidectomy. One hundred ninety (43.3%) of these patients with AFTT were operated on for clinical hyperthyroidism, compared to only 62 patients with Graves' disease during this same time period. The remaining 249 patients with AFTT underwent surgery because of nonsuppressible uptake of technetium (TcTU) (3.5% or greater) by the thyroid.AFTT was 5 times more common in women than men. Hyperthyroidism was more common in older patients (p< 0.001) and in patients with numerous autonomous nodules. Many patients had no obvious signs of hyperthyroidism, but 42.4% had cardiac disorders. A preceding history of goiter (mean 15.3 years) was present in patients with AFTT and hyperthyroidism. Serum T3and T4levels were elevated in 88.5% and 74.6% of AFTT patients with clinical hyperthyroidism, while in clinically euthyroid AFTT patients, T3and T4values were in the upper normal range, i.e., 53.7% and 15.2%, respectively.Hyperthyroid patients were prepared for operation with antithyroid drugs. Additionally, propranolol was used in the perioperative period. Patients were operated on selectively after 1979, either by enucleation or unilateral thyroidectomy for unifocal AFTT, and subtotal thyroidectomy for bilateral disease. The results of treatment were most satisfactory and only 11 patients with AFTT (2.5%) developed recurrent hyperthyroidism. Surgical treatment of patients with hyperthyroidism and AFTT is a safe and effective therapeutic modality.
Present status of surgical treatment of esophageal varices in Japan: A nationwide survey of 3,588 patients
Authors: Inokuchi Kiyoshi 
Published: May 2005

AbstractTo assess the current status of surgical treatments for esophageal varices in Japan, a nationwide survey on the clinical results was performed by the Japanese Research Society for Portal Hypertension. Data were collected in 59 participating institutions on 3,588 patients with portal hypertension, subjected to portal nondecompression surgery between January, 1967, and January, 1982. In these patients the operative mortality rate was 8.3%, the survival rate was 68.6%, the postoperative bleeding rate was 6.9%, and the incidence of Eck's syndrome was 4.8%. Operative death occurred in 24.8% of 506 patients undergoing emergency operations. No gross difference was noted in these data between direct interruption procedure and selective shunt surgery. The overall results of portal nondecompression surgery were far superior to results of portal decompression surgery, done before 1967. Esophageal transection with wider devascularization from both thoracic and abdominal approaches and selective shunt (left gastric venous caval shunt and distal splenorenal shunt) led to a diminished incidence of recurrent bleeding in the later follow‐up period, as compared to devascularization, using a sole abdominal or thoracic approach.
Hirschsprung's disease: Progress in management and diagnostics
Authors: Nixon H. Homewood 
Published: May 2005

AbstractEach of the basic operative methods for Hirschsprung's disease (the rectosigmoidectomy developed by Swenson, the retrorectal transanal approach developed by Duhamel, and the endorectal procedure developed by Soave and modified by Denda and Boley) can give good results. A protective colostomy should be routine. If only an occasional case is prevented from progressing to incontinence or septicemia and death, then I think this outweighs the hazards of the colostomy.The 25‐year review of 84 of the first 87 Swenson‐type operations carried out at our hospital revealed that in adult life every patient is continent even though some had a degree of lack of control for a considerable time during childhood. A follow‐up of the group of Soave‐type operations from our clinic, followed between 10 and 17 years, also showed maintenance of normalcy. Our first Duhamel operations were carried out in 1958 and these patients also maintained control.From the technical point of view, the remaining problem is that of the infant with a segment extending significantly proximally into the small intestine. Kimura's operation may prove to be the answer, although the rarest condition of total intestinal aganglionosis seems likely to remain insuperable and is mainly of clinical importance because of evidence that it recurs frequently in the family. Bodian preferred to call this condition agenesis of the intramural plexuses since there was no evidence of increased nerve bundles found in congenital aganglionosis.Enterocolitis remains the main threat in management. The urgency of treatment needs wider recognition. Hirschsprung's disease should be diagnosable almost entirely in the neonatal period now that reliable and minimally disturbing rectal suction or punch biopsy is available. It must be accepted, however, that this diagnostic tool requires an expert and experienced pathologist and means, therefore, some centralization of the examination of the material even if not always of the baby itself.The finding of overt neuropathological conditions in the presence of ganglia makes it likely that more subtle variations also exist and their recognition might account for some poor results of operation which are not explained by technical errors.The difficult case, and in particular the child whose superficial biopsy is reported “ganglionic but not normal,” should be investigated by full‐thickness biopsy studied by such special techniques as histochemical and silver staining, electron microscopy, and perhaps hormonal immunofluorescent studies as indicated. Nevertheless, it appears that these conditions are not sufficiently common to justify the recommendation of full‐thickness biopsy under general anesthesia or the use of these elaborate studies as routine, whereas by the encouragement of early rectal suction biopsy diagnosis, the course of the vast proportion of children who have typical Hirschsprung's disease will be made simpler for the surgeon, the child, and the family.
New surgical approaches to ulcerative colitis in children and adults
Authors: Coran Arnold G. 
Published: May 2005

AbstractUlcerative colitis continues to be a devastating disease for the child and the young adult. In spite of intensive medical therapy with sulfasalazine and corticosteroids, the majority of patients with universal ulcerative colitis will ultimately require a total colectomy. The standard operation of a total proctocolectomy and a permanent end ileostomy is probably still the best procedure for the definitive management of this disease because all diseased tissue is removed with this operation; however, the resultant abdominal stoma can create significant psychological trauma in many of these patients. For that reason, sphincter‐saving operations were introduced in 1933 but were only marginally successful until 1977, when renewed interest in the endorectal pull‐through occurred. Since that time, several centers around the world have gained significant experience with the endorectal procedure, with or without the use of an ileal reservoir. Although the ileal reservoir appears to have certain advantages over the straight endorectal pull‐through, the procedure also is associated with a significant number of complications and is a far more complicated technical exercise.The experience at the University of Michigan with the straight endorectal pullthrough procedure in patients with ulcerative colitis and familial polyposis during the period from 1977 to 1984 is herein reported. All of the patients in our series are continent and experience a median stool frequency of 6 per 24 hours 1 year after the procedure. Patient satisfaction has been excellent with the majority of patients preferring their lifestyle without an ileostomy to that experienced with an ileostomy. At the present time, we can strongly recommend the endorectal pullthrough procedure to all patients with ulcerative colitis.
Splenic preservation in children
Authors: Touloukian Robert J. 
Published: May 2005

AbstractThe diagnosis of splenic injury can be made with almost 100% certainty by physical examination and nuclear imaging or computerized axial tomography, eliminating the need for surgical exploration in children who are stable and have no evidence of an associated intra‐abdominal injury. The nonoperative approach of treatment has been successful in over 95% of selected cases. Operative splenic preservation methods, including splenorrhaphy with or without splenic artery ligation, hemisplenectomy, and splenectomy with autotransplantation have been attempted and each has a role in the unstable patient requiring operation. Splenectomy alone carries a 1.5% risk of overwhelming postsplenectomy infection which is only partially prevented by Pneumovax® and antibiotics. The regionalization of trauma care in children ensures proper monitoring of the injured child, and a surgeon knowledgeable about the treatment options has made splenic preservation a reality