bluuebunny/crossref_metadata_2025_split huggingface dataset:
Is There a Place for Laparoscopy in Management of Postcholecystectomy Biliary Injuries?
Authors: Azagra Juan Santiago , De Simone Paolo , Goergen Martine 
Published: October 2003

Abstract.Despite its minimal invasiveness, laparoscopic cholecystectomy (LC) carries unquestionably higher morbidity and mortality rates when compared with the open counterpart (OC). Among the iatrogenic injuries, biliary tract lesions are the most clinically relevant because of their potential for patient's disability and long‐term sequelae. No universal agreement exists for classifying these lesions, but numerous authors have advocated a distinction between bile leaks and bile injuries. Even if not entirely correct, bile leaks refer to fistulas from minor ducts in continuity with the major ductal system or from accessory ducts (as the duct of Luschka). Biliary injuries are major complications consisting of leaks, strictures, transection, or ligation of major bile ducts. While bile leaks are typically treated by percutaneous and/or endoscopic drainage and stenting, biliary injuries often require a combined radiology‐assisted and endoscopic approach or even conventional surgery. The role of laparoscopy in the management algorithm of biliary lesions is still anecdotal. To date, a total of 25 cases of laparoscopic drainage of post‐cholecystectomy bilomas have been reported in the literature, whereas there is no mention of laparoscopic primary repair of biliary injuries detected at or after cholecystectomy. The main reasons depend on the excellent results achieved by the ancillary techniques; the emergency settings that accompany more complex biliary lesions; the technical challenges posed by the presence of inflammation, collections, and obscured anatomy; and the potential for malpractice litigation. However, a sound laparoscopic technique and a strict adherence to basic surgical tenets are crucial in order to avoid the incidence of iatrogenic biliary injuries and reduce their still unknown impact on long‐term patient disability.
Surgical Repair after Bile Duct and Vascular Injuries during Laparoscopic Cholecystectomy: When and How?
Authors: Bachellier Philippe , Nakano Hiroshi , Weber Jean‐Christophe , Lemarque Pascal , Oussoultzoglou Elie , Candau Christophe , Wolf Philippe , Jaeck Daniel 
Published: October 2003

Abstract.Recent collective reviews have outlined when and how surgeons should treat patients with bile duct injuries after laparoscopic cholecystectomy (LC). However, little is described about other injuries combined with bile duct injuries, for example, hepatic arterial injury and secondary biliary cirrhosis. Fifteen patients with bile duct injuries following LC were referred and surgically treated from 1990 to 1998 in our institution. We report how patients with hepatic arterial injury combined with bile duct injuries during LC were treated. The present study also reports unusual complicated situations: one patient with biliary cirrhosis referred 4 years after LC, another treated with internal biliary metallic stent referred 2.5 years after LC, and another with isolated right hepatic ductal injury. Short‐ and long‐term surgical outcomes after biliary repair were compared between simply referred patients and those with complicated history. Patients who were referred several years after LC and who were referred after primary hepaticojejunostomy were included with patients with complicated history (n= 4, group B), and the other patients were included with patients with simple history (n= 11, group A). Simultaneous right hepatic arterial occlusion was observed in 3 of these 15 patients, and arterial reconstruction was performed in 2 of the 3 patients in addition to biliary reconstruction. No postoperative complication occurred in these three patients. The patient with isolated injury of the right hepatic duct and the other with biliary cirrhosis were successfully treated with hepaticojejunostomy. The other patient treated with biliary stent underwent hepaticojejunostomy but a second operation was required because of later stenosis. Mean hospital stay was significantly longer in group B (30.3 ± 6.9 days) than in group A (18.5 ± 2.5 days, p< 0.05). Rehospitalization was more frequent in group B than in group A (p < 0.01). However, long‐term outcome was successful in both groups. The present results showed that arterial reconstruction should be performed when the distal right hepatic artery can be exposed and reconstructed, and suggested that patients with bile duct injuries during LC should be immediately referred to surgical institutions in which surgeons have adequate experience of bile duct repair and hepatic arterial reconstruction.
Safety of Laparoscopic Approach for Acute Cholecystitis: Retrospective Study of 609 Cases
Authors: Navez Benoît , Mutter Didier , Russier Yves , Vix Michel , Jamali Faek , Lipski David , Cambier Emmanuel , Guiot Pierre , Leroy Joël , Marescaux Jacques 
Published: October 2003

Abstract.Laparoscopic cholecystectomy (LC) is now widely accepted as the modality of choice for the treatment of symptomatic uncomplicated cholelithiasis. The application of the laparoscopic technique in the setting of acute cholecystitis (AC) is more controversial. The precise role as well as the potential benefits of LC in the treatment of the acutely inflamed gallbladder have not been clearly established through large clinical series. The aim of our study was to assess the feasibility, safety, benefits, and specific complications of the laparoscopic approach in patients with AC. A retrospective chart analysis involving the patients admitted to two busy emergency digestive surgical units between October 1990 and December 1997 was carried out. Six hundred and nine patients meeting our criteria for AC were identified and evaluated. Overall complication rate was 15% with 12 postoperative bile leakages (1.97%) and 4 biliary tract injuries (BTI) (0.66%). The overall mortality rate was 0.66%. Local and overall complication rates were significantly correlated with the delay between the onset of acute symptoms and the operation but not the rate of general complications nor deaths. Our results demonstrate the safety and feasibility of LC in the setting of AC. Early cholecystectomy within 4 days is strongly recommended to minimize complications and increase the chances of a successful laparoscopic approach.
Transduodenal Sphincterotomy in Laparoscopic Era
Authors: Carboni Manlio , Negro Paolo , D'Amore Linda , Proposito Delia 
Published: October 2003

Abstract.Indications for transduodenal sphincterotomy have been reduced in recent years, mainly because of the development of endoscopic sphincterotomy and laparoscopic procedures. Endoscopic treatment is effective, but it is necessary to carefully evaluate its indications because the incidence of early and late complications is not negligible. Laparoscopic procedures require advanced and expensive technologies and considerable laparoscopic experience. Transduodenal sphincterotomy is safe and effective, if correctly performed. Some risk factors appear to be related to the incidence of complications that do not significantly differ from those following endoscopic sphincterotomy. Transduodenal sphincterotomy may be still indicated in selected cases, and for this reason it should be considered an essential part of the knowledge of a general surgeon.
Telesensor Integrated Circuits
Authors: Ferrell Thomas L. , Britton Charles L. , Bryan William L. , Clonts Lloyd G. , Emery Michael S. , Ericson M. Nance , Merraudeau Fabrice , Morrison G. Wayne , Passian Ali , Smith Steven F. , Threatt Tim D. , Turner Gary W. , Wintenberg Alan L. 
Published: October 2003

Progress in personal computing has recently permitted small research programs to design and simulate application‐specific integrated circuits (ASICs). Inexpensive fabrication of silicon chips can then be obtained using chip foundries,
and quite complex circuits can be greatly reduced in size with an accompanying increase in certain performance characteristics. Within the past 5 years it has also become possible to design ASICs which can transmit and receive radio signals and which thus may be employed in applications in which wired connections for input and output of signals are not practicable. We are currently developing research‐grade prototype ASICs for the monitoring of human vital signs. In this case one or more sensors placed on an ASIC provides a signal to be transmitted a distance of 2‐3 meters to a receiver/display unit. The use of ASIC telesensors provides the possibility of wireless monitoring, including long‐term monitoring, with inexpensive and unencumbering devices. Their self‐contained nature permits a number of potential uses in future biomedical applications as new sensors are devised which are amenable to deployment on silicon.
Importance of Delayed Imaging for Blunt Renal Trauma
Authors: Blankenship John C. , Gavant Morris L. , Cox Clair E. , Chauhan Ravi D. , Gingrich Jeffrey R. 
Published: October 2003

AbstractThe advent of noninvasive computed tomography of the abdomen and pelvis for evaluation of blunt renal trauma has led to the practice of expectant management for hemodynamically stable patients. Although expectant management of higher grade injuries (American Association for the Surgery of Trauma Renal Injury Scale) would intuitively result in an increased frequency of urologic complications, this has not been previously examined in a large series of patients utilizing contemporary radiologic imaging techniques. A retrospective review of patients from a single institution within a recent 4‐year period revealed 4 grade I, 13 grade II, 21 grade III, 7 grade IV, and 4 grade V injuries. None of grade I, 15% of grade II, 38% of grade III, 43% of grade IV, and 100% of grade V injuries had one or more (15 major and 11 minor) urologic complications. The incidence of urinary complications correlated significantly with increasing grade (0%, 15%, 38%, 43%, and 100% for grades I to V, respectively; r = 0.94, p = 0.0158). Of the delayed urologic complications, 50% were diagnosed on follow‐up imaging studies and 33% of them required intervention. Therefore we advocate repeat imaging 2 to 4 days after trauma resulting in grade III to V blunt renal lacerations to identify delayed complications that may require intervention.
Management of Penile Amputation Injuries
Authors: Jezior James R. , Brady Jeffrey D. , Schlossberg Steven M. 
Published: October 2003

AbstractPenile amputation is an uncommon injury resulting from self‐mutilation, felonious assault, or accidental trauma. Management requires resuscitation and stabilization of the patient with particular attention to underlying psychiatric illness.
Amputated tissue can be preserved under hypothermic conditions in preparation for surgical replantation. Current replantation techniques rely on microsurgical approximation of the dorsal structures and cavernosal arteries with uniformly good results. Phallic replacement may be necessary when the amputated segment is lost. Microsurgical free forearm flap phalloplasty is the current mainstay of penile replacement surgery. Although urethral complications remain problematic, the results continue to be acceptable with regard to appearance and function. A unique subset of patients sustaining amputation injury is children. Both replantation and phallic construction have been successful in children and represent an alternative to gender reassignment.
Changes in Bacterial Concentration in the Liver Correlate with That in the Hepaticojejunostomy after Bile Duct Reconstruction: Implication in the Pathogenesis of Postoperative Cholangitis
Authors: Chuang Jiin‐Haur , Lee Shin‐Yi , Chen Wei‐Jen , Hsieh Chie‐Song , Chang Nyuk‐Kong , Lo Sing‐Kai 
Published: October 2003

AbstractPostoperative cholangitis is a frequent and unpredictable complication of unknown etiology following bile duct reconstruction (BDR), particularly for biliary atresia. This study was undertaken to correlate the growth of bacteria in the hepaticojejunostomy with that in the liver after BDR. Quantitative bacterial culture was done on the specimens taken from the liver and from the hepaticojejunostomy at 1 week (group 1, n = 7), 1 month
(group 2, n = 7), and 2 months (group 3, n = 7) following BDR with Roux‐en‐Y hepaticojejunostomy in piglets after 2 weeks of common bile duct ligation. The histological examination of the liver and the hepaticojejunostomy, as well as serial monitoring of hemogram and liver function tests, were performed to correlate the findings with the bacterial concentration of the liver and the hepaticojejunostomy following BDR. The bacterial concentration of the hepaticojejunostomy,
expressed as log10 colony‐forming units per gram
(log10 CFU/g) of the hepaticojejunostomy, showed a progressive decrease from 8.38 ± 1.36 in group 1, 7.07 ±
2.54 in group 2, to 3.56 ± 1.31 in group 3 (p =
0.001). The log10 CFU/g of the liver also showed a progressive decrease from 5.02 ± 1.59 in group 1, 3.16 ±
1.56 in group 2, to 2.19 ± 1.09 in group 3 (p =
0.006). There was a significant positive correlation of the log10 CFU/g of the liver (n = 21) with that of the hepaticojejunostomy (n = 21) following BDR (r = 0.600,
p = 0.004). Most of the infectious pathogens isolated from the liver were also isolated from the hepaticojejunostomy. The changes in hemoglobin, bilirubin, albumin, and ammonia significantly correlated with the changes of the bacterial concentration of the liver. The results of the study suggests that hepatic bacterial proliferation after BDR is significantly affected by microbial overgrowth in the bilioenteric anastomosis and is associated with deteriorated liver function and hemogram.
Total Pelvic Exenteration for Primary Local Advanced Colorectal Cancer
Authors: Chen Han‐Shiang , Sheen‐Chen Shyr‐Ming 
Published: October 2003

AbstractTotal pelvic exenteration (TPE) is an ultraradical operative procedure for locally advanced pelvic tumors with high morbidity and mortality rates. We retrospectively reviewed the results of TPE for primary locally advanced colorectal cancer in terms of mortality, morbidity, and long‐term survival. Of 2952 patients with colorectal cancer, 50 underwent TPE for primary locally advanced colorectal cancer between 1986 and 1995. There was one operative death
(2%). The other 49 cases were entered into a retrospective study.
Thirty‐two cases (65%) showed involvement of one or more adjacent organs. Thirty‐one patients (97%) had urologic organs invaded by tumor. The overall 5‐year survival rate was 49% and the overall morbidity was 37%. The survival rate for stage II was 62%, and that for stage III was 35%; there was no survival in stage IV. Early morbidity was noted in 24% of patients; late morbidity, in 15%. TNM stage appeared to be the only independent factor for survival
(p = 0.022). Our study showed that TPE can be performed with relatively low operative mortality and acceptable morbidity. With thorough preoperative evaluation and adequate surgical dissection, satisfactory outcomes for a primary locally advanced colorectal cancer can be achieved, especially at the earlier stages.
Arrow Wounds: Major Stimulus in the History of Surgery
Authors: Karger Bernd , Sudhues Hubert , Brinkmann Bernd 
Published: October 2003

AbstractTo illustrate how the high incidence of arrow wounds provided a major stimulus for the development of surgery until a century ago, we conducted a literature search. Our research shows that archaic peoples developed considerable surgical skill for extraction of arrows, including thoracotomy and trephination. A classical Hindu veda describes a variety of extraction methods, and Homer's Iliad introduces the term iatros,
which means "he who extracts arrows." Hippocrates of Kos and Galen,
representatives of the humoral doctrine, both shunned surgical intervention and considered purulence a drainage of materia peccans (spoiled humors). Cornelius Celsus was the first to systematically differentiate removal of arrows per extractionem and per expulsionem. Celsus recommended the spoon of Diocles, an ancient surgical instrument specially designed for extraction of arrows. Paulus of Aegina favored rapid extraction,
aggressive therapy, and ligature on both sides of a vessel before extraction efforts. Paulus was the first to describe a special instrument for the removal of detached arrowheads per expulsionem
(propulsorium). In medieval Europe, the standard of surgery declined drastically. The classical procedure under the dominant influence of the humoral concept was to await pus before extraction and to burn the wound with boiling oil and a branding iron. Arab authors had conserved the knowledge of Celsus and Paulus, and in Europe a renewal was achieved by Ambroise Paré, who has been called the creator of modern surgery. The incidence of arrow wounds increased once more in the American West. Joseph H. Bill, a famous U.S. Army Surgeon preoccupied with arrow wounds, favored rapid extraction and aggressive therapy, and he taught recruits not to apply traction on the shaft. The principles established by Celsus, Paulus, Paré, and Bill not only mark important landmarks in the evolution of surgery but can also serve as the basis for modern treatment of arrow wounds, which still occur,
although on a small scale.
Incidence of Umbilical Hernia in African Children: Redefinition of “Normal” and Reevaluation of Indications for Repair
Authors: Meier Donald E. , OlaOlorun David A. , Omodele Rachael A. , Nkor Sunday K. , Tarpley John L. 
Published: October 2003

Abstract.This study was undertaken to assess the degree of ubiquity of umbilical hernias (UHs) in Nigerians and to determine if a laissez faire approach to the presence of UHs is justified. A prospective evaluation was conducted of the umbilical area of 4052 Nigerians living in the vicinity of the Baptist Medical Centre (BMCO) in Ogbomoso, Nigeria. The diameter of the fascial defect was measured with the subject supine and the protrusion of the umbilical skin with the subject erect. Subjects were divided into three groups: group 1 (1 month to 18 years old); group 2 (older than 18 years); and group 3 (pregnant women in an antenatal clinic). “Outies” (defined as any protrusion of the umbilical tip past the periumbilical skin) were present in 92% of group 1, 49% of group 2, and 90% of group 3 subjects. UHs (defined as protrusion of at least 5 mm and diameter of at least 10 mm) were present in 23% of group 1, 8% of group 2, and 15% of group 3 subjects. Spontaneous closure of UHs seems to occur until age 14. A retrospective analysis identified 11 patients undergoing emergency operations for UH‐related problems during the past 15 years. With a low incidence and 0% mortality rate associated with management of these emergencies, a policy of prophylactic repair is not justified at BMCO. Because most of the children we examined had outies, repair for cosmetic reasons is rarely requested. The only logical indication for repair of UHs at BMCO is incarceration, and this rarely occurs.
Esophageal Shortening during the Era of Laparoscopic Surgery
Authors: Awad Ziad T. , Mittal Sumeet K. , Roth Terese A. , Anderson Peter I. , Wilfley William A. , Filipi Charles J. 
Published: October 2003

Abstract.An effective method for determining the presence of a short esophagus preoperatively would be helpful to surgeons. In this study 260 patients underwent primary laparoscopic antireflux surgery; 44 of them were suspected to have esophageal shortening on the basis of: (1) Barrett's esophagus or evidence of peptic stricture formation on endoscopy; (2) an irreducible hiatal hernia ≥ 5 cm in length on upright barium esophagram; or (3) a short esophagus on manometric analysis, defined as 2 SD below normal for height. Six patients without preoperative criteria required extensive esophageal mobilization and intraoperative endoscopic/laparoscopic assessment. Preoperative results were then compared with intraoperative esophageal length assessments. Altogether, 13 patients (5% of the whole series) underwent a lengthening procedure: left thoracoscopically assisted laparoscopic Collis gastroplasty (n= 11) or open transthoracic Collis gastroplasty (n= 2) plus antireflux repair (Nissen fundoplication in 9 and Toupet repair in 4). Among the preoperative tests, endoscopy had the highest sensitivity rate (61%); a combination of tests resulted in an increase in the specificity (63–100%) without a corresponding increase in sensitivity (28–42%). Preoperative testing is thus useful for predicting the need for an esophageal lengthening procedure. Endoscopy is the best screening test for the short esophagus. A well planned prospective trial to test the reliability of each test is needed.
Treatment of Thoracic Outlet Syndrome: Long‐term Results
Authors: Athanassiadi Kalliopi , Kalavrouziotis Georgios , Karydakis Kleanthis , Bellenis Ion 
Published: October 2003

Abstract.Thoracic outlet syndrome (TOS) refers to a complex of symptoms in the upper extremity caused by compression of the neural and vascular structures at some point between the interscalene triangle and the inferior border of the axilla. A review of our experience in treating this controversial syndrome is presented. Between 1989 and 1997 a series of 23 patients (5 men, 18 women) were operated on for TOS. The average age of the patients was 26.4 years (range 17–60 years). All patients complained of pain typically in the shoulder and proximal upper extremity with radiation to the neck, and most had paresthesias and numbness in the forearm and hand. Their symptoms had been present for 8 months to 9 years (mean 2.6 years). All were evaluated by history, physical examination, radiographs of the chest and cervical spine, electromyography, and nerve conduction studies; computed tomography, magnetic resonance imaging, angiography, and myelography were conducted selectively. When TOS was suspected, a cooperative concept was utilized employing the aid of the neurologist, orthopedist, and occasionally a cardiologist. The initial treatment was physical therapy for a minimum of 6 weeks. If no relief occurred they underwent surgery. In all patients in the present series the first rib was removed through a transaxillary approach. A cervical rib was also removed in four cases. Postoperatively, they were evaluated by questionnaire and reexamination. Nineteen (82.6%) had complete relief, and four had partial relief of symptoms. Complications included pneumothorax and temporary brachial paralysis in one case each. We concluded that careful selection of patients for surgery can yield satisfactory results, and a coordinated team of thoracic surgeons, neurologists, and physical therapists is important for management of these patients.