bluuebunny/crossref_metadata_2025_split huggingface dataset:
Logistic regression and discriminant analyses of hepatic failure after liver resection for carcinoma of the biliary tract
Authors: Nagino Masato , Nimura Yuji , Hayakawa Naokazu , Kamiya Junichi , Kondo Satoshi , Sasaki Ryuichiro , Hamajima Nobuyuki 
Published: May 2005

AbstractStepwise logistic and discriminant analyses were used to define the risk factors for hepatic failure after liver resection for carcinoma of the biliary tract and to predict this complication. The logistic analysis identified the linear pattern of oral glucose tolerance test, cholangitis, pancreatoduodenectomy, and indocyanine green disappearance rate as the factors most related to hepatic failure among 18 pre‐ and perioperative parameters of the past 84 hepatectomized cases (55 hilar bile duct carcinomas and 29 gallbladder carcinomas). Our discriminant formula using five variables, including the above‐mentioned four plus the liver resection rate, could distinguish the patients with posthepatectomy liver failure (n=25) from those without (n=59) with 86.9% accuracy, 96.0% sensitivity, and 83.1% specificity. The cross‐validation test has confirmed that this model was robust for discriminant analysis. The results of this study show that statistical multifactorial analysis makes possible the preoperative prediction of hepatic failure after liver resection for carcinoma of the biliary tract.
Laparoscopic cholecystectomy: Treatment of choice for cholelithiasis in children
Authors: Vinograd Itzhak , Halevy Ariel , Klin Baruch , Negri Michael , Bujanover Yoram 
Published: May 2005

AbstractLaparoscopic cholecystectomy is rapidly replacing traditional cholecystectomy as the standard treatment for cholelithiasis and cholecystitis in adults. Over a period of 16 months, 14 children with a clinical diagnosis of cholelithiasis, ranging in age from 4 to 15 years (mean 12.2), were treated. All had symptoms of abdominal pain or vomiting; one had jaundice and recurrent cholecystitis. Five children (35%) had associated metabolic or hemolytic diseases. The 14 children were operated on using the laparoscopic cholecystectomy technique. No operation was converted to open cholecystectomy, but two patients required laparotomy: one because of suspected injury to the common duct, and the other because of non visualization of the gallbladder during laparoscopy. The mean post‐operative hospital stay for the 11 children who underwent only laparoscopic cholecystectomy (one patient also had a simple mastectomy) was 50 hours (range 48–72 hours). All children resumed their normal activities almost immediately after discharge from hospital. No long‐term biliary or other complications were seen in any patient throughout an average follow‐up period of 6.2 months (range 3–16 months). The benefits of this operation in children are obvious: It is safe, effective, and well tolerated.
Colon J‐Pouch rectal reconstruction after total or subtotal proctectomy
Authors: Cohen Alfred M. 
Published: May 2005

AbstractMultiple stools, urgency, and episodic frequency are common during the first 6 months after proctectomy and coloanal or low colorectal reconstruction. We used an 8‐cm colon J‐pouch in 23 patients and have confirmed that this approach obviates much of this early dysfunction.
Endorectal ultrasonography for staging small rectal tumors: Technique and contribution to treatment
Authors: Detry Roger J. , Kartheuser Alex , Kestens Paul J. 
Published: May 2005

AbstractThirty‐one tumors, lying in the lower two‐thirds of the rectum and possibly suitable for local excision, were analyzed by endorectal ultrasonography (EUS) using the Aloka® scanner SSD 520. There were 18 sessile villous adenomas (group I) and 13 invasive cancers 3 cm or less (group II). Preoperative endosonographic staging (uT, uN stages) was compared with the histologic analysis of the specimens (pT, pN) and the possible contribution to therapy was evaluated. In group I, the depth of tumor infiltration was accurately assessed in 89% of cases. Malignant transformation was suspected in 4 cases (uT2) and confirmed postoperatively in 3 cases. In group II, the extent of the tumor was correctly evaluated in 84% of cases. With regard to the overall differentiation between T1 and T2/T3 tumors on one hand, and between T1/T2 and T3 lesions on the other hand, the positive predictive values were 93.3% and 100%, respectively. The negative predictive values were 93.7% and 92.8%. In group II the search for regional lymph nodes was positive in 4 cases and negative in 9 cases. An accuracy rate of 82% (sensitivity 75%, specificity 85%) was estimated by analysis of the specimens and postoperative follow‐up. The exact performance could not be evaluated because a radical resection was not carried out in most cases. EUS was useful for planning the treatment of villous adenomas. A broad full‐thickness excision was carried out without delay for the four uT2 villous tumors, allowing safe margins to be obtained in all cases. Using EUS the choice of local excision was questioned for six small invasive cancers (uT3 and/or uN+), although radical resection was carried out for only two. As high sensitivity could not be achieved when detecting lymphatic metastasis, the choice of limited surgery based on EUS staging requires strict postoperative follow‐up.
Acute temporary laterofixation for treatment of bilateral vocal cord paralyses after surgery for advanced thyroid carcinoma
Authors: Ejnell Hasse , Tisell Lars‐Erik 
Published: May 2005

AbstractFour patients with breathing obstruction after surgery for advanced thyroid carcinoma were found to have bilateral vocal cord paralysis. They were treated with acute temporary laterofixation of one of the vocal cords. This measure established a stable airway in all the patients and maintained acceptable voices. None of the patients had aspiration problems. After 4 to 7 weeks the nonlaterofixated vocal cord had regained normal function in each patient, and the thread used for the laterofixation could be removed. In the two patients who had anatomically intact recurrent laryngeal nerves bilaterally, the previously laterofixated vocal cords displayed normal movements within another 8 weeks in one patient and 7 weeks in the other patient. This observation demonstrates that a temporary laterofixation can be done without lasting damage to the vocal cord. Acute temporary vocal cord laterofixation is a procedure that has the potential to minimize the morbidity and complications of bilateral vocal cord paralysis, and in most patients it can be done instead of tracheostomy.
Natural history of adenomas
Authors: Eide Tor J. 
Published: May 2005

AbstractOne‐third of individuals over the age of 55 years have single or multiple colorectal adenomas. During a subsequent period of 10 years, 3–5% of adenoma‐bearing individuals will probably develop a carcinoma. The rather low conversion rate from benign to malignant disease indicates that most individuals with adenomas will never develop colorectal carcinoma. More knowledge is required to predict the outcome of the individual adenoma in a given patient. This will probably be obtained by increasing progress within gene technology and through large prospective follow‐up studies of adenoma‐bearing patients.
Diagnosis of familial adenomatous polyposis
Authors: Bülow Steffen 
Published: May 2005

AbstractFamilial adenomatous polyposis (FAP) includes early development of up to thousands of colorectal adenomas and of colorectal adenocarcinoma in all untreated cases. Moreover, a variety of extracolonic manifestations are seen. Proctosigmoidoscopy is used for screening; when adenomas are found, the diagnostic evaluation includes colonoscopy and gastroduodenoscopy. Screening of first degree relatives should start at the age of 10 years, using proctosigmoidoscopy at regular intervals. The recent detection of a specific FAP gene at chromosome 5 and of congenital retinal pigmentations will allow an early preclinical diagnosis in the future. A centralized registration of FAP has resulted in an improved prognosis, and the establishment of international groups will contribute to increased research of this disease.
Other gastrointestinal polyps
Authors: Järvinen Heikki J. 
Published: May 2005

AbstractGastrointestinal polyp is a descriptive concept—observation of an elevated broad‐based or stalked lesion which can be defined exactly only when examined histologically. Therefore, all polyps must, in principle, be snared or excised to achieve a final diagnosis. Nonneoplastic polyps or tumor‐like lesions were formerly considered innocent findings with no malignant potential, while neoplastic adenomas with dysplasia are well‐known premalignant lesions. This view of the totally harmless nature of nonneoplastic polyps is no longer true. At least the dominantly inherited juvenile polyposis and Peutz‐Jeghers polyposis syndromes definitely have malignant potential through adenomatous change in the originally hamartomatous lesions. Consequently, juvenile polyposis is best treated with colectomy and ileorectal anastomosis, and repeated multiple polypectomies are now recommended in Peutz‐Jeghers polyposis, in combination with laparotomy when feasible. In addition, hyperplastic gastric polyps may reflect an underlying atrophic gastritis implying increased risk of gastric carcinoid tumors and cancer. Furthermore, even colorectal hyperplastic polyps may undergo adenomatous change, and thus represent, theoretically, a reservoir from which adenomas arise.
Bleeding esophageal varices associated with pancreatic arteriovenous malformation
Authors: Katoh Hiroyuki , Kojima Tetsufumi , Okushiba Shunichi , Shimozawa Eiji , Tanabe Tatsuzo 
Published: May 2005

AbstractThree cases of bleeding esophageal varices associated with arteriovenous malformation of the pancreas have been observed over the last 7 years. In 1 case, arteriovenous malformation (AVM) was the cause of the portal hypertension; thus, it was considered to be a “primary lesion.” In the other cases, liver cirrhosis was the cause of the portal hypertension, and the AVM, which originally was a minor pathology, became significant as the portal hypertension progressed, thus making it a “secondary lesion.” In the case of a “primary lesion,” resection of the lesion is the preferred treatment for bleeding varices, but our case had multiple lesions, and excision was problematic. In the case of bleeding varices caused by liver cirrhosis, if liver function is normal, surgical treatment of both the varices and the AVM is recommended, while if the liver function is abnormal, repeated sclerotherapy is the best mode of therapy.
Resection of synchronous liver metastases from colorectal cancer
Authors: Vogt P. , Raab R. , Ringe B. , Pichlmayr R. 
Published: May 2005

AbstractWhereas resection for metachronous liver metastases from colorectal cancer is considered to be a potentially curative approach, little is known about the prognosis after resection of synchronous liver metastases. In the past, these patients usually underwent only palliative therapy. Therefore, we have analyzed the data of 36 patients who underwent curative hepatic resection of synchronous liver metastases from colorectal carcinomas from 1977 to 1987 at the Department of Surgery, Hannover Medical School. In 19 patients, liver resection was combined with colonic resection; in the other 17 patients, hepatic resection was performed after a median interval of 2 months following resection of the primary tumor. No operative mortality was observed in either of the approaches. The median survival time was 28 months for all patients with a median recurrence‐free interval of 13.5 months. Overall 5‐year survival probability for all patients was 20%. There were no significant differences observed between immediate or delayed liver resection (median survival 18 months versus 31 months). Survival rates were not different after resection of solitary versus multiple liver metastases (26 versus 28 months). Twenty‐one of the 36 patients had a recurrence of their liver metastases. In 7 of them, curative liver resection could be performed again. These 7 patients had a significantly improved survival (p<0.05) compared to the residual 14 patients. It is concluded that patients with synchronous liver metastases from colorectal cancer may profit from resection of the primary tumor and liver metastases. Timing of liver resection—immediate versus delayed—obviously has no impact on survival rates.
Body composition in Chinese subjects: Comparison with data from North America
Authors: Jiang Zhu‐ming , Yang Nai‐fa , Chou Chun , Liu Zhen‐hua , Sun Te‐lin , Chen Yuan‐he , Xue Bao‐zhen , Fei Li‐ming , Tseng Hsien‐chiu , Brown Elaine , Scheltinga Marc , Wilmore Douglas W. 
Published: May 2005

AbstractA multiple tracer dilution method measuring total body water, extracellular water, plasma volume, and red cell volume was used to study body composition. Healthy Chinese subjects were compared to a group of Chinese patients with various newly diagnosed gastrointestinal disorders scheduled for elective operation. Compositional data obtained from these groups showed no significant differences in compartmentalization, suggesting absence of major changes during the early stages of certain gastrointestinal diseases. In addition, healthy Chinese subjects were compared to a group of healthy Americans previously evaluated by similar dilutional methods. In males, body weight (kg) differed considerably (Chinese=62.1±2.0 versus American = 72.5±4.1,p<0.02) and could be explained by alterations in body fat (Chinese=12.4±1.3 versus American=19.2±2.2,p<0.02) and extracellular water (Chinese=14.4±0.5 versus American=16.8±0.8,p<0.02). Functional tissue (“body cell mass”) was similar in the 2 groups which suggested that Chinese have comparable body composition without an additional fat burden.The multiple tracer technique using deuterium oxide, sodium bromide, Evans dye, and Cr51for body compositional assessment is accurate but expensive and laborious. Therefore, equally precise but more economical bedside methods are needed for routine compositional analysis.
Retroperitoneal drainage in the management of the septic phase of severe acute pancreatitis
Authors: Alberto Villazón S. , Oscar Villazón D. , Francisco Terrazas E. , Ricardo Raña G. 
Published: May 2005

AbstractEighteen consecutive patients with sepsis due to surgically confirmed peripancreatic necrosis extending diffusely into the retroperitoneal fat were treated in our hospital from 1980 to 1987. Management consisted of early retroperitoneal debridement of necrotic tissue and drainage through lumbar incisions. Enteral nutrition was implemented in all patients 3–8 days after their first surgery. A total of 40 reoperations were required—an average of 2.6 per patient. Complications included respiratory failure (17), renal failure (4), gastrointestinal bleeding (4), retroperitoneal bleeding (1), and gastrointestinal fistulas (6). Four (22%) of the 18 patients died; the major cause of death was multiple organ failure secondary to sepsis. Before 1980, all patients with severe pancreatitis treated in our hospital died, despite the use of different management techniques. The use of the extraperitoneal route for early debridement of necrotic tissue and to avoid contamination of the peritoneal cavity has substantially reduced the mortality associated with peripancreatic necrosis in our hospital. The mortality in this series of patients (22%) compares very favorably with that reported in studies of similar patients.
Lower esophageal sphincter characteristics and esophageal acid exposure following partial or 360‡ fundoplication: Results of a prospective, randomized, clinical study
Authors: Lundell Lars , Abrahamsson Hasse , Ruth Magnus , Sandberg Nils , Olbe Lars C. 
Published: May 2005

AbstractIn a prospective, randomized, clinical trial, we compared a partial (180–200‡, Toupet) with a total fundoplication (360‡, Rossetti) in the surgical treatment of gastroesophageal reflux disease. Seventy‐one patients entered the trial; 33 were allocated to a partial fundoplication and 38 to a 360‡ fundic wrap. Each patient was investigated prior to as well as 3 and/or 6 months after the operation, including an endoscopic and clinical assessment. Manometry was carried out via a triple lumen catheter and the pressure in the high pressure zone (HPZ) in the distal esophagus was measured as well as the length of the intraabdominal segment by a “station pull‐through” technique. Acid exposure of the esophageal mucosa was evaluated by ambulatory 24‐hour pH measurements.Acid exposure of the esophageal mucosa was “normalized” by the 2 operations. In addition, the length of the HPZ was increased to a “normal” level by both operations. The pressure of the HPZ was, however, “normalized” only in patients allocated to a Rossetti fundoplication, whereas patients operated on with a partial fundoplication had a significantly lower HPZ pressure (p<0.01). The clinical assessment revealed excellent results in both groups with no significant differences between the 2 operations except for a higher incidence of dysphagia at 3 months after a Rossetti fundoplication (p<0.01), which disappeared during the subsequent 3 months.
Scintigraphic detection of gastric and pancreatic carcinomas with In‐111 ZCE 025 monoclonal antibody
Authors: Abdel‐Nabi Hani H. , Schwartz Alan N. , Wechter Debra G. , Higano Celestia S. , Ortman‐Nabi Judith A. , Unger Michael W. 
Published: May 2005

AbstractWe have evaluated the role of In‐111 anti‐CEA (carcinoembryonic antigen) monoclonal antibody ZCE 025 in 8 patients. Three patients had a confirmed diagnosis of gastric carcinoma. Three had a confirmed diagnosis of pancreatic carcinoma. Two patients had elevated serum levels of CEA with no known primary. Each patient received 5.5 mCi In‐111 ZCE 025 infused at doses of 10–80 mg. Planar and single photon emission computed tomography (SPECT) imaging at 3 and 7 days after infusion detected 9 of 12 known tumor sites and all 5 of the previously identified sites of metastasis. In‐111 ZCE 025 MoAb imaging also found 6 previously unsuspected tumor sites and changed the preoperative evaluation in 50% of the patients studied. It changed the clinical management in 2 patients and established the site of primary involvement in 2 others. There were no clinical or biochemical reactions. In‐111 ZCE 025 monoclonal antibody scintigraphy is a useful adjunct in the evaluation of patients with either gastric or pancreatic carcinoma. It may have a beneficial impact on the surgical decision making in these patients.
Cervicothoracic arterial injuries: Recommendations for diagnosis and management
Authors: George Salem M. , Croce Martin A. , Fabian Timothy C. , Mangiante Eugene C. , Kudsk Kenneth A. , Voeller Guy R. , Pate James W. 
Published: May 2005

AbstractManagement of arterial injuries at the thoracic outlet and neck presents a major challenge to the trauma surgeon; hemorrhagic shock, neurologic deficit, and limb loss are the serious sequelae. Over a 13‐year period, 118 patients with injuries to the innominate, carotid, subclavian, and axillary arteries were evaluated. Most injuries were penetrating (78%). Half of the patients were diagnosed by physical examination and half by angiography. Patients were treated by either primary repair (35%), interposition graft (31%), ligation (8%), or anticoagulation (26%). Two patients required amputations (1 digit, 1 above elbow). Overall mortality was 14%, with 5% due to consequences of hemorrhagic shock, 7% due to cerebral ischemia, and 2% due to other causes. Claviculectomy, median sternotomy, and trap door incisions were routinely used for proximal vascular control and repair. We conclude that liberal use of angiography is indicated in stable patients for penetrating wounds near major arteries, and for blunt injuries associated with neurologic deficits unexplained by computed tomography. Patients with obvious arterial injury should have immediate exploration. Extensile exposure is mandatory for appropriate management. Blunt carotid dissections are generally best managed nonoperatively with anticoagulation.
Hepatectomy for large hepatocellular carcinoma: The optimal resection margin
Authors: Lai Edward C. S. , Ng Irene O. L. , You K. T. , Choi T. K. , Fan S. T. , Mok Francis P. T. , Wong John 
Published: May 2005

AbstractThe necessary resection margin (RM) for cure during hepatectomy for hepatocellular carcinoma (HCC) remains conjectural. From January, 1972 to June, 1988, a total of 96 patients who had complete macroscopic extirpation of their large tumor (≥5 cm in largest diameter) were studied retrospectively to determine the macroscopic distance of RM required to secure histological disease clearance. Positive histological RM, which was found in 31 (32.3%) patients, had significantly compromised both diseasefree survival (p<0.04) and overall survival (p<0.006) of these patients. Among the 65 patients with detailed measurement of macroscopic RM, a significant reduction of residual histological disease was observed when a 0.5 cm margin had been established (p<0.05). Further extension of margin had no additional benefit. The presence of microsatellite (p<0.03) and multiple tumor nodules (p<0.03) was associated with an increased risk of positive histological margins among the 15 pathological parameters evaluated, including macroscopic RM. Since measurement of RM is an unreliable guide, histological confirmation is the only means for establishing the diagnosis of complete tumor clearance. Within safety limits dictated by anatomical factors and severity of underlying cirrhosis, aggressive surgery should be offered for patients with large HCC; however, resection is not advisable unless a 0.5 cm margin can be secured with certainty, especially for multinodular lesions.
Decision making in surgical practice
Authors: Clarke John R. 
Published: May 2005

AbstractJudgment has been defined as the ability to make correct decisions with uncertain, incomplete, or inconsistent information. Decision analysis is a scientific method of choosing between trade‐offs. This review provides evidence that the model of decision analysis adequately represents clinical problems and that the use of decision analysis can improve clinical judgment. The technique of analyzing decisions using a decision tree model is reviewed. Using the decision tree model, a decision consists of specifying the options, specifying the outcomes associated with each option, assigning probabilities to those outcomes when they are not known with certainty, and assigning values or utilities to those outcomes. Surgical decisions can be described by a limited number of decision trees despite a much larger number of clinical problems. A model of the surgical decision making process, consistent with the analytical decision tree model, details steps useful in clinical decision making. The surgeon determines whether the characteristics of the patient match those of the typical patient with the condition. If so, the standard solution is recommended. If not, the surgeon concentrates on assessing or revising the specific probabilities or utilities that are different. If the best option is suboptimal, consideration is given to more aggressive diagnosis or to a therapy that offers the potential for a better outcome, but at a risk.The recommendations of surgeons for 6 patient management problems was compared to the analytical solutions using their own subjective estimates of probabilities and utilities. Decision analysis provided a net gain in accuracy in all 6 problems. Decision analysis was also significantly more accurate than the conventional second opinion program.Evidence exists that decision trees are reasonable models of the clinical trade‐offs involved in surgical judgment. Resolving clinical trade‐off decisions with decision analysis can be shown to be practical and result in improvement in clinical judgment.