bluuebunny/crossref_metadata_2025_split huggingface dataset:
Preoperative Chemoradiation Therapy and Anal Sphincter Preservation with Locally Advanced Rectal Adenocarcinoma
Authors: Luna‐Pérez Pedro , Rodríguez‐Ramírez Saúl , Rodriguez‐Coria Darío F. , Fernández Armando , Labastida Sonia , Silva Alejandro , López Marvin J. 
Published: October 2003

AbstractPreoperative irradiation has been used to produce tumor regression and allow complete resection of rectal cancer with a sphincter‐saving procedure. To evaluate the associated toxicity, the response in the primary tumor, and the postsurgical morbidity in a group of patients with locally advanced rectal cancer treated with preoperative chemoradiation therapy and low anterior resection, 120 patients were treated with 45 Gy of preoperative radiotherapy and a bolus infusion of 5‐fluorouracil 450 mg/m2 on days 1 to 5 and 28 to 32 of radiotherapy. Four to six weeks later, 16 lesions were found unresectable; 36 patients underwent abdominoperineal resection or pelvic exenteration, and in the remaining 68 a low anterior resection was performed. For the purpose of this study only the latter group was included. There were 38 men and 30 women, with a mean age of 54.7 ± 13.1 years. Gastrointestinal and hematologic acute toxicity grade 3 to 4 occurred in 12 and 7 patients, respectively. The mean distance of the tumor above the anal verge was 8.2 ± 2.6 cm. In 10 patients the surgical resection included neighboring pelvic organs; 16 patients (23.5%) required a temporary diverting colostomy. The main causes of surgical morbidity were clinical anastomotic leakage in seven (10%), abdominal wall infection in five (7.4%), anastomotic stenosis in three (4.5%), and intraabdominal abscess in one (1.5%). No operative deaths occurred. The postsurgical stages were as follows: no tumor in the specimen, 17 (25%); T1, 4 (6%); T2, 12 (17%); T3, 17 (25%); T4, 5 (7%); any T with N+, 9 (13%); and any T, N with M+, 4 (6%). The median and mean follow‐ups were 30.0 months and 37.4 ± 25.0 months, respectively. The local recurrence rate was 2.9%, and the distant recurrence rate was 17%. The administration of preoperative chemoradiation therapy for locally advanced rectal cancer is associated with tolerable toxicity, a high rate of response in the primary tumor that allowed anal sphincter preservation, and a low rate of local recurrence.
Ernst Ferdinand Sauerbruch: Rise and Fall of the Pioneer of Thoracic Surgery
Authors: Cherian Sanjay M. , Nicks Rowan , Lord Reginald S.A. 
Published: October 2003

AbstractFerdinand Sauerbruch (1875–1951) was a pioneer of thoracic and cardiac surgery and is undoubtedly one of the twentieth century's most outstanding surgeons. Before 1904 operations on the thorax met with fatal complications due to pneumothorax. Sauerbruch developed a pressure‐differential chamber that maintained normal respiration and enabled safe operations to be undertaken on the thorax. Together with von Mikulicz, he initiated intrathoracic operations and later developed various surgical procedures on the mediastinum, lungs, pericardium, heart, and esophagus. The simple yet effective techniques of positive‐pressure ventilation replaced the expensive, cumbersome negative‐pressure chamber. Sauerbruch's latter years were marred by dementia that adversely affected his personality, intellect, and capacity as a surgeon. The unjustifiable toll of increasing patient morbidity and mortality forced authorities to dismiss him in 1949. He died at the age of 76 in Berlin. After almost a century since the advent of the first safe thoracic surgery, the advances in technique and technology have been enormous. A great deal is owed to the inspiration and contributions of Ferdinand Sauerbruch.
Present Status of Neurosurgical Trauma in Germany
Authors: Firsching Raimund , Woischneck Dieter 
Published: October 2003

Exact epidemiological data on head injury in Germany are limited and based on data from death certificates, the Federal Board of Statistics (Bundesamt für Statistik), small regional cohort studies, and health insurance. With a population of 82
million people there had been 279,029 head injuries admitted to hospital in Germany in 1996. The majority had the diagnosis.
"concussion," which refers to completely reversible lesions. Head injury caused the deaths of 9415 patients in 1996, which amounts to a mortality of 11.5 per 100,000 inhabitants. At the same time there were
135 independent neurosurgical units, all of which had a computerized tomography scanner available. Of all fatal cases, however, 68.4% died before they reached a hospital. The exact cost is difficult to assess,
because head injury causes more costs than only the hospital stay and rehabilitation.
Surgical Management of Benign Strictures of the Biliary Tract
Authors: Quintero Gustavo A. , Patiño José Felix 
Published: October 2003

Abstract.Benign strictures of the biliary tract are difficult to treat surgical complications. Most biliary strictures result from injuries during cholecystectomies, and their initial management is a major determining factor of the long‐term outcome. Only surgeons well trained and experienced in their management should treat this entity. The affected patients present various signs and symptoms depending on the time the lesion is detected, and the treatment modality largely depends on such timing. The success of surgical treatment with its attendant low morbidity and mortality makes it the preferred modality over transhepatic image‐guided or endoscopic balloon dilatation, with or without the insertion of stents. Surgical treatment is based on three principles: good exposure for internal drainage of the intrahepatic biliary tract, mucosa‐to‐mucosa anastomosis, and prevention of the risk of reoperation for recurrent stenosis. Roux‐en‐Y hepaticojejunostomy with a blind subcutaneous jejunal loop seems to comply with these three principles. Transanastomotic stents are not necessary. We have analyzed our experience from 1988 to 1999 with 65 consecutive patients referred to us for biliary reconstruction. We used the Roux‐en‐Roux‐en‐Y hepaticojejunostomy with a blind subcutaneous jejunal loop, performed by the same surgical group in all cases.
Dilatation of Biliary Strictures through the Afferent Limb of a Roux‐en‐Y Choledochojejunostomy in Patients with Sclerosing Cholangitis
Authors: Hutson Duane G. , Russell Edward , Levi Joe U. , Jeffers Lennox J. , Reddy K. Rajender , Yrizarry Jose M. , Scagnelli Tomas , Sleeman Danny , Schiff Eugene R. , Livingstone Alan S. 
Published: October 2003

Abstract.Repeated dilatation of biliary strictures in patients with sclerosing cholangitis through a subcutaneously placed afferent limb of a choledochojejunostomy is technically feasible and safe. This study is a prospective 15‐year evaluation of 36 patients treated by repeat dilatation through this jejunal limb. There was one operative death and one major complication of dilatation. The 5‐year survival of all patients was 74%. If patients with cirrhosis or unproven cholangiocarcinoma at the time of operation are not included, the 5‐year survival is 86%. The 15‐year survival of all patients was 30%; it was 64% if those with cirrhosis and unproven cholangiocarcinoma at the time of operation are not included. Six patients are presently alive with an average survival of 159 months. The study suggests that a combination of repeated dilatations combined with transplantation is the approach of choice in selected patients.
Long‐term Biliary Complications after Liver Surgery Leading to Liver Transplantation
Authors: Loinaz Carmelo , Moreno González Enrique , Jiménez Carlos , García Ignacio , Gómez Ramón , González‐Pinto Ignacio , Colina Francisco , Gimeno Alberto 
Published: October 2003

Abstract.Chronic biliary obstruction with repeated bouts of cholangitis adversely affects quality of life and may lead to secondary biliary cirrhosis with liver failure. We reviewed our experience with chronic biliary complications after surgical treatment of various diseases that at the end needed a liver transplantation. Twelve patients with previous biliary surgery developed secondary biliary cholangitis, secondary biliary cirrhosis, or both. Seven had surgery for liver hydatid disease by Echinococcus granulosus, another four had complicated biliary surgery unrelated to hydatid disease, and one had a history of a traffic accident with liver trauma and hepatectomy with chronic biliary fistula. The repeated cholangitis attacks and in two cases of hydatid disease the development of biliary‐bronchial fistulas made these patients' lives miserable. All had had previous surgical procedures that made the transplantation procedure more difficult. Nevertheless, patient survival and graft actuarial survival after liver replacement were 75.0% and 69.2%, respectively, at 5 years.
Management of Biliary Duct Confluence Injuries Produced by Hepatic Hydatidosis
Authors: Vicente Emilio , Meneu Juan C. , Hervás Pedro L. , Nuño Javier , Quijano Yolanda , Devesa Manuel , Moreno Alberto , Blazquez Luis 
Published: October 2003

Abstract.From 1978 to 1999 a total of 850 patients underwent surgical treatment for hydatid disease of the liver at our surgical department. Biliary duct confluence injuries produced by hepatic hydatidosis (HH) were founded in six patients (0.7%). Surgical intervention was undertaken to relieve the obstructive jaundice and clinical manifestations of cholangitis and to treat the hydatid cyst. A partially open cystopericystectomy technique was used in three patients with a double bilioenteric Roux‐en‐Y reconstruction. The remaining three patients (two with prehepatic portal hypertension and one with triple hepatic duct confluence) were subjected to a cystojejunostomy. There were no hospital deaths. Two cases of anastomotic leakage following a high bilioenteric anastomosis occurred but did not require surgical treatment. During the follow‐up (5–19 years) one patient suffered local recurrence of the hydatid disease 7 years after cystojejunostomy. The site of intrahepatic biliary and vascular involvement, the presence of biliary duct anomalies, and the presence of portal hypertension are decisive factors when choosing the “ideal” procedure for reconstruction. Conservative surgical approaches (partial cystectomy and cystojejunostomy) are the treatments of choice. Radical surgery is often a serious matter.
Choledocholithiasis: New Approach to an Old Problem
Authors: Cervantes Jorge , Rojas Guillermo 
Published: October 2003

Abstract.The old problem of diagnosis and treatment of choledocholithiasis is analyzed in light of recent developments in the field of radiology and surgery. The traditional indications for common bile duct (CBD) exploration resulted in a large number of unnecessary manipulations of the bile ducts. The same is now true of the widespread use of endoscopic retrograde cholangiopancreatography. With the advent of magnetic resonance imaging cholangiography, which can clearly demonstrate CBD calculi by means of a noninvasive, complication‐free technology, we should abandon the old indications for CBD exploration and be more conservative regarding the diagnosis and management of this condition. In an era of minimally invasive surgery we are seeing a significant reduction in the number of patients with choledocholithiasis.
Biliary Complications during Liver Resection
Authors: Lam Chi‐Ming , Lo Chung‐Mau , Liu Chi‐Leung , Fan Sheung‐Tat 
Published: October 2003

Abstract.Biliary complications after hepatectomy may lead to sepsis, liver failure, and death. Measures to detect biliary injury after liver transection may reduce such morbidity. The aim of this study was to investigate the trend of biliary complications after hepatectomy during the last 10 years and assess the efficacy of intraoperative measures (methylene blue test, cholangiography, fibrin glue application) for reducing postoperative biliary complications. This is a retrospective study of 616 consecutive patients who underwent hepatectomy in our institution from January 1989 to September 1998. The study period was divided into the first 5 years and the second 5 years for comparison. The hospital mortality rate was 6%. It was significantly reduced during the second 5‐year period (3.3% vs. 10.6%; p= 0.0002). The postoperative biliary leakage rate was 5.5% and was also reduced during the second 5‐year period (3.5% vs. 9.8%; p= 0.004). Postresection methylene blue tests were performed more frequently during the second 5‐year period than the first (63% vs. 28%; p= 0.0001). The postoperative biliary leakage rate was reduced by the methylene blue test (3.6% vs. 7.3%; p < 0.05) but not by application of fibrin glue (7.2% vs. 4.2%) or postresection cholangiography. However, among the 60 patients with a positive methylene blue test, postoperative biliary leakage still occurred in 10% of them after the leakage sites were sutured. In conclusion, the biliary complication rate is decreasing. Only the postresection methylene blue test, but not postresection cholangiography or application of fibrin glue, helps to reduce the postoperative biliary leakage rate.
Surgical Complications and Treatment during Resection for Malignancy of the High Bile Duct
Authors: Meunier Bernard , Lakehal Mohamed , Tay Khoon‐Hean , Malledant Yannick , Launois Bernard 
Published: October 2003

Abstract.From January 1968 to January 1997 a series of 50 of 109 patients had undergone resection for high bile duct cancer in our institution in Rennes, France. The overall operative mortality was 12%, but there were no deaths among those who had only tumor resection or those with hepatectomy with vascular reconstruction. The early complications were biliary fistula (four cases) and subphrenic abscess (three cases), of which two of the biliary fistulas resulted in mortality. There were three gastrointestinal hemorrhages; one was due to gastritis related to hepatorenal insufficiency and was fatal. Two other deaths were due to respiratory failure and ascites associated with hepatic insufficiency. In one patient after liver transplantation with cluster resection, a biliary leak and ileocolic fistula were the cause of postoperative mortality. Another patient suffered a ruptured mycotic aneurysm after pretransplant transtumoral intubation, which emphasizes the risk of infection in an immunosuppressed patient. The main late complication was cholangitis (8 cases). This complication is most often a symptom of recurrence (four cases). Some are due to benign causes (intrahepatic lithiasis, intrahepatic foreign body granuloma). Surgical exploration is mandatory to exclude benign complications, which can then be treated palliatively. Four patients presented with recurrence but without cholangitis. In conclusion, the causes of complications after resection of high bile duct cancer should be carefully assessed to choose the correct treatment. Late cholangitis is a symptom of recurrence, but it should be explored and managed precisely.
Endoscopic Stenting for Malignant Biliary Obstruction
Authors: Lai Edward C.S. , Lo Chung‐Mau , Liu Chee‐Leung 
Published: October 2003

Abstract.Use of endoscopic stents to manage patients with malignant obstructive jaundice is a well accepted measure. Interpretation of the results of endoscopic stenting must be made with reference to the level of the bile duct obstruction. Results were generally unsatisfactory for hilar lesions, especially when the intrahepatic ducts were segregated into multiple isolated systems. After deployment, stent dysfunction due to clogging by biliary sludge is apparently an inevitable process for the conventional plastic stent. Considerable efforts had been made to prolong the stent patency by changing its physical configuration, coating the inner lumen, and the choice of material but with little success. The development of a self‐expandable metal stent is a major advance, but the benefits derived from a larger stent lumen are compromised by the initial expense and the tumor ingrowth through the wires for all models available commercially. Current data failed to substantiate the value of routine preoperative biliary decompression, as there is no reduction in the morbidity and mortality rates after surgery. Although biased patient selection may have resulted in the negative observations made, repeated clinical trials should probably focus on patients with distal bile duct tumors who are preparing for a major pancreatic resection. As a definitive palliative measure, endoscopic stenting is a more cost‐effective option than surgery for patients with limited life expectancy based on data regarding plastic stents. The recommendations are evolving however, as there is progressive refinement of laparoscopic surgery techniques and designs of endoscopic stents.
Biliary Anastomotic Complications in 400 Living Related Liver Transplantations
Authors: Egawa Hiroto , Inomata Yukihiro , Uemoto Shinji , Asonuma Katsuhiro , Kiuchi Tetsuya , Fujita Shiro , Hayashi Michihiro , Matamoros Maria A. , Itou Kyo , Tanaka Koichi 
Published: October 2003

Abstract.The purpose of this study was to evaluate the cause and outcome of biliary anastomotic complications occurring after living related liver transplantation (LRLT). A database of 391 patients undergoing 400 LRLT from June 1990 to August 1998 was reviewed. The overall incidence of biliary anastomotic complications was 18.2% (71 patients). There were 45 bile leaks, 35 anastomotic strictures, and the bile duct was ligated inadvertently in 3 cases. Univariative analysis revealed that the manner of stent usage, intrapulmonary shunting, and gender of recipients were significant risk factors for leakage. Anastomotic leaks, cytomegalovirus infection, hepatic artery complications, and gender of recipients were significant risk factors for stricture. In pediatric patients older than 2 years old, ABO blood type compatibility was another risk factor for leakage and stricture. Choice of stent usage and earlier transplantation for patients with intrapulmonary shunting should reduce the rate of biliary leaks, and prophylaxis of leaks for patients with intrapulmonary shunting, and minimizing hepatic artery complications should reduce the rate of biliary stricture after LRLT. Avoidance of ABO‐incompatible donors or innovative immunosuppression in ABO‐incompatible transplantation should be considered in children.
Choledochocholedochostomy Conversion to Hepaticojejunostomy due to Biliary Obstruction in Liver Transplantation
Authors: Gómez Ramón , Moreno Enrique , Castellón Camilo , González‐Pinto Ignacio , Loinaz Carmelo , García Ignacio 
Published: October 2003

Abstract.Choledochocholedochostomy with tutor (CC‐T) or without (CC) is the technique of choice for biliary reconstruction in orthotopic liver transplantation (OLT), however, its rate of complications is high and does not decrease significantly over the years. Biliary obstruction is the most frequent complication and surgical treatment frequently involves conversion to hepaticojejunostomy (H‐J). Out of 412 patients (448 OLTs) analyzed retrospectively, 74 (18%) presented biliary complications and 25 (6%) required conversion to H‐J because of biliary obstruction, generally due to anastomotic stenosis (17 patients, 68%). Sixteen out of the 25 presented after the first 3 months, and in two patients, stenosis was secondary to arterial thrombosis. Anastomotic stenosis was more frequent in the CC group than in the CC‐T group (9.9% versus 2.6%, p < 0.05). Sixteen patients (64%) underwent percutaneous dilatations, but the response was only transitory. There were no postoperative deaths. At the follow‐up, three (12%) of the 17 surviving patients presented episodes of cholangitis which required percutaneous dilatations (1), revision of the H‐J (1), or conversion to hepaticojejunoduodenostomy (1). Mean survival of patients with H‐J was 70.9%, and the actuarial survival rate was 68% at 5 years. This does not differ from the actuarial survival in our series of transplanted patients (65%). CC or CC‐T (in selected cases) is an adequate biliary reconstruction for OLT, in spite of the fact that a small number of patients will require conversion to H‐J. H‐J is an excellent technique of rescue in cases of biliary obstruction that are not possible to resolve by percutaneous dilatations.
Laparoscopic Surgeon and the Common Bile Duct
Authors: Fitzgibbons Robert J. , Gardner Glenn C. 
Published: October 2003

Abstract.Many biliary tract surgeons have now reached a level of sophistication with laparoscopic cholecystectomy that they are now able to deal with the common bile duct at the same time. Preoperative endoscopic cholangiography can be reserved for cases where choledocholithiasis has a high degree of probability. This has served to decrease the number of negative studies. The surgeon has five choices regarding stones confirmed by operative cholangiography during laparoscopic cholecystectomy: (1) do nothing, hoping the stones will pass spontaneously or that a postoperative sphincterotomy with stone extraction will be successful; (2) perform a transcystic laparoscopic common bile duct exploration (best for stones less than 1 cm and distal to the cystic duct); (3) perform a laparoscopic common bile duct exploration by choledochotomy (best for large stones in patients with common bile ducts greater than 1 cm. It is also the preferred approach with stones proximal to the insertion of the cystic duct.); (4) perform an intraoperative sphincterotomy with stone extraction, either retrograde or antegrade (this approach has some proponents but has not gained popularity among the majority of surgeons); and (5) place a double lumen catheter through the cystic duct with a proximal lumen in the common bile duct and the distal lumen in the duodenum. This can be used for serial postoperative cholangiography to confirm spontaneous stone passage or falsely positive operative cholangiograms. It is useful in situations when laparoscopic common bile duct exploration equipment or surgeon expertise is not available. If stones persist, a guidewire can be introduced through the distal lumen of the catheter for a guidewire‐assisted sphincterotomy. Other CBD interventions that have been reported include laparoscopic biliary bypass and resection of choledochal cysts. Malignant lesions should not be approached by a laparoscopic method except in unusual circumstances.