bluuebunny/crossref_metadata_2025_split huggingface dataset:
Radiotherapy in the management of non‐small‐cell lung cancer
Authors: Bezjak Andrea , Payne David 
Published: May 2005

AbstractRadiation plays an important role in the management of patients with non‐small‐cell carcinoma of the lung. Understanding the impact of radiation on this tumor and on normal tissues requires a knowledge of the natural history of the tumor, and of basic sciences, including radiation physics and biology. This review gives a brief outline of the scientific basis of radiotherapy, followed by a discussion of some practical issues concerning radiation tolerances of tissues within the thorax, the acute and late sequelae of radiation, and the treatment planning process. The role of radiotherapy is explored in the following settings: Radical radiation with curative intent for early stage disease, adjuvant mediastinal irradiation for completely resected tumors, radiation of known residual disease after surgical resection, preoperative radiation, prophylactic cranial radiation, radiation of locally advanced unresectable disease, and, finally, radiation with palliative intent in patients with metastatic disease. Pertinent studies, with the emphasis on randomized trials, are outlined to document the present state of understanding with respect to the impact of radiation in each of these situations. Several of the controversies in this area are addressed, with particular emphasis on selection of patients for high‐dose radiation and recent results of combined modality treatment with radiation and chemotherapy.
Pyloric exclusion in severe penetrating injuries of the duodenum
Authors: Degiannis E. , Krawczykowski D. , Velmahos G. C. , Levy R. D. , Souter I. , Saadia R. 
Published: May 2005

AbstractThis study comprises 74 patients with penetrating injuries of the duodenum. Sixty‐three of these had sustained gunshot wounds, many of which were high velocity. The change in the incidence and the severity of the gunshot injuries within the last few years resulted in changes in the operative management of the duodenal wound with gradually improving results. When pyloric exclusion was added to the operative management of grade III duodenal injuries, the postoperative leakage rate was 12%. When only primary repair was done, the leakage rate was 43%. We suggest that pyloric exclusion be added to the treatment of most severe grade II and all grade III gunshot duodenal injuries. The adequacy of primary repair and pyloric exclusion in grade IV injuries requires further study.
Does esophagectomy cure a resectable esophageal cancer?
Authors: El Nakadi Issam , Houben Jean ‐Jacques , Gay France , Closset Jean , Gelin Michel , Lambilliotte Jean ‐Pierre 
Published: May 2005

AbstractDuring the years 1978–1990, 401 patients with esophageal cancer were evaluated for curative resection.A retrospective study was undertaken to estimate the efficacy of surgery and select criteria for long‐term survival.After investigation, 187 patients (47%) underwent surgery. To evaluate the long‐term results, 101 curative esophageal resections classified into stage I (11 patients), II (24 patients), and III, pathological TNM (66 patients), with at least 2 years' follow‐up, were considered. Esophagogastrectomy was performed in 91% of the cases and gastric transposition was achieved in 96% of the patients.The anastomoses were intrathoracic (98%) and at the apex of the right thorax for tumors of the middle third of the esophagus. Staplers were used in 76% of sutures. Postoperative hospital mortality was 5.9%. Specific morbidity included strictures 11%, esophagitis 12%, and anastomotic leak 2%.Actuarial 5‐year survival was 90.9% in stage I, 52.3% in stage II, and 17.7% in stage III. The overall 5‐year survival rate was 34.2%, 64.8% for the No patients, and decreased to 17.7% when node involvement was observed. Five‐ to 8‐year survival is also considered.It is concluded from this study that esophagectomy is actually the appropriate treatment in patients with nonmetastatic resectable carcinoma with an overall 34.2% 5‐year survival.The operation can be performed with a low morbidity and mortality rate if done in experienced centers.
Cancer of the stomach: A review of two hospitals in Korea and Japan
Authors: Mok Young Jae , Koo Bum Whan , Whang Chung Woong , Kim Sae Min , Maruyama Keiichi , Sasako Mitsuru , Kinoshita Taira 
Published: May 2005

AbstractThe records of 525 patients with primary adenocarcinoma of the stomach treated at Korea University Hospital (K.U.H.), Seoul, Korea, and 1,932 patients treated at National Cancer Center Hospital (N.C.C.), Tokyo, Japan, over a 7‐year period were reviewed to study biologic characteristics and treatment results in the two hospitals. More than 70% of the patients were 41 to 70 years old in both hospitals, though K.U.H. had more younger patients and N.C.C. had more older patients. Comparison in regard to clinicopathologic features showed significant differences in type of cancer, tumor size, depth of invasion, lymph node metastasis, stage, and histologic type. Such a difference mostly was due to a greater frequency of early gastric cancer in N.C.C. patients (51.2%) than in K.U.H. patients (19.0%). Patients of K.U.H. were more likely to have advanced cancer, large invasive tumors, a higher percentage of lymph node metastasis, a higher stage, and more undifferentiated tumors. The 5‐year survival rate of all resected cases was 69.5% in N.C.C. and 54.2% in K.U.H. (p>0.05). Those factors which showed a significant difference in clinicopathologic features did not affect the survival difference between the two hospitals except in stage IIIb and signet‐ring‐cell cancer. The 5‐year survival rate for stage IIIb was 18.0% in K.U.H. and 36.8% in N.C.C. It would seem that survival difference in stage IIIb related to extensive lymph node dissection in N.C.C. Survival difference in signetring‐cell gastric cancer (31.2% in K.U.H. and 91.0% in N.C.C.) was related to the fact that 79.1% of signet‐ring‐cell gastric cancer patients in N.C.C. had early gastric cancer. This present study once again demonstrates the importance of early detection in the treatment of gastric cancer and suggests that gastric cancer of two countries is not different.
The pathological basis of resection margin for hepatocellular carcinoma
Authors: Lai Edward C. S. , You Kok ‐Tjan , Ng Irene O. L. , Shek Tony W. H. 
Published: May 2005

AbstractAt the time of hepatectomy for primary hepatocellular carcinoma (HCC), the necessary amount of surrounding nontumorous liver to be sacrificed, or the resection margin, which will ensure a complete histologic disease clearance is uncertain. Twenty‐three resected liver specimens were studied by serial section followed by histological examination prospectively. All histologic diseases identified were assumed to spread radially in all directions from a unicentric lesion. Histologie disease from capsular and liver invasion was found confined to the immediate surrounding liver parenchyma. Eleven of the 14 large (≥5 cm) tumors and all six small (<5 cm) HCCs had either microsatellites and/or histologic venous permeation found beyond 1 cm from the lesion. A large tumor, multinodular lesions, macroscopic venous thrombi, liver invasion, and nonencapsulation were associated with an extensive spread of histologic disease. In the presence of either microsatellites or histologic venous permeation, no distance could ensure a complete disease clearance.
Role of surgical treatment for recurrent hepatocellular carcinoma after hepatic resection
Authors: Nakajima Yasuaki , Ohmura Takashi , Kimura Jun , Shimamura Tsuyoshi , Misawa Kazuhito , Matsushita Michiaki , Sato Naoki , Une Yshie , Uchino Junichi 
Published: May 2005

AbstractFrom 1978 to 1989, 164 patients underwent hepatic resection for hepatocellular carcinoma at our institution. The carcinoma was resected completely in 149 patients. Sixteen patients were excluded from this study because it was not known whether they were recurrent or disease free, or because death occurred as a result of surgical complications. Recurrent disease occurred in 48.1% of the remaining 133 patients. Fifty‐seven patients had recurrent tumor only in the residual liver. A second hepatic resection was performed in 14 cases, 22 received intraarterial chemotherapy and/or arterial embolization without resection, and the remaining 21 received no anticancer therapy. The 5‐year survival rate of patients who had a second resection was 92.0%. Recurrences in distant organs occurred in 14 patients, and the recurrent carcinoma was resected in five cases. Four of these 5 patients survived more than 3 years after the second surgery. Aggressive surgical resection of recurrent HCC, even for distant metastasis, is a viable approach, and may produce long‐term survivors.
Multifactorial analysis of local recurrences in rectal cancer, including DNA ploidy studies: A predictive model
Authors: Moran Manuel R. , Rothenberger David A. , Gallo Roel A. , Goldberg Stanley M. , James Edwin C. 
Published: May 2005

AbstractDNA ploidy studies were performed in 188 patients operated on for rectal cancer. In order to define different risk groups of patients, a stepwise logistic regression was carried out in 138 patients who underwent abdominal “curative” resections. Thirtyseven variables were analyzed. Although several variables were significant, only three improved the prognostic value: (1) more than three positive lymph nodes (p=0.0007); (2) macroscopic local tumor invasion (p=0.01); and (3) DNA ploidy (p=0.03). Standardized discriminant coefficients were used to obtain a model and format for predicting local recurrences. This is the first time that a predictive model for rectal cancer, using DNA ploidy as a variable, is reported.Based on calculated discriminant values (DV), patients can be divided into three subgroups: (1) low risk for local recurrences (DV<−1.9,n=56)—local recurrences were observed in two patients (3.6%); (2) moderate risk (DV between −1.9 and −0.6,n=55)—local recurrences occurred in nine patients (16.4%); and (3) high risk (DV>−0.6,n=27)—local recurrences occurred in 14 patients (51.8%). This predictive model for local recurrences has much better prognostic value than Dukes' staging (p<0.0001).
Suppressibility of serum levels of PTH by calcium in the immediate postoperative period after surgery for primary hyperparathyroidism
Authors: Bergenfelz Anders , Ahrén Bo 
Published: May 2005

AbstractThe ability of calcium to suppress the secretion of parathyroid hormone (PTH) is impaired in primary hyperparathyroidism (pHPT). Whether the nonadenomatous glands in pHPT also exhibit altered calcium/PTH homeostasis is not known, but this may be the case since in the immediate postoperative period after surgery for pHPT, hypocalcemia often evolves in spite of a rapid normalization of serum levels of PTH. In this study, therefore, the suppression of serum levels of PTH by an oral calcium load was investigated pre‐ and postoperatively in 12 patients operated on for parathyroid adenoma. There was no difference in the calcemic response during the calcium load pre‐ and postoperatively. We found that the suppression of serum levels of PTH by calcium was increased already on the first postoperative day. However, postoperatively, the suppression of serum levels of PTH corrrelated positively to serum levels of ionized calcium and, furthermore, negatively to the weight of the excised parathyroid adenoma and the preoperative serum levels of ionized calcium. The results indicate that the function of the remaining parathyroid glands in patients with parathyroid adenoma could have been altered during the hyperparathyroid state and that postoperative hypocalcemia more readily evolves in patients with severe pHPT and impaired suppressibility of PTH (by calcium) in the remaining parathyroid glands.
Correlation of metabolic acidosis with outcome following injury and its value as a scoring tool
Authors: Falcone Robert E. , Santanello Steven A. , Schulz Malcolm A. , Monk John , Satiani Bhagwan , Carey Larry C. 
Published: May 2005

AbstractThis study looked at preresuscitation arterial pH as a predictor of outcome in injury. Seriously injured patients admitted to the Trauma Service over a 5‐month period were evaluated prospectively. Data collected included basic patient demographics, initial arterial blood gas determinations (ABGs) including pH, bicarbonate (HCO3), base deficit or excess (BASE), admitting trauma score (TS), discharge injury severity score (ISS), total blood products used for initial resuscitation (TBP), and outcome. There were 191 patients averaging 34.7 years old with average TS 13.6, ISS 19.5, initial pH 7.38±0.09, HCO3 20.9±4.0, and BASE −3.3±4.7. The average TBP was 1309 cc, and overall mortality was 13/191 (6.8%). Comparing survivors to nonsurvivors, the ISS (18.2 vs. 38.3), TS (14.1 vs. 7.8), TBP (976 vs. 5881 cc), HCO3 (21.1 vs. 17.6), and BASE (−3.1 vs. −5.8) data were significantly different; pH (7.38 vs. 7.36) and age (34.4 vs. 38.5) were not. Using multiple regression with TBP as the dependent variable, BASE, age, TS, and to a lesser extent pH and HCO3 correlated (r=0.536; p<0.001); using outcome as the dependent variable, only TS and age correlated (r=0.465; p<0.0001). Although metabolic acidosis (pH, HCO3, BASE) predicts the TBP used, it does not improve on TS and age for predicting outcome.
Role of parenteral nutrition in preventing malnutrition and decreasing bacterial translocation to liver in obstructive jaundice
Authors: Chuang Jiin‐Haur , Shieh Chie‐Song , Chang Nyuk‐Kong , Chen Wei‐Jen , Lin Jer‐Nan 
Published: May 2005

AbstractSurgery in patients with obstructive jaundice is associated with significant infectious complications probably due to impaired immune function and malnutrition. Total parenteral nutrition (TPN) may alleviate malnutrition but may also promote bacterial translocation (BT) from the gut. To elucidate if TPN can prevent malnutrition without promotion of BT in obstructive jaundice, 40 dogs underwent laparotomy for tissue sampling and placement of a central venous line and were allocated into one of four groups: I (PO‐control) received dog chow and water ad libitum; II (PO‐CBDL) underwent ligation of common bile duct (CBDL) and was fed dog chow; III (TPN‐control) received TPN; and IV (TPN‐CBDL) underwent CBDL and received TPN. Body weight, blood samples for liver function tests and bacterial culture, and tissues from liver and mesenteric lymph nodes (MLN) for quantitative bacterial culture and for histology were obtained prior to and 2 weeks after the experiment. The incidence of BT to MLN was 40% in the PO‐CBDL and TPN‐CBDL animals, which was significantly different from the other two groups (0%);p<0.05). The incidence of BT to liver was 70% (7/10) in the PO‐CBDL animals, which was significantly higher than that in groups I, III, and IV (0%, 20%, 20%, respectively) (p<0.05). The PO‐CBDL animals showed a significant decrease in body weight and prealbumin compatible with malnutrition, whereas the TPN‐CBDL animals showed a significant increase in alkaline phosphatase and a consistent cholestasis on histology. The data suggest that TPN can prevent jaundice‐associated malnutrition and decrease BT to liver but should be administered cautiously because it may precipitate cholestasis.
Evaluation of “Gastric” emptying time in the J pouch compared with a standard esophagojejunal anastomosis
Authors: McAleese P. , Calvert H. , Ferguson W. R. , Laird J. 
Published: May 2005

AbstractGastric emptying times and symptoms were recorded in 18 patients after total gastrectomy and either a 15‐cm J‐pouch (n=10) or a standard esophagojejunal anastomosis (n=8). A solid test meal labeled with99mTc was used to compare the emptying times. The postoperative symptoms and nutritional status were also assessed. The J‐pouch resulted in a prolonged period of food retention in the upper jejunum (p<0.02) compared to that with a standard esophagojejunal anastomosis. The patients with a Jpouch had fewer episodes of postprandial pain (p<0.03) or vomiting (<0.04). They also had fewer dietary restrictions (p<0.04) and better nutritional status.
Endocrine‐metabolic response to abdominal aortic surgery: A randomized trial of general anesthesia versus general plus epidural anesthesia
Authors: Smeets Harm J. , Kievit Job , Dulfer Frans T. , van Kleef Jack W. 
Published: May 2005

AbstractThe influence of epidural anesthesia on the endocrine‐metabolic response following abdominal aortic reconstruction was studied in a prospective randomized trial. Cortisol and catecholamine responses and nitrogen balance were measured in two groups of five patients receiving general anesthesia only (group 1) or general anesthesia combined with epidural bupivacaine (group 2). The study lasted from preoperatively until the first postoperative day. At 2100 hours on the day of surgery serum cortisol concentrations were higher in group 1 than in group 2 (1.41 versus 0.82 μmol/L; p<0.01). Likewise the total perioperative hypercortisolemia, expressed as the area under the curve, was significantly higher in group 1 (11.7 versus 5.7 μmol/L/hr, p<0.01). Intraoperative urinary excretion of epinephrine and postoperative norepinephrine excretion were significantly higher in group 1 than in group 2. Urinary excretion of free cortisol and cumulative nitrogen balance were not different between the groups. Although the number of patients was limited and the sensory nerve block level was not measured perioperatively, this study suggests that epidural anesthesia attenuates the stress response to aortic surgery.
Palliation of malignant dysphagia using the Nd:YAG laser
Authors: Carter R. , Smith J. S. , Anderson J. R. 
Published: May 2005

AbstractA group of 141 patients with biopsy‐proved malignant dysphagia, treated with neodymium YAG laser between April 1985 and November 1988, have been prospectively evaluated. Patients treated since November 1988 have not been included to allow minimum follow‐up of 18 months. The success of treatment has been assessed in terms of survival, relief of dysphagia, complications, and length of inpatient stay. One‐ and two‐year survival rates were 12.6% and 3.5%, respectively (mean survival 24.7 weeks). Ninety‐two percent of patients were returned to a semisolid diet or better. In 4% recanalization was impossible, and 4% swallowed only liquids despite an adequate channel. Tumor histology, site of tumor, and length of previous treatment had no significant influence on outcome. The presence of metastases significantly influenced survival (p=0.007). The principal complications were perforation (6.4%) and tracheoesophageal fistula (2.8%). Laser recanalization provides effective palliation for malignant dysphagia.
Amiodarone‐induced thyrotoxicosis: Is there a place for surgery?
Authors: Meurisse Michel , Hamoir Etienne , D'Silva Milbhor , Joris Jean , Hennen Georges 
Published: May 2005

AbstractAmiodaroneinduced hyperthyroidism has on most instances been reported as mild, and thyroid functions return to normal after discontinuation of the drug. Nevertheless, lifethreatening amiodaroneinduced thyrotoxicosis has also been described. Conventional treatments such as antithyroid drugs (thionamide) and corticosteroids are essentially ineffective or fail to alter the dramatic course of the thyroid crisis. This limited effectiveness of medical therapy, particularly in patients with previously neglected or unknown thyroid disease, prompted us to intervene surgically. We report a series of nine patients who underwent total or neartotal thyroidectomy as a firstline therapy for five of them. Surgery resulted in rapid resolution of thyrotoxicosis with an uneventful postoperative course. This approach has the advantage of immediate effectivity, low risk of relapse, and appears to be the only treatment that permits continued therapy with amiodarone when the drug appears needed to control a lifethreatening arrhythmia.
Transplantation of human cryopreserved adenomatous and hyperplastic parathyroid tissue to the hypocalcemic Nude mouse
Authors: Goudet P. , Cougard P. , Zeller V. , Brunet‐Lecomte P. , Viard H. 
Published: May 2005

AbstractCryopreserved parathyroid glands from patients operated on for hyperparathyroidism were stored for further auto‐ or allografting. In an attempt to better use cryopreserved parathyroid glands in humans, we designed a study whose goal was to compare human parathormone (hPTH) secretion from cryopreserved parathyroid glands with regard to tissue histology (adenoma or hyperplasia), mass, and time of storage in hypocalcemic Nude mice and to be able to better use them in humans. A new hypocalcemic experimental model, using parathyroidectomized Nude mice was set up. Hypocalcemicmice received calibrated grafts from human parathyroid glands cryopreserved between 1982 and 1992 originating from 30 patients (15 adenomas, 15 hyperplasias). Each parathyroid was grafted into two mice under the ratio of one mass‐unit (12 mg) and three mass‐units (36 mg). The hPTH concentration was assessed by an immunoradiometric method 21 days after grafting. The mean cryopreservation time was 677 days (54–3187 days). The time of cryopreservation was identical in the two kinds of tissue (p=0.88). The hPTH concentration in 59 living mice was 72.2 ±271.4 (SD) ng/ml (3–1936 ng/ml). This concentration was 7.1 ±4.3 ng/L for adenomas versus 139.4 ±378.6 ng/L for hyperplasias (p=0.003) and 87.1 ±352.6 ng/L for one‐unit‐mass grafts versus 56.7 ±152.5 ng/L for three unit‐mass grafts (p=0.824). Hyperplastic glands showed more secretion, which was confirmed in both mass related groups (p=0.02,p=0.006). The multiple linear regression showed no hPTH concentration difference related to mass or time of cryopreservation (p>0.15), and it confirmed that the highest secretion of hPTH was in the hyperplastic tissues (p=0.0001). These results show that cryopreservation preserves glands for several years, and that hyperplastic tissue preferentially should be used.
Incidentalomas of the adrenal gland: 36 Operated patients and review of literature
Authors: Sirén Jukka E. , Haapiainen Reijo K. , Huikuri Kauko T. , Sivula Arto H. 
Published: May 2005

AbstractIncidental discovery of an adrenal mass during radiologic‐examinations is common. Several recommendations have been made for the management of so‐called incidentalomas. It has become clear that not all incidentalomas should be operated, but the criteria for nonoperative treatment have been under continuous debate. In this study 36 operated incidentalomas are presented, and the indications for operative treatment are discussed with a review of the recent literature on the subject. Four pheochromocytomas and three hormonally active cortical adenomas, two producing cortisol and one androgens, were found. In this series there were no malignancies. The operation could have been avoided in most cases, and patients could have been followed up with repeated radiologic‐examinations. It is suggested that masses smaller than 6 cm in diameter be followed radiologically after 3, 9, and 18 months. Masses between 3 and 6 cm could be further examined using magnetic resonance imaging and fine needle aspiration and then operated if features suggestive of malignancy are found. Masses larger than 6 cm in diameter should be treated operatively.