bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reliable procedure for closing the duodenal stump for bleeding posterior duodenal ulcer
Authors: Meyer Christian , Rohr Serge , de Manzini Nicolo , Dai Bernadette 
Published: October 2004

AbstractBleeding posterior duodenal ulcers is a critical problem espelally in patients of advanced age. Surgical treatment should obtain fficient and stable hemostasis and avoid digestive fistulas due to leakage if the duodenal stump. The main difficulty lies in the closure of the duodenal stump. A procedure using intramural dissection of the duodellum and closure by means of a stapler is reported for a series of 40 patients without recurrent bleeding or duodenal fistula. Seven patients (17%) died from associated diseases, especially respiratory insufficiency (3 patients) and cirrhotic liver failure (2 patients).
Prognostic factors for gastric cancer influencing clinical practice
Authors: Harrison J. D. , Fielding J. W. L. 
Published: October 2004

AbstractDespite a slow decline in the incidence of gastric cancer over the last 90 years, we can still expect to see over 100,000 patients die of this disease each decade in England and Wales. The 5‐year survival rate has not improved during this century, which is largely due to the stage at diagnosis being unchanged. There are a number of prognostic determinants in gastric cancer which have clinical relevance. Age is an important determinant; patients under 40 years commonly have more advanced diffuse lesions than older patients so that a higher index of suspicion needs to be maintained in younger patients with persistent symptoms. Conflicting reports make it unclear whether the duration of symptoms bears any relationship to tumor stage, but there is some evidence that actively shortening the symptom duration by early investigation can have a beneficial effect in the proportion of patients diagnosed with early cancers. The site of the tumor is important; unfortunately, the proportion of patients with cardia lesions is increasing and this has had the effect of reducing the overall survival. Tumor size should not play a part in the decision to resect a lesion as most studies show no clear relationship between tumor size and stage. Tumor stage is the most important prognostic determinant and efforts to increase the proportion of stage I cancers presenting for surgery can be shown to alter the natural history of the disease, by diagnosing it when it is still surgically curable.
Review of adjuvant chemotherapy for gastric cancer
Authors: Nakajima Toshifusa 
Published: October 2004

AbstractControlled randomized studies that compared surgery alone to adjuvant chemotherapy for gastric cancer were reviewed. The amount of residual tumor after surgery, selection of drug regimens, compliance with drug administration, and trial design seem to be responsible for the success of adjuvant chemotherapy. Though there are few beneficial regimens of adjuvant chemotherapy with statistical significance, single drug therapy with mitomycin C (MMC) and combination therapy with 5‐fluorouracil (5FU) and methyl‐CCNU, MMC/5FU/cytosine arabinoside (MFC), and 5FU/Adriamycin/MMC (FAM) seem to have potential survival benefit for patients with curative surgery. Incorporation of new drugs into adjuvant or neoadjuvant chemotherapy might open a new aspect of multimodality therapy for gastric cancer.
Organ‐specific support in multiple organ failure: Pulmonary support
Authors: Barie Philip S. 
Published: October 2004

AbstractThe catastrophic pulmonary failure that complicates management of patients with multiple trauma or sepsis syndrome with shock is recognizable to nearly all experienced surgeons. However, the spectrum of injury is broad, the distribution of lung injury may be heterogeneous within a single patient, and may patients will not develop acute respiratory distress syndrome (ARDS) even after a major predisposing insult. The lung responds stereotypically to many disparate insults, so a better conceptual construct of ARDS may be to consider it as one component of the multiple organ dysfunction syndrome. Support of oxygen transport with positive pressure ventilation and high levels of positive end‐expiratory pressure, long the mainstay of pulmonary support, has been criticized for its predilection to cause barotrauma. Newer modes of ventilation, such as pressure‐controlled, inverse‐ratio ventilation and permissive hypercapnia, are under investigation but have not yet been reported with scientific rigor. However, pulmonary support extends beyond the support of gas exchange. Fluid management requires close attention so that the circulation is supported but lung water accumulation is minimized. Nosocomial pneumonia greatly increases the mortality rate in ARDS, but is difficult to diagnose and must be sought aggressively. Until recently, pharmacologic therapy has held little promise, but inhalation of very low concentrations of nitric oxide appear to decrease pulmonary vascular pressures and intrapulmonary shunt. It remains unknown whether nitric oxide is effective therapy for the underlying injury, or is simply treatment for certain manifestations.
Long‐term outcome of cholecystoenterostomy as a definitive biliary drainage procedure for benign disease
Authors: Oishi Andrew J. , Sarr Michael G. , Nagorney David M. , Traynor Michael D. , Mucha Peter 
Published: October 2004

AbstractOur aim was to examine the long‐term success of cholecystoenterostomy performed for the relief of benign extrahepatic biliary obstruction. Concern about the ability of cholecystoenterostomy to provide reliable long‐term biliary decompression has led many to abandon its use for benign biliary obstruction. Thirty‐four patients who underwent cholecystoenterostomy for benign biliary obstruction over a 17‐year period were reviewed. Patients were followed until cholecystoenterostomy failure, death, or to date. Failure was defined as recurrent biliary obstruction or cholangitis requiring therapeutic intervention. Mean follow‐up was 8.0 years. Early postoperative morbidity occurred in 11 patients (32%), but only one early complication (cholangitis) was related directly to the cholecystoenteric anastomosis. Five patients (15%) experienced late biliary tract complications related directly to the cholecystoenterostomy including recurrent biliary stones with biliary obstruction in four and anastomotic stricture in one. All required reoperation and conversion to choledochoenterostomy at a mean of 112 months. Cholecystoenterostomy can provide reasonably effective long‐term biliary decompression in selected patients with benign biliary obstruction.
Occult well differentiated thyroid carcinoma presenting as cervical node disease
Authors: Sanders Laura E. , Rossi Ricardo L. 
Published: October 2004

AbstractRecords of 92 patients with differentiated thyroid carcinoma presenting as cervical adenopathy without a palpable mass were reviewed to identify prognostic factors and to evaluate therapy. Patients were treated between 1940 and 1990 and were observed for 3 to 48 years (median 18 years). Follow‐up data were obtained by chart review, correspondence, and telephone contact. Among the group, 20 patients had unilateral and 72 bilateral thyroid lobectomy, with node dissection in 77. Thyroid hormone was used in 50 patients and radioactive iodine in 20. Patients were younger than the overall population of patients with differentiated thyroid carcinoma, with more men and more multifocal thyroid disease. Risk group defined by age and sex was the most important determinant of survival. All women 50 years of age or younger and all men 40 or younger (low risk group) survived independent of the type of initial operation or use of thyroid‐stimulating hormone suppression or radioactive oidine. Of the low risk patients, 16% had recurrent disease but were treated successfully with surgery or radioactive iodine; 28% of the older patients (high risk) died of disease. A trend for better survival was noted in high risk patients undergoing bilateral thyroideetomy and in patients receiving thyroid suppression. Of the high risk patients, 26% had recurrent disease, with a 71% mortality rate. Age and sex are the primary determinants of survival. Therapy should be based on risk factors. Low risk patients should have conservative thyroid surgery and modified or limited node dissection. However, bilateral thyroid surgery may facilitate the use of radioactive iodine when required. Use of prophylactic radioactive iodine or thyroid suppression should be selective. For high risk patients, we suggest bilateral thyroidectomy, modified or limited node dissection, thyroid suppression, and radioactive iodine.
Optimal timing and indications for cholecystectomy in cardiac transplant patients
Authors: Begos Dennis G. , Franco Kenneth L. , Baldwin John C. , Lee Forrester A. , Revkin James H. , Modlin Irvin M. 
Published: October 2004

AbstractCardiac transplant is performed with increasing frequency as the treatment for end‐stage cardiac disease. Although cholelithiasis is more frequent in both pretransplant and posttransplant patients, no standard management approach exists. Because many such patients are cared for outside the transplant center, it is important that general surgeons develop an appropriate strategy to manage this entity. We present our experience with 11 patients from our institution who underwent cholecystectomy before or after cardiac transplantation. In addition, we have reviewed the 76 reported cases of cholecystectomy performed in precardiac or postcardiac transplant patients from centers throughout the world. Any procedure in this patient group requires critical consideration in regard to the timing and type of procedure. Pretransplant patients are well recognized cardiac risks, and posttransplant immuno‐suppressed patients are at considerable risk for septic complications. Six patients underwent cholecystectomy prior to heart transplant. Five were performed laparoscopically, one as an open procedure. We also report five laparoscopic cholecystectomies in patients after cardiac transplant. One patient in the pretransplant group died 7 days after surgery from an uncontrollable arrhythmia. There were no hemodynamic or septic complications in either group. Current summated experience (87 cases) indicates that the mortality rate for urgent cholecystectomy in the posttransplant group is at least 36%. Because the first presentation of gallstones in this population is often acute cholecystitis, asymptomatic calculi cannot be considered benign. Elective cholecystectomy, laparoscopic or open, is tolerated well both before and after transplant. Given these facts, it seems reasonable to recommend pretransplant screening and posttransplant surveillance for gallstones. Prophylactic pretransplant laparoscopic cholecystectomy should be undertaken in the stable patient to avoid the substantial mortality associated with postoperative acute cholecystitis.
Diaphragmatic or transdiaphragmatic thoracic involvement in hepatic hydatid disease: Surgical trends and classification
Authors: Gómez Ramon , Moreno Enrique , Loinaz Carmelo , De la Calle Angel , Castellon Camilo , Manzanera Marina , Herrera Vicente , Garcia Arturo , Hidalgo Manuel 
Published: October 2004

AbstractWe performed a retrospective study of 19 patients who had been operated on for hepatic hydatid disease with diaphragmatic or transdiaphragmatic (D‐TD) thoracic involvement chosen from a total of 444 patients who underwent operations for hepatic hydatid disease. In all cases D‐TD involvement was confirmed by ultrasonography, CT, or MRI scan. We propose a new classification (grades 1–5) based on the degree of development of D‐TD involvement. Before 1984 exposure was obtained by thoracophrenolaparotomy (nine cases) and later by right subcostal incision. Only four patients required atypical pulmonary resection. In 13 cases the diaphragm was repaired, and all 24 hepatic cysts were treated with total (16 cases) or partial (8 cases) cystopericystectomy. There was no operative mortality, and the most serious morbidity consisted of a biliary fistula and a biliobronchial fistula. For treatment of these patients we recommended right subcostal incision and total or near‐total cystopericystectomy as a first choice of surgical technique.
Laparoscopic surgery of hepatic hydatid disease: Initial results and early follow‐up of 16 patients
Authors: Alper Aydin , Emre Ali , Hazar Hovsep , Özden İlgin , Bilge Orhan , Acarli Koray , Arloğul Orhan 
Published: October 2004

AbstractSurgery is the main modality in the treatment of hepatic hydatid disease. In this report, a laparoscopic surgical method is described, and the results in the first 16 cases are presented. The method involves the use of an aspirator‐grinder apparatus that achieves effective evacuation of viable cyst contents with the patient benefiting from the laparoscopic approach. Cavity infection occurred in two patients and was treated conservatively. In another patient, postoperative ultrasonography revealed a thick‐walled cavity containing a dense fluid. Because the patient was symptomatic, pericystectomy was performed during the sixth postoperative month. Early postoperative parameters and the early follow‐up results in other patients (2–17 months) are encouraging. The method is particularly suitable for uncomplicated, early‐stage cysts located in laparoscopically accessible locations.
Video‐assisted endoscopic esophagectomy with stapled intrathoracic esophagogastric anastomosis
Authors: Liu Hui‐Ping , Chang Chau‐Hsiung , Lin Pyng Jing , Chang Jen‐Ping 
Published: October 2004

AbstractThoracic esophagus was usually removed through the transhiatal approach or via an open thoracotomy. The long incision and spreading of the ribs usually resulted in much pain and interference with chest wall mechanics. Today, with the development of a video‐assisted endoscopic procedure, many intrathoracic lesions can be removed through small incision. Since March 1992 we have attempted 20 esophagectomies and reconstruction using a right thoracoscopic approach in 16 males and 4 females whose average age was 56 years. Indications for its use were esophageal cancer in 17 patients (squamous cell carcinoma in 12 patients, adenocarcinoma in 5) and caustic stenosis in 3. It is our impression that video‐assisted endoscopic esophagectomy and reconstruction potentially causes less trauma, less postoperative discomfort, and a rapid functional recuperation. Our initial experiences showed that it is a feasible, effective procedure.
Effect of hepatic artery chemotherapy on survival of patients with hepatic metastases from colorectal carcinoma treated with cryotherapy
Authors: Preketes A. P. , Caplehorn J. R. M. , King J. , Clingan P. R. , Ross W. B. , Morris D. L. 
Published: October 2004

AbstractThirty‐eight patients with unresectable multiple liver metastases from colorectal carcinoma were treated with either hepatic artery chemotherapy (HAC) and cryotherapy (n=27) or cryotherapy alone (n=11). Follow‐up survival data were summarized using Cox regression. Allowing for the effect of the pathology of the primary tumor and the preoperative carcinoembryonic antigen (CEA) level, those patients who did not receive HAC after cytoreduction were three times as likely to die as those given HAC (RR 3.3, 95%; CI 1.2–9.3). The estimated median survival of patients treated with cryotherapy alone was 245 days, whereas for those given more than 3 months of HAC plus cytoreduction therapy it was 570 days. It is recommended that all patients who receive cryotherapy for multiple liver metastases from colorectal rectal carcinoma be given subsequent hepatic artery chemotherapy.
Recommended width of excision for primary malignant melanoma
Authors: O'Rourke Michael G. E. , Bourke Christopher 
Published: October 2004

AbstractWide local excision for melanoma with margins of 3 to 5 cm have been advocated in the literature for nearly 140 years. These reports have grouped all stages of melanoma rather than addressing primary early stage disease. Breslow first advocated limited excision margins for these tumors. We have been excising all thicknesses of melanoma with a limited margin (1.00–1.50 cm, mostly 1.00 cm) since 1975. We advocate a 1 cm excision margin irrespective of tumor thickness. Clark has shown that melanoma invades in a vertical fashion, and thus one would expect to be more generous in depth than in width on a pathologic basis. Two studies have shown that there is no difference in the increase in locoregional recurrence and no change in death rate from the disease with more conservative treatment margins. Excision of this lesion is not an office procedure. It should be performed meticulously in an operating room, preferably under light general anesthesia.
Local hyperthermia and systemic chemotherapy for treatment of recurrent melanoma
Authors: Di Filippo Franco , Carlini Sandro , Garinei Rosa , Perri Pasquale , Anzà Michele , Ferranti Francesca , Saracca Elena , Schiratti Monica , Cavaliere Francesco , Cavaliere Renato 
Published: October 2004

AbstractThirty‐two patients with recurrent (skin) or metastatic (skin, mode, or both) melanoma have been treated with a hyperthermiacisplatin regimen. The hyperthermic treatment was carried out for 60 minutes at 43°C with the MHS‐SMA and the Sapic SVO3 ALENIA devices once a week. When the tumor temperature reached 42°C, cisplatin was administered at a dosage of 50 mg/m2 given by intravenous bolus infusion. The treatment was repeated four times and the tumor response evaluated 4 weeks after the last treatment. Significant systemic or local toxicity was not seen. In terms of results, there were 9 patients with complete responses (28.1%), 13 with partial responses (40.6%), 8 with no change (25.0%), and two with disease progression (6.3%). The objective response rate was 68.7%. The response duration for those with complete responses ranged from 4 to 49 mònths (median 20 months). The median time to progression for patients with partial responses and those with no change was 6 and 5 months, respectively, with ranges of 1–7 and 1–10 months, respectively. The 4‐year actuarial survival rates were 47.6% and 20.3% for the complete and incomplete responders, respectively. These results can be considered satisfactory, taking into account that most patients were pretreated with radiotherapy, chemotherapy or both, confirming the therapeutic potential of the hyperthermia and cisplatin regimen.
Hyperthermic isolated limb perfusion for malignant melanoma: Response and survival
Authors: Bryant Peter J. , Balderson Glenda A. , Mead Paul , Egerton William S. 
Published: October 2004

AbstractResponse to and survival after hyperthermic isolated limb perfusion (HILP) with melphalan in patients with malignant melanoma at the Royal Brisbane Hospital were reviewed in order to assess the major determinants of response to treatment. Data were collected by clinical chart review and direct patient contact. Response was assessed by clinical observation and measurement of nodules. Survival was calculated from the date of perfusion to the date of patient death. Since 1965 there have been 85 patients (38 men, 47 women) who have undergone 109 limb (102 leg, 7 arm) perfusions. The mean age was 58 years (range 32–82 years). The number of patients per disease stage (M.D. Anderson classification) was as follows: stage I, 5 patients; stage II, 8 patients; stage IIIa, 41 patients; stage IIIab, 25 patients; and stage IIIb, 8 patients. The mean duration of perfusion was 81 minutes. Melphalan was given in divided doses, with a mean total dose 1.39 mg/kg. The mean maximal limb temperature was 41.5°C. Major complications occurred during 20 perfusions (18%). There was one postoperative death from myocardial infarction, and one patient required amputation. Median patient follow‐up was 2.65 years (range 1–27 years). A complete response was noted in 34 patients (40%), a partial response in 36 patients (42%), and no response in 11 patients (13%). response could not be assessed in four patients. The actuarial 5‐year survival for the whole group was 45%: stage I, 80%; stage II, 75%; stage IIIa, 44%; stage IIIab, 23%; stage IIIb, 56%. The two significant determinants of response to perfusion were disease stage (p=0.00005) and nodal status (p=0.03). The major determinant of survival was a complete perfusion response (p=0.0012). Less advanced disease responds better to perfusion and is associated with increased survival after perfusion.
Diagnostic outcome of repeated mammography screening
Authors: Arnesson Lars‐Gunnar , Vitak Bedrich , Månson Jan‐Christer , Fagerberg Gunnar , Smeds Staffan 
Published: October 2004

AbstractMammographic screening for breast cancer within health service routines was evaluated for the years 1987–1992, with special focus on repeated screening during 1989–1992. The overall attendance rate by women aged 40 to 74 years was 82.8%. During 1989–1992 malignancy was found in 2.6/1000 screened women, giving a 87.4% positive predictive rate at surgery and 95.9% efficiency. Among women aged ≥45, the positive predictive rate was >94%. Fine‐needle aspiration (FNA) biopsy showed invasive cancers in 84% and highly suspected cancer in another 15%; 60% of the lesions were nonpalpable. For first‐time (prevalence) screening (1987–1988) the positive predictive rate was 86% and the malignancy yield 6.4/1000. In women aged 40–44 years there were few surgical referrals (1.6%), but the positive predictive rate at surgery was only 48.3%, indicating diagnostic difficulties in young women. The median size of all invasive cancers was 12 mm: 84% were classified as pT1, and 23% had lymph node involvement. Stage II disease was found in 27% of all malignancies. The use of FNA in the diagnostic workup for breast cancer screening is of crucial importance to the maintenance of high positive predictive rates at surgery. Moreover, regular analysis is important even when mammographic screening is incorporated into the routine work of health services.
Tuberculosis of the breast masquerading as carcinoma: A study of 100 patients
Authors: Shinde S. R. , Chandawarkar R. Y. , Deshmukh S. P. 
Published: October 2004

AbstractOne hundred patients with tuberculous mastitis were referred to the Tata Memorial Hospital, a cancer center, with a clinical diagnosis of malignancy. This study identifies the possible causes of misdiagnosis and reviews the management of these patients. A lump in the breast with or without ulceration was the commonest presentation, the others being diffuse nodularity and multiple sinuses. Concomitant axillary lymph nodes were found in one‐third of the patients. Tuberculosis lesions such as nodular mastitis, disseminated mastitis, and sclerosing lesions clinically mimicked a fibroadenoma, carcinoma, and fibrocystic mastitis depending on the mode of presentation. A young, multiparous, lactating woman with a lesion should arouse the suspicion of tuberculous mastitis, although pretherapcutic pathologic confirmation of a benign disease is mandatory. Mammography, fine‐needle aspiration cytology, and excision biopsy for this purpose are successful in 14%, 12%, and 60% of cases, respectively. Acid‐fast bacilli were identified in 12% patients. All patients received antituberculous chemotherapy, and 14% patients required simple mastectomy, due to either lack of response to chemotherapy (10%) or large painful, ulcerative lesions involving the entire breast (4%). Axillary dissection was performed in only 8% patients with large ulcerated axillary nodes. All patients, followed for a minimum of 2 years, were free of disease after therapy.