bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early hemodynamic changes following selective distal splenorenal shunt for portal hypertension: Comparison of surgical techniques
Authors: Spina Gian Paolo , Santambrogio Roberto , Opocher Enrico , Gattoni Filippo , Baldini Umberto , Cucchiaro Giovanni , Uslenghi Carlo , Pezzuoli Giuseppe 
Published: May 2005

AbstractNinety patients with cirrhosis undergoing elective distal splenorenal shunt (DSRS) for variceal bleeding between January, 1977 and September, 1988 comprised the study group. In 63 cases, the original technique of Warren was used and, in 15, the modified Britton procedure was employed. Twelve patients had a DSRS plus splenopancreatic disconnection. Thirtyfour had alcoholic cirrhosis and 56 had nonalcoholic cirrhosis. Intraoperative portal pressure remained high after the shunt (29.4 cm H2O)even if its initial value was probably decreased by the loss of the splenic flow. Splenic pressure was reduced to 21 cm H2O. The hepatic artery diameter enlarged even after selective shunt (from 6.5 to 7.1 mm). The persistence of a high portal pressure allowed for the preservation of hepatopedal portal flow in 87% of cases. Disconnection between the high‐pressure mesenteric area and the low‐pressure splenic area seemed to be ideal in only 17% of cases. Fifty‐five percent of cases had the early development of minimal or moderate portomesenteric gastrosplenic (PM‐GS) collateral pathways. In 33%, the PM‐GS collaterals were generally abundant and often allowed visualization of the splenic and caval veins during the venous phase of the superior mesenteric arteriograms. In this group, portal flow was generally highly reduced and even abolished. The incidence of portal thrombosis was 11%. Early angiographic checks after DSRS did not show a different hemodynamic behavior between alcoholics and nonalcoholics. Splenopancreatic disconnection seems to prevent the development of collaterals and the loss of portal perfusion after shunt surgery.
Can hepatic failure after surgery for hepatocellular carcinoma in cirrhotic patients be prevented?
Authors: Takenaka Kenji , Kanematsu Takashi , Fukuzawa Kengo , Sugimachi Keizo 
Published: May 2005

AbstractTo study the causes of postoperative hepatic failure in cirrhotic patients undergoing resection for hepatocellular carcinoma, we evaluated data on 126 cirrhotic patients surgically treated from 1977 to 1987. The records of 102 patients with a good postoperative course (survival group) and 24 patients who developed hepatic failure and died (hepatic failure group) were reviewed. No difference in preoperative liver function was apparent between the 2 groups. Histologically, moderate to severe inflammatory activity in the liver was present in 20 (83%) of 24 patients in the hepatic failure group. Major hepatic resections (lobectomy and extended lobectomy) were more frequent in the hepatic failure group. Mean perioperative blood loss was 1,945 g and 4,322 g in the survival and hepatic failure groups, respectively, with a significant difference (p< 0.01). Major postoperative complications occurred in 22 (22%) of 102 patients in the survival group and major complications followed by hepatic failure occurred in 21 (88%) of 24 patients in the hepatic failure group, with a significant difference (p< 0.001).In light of these data, we propose that: (a) histological examination should be done before the resection, (b) perioperative blood loss should be less than 2,000 g, and (c) intensive care is needed postoperatively to prevent complications which might lead to hepatic failure.
Necrosis of intraabdominal esophagus and proximal third of the stomach after proximal gastric vagotomy and fundoplication
Authors: Ackermann Christoph , Müller Claude , Harder Felix 
Published: May 2005

AbstractLesser curve necrosis is a rare but known complication of proximal gastric vagotomy (PGV). Incidence seems to increase when PGV is combined with fundoplication. In reports of this complication, the necrosis was of various sizes, but generally limited to the lesser curve. We report a 54‐year‐old patient with hiatus hernia, severe peptic esophagitis, and increased acid output who developed necrosis of the whole intraabdominal esophagus, cardia, and proximal third of the stomach after PGV and fundoplication with division of several short gastric vessels. A proximal gastric resection with intrathoracic esophagogastric anastomosis had to be performed. After drainage of a subphrenic abscess, the patient made a complete recovery.When combining PGV with a fundoplication, an increased risk of necrosis of the stomach must be considered. Division of the short gastric arteries should be avoided and the original Nissen fundoplication is preferred.
Quantitative approaches to the evaluation of screening programs
Authors: Day N. E. 
Published: May 2005

AbstractThe evaluation of screening programs for cancer is considered. Initial evaluation has to be in terms of mortality, but increasing importance should be attached to measures which evaluate the interaction of early detection with the disease process. These include the degree to which diagnosis is advanced, both in time and in stage of disease, and the ability of the screening test to identify presymptomatic lesions. Randomized trials are of major importance in establishing—in quantitative terms—the benefits of screening; in their absence, case‐control methods can be adapted for this purpose, but cannot provide evidence of the same rigor. Currently, only screening for breast cancer and cervical cancer have been fully demonstrated to be effective.
The biology and natural history of breast cancer from the screening perspective
Authors: Holmberg L. , Pontén J. , Adami H. ‐O. 
Published: May 2005

AbstractA review of the tumor biology of breast cancer from the screening perspective reveals important research issues. It is not known if the induction phase includes any detectable preneoplastic lesions. Evidence for the existence of preneoplasias is conflicting. The effect of removal of such lesions on the incidence of breast cancer has not yet been studied. The mechanisms that govern progression of in situ lesions—or even small preclinical invasive cancers—are not fully understood. It is not clear to what extent progression into cancers with metastatic behavior occurs. Current predictors for progression are weak.One major benefit of the scientific evaluation of the screening programs is that we can learn more about the natural history of the disease. Mammographic screening detects tumors that are smaller in size than those detected by clinical examination only. There is an inverse relationship between tumor size and the probability that the patient has acquired axillary metastases. These facts, taken together, indicate that the mortality reduction seen in screening is a result of a real impact on the natural history. Calculations of the lead time gained in randomized screening projects give empirical proof that a third of the cancers progress from a localized stage to a disseminated disease relatively late in the preclinical phase of the tumor. Analyses of interval cancers in screening have pointed to the conclusion that the net growth rate of the primary tumor does not directly parallel metastatic ability, and that the tumors grow faster in younger women.
Screening for colorectal cancer: A critical review
Authors: Hardcastle Jack D. , Pye Geoffrey 
Published: May 2005

AbstractThis article discusses the place of symptom detection, endoscopy, and fecal occult blood testing in population screening for colorectal cancer. There is now considerable evidence that screening the population over the age of 50 years for occult blood in the feces will result in an increased yield of tumors localized to the bowel at the time of surgical treatment. These tumors also have other favorable prognostic features and it is likely that the prognosis of this group will be better than the prognosis of patients presenting with symptoms in the usual way. Because of the biases that result from the selection and detection of tumors in screening studies, the mortality results of the control trials now underway must be awaited until it is known whether population screening is of real value.In chemical fecal occult blood screening tests, a compromise has to be made between sensitivity and specificity. The fecal occult blood test most widely used and the one that has been subjected to the most evaluation in screening studies is the guaiac‐based slide test, Hemoccult. The predictive value of a positive test for invasive cancer is 11–17%, and for adenomas, 36–41%. This specificity is achieved at a loss of sensitivity, the interval cancer rate reported in screening studies being over 20%. Newly developed immunological techniques appear to be more sensitive and specific, but require further evaluation in population screening studies.
Progress and problems in screening for carcinoma of the prostate
Authors: Chodak Gerald W. , Schoenberg Harry W. 
Published: May 2005

AbstractCarcinoma of the prostate is the second most common cause of cancerrelated deaths in American men. This is due, in part, to the low percentage of cases that are diagnosed when the tumor is still curable. To improve early detection, routine screening has been performed using one or a combination of tests that included open prostate biopsy, serum acid phosphatase, the digital rectal exam, and transrectal sonography. These studies have been critically reviewed and the problems associated with prostate cancer screening have been discussed. No study has proven that routine screening reduces the mortality from prostate cancer. Furthermore, the positive predictive value and the sensitivity of each of these tests are too low for any of them to be useful for screening at the present time. To determine the value of screening, new studies are needed which should include a control group and an assessment of the disadvantages of screening as well as the potential benefits. Based on published reports, however, routine screening for prostate cancer using any test should be considered investigational at the present time.
Screening for carcinoma of the prostate: Efficacy of available screening tests
Authors: Thompson Ian M. , Fair William R. 
Published: May 2005

AbstractDespite the high prevalence and mortality from carcinoma of the prostate, very few prospective, controlled, population‐based studies are available to assess the impact of early diagnosis programs. Three screening modalities have been suggested for this tumor : rectal examination, serum tumor markers, and transrectal ultrasound. Prostatic acid phosphatase and prostatic specific antigen have proven to be insensitive and nonspecific in large trials and generally, when elevated, allow diagnosis of metastatic disease. Transrectal ultrasound also suffers from poor specificity. Rectal examination, although insensitive to small tumors (less than 1 ml in volume), has the advantage of possibly detecting tumors of a higher biologic activity. An improved survival has been demonstrated in populations undergoing routine rectal examinations. Further prospective, population‐based trials comparing early detection techniques are necessary before mass screening for carcinoma of the prostate can be recommended.
Screening for cancer of the cervix uteri
Authors: Lynge Elsebeth 
Published: May 2005

AbstractCervical cancer is the second most common cancer in women worldwide. The majority of cervical cancers are squamous cell carcinomas. Pap smears for early detection of precursor lesions of cervical cancer have been availáblé for 40 years. A clinical trial to evaluate Pap smears was never undertaken; however, evidence gradually accumulated from time trend analyses and from cohort and case‐control studies showed the incidence and mortality of cervical cancer to be reduced by organized screening programs. The risk of cervical cancer following different screening histories was estimated in a recent study of the International Agency for Research on Cáncer. Screening with 1‐year and 3‐year intervals was estimated to reduce the incidence of squamous cervical cancer by 94% and 91%, respectively. Cervical cancer is rare in young women, and little was estimated to be gained from including women below the age of 25 years in organized screening programs. The age distribution of cervical cancer has changed; a substantial proportion of cases now occur in the older generations of women, who have never been offered organized screening. Computerized pathology registration systems may serve as a tool for integration of the total smear‐taking activity and, thus, ensure that a high percentage of women are screened regularly at minimized costs. The planning of a screening program should include both the smear‐taking activity and the treatment.
Screening for cancer: State of the art and prospects for the future
Authors: Miller Anthony B. 
Published: May 2005

AbstractEffectiveness of screening has been established for two cancer sites: breast and cervix uteri. Only for these, therefore, are national policies applicable. The degree of effectiveness of such programs will depend on the coverage of the eligible population; organized programs are, therefore, essential. For cancer of the cervix, nearly maximal efficacy will be obtained by screening sexually active women from 25 to 60 years of age every 3 years. For cancer of the breast, current evidence only justifies screening from 50 years of age; most programs will stop at 70 years of age. Mammography every 2 years will provide nearly maximal efficacy. The place of breast self‐examination and physical examination of the breasts is under investigation. In Japan, screening for stomach cancer is justifiable, although strict evidence of effectiveness is lacking. Screening for other cancers must still be regarded as experimental, including the use of sigmoidoscopy and fecal occult blood tests for colorectal cancer, and visual examination of the mouth for oral cancer. Because of organizational and other difficulties, screening seems unlikely to make a major contribution to reduction in overall cancer mortality by the year 2000. However, if organizational problems can be overcome, screening has the potential to control invasive cancer of the cervix, and to make a major contribution to reduction in breast cancer mortality.
Colonic involvement in acute necrotizing pancreatitis: Results of surgical treatment
Authors: Bouillot J. L. , Alexandre J. H. , Vuong N. P. 
Published: May 2005

AbstractIn this series of 15 personal cases, the authors emphasize the unusual colonic complications which occur during acute necrotizing pancreatitis. These lesions always indicate a particularly severe pancreatitis and depend on 2 factors: extension of pancreatic necrosis into the mesocolon with encasing pericolic tumoral fibrosis, and parietal ischemic necrosis secondary to shock and thrombosis with infection. Laparotomy followed by colectomy is indicated in these severely ill patients. Prognosis is poor (8 deaths of 15 patients), sometimes in spite of extensive pancreatic excision. The existence of colonic complications gives evidence of the particular severity of certain forms of pancreatitis.
Appraisal of distal splenorenal shunt in the treatment of esophageal varices: An analysis of prophylactic, emergency, and elective shunts
Authors: Nagasue Naofumi , Kohno Hitoshi , Ogawa Yuichiro , Yukaya Hirofumi , Tamada Ryuichiro , Sasaki Yukiharu , Chang Yu‐Chung , Nakamura Teruhisa 
Published: May 2005

AbstractFrom June, 1969 to February, 1987, distal splenorenal shunt was carried out on 78 patients with esophagogastric varices. The operations were urgent in 9, elective in 40, and prophylactic in 29 patients. There were 52 males and 26 females. Age ranged from 16 to 76 years with an average of 53 years. Thirty‐seven patients were alcoholics. Hepatitis B surface antigen was positive in only 15.5%. The causes of portal hypertension were cirrhosis of the liver in 67, chronic hepatitis in 5, idiopathic portal hypertension in 4, primary biliary cirrhosis in 1, and fatty liver in 1 patient. Fifty‐two patients were in Child's class A, 18 in class B, and 8 in class C. Emergency shunts were performed only when conservative therapy had failed to stop variceal bleeding. Prophylactic operations were done in patients having Child's class A or class B liver disease and risky varices, in varices larger than 5 mm in diameter and/or varices with red color signs such as cherry red spots. Forty‐two patients underwent the original Warren shunt, but the remaining 36 had modified distal splenorenal shunt with expanded polytetrafluoroethylene interposition. The operative mortality rates were 11.1% in the emergency group, 2.5% in the elective group, and 3.4% in the prophylactic group. The overall operative and hospital death rates were 3.8% and 7.7%, respectively. The patency rate was 94.1% and the incidence of rebleeding from esophageal varices was 3.8%. Hepatic encephalopathy, although mild to moderate in degree, was observed in 14.7% of 75 patients excluding 3 operative deaths. The 1‐, 2‐, and 3‐year survival rates of the emergency group were all 77.8%. The 1‐, 2‐, 3‐, 5‐, and 10‐year survival rates of the elective patients were 86.9%, 75.1%, 71.3%, 55.2%, and 29.4%, respectively. The 5‐, 10‐, and 15‐year survival rates of the prophylactic group were all 85.5%. The long‐term prognosis was significantly worse in patients in Child's class C and alcoholics as compared with otherwise.In the light of this retrospective evaluation, it can be concluded that distal splenorenal shunt is a reliable operative method in the treatment of esophagogastric varices associated with portal hypertension and that it can be performed safely in emergency, elective, and prophylactic situations.
Proximal stenosis of the bile ducts: Results with a new surgical endoprosthesis
Authors: Sezeur Alain , Kracht Matthias , Fagniez Pierre‐Louis , Rey Pierre , Leandri Jeanine , Julien Michel , Malafosse Michel 
Published: May 2005

AbstractA new endoprothesis designed for surgical intubation of neoplastic strictures of the proximal biliary tract has been developed. The technical aspects of intubation by this endoprothesis are discussed, and the results in the first 25 patients are given. The results suggest that this device was well tolerated. Mortality and morbidity related to the endoprothesis were low in comparison to the results given in the literature for intrahepatic cholangioenteric anastomosis. The authors conclude that this procedure could favorably replace intrahepatic cholangioenteric anastomosis as currently used for selected cases of malignant biliary stricture.
Pancreatoduodenectomy with occlusion of the residual stump by Neoprene® injection
Authors: Di Carlo Valerio , Chiesa Roberto , Pontiroli Antonio E. , Carlucci Michele , Staudacher Carlo , Zerbi Alessandro , Cristallo Marco , Braga Marco , Pozza Guido 
Published: May 2005

AbstractPancreatojejunal anastomosis disruption still represents the main postoperative complication after pancreatoduodenectomy. In this study, a technique of occlusion of the residual pancreatic stump instead of pancreatojejunal anastomosis is proposed. Between March, 1981 and August, 1987, we performed 51 pancreatoduodenectomies, using Neoprene®injection in the Wirsung duct, for carcinoma of the pancreatic head (28 cases), ampullary carcinoma (12 cases), islet cell carcinoma (5 cases), and chronic pancreatitis (6 cases). We observed a 33.3% overall morbidity, with a 5.8% operative mortality. The complications observed seemed not to be related to the technique of pancreatic stump occlusion, except for 2 pancreatic fistulas which spontaneously resolved. Abdominal ultrasound and computed tomography scan performed during the follow‐up did not show any significant morphological alteration of the residual stump. Pancreatic endocrine function was assessed in 10 patients by evaluating blood glucose, plasma insulin and plasma glucagon levels both fasting and after oral glucose, and intravenous arginine infusion. These tests were performed before surgery and 15 days, 6 months, 1, 2, and 3 years after surgery. The results showed that 60% of the patients had impaired glucose tolerance before surgery and the percentage did not significantly change up to 3 years later (75%). No patient developed diabetes mellitus, and only 1 patient progressed from a normal to an impaired glucose tolerance. In conclusion, intraductal injection of Neoprene®after pancreatoduodenectomy seems to be a safer procedure compared to pancreatojejunal anastomosis and does not induce a postsurgical diabetes.
Chronic traumatic aneurysms of the thoracic aorta
Authors: Thévenet André , Du Cailar Claude 
Published: May 2005

AbstractDuring the last 10 years (1975–1985), a total of 18 cases of posttraumatic aneurysm at the level of the thoracic isthmus were operated on. Six of the 18 were women (19–71 years of age) and 12 were men (17–61 years of age). The mean age at the time of injury was, respectively, 22 and 25.8 years and, at the time of operation, 34.5 and 35.5 years. The patients were all involved in a motor vehicle accident, except for 2 (1 falling, 1 crushing).Thirty‐nine percent of the patients had no apparent thoracic injury and 89% had associated injuries (bony fractures, craniofacial, visceral and abdominal). Eight of the 18 were asymptomatic at the time of operation, the others had various symptoms (pain, fever, dyspnea, cough, hoarseness, murmur, or hemoptysis). Enlargement of the aortic button was present in every case.Seventeen patients were operated on electively from 4 months to 50 years after the injury. Circumferential rupture was total in 9 patients and partial (2/3 to 9/10) in the others. Complete repair was done by either prosthetic Dacron®tube (3), Dacron®patch (2), or direct suture (12). Protection by femoro‐femoral bypass was used in 3 and simple aortic cross‐clamp was used in 14. Mean time of aortic cross‐clamp was 36.9 minutes (range, 16–80 min).Among these 17 patients, there was no hospital mortality and no late death. One patient had regressive paraplegia. One patient was submitted to an emergency operation for an intrapulmonary rupture of an infected aneurysm and died in the operating room before completion of the repair.Due to the lethal risk of rupture, traumatic aneurysms of the thoracic aorta have to be looked for systematically and treated surgically.
Lymph node involvement as the only prognostic factor in curative resected gastric carcinoma: A multivariate analysis
Authors: Msika Simon , Chastang Claude , Houry Sidney , Lacaine François , Huguier Michel 
Published: May 2005

AbstractThe aim of this study was to evaluate the independent influence of clinical and pathological variables on survival of patients with gastric carcinoma using the Cox regression proportional hazard model. Of 156 patients operated on for gastric carcinoma, 46 (29.5%) underwent palliative operation, 24 (15.5%) had a palliative resection, and 86 (55%) had a curative resection. The overall 5‐year survival rate was 25±4%. After curative resection, the 5‐year survival rate was 44±6%. Univariate analysis applied to these patients showed that poor survival was related(p<0.01)to : age (over 80 years), absence of epigastric pain, vomiting and dysphagia, total gastrectomy, tumor size (more than 4 cm), lymph node involvement (LNI), invasion through the muscularis propria, absence of intestinal metaplasia near the tumor, and linitis plastica. In multivariate analysis, lymph node involvement was found to be the only independent prognostic factor. The 5‐year survival rate was 75.5±8% without LNI, 28±10% with proximal LNI, and 7±6% with distal LNI. Our results suggest that classification into 3 LNI groups is the best staging system for curative resection in gastric carcinoma.