bluuebunny/crossref_metadata_2025_split huggingface dataset:
Resection of midesophageal carcinoma with esophagogastric anastomosis
Authors: McKeown Kenneth C. 
Published: May 2005

AbstractThis report is based on 432 cases of cancer of the oesophagus, 154 of which involved the middle third. There were 82 men and 72 women, ranging in age from 42 to 81, average 62. Operative mortality was 15.7%. The philosophic objectives were to restore promptly the ability to swallow, to obtain a worthwhile survival period, and to avoid the miseries associated with oesophageal carcinoma.Preoperative preparation, operative techniques including errors and safeguards, postoperative management, and overall results are specified. The stomach is preferred to jejunum or colon as a means of restoring continuity of the alimentary tract following resection of oesophageal carcinoma.
Surgery for carcinoma of the lower esophagus and cardia
Authors: Ellis F. Henry , Maggs Peter R. 
Published: May 2005

AbstractEsophagogastrectomy with esophagogastrostomy is the treatment of choice for patients with cancer of the lower esophagus and cardia. The Lahey Clinic experience with the surgical management of this disease between January, 1970 and March 1, 1980, consists of 68 patients, 58 of whom (85.3%) had resections. Forty‐three had stage III disease, and the remainder (25) were equally divided between stages I and II. Esophagogastrectomy and end‐toside esophagogastrostomy is performed through a left thoracotomy without the use of clamps and without tension.One patient died postoperatively of a myocardial infarction‐an overall hospital mortality rate of 1.7%. With few exceptions, all of the hospital survivors were able to swallow without difficulty throughout the follow‐up period. Long‐term survival was rare, but of the 22 patients operated on 5 or more years ago, 4 survived from 5 to 8 years; the 5‐year survival rate was 50% for patients with cancer developing in the lower esophagus but only 11.1% for those with disease arising at the cardia.The low mortality and morbidity rates and the excellent palliation afforded patients with cancer of the lower esophagus and cardia by esophagogastrectomy with esophagogastrostomy justify its continued use in the management of patients with lesions in this location.
Intubation in the treatment of carcinoma of the esophagus
Authors: Angorn I. Barnett 
Published: May 2005

AbstractIntubation for the palliation of dysphagia due to squamous carcinoma of the esophagus has been analyzed in a series of 1,135 patients treated over a 5‐year period. Tumors involving the upper thoracic esophagus in 1,045 patients were intubated with the Procter‐Livingstone tube using a pulsion technique. The hospital mortality rate in this group was 16%, with 80% of patients intubated swallowing satisfactorily on discharge. Tumors of the lower esophagus in 90 patients were intubated with the Celestin tube, using a traction technique. The hospital mortality rate was 20%, with 73% of patients swallowing an adequate diet on discharge. In 184 patients with malignant esophago‐respiratory fistulas, pulsion intubation successfully palliated symptoms in 75% of patients. Objective evaluation of the nutritional status of patients following intubation demonstrated correction of protein‐calorie malnutrition.
The Kirschner bypass operation—A palliation for complicated esophageal carcinoma
Authors: Roeher Hans D. , Horeyseck Guenter 
Published: May 2005

AbstractThe original technique and modification of the Kirschner gastric bypass operation are described. This procedure provides an alternative to the Celestin tube in restoring oral food intake in case of complete neoplastic obstruction of the esophagus in an unresectable stage. The superiority of this procedure primarily concerns esophagobronchial fistulas of benign and malignant origin. Operative mortality rates between 10 and 33% and survival times of 3–6 months are approximately equal for the bypass procedure and tumor intubation.
Results of the Kirschner operation
Authors: Wong John , Lam K. H. , Wei W. I. , Ong G. B. 
Published: May 2005

AbstractBetween 1964 and 1979, a total of 1,536 patients with carcinoma of the thoracic esophagus were treated at this center. Of these, 142 patients with unresectable tumor underwent the Kirschner operation for palliation. In this operation, esophageal obstruction is bypassed by subcutaneous or retrosternal gastric esophagoplasty, and the thoracic esophagus defunctionalized by a long Roux‐en‐Y jejunal loop to the abdominal esophagus. Dysphagia is thus relieved and aspiration of esophageal and gastric contents into the respiratory tract avoided.Any patient who was not discharged from the hospital for any reason and eventually died in the hospital is counted as a mortality. The hospital mortality for these 142 patients was 41.5% (59 patients). In recent years, there has been a reduction in mortality rate. The most common cause of death was progressive bronchopneumonia (72.9%). Leakage of anastomosis occurred in 67 patients (47.2%), but most healed on conservative treatment. The ability to eat normally was restored in 69% of survivors, and another 28% were able to tolerate a soft diet. Although temporary postoperative aspiration was occasionally encountered when the patient started oral feeding, once swallowing was established, tracheobronchial aspiration did not occur.The mean survival of the discharged patients was 5.0 months. Malignant cachexia from growth of the primary tumor accounted for 61.4% of late deaths; metastatic disease, 10.8%; and cardiopulmonary insufficiency, the remainder. One patient is alive more than 5 years after operation, and presumably was cured by postoperative radiotherapy.Although the mortality rate of the Kirschner operation is substantial, other forms of treatment also have significant mortality rates but with less palliative potential. Therefore, we would recommend this operation for the palliation of unresectable carcinoma of the esophagus.
The utility of fine needle aspiration biopsy cytology in the management of thyroid tumors
Authors: Varhaug Jan E. , Segadal Elsa , Heimann Peter 
Published: May 2005

AbstractThis report is a retrospective survey of our experience with fine needle aspiration biopsy cytology in the evaluation of thyroid tumors in the years 1974–1978. The method was used as a routine procedure with 17 surgeons involved in the sampling and 4 cytopathologists involved in analyses of the smears. In 264 patients treated surgically, the preoperative cytopathologic diagnoses have been compared to the postoperative diagnoses. In 43 patients (16%), the biopsies were not representative. In patients with representative biopsies, a preoperative benign cytologic diagnosis was obtained in 112 of 160 patients with benign postoperative histology (70%), and a malignant or suspected malignant preoperative cytologic diagnosis was found in 52 of 61 patients (85%) with carcinomas. In 9 patients, the preoperative cytologic diagnoses were false‐negative (4.1% of the representative biopsies). No false‐positive cytologie diagnosis occurred. Sampling of adequate cellular material was the major problem in our experience. The high diagnostic reliability from representative material makes fine needle aspiration biopsy cytology a useful method in planning operations and in selecting patients for surgery. Due to the risk of false‐negative biopsies, a clinical suspicion of malignancy must not be ruled out by this method.
Calcitonin studies in the rhesus monkey
Authors: Geelhoed Glenn W. , Becker Kenneth L. , O'Neill William , Snider Richard H. , Moore Charles F. , Silva Omega L. 
Published: May 2005

AbstractThis study evaluates the utility of the rhesus monkey (Macaca mulatta) as a model for calcitonin (iCT) dynamics in humans. Two different anticalcitonin antisera were used, each having different region specificities for the hormone. Basal levels of iCT in both serum and urine were lower than those encountered in humans, whether measured with midportion (Ab‐IIIb) or carboxyl terminal (Ab‐IV) antisera. The totally thyroidectomized monkey continues to have detectable serum iCT while, in contrast to humans, urine iCT is undetectable by direct assay but measurable after concentration. Immunoperoxidase studies revealed a relatively larger concentration of C cells in the thyroid of the monkey, with, as in humans, a distribution in the central region along the median axis of the lateral lobes. Extraction of iCT from the thyroid gland demonstrated a higher concentration in the monkey than in humans. Many extrathyroidal tissues of the monkey contained iCT, which did not differ immunochemically from that in thyroid; this finding is also true of comparable human tissue. The very high concentration of iCT in liver decreased markedly after thyroidectomy, suggesting that hepatic iCT may be receptor‐bound hormone of thyroid origin. Other extrathyroidal sources of iCT persisted after thyroidectomy in the monkey, with the highest concentrations being found in thymus and in lung. The demonstration of the presence of extrathyroidal iCT may have important implications for its function as a tumor marker and for its presumed role in calcium metabolism. These studies demonstrate that the rhesus monkey, regardless of some differences from man, is nonetheless a useful animal model for the investigation of the pathophysiology of calcitonin.
Emergency decompression of bile duct in acute obstructive suppurative 3 cholangitis by duodenoscopic cannulation: A lifesaving procedure
Authors: Ikeda Seiyo , Tanaka Masao , Itoh Hideaki , Kishikawa Hideki , Nakayama Fumio 
Published: May 2005

AbstractAcute obstructive suppurative cholangitis is a life‐threatening condition characterized by abdominal pain, jaundice, spiking fever, shock, and central nervous system depression. Biliary calculi are by far the most common obstructing mechanism. This entity carries an almost 100% mortality unless early decompression of the obstructed common bile duct is performed. With recent progress in duodenofiberscopy, this can be accomplished by endoscopic cannulation using a large‐calibre stiff catheter. Three consecutive patients recently treated in the Kyushu University Hospital are presented. All were female and a stone was the cause of the obstruction in all. The stones impacted at the distal common bile duct of these patients were dislodged by endoscopic cannulation, resulting in a release of purulent bile and a dramatic improvement in the symptoms and signs. Endoscopic decompression is a quick, safe, and effective procedure for emergency treatment of acute obstructive suppurative cholangitis.
Operation‐sequel carcinoma of the stomach. Experimental studies of surgical techniques with or without resection
Authors: Langhans Peter , Heger Ralph A. , Hohenstein J. , Schlake Werner , Bünte Hermann 
Published: May 2005

AbstractSeveral etiopathogenetic factors responsible for carcinogenesis in the operated stomach have been proposed in the literature, but exact proof is still lacking. An experimental assay was planned to determine the pathogenetic roles of surgical trauma, of duodenogastric reflux, and of carcinogen application and its effects. Five different techniques of gastric surgery were performed on a collective of 466 Wistar rats: Billroth I resection, Billroth II resection, Billroth II plus gastroenterostomy with Roux‐en‐Y technique, Billroth II plus Braun's anastomosis, and gastroenterostomy without resection. Forty‐two animals were left unoperated as controls. The appropriate date for autopsy was determined by general clinical observation and random endoscopic and radiologic examinations, and eventually fixed on the 56th postoperative week.Carcinomas developing in the resected stomach were found in animals with and without carcinogen exposure. The actual rate of carcinoma incidence was strongly dependent on the surgical procedure chosen for the respective group. The lowest carcinoma incidence (0%) was found in gastroenterostomy without Roux‐en‐Y anastomosis, the highest rate (70% without carcinogen, 50% with carcinogen application) in gastroenterostomy alone.Tumor development was found to be connected with alterations of the physiological environment induced by the surgical intervention; a direct association between duodenogastric reflux and tumorigenesis can be postulated. The results of the present study are interpreted with an emphasis on reflux‐preventing techniques for gastric surgery that should be included in clinical routine.
Urgent surgery for ulcerative colitis: Early colectomy in 132 patients
Authors: Albrechtsen Dagfinn , Bergan Anstein , Nygaard Knut , Gjone Egil , Flatmark Audun 
Published: May 2005

AbstractIn accordance with a policy of early colectomy for severe ulcerative colitis, urgent/emergency surgery was performed in 132 patients during the last decade. The indication for surgery was toxic megacolon (45 cases), massive hemorrhage (6 cases), and fulminating colitis not responding to medical treatment within 4 days (81 cases). The operations performed were proctocolectomy (9 cases, mostly of hemorrhage), colectomy plus ileorectal anastomosis (3 cases), and abdominal colectomy plus ileostomy plus proctostomy (CIP) (120 cases, including 45 of toxic megacolon). Secondary proctectomy (SP) was later performed in 113 CIP cases.A major distinction of this series is a colonic perforation rate of only 3% (9% in toxic megacolon). Mortality after urgent/emergency colectomy was 5.3%. Total mortality within 2 years (including SP) was 6.8%. Two of 4 patients with colonic perforation died, as did 1 patient with colonic cancer. Postoperative complications occurred in 40% of the patients after urgent/emergency colectomy, and in 52% after all surgery combined (including SP). Mortality and morbidity were higher in toxic megacolon and in patients older than 60 years. Late complications, mostly persisting perineal sinuses, were seen in 31%.We believe that the low colonic perforation rate, and the subsequent favorable mortality and morbidity, are the results of our policy of early colectomy. Also, this study lends support to the choice of abdominal colectomy plus ileostomy plus proctostomy (and subsequent secondary elective proctectomy) when urgent/emergency surgery is indicated for severe ulcerative colitis.
Rectocolic familial polyposis; a study of 32 cases
Authors: Bigay D. , Plauchu H. , Berard Ph. , Robert J. M. , Guillemin G. 
Published: May 2005

AbstractThirty‐two cases of diffuse rectocolic polyposis, with a more or less marked hereditary character, have been analyzed. The homogeneity of the series, derived from the same surgical source and with the cooperation of a genetics department for the familial survey and detection, allowed precise observations on the evolution and treatment of the disease. Besides the imperative indications for removal of the rectum in those cases determined by endoscopy to be either locally degenerate or uncontrollable, a surgical protocol designed to meet more precisely the diagnostic needs must be developed, based on the preservation of the rectum and resulting in its unlimited supervision.
Studies in the healing of intestinal anastomoses
Authors: Ravitch Mark M. , Brolin Robert , Kolter Joseph , Yap Simon 
Published: May 2005

AbstractWe have assessed the security of anastomoses made by a variety of techniques, and under various circumstances. (a) In small bowel, inverting and everting silk anastomoses and stapled anastomoses give equivalent results. (b) With everting closures and anastomoses, healing is from the cut end, and not at the suture line. (c) Foreign material around an anastomosis produces leaks with any type anastomosis. (d) In the colon, inverting manual anastomoses and stapled anastomoses are equivalent, and superior to one‐layer manual everted anastomoses. (e) Induction of early intestinal action by Prostigmin® and castor oil has no adverse effect on inverted, or stapled anastomoses, at any level of bowel, but increases incidence of anastomotic leaks in silk everting anastomoses of colon. (f) Stapled anastomoses made in presence of 24‐hour perforative peritonitis, 48‐hour devascularized bowel, and 48‐hour intestinal obstruction are as secure as inverting anastomoses.
The kallikrein‐kinin system in circulatory and metabolic homeostasis
Authors: McConn Rita , Haberland Gert L. , Frölich J. C. 
Published: May 2005

AbstractThis review focuses on how the kallikrein‐kinin system may influence circulatory and metabolic homeostasis through its interrelationship with the renin‐angiotensin system and the prostaglandins. Biochemical and physiological aspects of each of these systems are described. Recent findings suggest that the kinins may play a role in the physiological processes of healthy individuals as well as in disease states. The major influence of kinins, both in tissue and plasma, on renal function and blood pressure homeostasis may be through their effect on prostaglandin synthesis rather than their effect on angiotensin II formation. Kinins also may play a role in metabolism since these oligopeptides were found to influence glucose uptake in the gut and in skeletal and cardiac muscle in normal and pathological conditions. The effects of these chemical mediators on renal function are presented in terms of their anatomical location, as well as the biochemical and physiological associations between these chemical mediators.
Combined arterial reconstruction and transluminal dilatation: Therapeutic teamwork to combat vascular insufficiency
Authors: Johansen Kaj , Ricketts Howard , Wales Lee R. , Morishima Michael 
Published: May 2005

AbstractPercutaneous transluminal angioplasty (PTA) is a nonoperative method for dilatation of arterial stenoses. A burgeoning interest in PTA, fueled by its speed, ease, relative noninvasiveness, and diminished expense, has been marred by its rapid adoption without sufficient understanding of the biophysics of plaque dilatation, healing of the arterial injury thus incurred, or long‐term consequences of the technique. Further, it has too frequently been considered to be a competitor with surgical reconstruction in the management of limb or organ ischemia. Five illustrative cases demonstrate that PTA and arterial reconstruction may occupy complementary roles. Arterial dilatation has permitted limb‐saving arterial reconstructive surgery to be done in some severely ill patients, and has diminished the scope of such surgery in others. Arterial reconstructive surgery and PTA can be used effectively in synchronous or staged fashion to the benefit of well‐selected patients with arterial insufficiency.
The initial evaluation of the multiple trauma patient
Authors: Shaftan Gerald W. 
Published: May 2005

AbstractThe primary evaluation and resuscitation of the multiple trauma patient is based upon diagnosis and therapy of the failures of oxygen transport. The sequence is clearly ventilation, circulatory failure, and pulmonary failure. The secondary evaluation is related to intracranial, intrathoracic, intra‐abdominal, and extremity injuries. These 2 phases overlap. Thus, ventilation needs to be achieved without further compromise of spinal cord function while the control of external bleeding certainly aids circulatory function. In addition, effective cardiopulmonary resuscitation commonly greatly improves cerebral function. Thus, although discussed separately, evaluation and resuscitation is a complex endeavor that involves all of the injuries and all of the organs on a varying time scale in which the failures of oxygen transport are of first order importance because of the time scale that leads to death. Effective resuscitation demands a detailed knowledge of cardiopulmonary physiology and an aggressive personality so that the various possible mechanisms are evaluated and treatment is rapidly initiated. In general, the patient should have good cardiopulmonary resuscitation prior to being transferred to the radiographic unit. Thus, chest tubes may be placed on the basis of emergency room physical evaluation. The various pump failures are recognized by the failure of adequate circulatory response to blood volume support, usually accompanied by a rising right atrial pressure. Intra‐abdominal and intrathoracic bleeding are largely diagnosed by chest or peritoneal lavage tubes without x‐ray examination.
Traumatic shock in polytrauma: Circulatory parameters, biochemistry, and resuscitation
Authors: Messmer Konrad F. W. 
Published: May 2005

AbstractTraumatic shock in multiple trauma patients essentially represents hypovolemic shock in association with the effects and sequelae of tissue damage. The primary factor rendering the patient at peril to develop multi‐organ failure is the persistence of impairment of the microcirculation. Resuscitation must take place efficiently to prevent shock if possible or to treat shock when manifest. Primary volume replacement with red cell‐free solutions, preferably with a long‐lasting colloid, is recommended as the most important single step in resuscitation. Sequential analysis of circulatory and biochemical parameters, together with evaluation of clinical symptoms, is needed to reverse traumatic shock as a prerequisite for surgical management.
Thoracic injury requiring surgery
Authors: Mattox Kenneth L. 
Published: May 2005

AbstractThis report concentrates on the 15% of chest injuries requiring thoracotomy. Eighty‐five percent of cases may be managed by a large‐bore chest tube placed in the midaxillary line. The indications for thoracotomy following placement of a chest tube are immediate egress of 1,500 ml of blood, continued bleeding at a rate of more than 100 ml/h, and large air leaks that prevent re‐expansion of the lung or that, on the ventilator, constitute a significant fraction of the tidal volume. Immediate thoracotomy is also indicated for the patient with a penetrating wound that may have reached the heart in association with acute loss of vital signs or shock that does not quickly respond to blood replacement. Emergency room thoracotomy may also allow salvage of blunt trauma patients with blood loss in the chest by allowing more effective control of blood loss, cardiac massage, and cross‐clamping of the aorta. A persistent diagnostic suspicion of the hidden injuries such as aortic rupture, esophageal injury, airway rupture, blunt cardiac injuries, and diaphragmatic rupture must be maintained, so that these injuries are properly diagnosed and treated. Sepsis following trauma to the chest is generally related to retained hematoma and damaged tissue. It is probably wise to resect the pulmonary parenchyma damaged by a high velocity gunshot wound. Chest tubes for hemothorax should be placed so that the blood is totally evacuated; otherwise, the clotted blood usually restricts pulmonary ventilation and commonly leads to an empyema which requires surgery.