bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sepsis: Stimulation of Energy‐Dependent Protein Breakdown Resulting in Protein Loss in Skeletal Muscle
Authors: Hasselgren Per‐Olof , Fischer Josef E. 
Published: August 2002

AbstractMuscle catabolism is a characteristic metabolic response to sepsis, severe infection, and injury. In patients with severe and protracted sepsis, the catabolic response results in muscle wasting and fatigue, which may adversely affect the outcome in these patients. An understanding of the regulation of muscle protein breakdown during sepsis and the mechanisms involved is important from a clinical standpoint and is essential for the development of new therapeutic modalities to prevent protein loss from muscle tissue. Studies in septic patients and experimental animals have provided evidence that the myofibrillar proteins actin and myosin are particularly sensitive to the effects of sepsis. Among the factors that regulate muscle protein breakdown during sepsis, the proinflammatory cytokines tumor necrosis factor and interleukin‐1, together with glucocorticoids, are the principal mediators. Intracellular protein breakdown is regulated by multiple proteolytic pathways. Among these, the energy‐ubiquitin‐dependent pathway accounts for a major portion of muscle protein breakdown during sepsis. The development of specific proteasome inhibitors may make it possible in the future to target the molecular mechanisms of sepsis‐induced increase in muscle proteolysis. Such treatment may prove an important avenue to reduce the metabolic cost in patients with severe infection or sepsis.
Nutritional Support and Infection: Does the Route Matter?
Authors: Minard Gayle , Kudsk Kenneth A. 
Published: August 2002

AbstractQuestions regarding the effects of the route of nutrition began to surface shortly after the introduction of total parenteral nutrition (TPN). Although TPN has become a life‐saving therapy for patients who cannot tolerate enteral nutrition, it is not the panacea it was hoped to be. It appears that the enteral route of nutrition decreases rates of infectious complications compared with parenteral feeding. Reasons for this phenomenon are not clear, but it seems that enteral nutrition supports the gut barrier and gut‐associated lymphoid tissue, which may have effects on infections at distant sites such as the lung. These effects do not appear to be due solely to prevention of malnutrition, as the infectious complications develop early after injury or illness. However, the lack of understanding of the mechanisms does not negate the fact that in many clinical studies the enteral route of nutrition is superior to the parenteral route in terms of reducing infectious complications in critically ill or injured patients.
Typhoid Intestinal Perforations in Nigerian Children
Authors: Meier Donald E. , Tarpley John L. 
Published: August 2002

AbstractThis study was a retrospective analysis of 75 children with perforated typhoid enteritis treated at the Baptist Medical Centre in Ogbomoso, Nigeria over a 4‐year period. The mean age was 11.4 years. The usual symptoms were fever and abdominal pain, with a mean duration of 10.5 days. The diagnosis of perforation was usually based on the history and physical examination alone. The time interval from hospital presentation to operation was 11 hours, during which intravenous crystalloid and antibiotics were administered. Among the 75 children, 53 (71%) had a single perforation, and 22 had multiple perforations. Débridement and two‐layered closure was performed in 71 (95%) and resection with anastomosis in 4 (5%). Ileus resolution was usually not complete until the eighth postoperative day, and the mean time until the surviving children were afebrile was 10 days. Complications other than death occurred in 7 (9%) children, and there were 15 deaths (20% mortality). All deaths were attributed to overwhelming sepsis, and all but one of the deaths occurred during the first 72 postoperative hours. The only factor statistically significant as a predictor of mortality was the duration of abdominal pain. Improvement in perioperative management including intensive care nursing and more effective antibiotics, although expensive, could result in decreased mortality. A significant decrease in mortality can occur only when the prevention of typhoid fever becomes a higher priority than its treatment.
Excision Curettage and Allografting of Giant Cell Tumor
Authors: Shih Hsin‐Nung , Hsu Robert Wen‐Wei , Sim Franklin H. 
Published: August 2002

AbstractBetween 1987 and 1994 we followed 22 patients with giant cell tumors involving the long bones. Their average age was 31 years (range 17–50 years). Five patients had grade II tumors and the other 17 grade III lesions. The average volume of lesions after curettage was 231 ml (range 56–450 ml). All of the patients underwent a modified excisional curettage, and the cavity was filled with deep‐frozen allogeneic corticocancellous bone graft with supplementary fixation. Two patients developed postoperative complications including a superficial wound infection in one case and a traumatic tibial plateau fracture in one case. The overall outcome was good or excellent in 91% of the patients (i.e., 20/22 cases). There was no degenerative joint arthritis and, surprisingly, no instance of tumor recurrence. Allograft infection and fracture were not present. An allogeneic cortical strut with cancellous bone graft can be used safely and is effective for grafting cavitary lesions created after complete removal of the tumor.
Cytokine Patterns in Patients Who Undergo Hemofiltration for Treatment of Multiple Organ Failure
Authors: Koperna Thomas , Vogl Sonja E. , Pöschl Gerald P. , Hamilton Gerhard , Röder G. , Germann Peter 
Published: August 2002

AbstractThe excessive uncontrolled activation of inflammatory cells and mediators after trauma or major surgery plays a key role in the development of adult respiratory distress syndrome and multiple organ system failure (MOSF). In the past elevated cytokine levels were shown to influence the outcome of these patients adversely. There are diverging results regarding the removal of circulating cytokines by various methods of hemopurification for clinical improvement of MOSF. Seven patients after trauma or major surgery underwent continuous venovenous hemofiltration (CVVH) for the treatment of severe organ failure of the heart and lungs (Murray score 2.74) but not for renal or liver failure. The cytokine levels were measured at the beginning and 15, 60, 120, and 240 minutes after initiation of CVVH (measure points MP1–5). Clinical improvement during the treatment was monitored, and correlation with cytokine levels was evaluated. Arterially measured tumor necrosis factor α rose from 11.14 ng/ml to 17.86 ng/ml
(p < 0.05). Arterial interleukin‐6 (IL‐6) levels significantly decreased during CVVH from 1284.7 ng/ml to 557.9 ng/ml; IL‐8 levels simultaneously decreased from an initial peak of up to 154.4 ng/ml at MP3 to 97.3 ng/ml at MP5. The drop in serum IL‐6 and IL‐8 levels closely correlated with clinical improvement. After 2 hours of CVVH the hemodynamic situation improved significantly, as revealed by a decrease in catecholamine expenditure, an increase in arterial pressure, and a decrease in pulmonary artery pressure. Moreover, 2 hours after the initiation of CVVH the oxygenation index rose significantly and correlated well with the drop in shunt fraction. The Murray score significantly fell to 1.86. The removal of IL‐6 and IL‐8 by CVVH after initial stimulation correlates with clinical improvement, which was demonstrated by significantly improved oxygenation and hemodynamics from 2 hours after the initiation of CVVH onward. The elimination of cytokines and several mediators by CVVH may contribute to the cardiopulmonary improvement of critically ill patients. In comparison with the clinical control group (n= 7), which was comparable in terms of MOSF, no intervention led to a similar improvement in cardiorespiratory failure, and overall two of these patients died. Moreover, patients of the control group experienced a significant longer stay at in the intensive care unit.
Radiation Enterocolitis: Overview of the Past 15 Years
Authors: Shiraishi Masayuki , Hiroyasu Shungo , Ishimine Tomonari , Shimabuku Masamori , Kusano Toshiomi , Higashi Masahiro , Muto Yoshihiro 
Published: August 2002

AbstractFrom April 1980 to April 1995 a total of 54 patients (53 women, 1 man) were hospitalized in our department for the surgical treatment of radiation enterocolitis. Two surgical protocols were applied for these patients: intestinal decompression procedures alone (intestinal bypass, colostomy, or both;
n= 18) or an intestinal resection in addition to decompression (n= 36). The clinical factors contributing to survival after irradiation were retrospectively reviewed by a multiple variate proportional hazards model. As a result, patients treated with decompression procedures alone had an 11 times higher risk for death than those treated with the addition of intestinal resection. In the former group, 5 of 18 patients died of bleeding from the remaining intestine after operation. We concluded that surgical resection of the diseased intestine is a useful procedure for treating radiation enterocolitis to reduce intestinal bleeding from the irradiated intestine.
Hypocalcemia following Thyroid Surgery: Incidence and Prediction of Outcome
Authors: Pattou François , Combemale Frederic , Fabre Sylvain , Carnaille Bruno , Decoulx Marc , Wemeau Jean‐Louis , Racadot Alain , Proye Charles 
Published: August 2002

AbstractPostoperative hypocalcemia is a common and most often transient event after extensive thyroid surgery. It may reveal iatrogenic injury to the parathyroid glands and permanent hypoparathyroidism. We prospectively evaluated the incidence of hypocalcemia and permanent hypoparathyroidism following total or subtotal thyroidectomy in 1071 consecutive patients operated during 1990–1991. We then determined in a cross‐sectional study which early clinical and biochemical characteristics of patients experiencing postoperative hypocalcemia correlated with the long‐term outcome. Postoperative calcemia under 2 mmol/l was observed in 58 patients (5.4%). In 40 patients hypocalcemia was considered severe (confirmed for more than 2 days, symptomatic or both). At 1 year after surgery five patients (0.5%) had persistent hypocalcemia. We found that patients carried a high risk for permanent hypoparathyroidism if fewer than three parathyroid glands were preserved in situ during surgery or the early serum parathyroid hormone level was ≤ 12 pg/ml, the delayed serum calcium levels ≤ 8 mg/dl, or the delayed serum phosphorus level ≥ 4 mg/dl under oral calcium therapy. When one or more of these criteria are present, long‐term follow‐up should be enforced to check for chronic hypocalcemia and to avoid its severe complications by appropriate supplement therapy.
Early Operative Intervention for Urologic Complications of Kidney‐Pancreas Transplantation
Authors: Kaplan Adam J. , Valente John F. , First M. Roy , Demmy Ann M. , Munda Rino 
Published: August 2002

AbstractBladder drainage of exocrine secretions during pancreas transplantation can be associated with significant complications. We present a proactive approach to these complications consisting of early cystoenteric conversion (CEC). Altogether 81 patients underwent pancreas transplant between March 1985 and May 1995; 26 (32%) required CEC. Complications presented as urine leaks, other complications, and refractory metabolic acidosis. There were 13 patients who presented with a urine leak: 12 with acute abdominal pain, and 1 asymptomatic. Serum amylase and creatinine rose a mean of 823 IU and 0.61 mg/dl, respectively. The interval to CEC ranged from 2 to 45 months. One patient died of fungal sepsis. Postoperative complications included duodenojejunal anastomotic bleed (n= 1), negative relaparotomy (n= 1), myocardial infarction (n= 1), graft pancreatitis (n= 1), and wound infection (n= 1). Twelve patients presented with other complications: three women with cystitis (n= 2) or hematuria (n= 1), and nine men with urethritis (n= 6), scrotal edema (n= 2), or dysuria (n= 1). The interval to conversion ranged from 1 to 108 months. There were no deaths. One patient required relaparotomy for anastomotic bleed. One patient was converted because of refractory metabolic acidosis. Admissions and inpatient days were significantly reduced. Overall mortality was 3.8%, morbidity 23.1%, and graft salvage rate 96.1%. Leak‐associated mortality was 7.7%, morbidity 38.5%, and graft salvage rate 92.3%. For other complications the mortality was 0, morbidity 7.7%, and graft salvage rate 100%. CEC is a safe, effective treatment for urologic complications of pancreas transplantation. Morbidity and mortality were acceptable; admissions and hospital days were decreased. Early CEC results in superior outcomes and improved quality of life. It is preferable to nondefinitive measures for management of urologic complications of pancreatic transplantation.
Other Laparoscopic Bariatric Procedures
Authors: Lönroth H. , Dalenbäck Jan 
Published: August 2002

AbstractLaparoscopic surgery is regarded as a major improvement reflected by a rapid recovery and low perioperative and postoperative morbidity. In obese patients the gains of this new technique may be affected by obesity‐related problems, such as impaired respiratory function, high intraabdominal pressure, thick abdominal wall, and liver steatosis. This review describes the development of laparoscopic vertical banded gastroplasty (VBG) and gastric bypass procedures; and it addresses questions such as feasibility, comparability to open procedures, procedure‐related problems, and recovery. The clinical outcome after laparoscopic VBG and gastric bypass is also updated. Up to May 1997 we have operated on 105 patients with laparoscopic VBG and another 26 completed laparoscopic gastric bypass procedures. The weight loss after both procedures are in accordance with the weight loss seen with open surgery. Procedure‐related complications are described in detail in this paper. It is concluded that laparoscopic bariatric surgery will remain an area of importance for clinical practice, research, and development.
Endoscopic Surgery: The History, the Pioneers
Authors: Litynski Grzegorz S. 
Published: August 2002

AbstractThe introduction of endoscopy into surgical practice is one of the biggest success stories in the history of medicine. Endoscopy has its roots in the nineteenth century and was initially developed by urologists and internists. During the 1960s and 1970s gynecologists took the lead in the development of endoscopic surgery while most of the surgical community continued to ignore the possibilities of the new technique. This was due in part to the introduction of ever more sophisticated drugs, the impressive results of intensive care medicine, and advances in anesthesia, which led to the development of more radical and extensive operations, or “major surgery.” The idea that large problems require large incisions so deeply dominated surgical thinking that there was little room to appreciate the advances of “key‐hole” surgery. Working against this current, some general surgeons took up the challenge. In 1976 the Surgical Study Group on Endoscopy and Ultrasound (CAES) was formed in Hamburg. Five years later, on the other side of the Atlantic, the Society of American Gastrointestinal Endoscopic Surgeons (SAGES) was called into being. In 1987 the first issue of the journal Surgical Endoscopy was published, and the following year the First World Congress on Surgical Endoscopy took place in Berlin. The sweeping success of the “laparoscopic revolution” (1989–1990) marked the end of traditional open surgery and encouraged surgeons to consider new perspectives. By the 1990s the breakthrough had been accomplished: endoscopy was incorporated into surgical thinking.
Value of Extended Resection and Intraoperative Radiotherapy for Resectable Pancreatic Cancer
Authors: Hiraoka Takehisa , Kanemitsu Keiichirou 
Published: August 2002

Abstract.Since 1984 intraoperative radiotherapy (IORT) combined with extended resection for pancreatic cancer has been performed in our clinic to prevent local recurrence. Following extended resection, a dose of 30 Gy of 9‐ to 12‐MeV electrons is administered to the operative field, including the paraaortic area from the diaphragm above to the inferior mesenteric artery below. The 5‐year survival rate was 15.3% in all 37 cases, 20.2% in patients who had macroscopic tumor clearance, and 16.9% in patients with stage IVa tumor according to the Japanese classification. In autopsies of 10 patients who underwent combined therapy, four had local recurrence enclosed by thick, firm connective tissue. There was no local control recurrence in two patients who underwent noncurative resection. Enhanced local control induced by the combined therapy, however, has only a limited impact on overall survival because of the systemic spread of disease, especially hepatic metastases. At present, as we have no effective treatment for hepatic metastases, it is important to perform an extended resection with IORT on carefully selected patients. The combined therapy may offer the best approach to control local recurrence when dealing with advanced, but not highly advanced, cancer as defined by the stage of tumor. Therefore a combination of IORT and extended resection can have an impact on the results of surgical treatment for pancreatic cancer when anticancer treatment of hepatic metastases is established.
Evidence‐based Surgical Practice: What Is It and Do We Need It?
Authors: Kreder Hans J. 
Published: August 2002

Abstract.The concept of evidence‐based clinical practice involves integrating personal experience with the best available scientific information when making decisions about the care of patients. The purpose of this article is to introduce surgeons to the philosophy of evidence‐based practice and to discuss some of the necessary skills required for clinical and research application. Some of the concerns about misuse of the concept are also addressed.
Penetrating Cardiac Trauma: Follow‐up Study Including Electrocardiography, Echocardiography, and Functional Test
Authors: Duque Hector A. , Florez Luz E. , Moreno Alejandro , Jurado Hector , Jaramillo Carlos J. , Restrepo Martha C. 
Published: August 2002

Abstract.A prospective study was carried out to analyze the evolution of patients who survived penetrating cardiac trauma. A total of 642 patients were evaluated. A 1‐year follow‐up, which included physical examinations, electrocardiography, echocardiography and stress tests, was completed in 192 patients. Data processing included calculation of average and percentage values. At follow‐up, 90% of patients were asymptomatic at 2 days after surgery, with normal cardiac monitoring; baseline and control ECGs showed myocardial infarction in 9.1% of patients. Baseline ECGs showed pericarditis as well in 27% of patients and repolarization changes in 35.2%. The latter became normal within 1 to 6 months after the trauma. All (100%) of the patients had a functional status I stress test, and 56% had a normal echocardiography. In conclusion, the epidemiologic behavior of penetrating cardiac trauma is identical to that of general trauma. ECG is useful during the postsurgery period for diagnosis of traumatic myocardial infarction. Likewise, the stress test is useful in patients with myocardial infarction and echocardiography in the presence of either myocardial infarction or any symptom suggesting anatomic or functional alterations of the heart.
Role of Wire‐guided Breast Biopsy for Diagnosis of Malignant Nonpalpable Mammographic Lesions
Authors: Lantsberg Leonid , Kirshtein Boris , Koretz Michael , Strano Selwyn 
Published: August 2002

Abstract.Biopsies of mammographically detected nonpalpable lesions have resulted in increased numbers of diagnosed early breast malignancies. From June 1992 to September 1996 a total of 433 consecutive patients underwent 438 biopsies. The mean age was 55.7 years (range 30–82 years); 150 patients were younger than 50 years. Mammographic findings were classified as microcalcifications (C), masses (M), masses with microcalcifications (MC), architectural distortions (A), and stellate lesions (S). In 30 women two needles were placed to localize a lesion in the ipsilateral side and in 5 on the contralateral side. There were 182 (41.6%) biopsies performed for M, 144 (32.9%) for C, 78 (17.8%) for A, 25 (5.7%) for MC, and 9 (2.1%) for S. The overall malignancy rate was 34% (149/438). Thirty‐four women (23%) who presented malignancy were younger than 50 years of age. From year to year, it increased from 27% during the first year to 51% during the fourth year. Altogether 100 (67%) patients had invasive carcinoma, 40 (27%) ductal carcinoma in situ (DCIS), 6 (4%) lobular carcinoma in situ, and 3 (2%) tubular carcinoma. Four patients had simultaneous bilateral palpable and nonpalpable carcinoma. Among the patients, 9 of 20 with previously operated breast carcinoma and 9 of 19 with other previous malignancies were found to have early breast carcinoma. The mammographic finding with high rates of malignancy were S 67%, MC 40%, M 34%, C 33%, and A 28%. A group of 11 of 110 (10%) patients had histologically proven axillary lymph node metastasis. Results from this large retrospective study of wire‐guided localization biopsies showed a relatively high rate of malignancy (34%) and DCIS (27%).
Gastric Acidity following Pancreaticogastrostomy with Pylorus‐preserving Pancreaticoduodenectomy
Authors: Shinchi Hiroyuki , Takao Sonshin , Maenohara Shigeho , Aikou Takashi 
Published: August 2002

AbstractPancreaticogastrostomy (PG) has been reintroduced and employed occasionally as a useful alternative to pancreaticojejunostomy (PJ) after Whipple resection or pylorus‐preserving pancreaticoduodenectomy (PPPD). Although the physiologic alteration in the stomach is important for the correlation between gastric and pancreatic functions, the actual intragastric pH profile after PG is still unclear. This study was conducted to investigate the physiologic changes in gastric pH and serum gastrin and secretin levels before and after PPPD reconstructed with PG (PPPD‐PG) in humans. Twenty‐four hour continuous intragastric pH and serum gastrin and secretin levels in the fasting state were examined in 25 patients who had undergone PPPD‐PG. No peptic ulcer was detected after the operation. After PG, serum gastrin and secretin levels were unchanged. Twenty‐four hour gastric pH monitoring revealed two distinct patterns during the nocturnal period before the operation: patients with acid‐type secretion (n= 11) exhibited a persistent acid pH, whereas those with alkaline‐type secretion (n= 14) had cyclic variations between an acid and an alkaline pH value. After PG, in both acid‐ and alkaline‐type patients, median pH and percentages of time that the gastric pH was less than 4 (% pH < 4) and more than 6 (% pH > 6) did not change, and circadian pH patterns also remained unchanged. These results suggest that PPPD‐PG has little influence on gastric acidity, and the neurohumoral relation between the stomach, duodenum, and pancreas is preserved after PG. Therefore, physiologically, PG can be recommended as a reconstructive procedure after PPPD.