bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prospective Evaluation of Laparoscopy‐assisted Colectomy versusLaparotomy with Resection for Management of Complex Polyps of theSigmoid Colon
Authors: Liang Jin‐Tung , Shieh Ming‐Jium , Chen Chiung‐Nien , Cheng Yung‐Ming , Chang King‐Jen , Wang Shih‐Ming 
Published: August 2002

Laparoscopy‐assisted colectomy istechnically feasible, but objective evidence of its benefits remainsscarce. This study was done to evaluate the outcomes and operativestress of laparoscopy‐assisted colectomy versus the traditional openmethod in the management of sigmoid complex polyps that cannot besafely or adequately removed by colonofibroscopy. Between January 1997and December 1999, a total of 42 patients were equally randomizedto the laparoscopy group and the laparotomy group by the blockedrandomization method. Three patients randomized to the laparoscopygroup did not complete the trial; therefore 18 patients treated bylaparoscopy‐assisted sigmoidectomy and the other 21 treated by the openmethod were prospectively evaluated. These two groups of patients werewell matched in age, gender, symptoms, tumor location, localizationmethod, tumor size, morphology, histopathology, and the accuracy of theclinical diagnosis. Two standardized surgical strategies, thelateral‐to‐medial and medial‐to‐lateral dissection sequences, wereperformed in 14 and 4 patients of the laparoscopy group, respectively,according to whether their tumors were located above or below 20 cmabove the anal verge. After evaluating the surgical outcomes, we foundthat the laparoscopy group was significantly better than the laparotomygroup in regard to parameters that included severity of postoperativepain, wound size, postoperative complication rate, and the duration ofpostoperative ileus, hospitalization, and disability. There was nosignificant difference in the operating times for these two groups.However, the costs of the laparoscopy group were significantly higher.To evaluate the surgical stress, we measured the serum C‐reactiveprotein (CRP) level, erythrocyte sedimentation rate (ESR), totallymphocyte count, and CD4+/CD8+ ratio 24 hoursbefore and after surgery. We found that the postoperative serum CRPlevel and the ESR were significantly less elevated and the totallymphocyte counts and CD4+/CD8+ ratio weresignificantly less depressed in the laparoscopy group than in thelaparotomy group. We thus concluded that laparoscopy‐assistedsigmoidectomy can be safely performed with shorter convalescence andless operative stress but at a higher cost. We strongly recommended theuse of this technique in the management of sigmoid complex polyps ifthe patient's economic status permits.
Urologic Oncology in the Twenty‐first Century
Authors: Kakizoe Tadao 
Published: August 2002

AbstractThe perspective of urologic oncology in the twenty‐first century is presented regarding detection, treatment, and prevention of cancer. There is increasing importance of a cancer information network. Biotechnology and medical engineering based on advances in computer science will be the two key technologies related to such advancement. Ethical, legal, social, and economic issues provoked by the technologic advances will increase in gravity at the same time. Balancing humans in terms of scientific technologic developments and state of mind will be a serious issue.
Minimal Incision Parathyroidectomy: Cure, Cosmesis, and Cost
Authors: Lowney Jennifer K. , Weber Beverly , Johnson Shirley , Doherty Gerard M. 
Published: August 2002

AbstractThe goals of operative treatment of primary hyperparathyroidism are (1) cure; (2) minimal invasion; and (3) cost‐effectiveness. The optimal strategy is controversial. Retrospective review of was undertaken 66 previously unoperated patients having minimal‐incision, full‐neck exploration by one surgeon over 29 months. A group of 51 women and 15 men had open full neck exploration under general anesthesia through a small (25–40 mm) incision using specifically selected instruments; patients remained hospitalized overnight. Preoperative sestamibi scans were obtained before referral for 17 patients: 11 had localized disease, and 6 did not (65% sensitivity). Four parathyroid glands were identified in 98% of patients; intraoperative frozen section was used selectively on a median of one gland per patient. About 76% of patients had single‐gland disease, 6% had two‐gland disease, and 18% had four‐gland hyperplasia. One patient had four normal cervical parathyroid glands and an aortopulmonary window parathyroid adenoma resected at thoracotomy 1 week later; preoperative sestamibi scans failed to localize his disease. There were no nerve injuries and a 98% cure rate after initial cervical exploration. Excluding the cost of the sestamibi scans, there was no difference between those who had preoperative localization and those who did not; 60% of hospital costs were operating room time‐related. Minimal‐incision parathyroidectomy is effective for curing hyperparathyroidism and has excellent cosmetic results with negligible scar. Preoperative sestamibi scanning had no impact on cure or treatment costs. Strategies to improve cost‐effectiveness must address the substantial costs of anesthesia and operating room services.
Lymphatic Mapping and Sentinel Node Biopsy of Operable Breast Cancer
Authors: Rodier Jean‐François , Routiot Thierry , Mignotte Hervé , Janser Jean‐Claude , Bremond Alain , David Eric , Barlier Catherine , Ghnassia Jean‐Pierre , Treilleux Isabelle , Chassagne Catherine , Velten Michel 
Published: August 2002

Abstract.The aim of this study was to evaluate the reliability and accuracy of sentinel node biopsy for invasive breast cancer and the predictability of axillary node status. Between January 1996 and June 1997 a total of 73 patients underwent patent blue dye lymphatic mapping and sentinel node biopsy followed by standard (level I and II) axillary node dissection (one bilateral procedure). The sentinel node was identified in 82.4% (61/74) of the cases and was predictive of axillary status in 96.7% (59/61). The false‐negative rate of the procedure was 8.0% (2/25). The sentinel node was involved in 37.7% (23/61) and was the only one invaded in 30.4% (7/23). The sensitivity of the procedure was 92% (CI95% 74–99%) and its specificity 100%. It is currently considered to be an attractive new procedure undergoing evaluation in prospective controlled trials. This study confirmed the reliability and reproducibility of intraoperative lymphatic mapping and sentinel node biopsy. This is the first step toward a new era of minimally invasive axillary surgery for breast cancer.
Pancreastatin Plasma Levels in Patients with Primary Hyperparathyroidism
Authors: Bergenfelz Anders , Luts Lena , Børglum Jensen Tine , Sundler Frank 
Published: August 2002

AbstractPancreastatin, a C‐terminally amidated peptide derived from chromogranin A, is known to inhibit insulin secretion, pancreatic enzyme release, and gastric acid secretion. It also inhibits parathyroid hormone (PTH) secretion in animals. The physiologic and clinical relevance of pancreastatin in humans, however, is not known. Because pancreastatin has been found in parathyroid adenomas, we investigated the plasma levels in patients with primary hyperparathyroidism (pHPT). Thirteen patients operated on for solitary parathyroid adenoma were investigated. Plasma levels of pancreastatin and serum levels of ionized calcium and intact PTH were measured before and 6 weeks after operation. In 10 patients the levels were also monitored before and 60 minutes after adenoma excision. The adenomas were investigated for pancreastatin immunoreactivity by immunocytochemistry. The median weight of the excised parathyroid adenoma was 0.64 g (range 0.07–2.00 g). Cells displaying pancreastatin immunoreactivity were present in all adenomas examined and varied in number and immunostaining intensity among and within the adenomas. Intraoperatively, after adenoma excision the levels of PTH and pancreastatin declined (p < 0.01), whereas the levels of ionized calcium did not change (p= 0.96). At the 6‐week follow‐up the levels of ionized calcium and PTH had decreased compared to the preoperative levels (p < 0.01), and all patients were normocalcemic. In contrast, the pancreastatin levels were not changed (14.5 ± 6.1 pmol/L preoperatively vs. 12.8 ± 11.2 pmol/L 6 weeks postoperatively; p= 0.12). In patients with pHPT, pancreastatin is likely to be produced by the parathyroid adenoma. The changes in pancreastatin levels immediately after surgery warrant further investigation.
PET Scans of Abdominal Malignancy
Authors: Blahd William H. , Brown Charles V. , Khonsary Seyed A. , Farahi Judah B. , Quinones Nayda , Ribe Josephine Y. , Coyle John J. , Glass Edwin C. , Mandelkern Mark A. 
Published: August 2002

AbstractPositron emission tomography (PET) with fluorine‐18‐2‐d‐deoxyglucose (FDG) currently is being integrated into clinical oncology because it provides unique functional information that can be applied to the management of cancer. In particular, it is useful for assessing tumor activity and growth, evaluating efficacy of therapy, and detecting tumor recurrence. Studies have demonstrated the value of whole‐body PET‐FDG imaging when staging and managing abdominal malignancy.
p53 Hot‐Spot Mutational Analysis in Advanced Western Gallbladder Carcinoma
Authors: Jonas Sven , Springmeier Giovanni , Tauber Rudolf , Wiedenmann Bertram , Gessner Reinhard , Kling Norbert , Lobeck Hartmut , Fieger Claudia , Bechstein Wolf O. , Neuhaus Peter 
Published: August 2002

AbstractIn gallbladder carcinoma, studies on the prime target of genetic alterations and gene therapy in human gallbladder malignancies, the p53 tumor suppressor gene, have been focusing on this gene's immunohistochemical detection. From November 1991 to October 1993, seven patients suffering from gallbladder carcinoma underwent surgical resection. Cancerous and normal liver tissues were obtained immediately after surgery, snap‐frozen in liquid nitrogen, and stored at −80°C for immunohistochemistry and DNA isolation. Exons 5, 6, 7, and 8 of thep53 gene were completely sequenced following polymerase chain reaction (PCR) amplification of a 1574‐bp fragment. Missense mutations were detected in the cancerous tissues of two patients: one transition each on codons 134 (Phe→Leu) and 146 (Trp→Arg). Immunohistochemical p53 staining was positive in the latter patient only. This is the first report on sequence analysis and mutagenesis of the p53 gene in Caucasian patients with gallbladder cancer. Both mutations were transitions and seem to represent a rather rare event. The possible impact of p53mutagenesis on gallbladder tumorigenesis requires evaluation in larger studies.
Adrenalectomy for Primary Aldosteronism: Long‐term Follow‐up Study in 29 Patients
Authors: Sirén Jukka , Välimäki Matti , Huikuri Kauko , Sivula Arto , Voutilainen Petri , Haapiainen Reijo 
Published: August 2002

AbstractPrimary aldosteronism consists of a mixture of subgroups. The operative treatment is successful only in cases of aldosterone‐producing neoplasia (and in rare cases of primary unilateral hyperplasia); all other cases should be treated medically. The aim of this study was to determine if aldosterone‐producing neoplasia had been successfully differentiated from the other subgroups and the outcome of operative treatment. Altogether 29 patients with primary aldosteronism were operated on between January 1, 1979 and December 31, 1993. Patient charts were reviewed retrospectively. The follow‐up data were collected from the patients’ charts, and all patients were contacted to obtain recent blood pressure and serum potassium values. The patients were asked about symptoms related to hyperaldosteronism. If any suspicion of recidive aldosteronism was present, patients were carefully reexamined by hormonal tests and computed tomography (CT). A total of 27 patients had unilateral adenoma, 1 patient had hyperplasia, and 1 patient had an aldosterone‐producing cortical carcinoma. There was no operative mortality or morbidity. The serum potassium level had normalized in all patients. Mean follow‐up time was 76 months. One patient died during the follow‐up from cholangiocarcinoma; 11 patients (41%) were cured by the operation, 10 patients (37%) have a mild but medicated hypertension, and in the remaining 22% the hypertension persisted but was well controlled by the medication. Of the 29 patients, 28 were correctly diagnosed as having an aldosterone‐producing neoplasm. Basic hormonal studies and CT can be used effectively to differentiate aldosterone‐producing neoplasia from hyperplasia in most cases.
Final Reflections: Wellness after Obesity Surgery
Authors: Alvarez‐Cordero Rafael 
Published: August 2002

AbstractThe articles presented in this symposium on treatment of clinically severe obesity cover most of the topics related to obesity surgery, from basic research about genetic causes of obesity to surgical techniques and clinical results on the severely obese patient. The most striking feature of those results observed after bariatric surgery for the clinically severe obese is not the remarkable weight loss and normalization of the body mass index but the amelioration of some of the metabolic and physiologic abnormalities related to obesity. In fact, carbohydrate and lipid metabolism show improvement, as do cardiac and pulmonary function. These observations justify all efforts devoted to the design and improvement of sound bariatric surgical techniques. Moreover, surgeons seek the well‐being of the ex‐obese patient, and in doing so they face special discriminatory attitudes from colleges, patients’ families, and the society, mainly because of negative stereotypes related to the obese individuals and the lack of information on the real benefits of bariatric procedures. Bariatric surgeons will reach their goal only when an informed society, educated physicians, and properly oriented obese patients together give to bariatric surgery its real dimension. The objective of any surgeon is the wellness of his or her patient. This is important in bariatric surgery as well; beyond excess weight loss and normalization of biochemical parameters, the ex‐obese patient should be able to live a normal, productive, happy life. Approaching this goal is a task that takes months or even years. Bariatric surgeons are committed to support and help their patients until they reach wellness after obesity surgery.
Medical Challenges of Internal Conflicts
Authors: Leppäniemi Ari K. 
Published: August 2002

AbstractThe most prevalent menace since the end of the cold war is the occurrence of civil wars and local and regional conflicts. The term “low intensity conflict” describes the new threat environment and covers a multitude of phenomena, such as civil wars, guerrilla warfare, terrorism and counterinsurgency operations occurring between routine, peaceful inter‐ or intrastate competition, and a sustained conventional conflict. There is a great challenge to alert the physicians in general, and the surgical community of the world in particular, to the new threat environment and the medical challenges involved in treating casualties of low intensity conflicts. Specifically, a new international body of surgeons might be required to coordinate the recruitment, training, and creditation for surgeons with special expertise in the management of victims of such conflicts and to facilitate research and general knowledge of the medical challenges of modern conflicts.
Changes in Erythrocyte Deformability after Liver Resection for Hepatocellular Carcinoma Associated with Chronic Liver Disease
Authors: Horii Katsuhiko , Kubo Shoji , Hirohashi Kazuhiro , Kinoshita Hiroaki 
Published: August 2002

AbstractErythrocyte deformability is an important factor in the microcirculation. The deformability in patients with chronic liver disease is less than normal. We studied changes in erythrocyte deformability in 32 patients undergoing liver resection for hepatocellular carcinoma with underlying chronic liver disease to investigate whether the measurement of deformability gives information useful for postoperative management. We measured erythrocyte deformability as erythrocyte transit time (ETT) before and after resection, as well as the erythrocyte adenosine triphosphate level, mean corpuscular volume, mean corpuscular hemoglobin concentration, and indices of liver function. The 15‐minute indocyanine green retention rate (ICGR15) was measured before resection. Correlations between the change in deformability and these values were evaluated, as was correlation with the scale of the operation and with the occurrence of postoperative complications. Mean ETT was higher in the patients before resection than in healthy volunteers. ETT was correlated with serum high density lipoprotein‐cholesterol (p <
0.05). The incidence of postoperative complications was higher
(p= 0.001) in the patients (group A) with ETT increased during the first 3 postoperative days by ≥1 SD of the mean of the preoperative value than in patients (group B) with less change. Of the 12 patients whose ICGR15 value was ≥20%, all 9 patients in group A had postoperative complications. The increase in ETT (decrease in erythrocyte deformability) is associated with the development of postoperative complications. The measurement of erythrocyte deformability gives information useful for postoperative management, and special monitoring for postoperative complications is necessary in patients with the increase soon after liver resection.RID="" ID="" <E5>Correspondence to:</E5> K. Horii, M.D.
Intraarterial Adjuvant Chemotherapy after Pancreaticoduodenectomy for Pancreatic Cancer: Significant Reduction in Occurrence of Liver Metastasis
Authors: Beger Hans G. , Gansauge Frank , Büchler Markus W. , Link Karl Heinz 
Published: August 2002

Abstract.The clinical benefit of adjuvant chemotherapy in pancreatic cancer patients is still questionable. Phase II studies using radiochemotherapy based on 5‐fluorouracil (5‐FU) provided evidence of an increase in median survival times. Because palliative chemotherapy by celiac artery infusion (CAI) led to an increase in survival in pancreatic cancer, we treated 24 patients with adjuvant CAI following resection of the head of the pancreas for pancreatic cancer (21 patients with Union Internationale contre le Cancer (UICC) stage III, 2 with UICC stage II, 1 with UICC stage I). Catheters were placed angiographically into the celiac artery and remained there for 5 consecutive days. One cycle of chemotherapy consisted of mitoxantrone, 5‐FU, folinic acid, and cisplatinum. This treatment was repeated five times at monthly intervals. CAI was well tolerated, and World Health Organization (WHO) grade III toxicities were observed in 8%; WHO grade IV was seen in none of the treatment cycles. Furthermore, we observed pain reduction in nearly all patients under CAI. Median survival times in patients who received CAI were 23 months for all patients, whereas in patients who did not receive adjuvant treatment the median survival was 10.5 months. With Kaplan‐Meier regression analysis of the patients who were curatively resected (R0 resection) and received CAI, the overall 4‐year survival was 54%, whereas in patients without CAI the 4‐year survival was 9.5%. The occurrence of liver metastases in the CAI group went down to 17%. These results demonstrate that CAI is well tolerated, reduces the risk of liver metastasis, and increases the survival time of pancreatic cancer patients.
Treatment Strategy for Mucin‐producing Intrahepatic Cholangiocarcinoma: Value of Percutaneous Transhepatic Biliary Drainage and Cholangioscopy
Authors: Sakamoto Eiji , Hayakawa Naokazu , Kamiya Junichi , Kondo Satoshi , Nagino Masato , Kanai Michio , Miyachi Masahiko , Uesaka Katuhiko , Nimura Yuji 
Published: August 2002

Abstract.Intrahepatic cholangiocarcinomas that secrete macroscopically excessive mucin into the biliary system are rare, and few of the previously reported cases have achieved a curative resection. We defined these tumors as “mucin‐producing intrahepatic cholangiocarcinomas” and clarify the optimal preoperative and surgical management for them. Eleven patients with mucin‐producing intrahepatic cholangiocarcinomas underwent surgical resection in our department. The clinical, radiologic, surgical, and pathologic findings were studied. The clinical presentation of the 11 patients included repeated abdominal pain, jaundice, and fever. Conventional cholangiographies, such as percutaneous transhepatic cholangiography or endoscopic retrograde cholangiography, could not offer precise information about tumor location and extension because of abundant mucin in the biliary system. Using percutaneous transhepatic biliary drainage (PTBD) and percutaneous transhepatic cholangioscopy (PTCS), we were able to drain the mucin and determine precisely the cancer extension into intrahepatic segmental bile ducts. Based on these findings, various types of liver resection with or without extrahepatic bile duct resection were planned, and 10 patients obtained curative resection. The cumulative 5‐year survival rate after curative resection was 78%. In patients with mucin‐producing intrahepatic cholangiocarcinoma, PTBD and PTCS are important for evaluating the cancer extension. Rational surgery based on accurate preoperative diagnosis improved the prognosis of patients with this disease.
Syringe Pressure Irrigation of Subdermic Tissue after Appendectomy to Decrease the Incidence of Postoperative Wound Infection
Authors: Cervantes‐Sánchez Carlos R. , Gutiérrez‐Vega Rafael , Vázquez‐Carpizo Jorge A. , Clark Patricia , Athié‐Gutiérrez Cesar 
Published: August 2002

AbstractTo evaluate syringe pressure irrigation of the surgical wound to decrease its infection after appendectomy, we designed a randomized control trial at the Emergency Department of Mexico City General Hospital, including 350 patients with acute abdomen suggestive of appendicitis, without any other infection clinically evident. The trial was randomized into 2 groups. Group I patients received prophylactic systemic antibiotics before surgery. Group II patients received the same prophylactic systemic antibiotics plus syringe pressure irrigation of the surgical wound with 300 ml of saline solution using a 20‐ml syringe with 19‐gauge intravenous (IV) catheter to measure the incidence of postoperative wound infection. In our results, 283 patients had appendicitis. Of these, 188 were uncomplicated (66.4%) and 95 (33.6%) were complicated. Of the complicated cases, 40 were assigned to group I, and of these, 29 (72.5%) developed wound infection. In group II there were 55 patients and only 9 (16.3%) developed wound infection after syringe pressure irrigation [p= 0.000001; 95% confidence interval (CI) = 0.02–0.22]. We conclude that syringe pressure irrigation of the surgical wound after appendectomy contributes significantly to decrease the incidence of postoperative wound infection in complicated cases. It is a cheap, safe, and accessible method in any surgical room.