bluuebunny/crossref_metadata_2025_split huggingface dataset:
The value of intraoperative scintigraphy as a routine procedure in thyroid carcinoma
Authors: Lennquist Sten , Persliden Jan , Smeds Staffan 
Published: May 2005

AbstractIntraoperative scintigraphy (IOS) was performed with a previously developed and described technique in a prospective study of 64 patients with highly differentiated thyroid carcinoma. Residual iodine uptake after macroscopically radical thyroidectomy was registered at IOS in 43 patients. IOS permitted identification and removal of the residual tissue in 33 of these patients, leading to negative postoperative scintigraphy in 27. Of the 10 patients in whom the residual iodine uptake at IOS could not be eliminated, 3 had metastases outside the operative field (treated with postoperative radioiodine ablation) and 7 had a tiny remnant of thyroid tissue behind the entrance of the inferior laryngeal nerve.The residual tissue detected by IOS was localized in or associated with the pyramidal lobe in 11 patients, and in 8 it was immediately behind and below the entrance of the inferior laryngeal nerve. Other locations were lymph nodes along the carotid artery or internal jugular vein, in the supraclavicular fossa or in the ligated inferior thyroid artery.Conclusions from this case series were that IOS is more sensitive than regular postoperative scintigraphy for detection of residual thyroid tissue, that it significantly reduces the need for postoperative radioiodine ablation (which was avoided in more than half of the patients with residual uptake at IOS), and that it technically facilitates performance of the operation and greatly enhances the possibility of achieving complete thyroidectomy.
Evaluation of surgical results and prediction of prognosis in patients with medullary thyroid carcinoma by analysis of serum calcitonin levels
Authors: Miyauchi Akira , Matsuzuka Fumio , Kuma Kanji , Takai Shin ‐ichiro , Nakamoto Kembu , Nakamura Kenji , Nanjo Satoru , Maeda Masazumi 
Published: May 2005

AbstractSerum calcitonin levels before (S1) and after (S2) surgery were measured in 67 patients with medullary thyroid carcinoma and the patients were followed with serial calcitonin measurements for a mean duration of 7 years. The calcitonin doubling time (T2) was calculated in patients with elevated postoperative calcitonin levels. Assuming that the serum calcitonin level is linearly correlated with tumor weight, the residual tumor weight (W2) is estimated as W1S2/(S1−S2) where W1 is the weight of the resected tumor. The reduction index (α) is defined as W2/(W1+W2)=(1/2)α.αT2indicates the expected prolongation in survival (EPS) by surgery. The survival index (β)is defined as the number of doublings of residual tumor until it weighs 1,000 g, which would generally kill the host. The expected duration of survival (EDS) after surgery is estimated asβT2.Death within 3 years after surgery or recurrence within 5 years was best associated with short EPS followed by short T2 or smallα.S2had a rather weak correlation and S1had almost no correlation with the prognosis. The duration of survival in 3 patients who died of the disease was very close to the EDS. T2indicates growth rate of the tumor,αindicates degree of radicality of the surgery, EPS indicates the effects of the surgery, and EDS indicates duration of survival after surgery. These parameters allow quantitative judgment of the effect of surgery and quantitative prediction of the prognosis in each patient.
Blood flow and tissue reaction at skin wound closures
Authors: Nagamachi Yukio 
Published: May 2005

AbstractThe purpose of this study was to compare blood flow and tissue reaction in rats following wound closure with either staples or interrupted sutures using nylon pr silk. Microblood flow over a period of 6 days was measured in each layer of normal skin and at the incision site, Macroscopic changes in skin incisions were evaluated 2 hours after closure and 6 days after closure for histologic examination. Measurements of blood flow in normal skin showed the greatest amount of the stratum papillare of the corium. Blood flow in wound tissue closed with staples increased from baseline after 1 hour and continued over the 6‐day period, suggesting active regeneration of new capillaries. Blood flow in rats sutured with nylon decreased markedly to below baseline value, but increased after 3 days and 6 days. A similar trend occurred in wounds closed with silk although the decrease was greater and blood flow did not increase above the baseline at 6 days. Wound healing was complete 6 days after closure with staples, skin color normal, the incision hardly discernible. The wound sutured with nylon showed anoxia of tissue after 2 hours, but at 6 days, appeared similar to the stapled wound. Six days after closure, the silk suture site was swollen, dark in color, and tight. Histologic findings revealed no hypertrophy of the regenerated epidermis at the stapled suture site. The nylon group showed slight hypertrophy of the epidermis, inflamed cells in the subcutaneous tissues, and slight edema at the wound site. It is my conclusion that blood flow and wound healing are most satisfactory when staples are used for wound closure.
Penetration of cefazolin, ceftriaxone, cefoperazone, and ceftazidime into human gallbladder tissue and bile
Authors: Berger Stephen A. , Levy Yeheskel , Halevy Ariel , Gorea Alfred , Orda Ruben 
Published: May 2005

AbstractForty patients underwent elective cholecystectomy following administration of a single intravenous dose of cefazolin, ceftriaxone, cefoperazone, or ceftazidime. Mean gallbladder bile concentrations of cefoperazone (398.8μg/ml and ceftriaxone (153.4μg/ml) were significantly higher than those of cefazolin (12.3μg/ml) and ceftazidime (3.08μg/ml) (p<0.008). Mean gallbladder tissue levels of cefazolin (30.1μg/g), ceftriaxone (50.5μg/g), and cefoperazone (91.0μg/g) exceeded that of ceftazidime (7.25μg/g) (p<0.001). When adjusted for known in vitro activity against biliary pathogens, these data suggest that cefoperazone and ceftriaxone are superior to ceftazidime and cefazolin for prophylaxis in elective biliary surgery.
A new method of reconstruction after pylorus‐preserving pancreatoduodenectomy
Authors: Suzuki Takashi , Imamura Masayuki , Kajiwara Takehiro , Kim Hwi ‐Cha , Miyashita Tadashi , Tobe Takayoshi 
Published: May 2005

AbstractIn pylorus‐preserving pancreatoduodenectomy, it has been traditional to perform the duodenojejunostomy distal to the biliojejunal and pancreatojejunal anastomoses. In 11 patients, we performed a new type of reconstruction: the cut end of the duodenum was anastomosed to the fourth portion of the duodenum or to the jejunum, which was shifted retrocolically, then the pancreas and the choledochus were anastomosed to the distal jejunum. In this Billroth I type of reconstruction, regulation of the pH in the duodenum and proximal jejunum and enzymatic digestion of diet in the small intestine contents are thought to be maintained more physiologically than after the former Billroth II type reconstruction, because food or gastric juice passing through the pylorus immediately stimulates the duodenum and the proximal jejunum to release various gut hormones such as secretin, cholecystokinin, somatostatin, gastric inhibitory peptide, etc., resulting in prompt mixing of the food with the pancreatic juice and bile. The postoperative course of the patients was uneventful. They gained weight to the preoperative level within 12 months. No marginal ulcer has developed in these patients.
Total pancreatectomy for ductal adenocarcinoma of the pancreas: An update
Authors: van Heerden Jon A. , McIlrath Donald C. , Ilstrup Duane M. , Weiland Louis H. 
Published: May 2005

AbstractFrom 1951 through December, 1985, a total of 89 patients underwent total pancreatectomy for ductal adenocarcinoma. Of the 89 patients, 54 were male and 35 were female; their average age was 60.0 years. Histologic grading (Broders') demonstrated that 56% of the patients had a grade 2 tumor and 38%, a grade 3 tumor. None of the patients had grade 4 tumors. Peripancreatic lymph nodes were positive in 47% of the patients at the time of resection. Multicentricity was noted in 32.5% of patients. The operative mortality was 10.1%; however, for the patients who had surgery after January, 1980, the operative mortality was 6.2%. At the completion of the study, 78 patients had died and 11 were alive. The principal cause of death was recurrent malignancy. The median duration of survival, including the duration of survival in patients who had operative deaths, was 1.03 years. The influence of sex, tumor grade and size, multicentricity, and nodal status was evaluated multivariately with Cox's proportional hazard model.
Long‐term evaluation of pylorus preservation during pancreaticoduodenectomy
Authors: Fink Aaron S. , DeSouza Luis R. , Mayer Emeran A. , Hawkins Randall , Longmire William P. 
Published: May 2005

AbstractAlthough pyloric preservation can be performed during pancreaticoduodenectomy without increased morbidity or mortality or decreased survival, the long‐term benefit of this technique remains unproven. In this study, the functional status of patients recovered from pyloric‐preserving pancreaticoduodenectomy was evaluated by comparing 6 long‐term survivors of the standard Whipple procedure (1–7 years postoperative; mean, 4.7 yr) to a similar group of 6 patients recovered from pylorus preservation pancreaticoduodenectomy (1–7 years postoperative; mean, 3.0 yr). All patients completed a questionnaire evaluating postgastrectomy symptoms. Fasting blood specimens were obtained for hematologic and biochemical analysis. Ten of the 12 patients then underwent endoscopy; perianastomotic and midgastric biopsies were graded for inflammation. Gastric emptying of both liquid and solid phases was measured with an isotopically‐labeled meal. Gastric emptying data were compared between groups and also to a group of 7 normal controls studied previously using the same methodology. Analysis of questionnaire results and mean laboratory values revealed no significant differences between the 2 surgical groups. Serum carotene levels were low in most patients. Several patients demonstrated abnormal indices of iron homeostasis. No significant abnormalities were noted on endoscopic examinations and biopsy results did not differ between the 2 surgical groups. Liquid gastric emptying was significantly prolonged in patients following standard pancreaticoduodenectomy (t1/2=98.3±26.2 min) as compared to pylorus preservation patients (t1/2=37.5±10.9 min) or normal controls (t1/2=33.1±2.8 min). We conclude that, in the long‐term, pylorus preservation appears to be at least functionally equivalent to the standard pancreaticoduodenectomy. As such, we believe that pyloric preservation, obviating vagotomy and gastric resection, deserves consideration during pancreaticoduodenectomy.
Primary adenocarcinoma of the duodenum: Analysis of survival
Authors: Lai Edward C. S. , Doty Jeffery E. , Irving Christine , Tompkins Ronald K. 
Published: May 2005

AbstractA survival analysis of 24 patients with primary adenocarcinoma of the duodenum managed at UCLA, Los Angeles, California, U.S.A. was made with reference to their pathological findings. Pancreaticoduodenectomy as a curative procedure was performed in 15 patients with 2 deaths postoperatively. Palliative surgery with either segmental duodenal resection (4 patients) or gastrojejunostomy (5 patients) had no complications. Metastatic disease to the paraduodenal nodes in close proximity of the duodenum, and distant regional nodes around the celiac axis, paraaortic region, and mesentery occurred frequently (63.6%). The extent of nodal disease significantly affected the survival of these patients (p=0.016). When the disease was confined to the paraduodenal nodes, the median survival was 16.47 months, which was less than that for those patients without nodal secondaries (median survival, 42 months) but much better than that for those who had metastasized to distant regional nodes (median survival, 5.97 months). The depth of transmural neoplastic penetration was also probably of prognostic importance since it correlated significantly with the extent of metastatic lymph nodes (p=0.04). Regardless of the paraduodenal nodal status, pancreaticoduodenectomy should be attempted for all patients with primary duodenal adenocarcinoma when careful examination has excluded regional nodal involvement and systemic dissemination.
Recurrence of hydatid disease
Authors: Little John M. , Hollands Michael J. , Ekberg Henrik 
Published: May 2005

AbstractA series of 39 consecutive patients with proven hepatic hydatid disease have been followed from the time of presentation to Westmead Hospital with 6 monthly ultrasound examinations. In the 32 patients having surgery in this unit, it has been found that the standard operation—evacuation of the cyst in the plane of the laminated membrane, suture of bile duct openings, and omentoplasty—achieved good local control of liver cysts. Further cysts, mainly in the retroperitoneal area, were identified with increasing frequency as time passed. The recurrence rate reached 22% by 30 months. Recurrence was not seen after that time. The longest period of follow‐up was 7 years. Not all recurrences required surgical treatment. Small asymptomatic cysts have been simply observed, and some shrink without further treatment. Multivariate analysis showed that the single main determinant of recurrence was evidence of previous cyst rupture before operation.
A microbiological etiology for gastritis and peptic ulceration
Authors: Quintero Gustavo A. , Williams John D. , Wingate David L. , Newell Diane G. 
Published: May 2005

AbstractThe relationship betweenCampylobacter pyloriinfection and gastroduodenal disease was investigated using antral biopsies from 102 patients undergoing endoscopy.C. pyloriwas isolated from the majority of patients with histologically defined gastritis (89%), gastric ulcer (100%), and duodenal ulcer (94%), but only in 6% of patients with normal gastric mucosa. No obvious epidemiological association betweenC. pyloriinfection and recent travel, domestic pets, diet, dental hygiene, drug treatment or symptoms could be established. The susceptibility of 38 of these isolates ofC. pylorito 12 antibiotics was determined.The serum anti‐C.pyloriantibody response was determined by an ELISA technique using an acid extractable antigen on the solid phase, in order to improve the sensitivity and specificity. There was a significant increase in antibody level (p=0.001) of patients with histologically defined gastritis over patients with a normal mucosa. The majority of patients (96%) with a culturableC. pyloriinfection had raised anti‐C.pyloriantibodies. However, some patients with neither C.pyloriinfection nor gastritis had serum antibodies. Possible reasons for this are discussed.The results suggest that a serodiagnostic assay forC. pyloriinfection may be of value in the assessment of gastroduodenal disease.
Gastric and duodenal cutaneous fistulas
Authors: Tarazi Riyad , Coutsoftides Theodore , Steiger Ezra , Fazio Victor W. 
Published: May 2005

AbstractForty‐seven patients, 18 with gastric and 29 with duodenal cutaneous fistulas, managed at the Cleveland Clinic Foundation between 1956 and 1976 are analyzed. This is done with the intention of defining factors responsible for increased rates of morbidity and mortality. The location and number, output, associated sepsis, and nutritional status are reviewed. Treatment modalities ranged from nonsurgical medical treatment to conservative surgical and radical surgical treatment. Overall mortality rate was 29.8% with a 34.5% mortality rate from duodenal fistulas and 22.2% from gastric fistulas. A review of the literature and guidelines for management of gastric and duodenocutaneous fistulas are presented.
Postoperative fistulas of the small intestine: Therapeutic principles
Authors: Hollender L. F. , Meyer C. , Avet D. , Zeyer B. 
Published: May 2005

AbstractPostoperative fistulas of the small intestine are a daunting and distressing complication in abdominal surgery. On the basis of a series of 54 observations and a review of the literature, the writers evaluated various factors, concluding that the following have a significantly unfavorable effect on prognosis: existence of an intraperitoneal septic focus, diseased fistulized intestine, a fistula exposed in an evisceration, complex fistulas, and the patient's age. The aim of treatment is to find solutions to 3 problems: sometimes that of peritonitis, frequently that of the loss of parietal substance, and invariably that of the fistula. If early surgery must be carried out, it will be regarded as a rescue operation, involving notably an enterostomy and sometimes a laparotomy. Otherwise, surgery will be deferred as long as possible (beyond the second month) and will be based on a single‐stage operation (resection‐anastomosis) or, more frequently, phased operations, precedence being given to treatment of the intestinal fistula rather than that of parietal dehiscence.
Factors influencing the outcome of treatment of small bowel cutaneous fistula
Authors: Fazio Victor W. , Coutsoftides Theodore , Steiger Ezra 
Published: May 2005

AbstractA 20‐year review of 174 external fistulas of the jejunum and ileum led to the identification of factors affecting morbidity and mortality. The mortality rate for jejunal fistulas was higher as compared to ileal fistulas, whether treated by nonoperative means (41.7% and 29.4%, respectively), conservative surgical means (70% and 21%, respectively) or by radical, i.e., resectional surgical techniques (21.7% and 12.2%, respectively). Overall mortality rate in the series was 22.4% (39 patients). Respective mortality rates for high‐output (greater than 200 ml/day) and low‐output fistulas were 30.3% and 4.8%; where the presence or absence of significant intra‐abdominal sepsis could be clearly established on chart review, mortality rates were 29.6% and 0%, respectively. The presence of anemia, hypoalbuminemia, and malnutrition adversely affected outcome, with mortality rates of 30.7%, 41.9%, and 31.8%, as compared to the outcome when these features were absent (8.2%, 0%, and 3.0%, respectively). Etiological factors were also examined. High mortality rates were observed for fistulas arising due to radiation effect (45.4%), gangrenous intestine or evisceration (52.4%), and those secondary to surgery for ulcerative colitis (33.3%). Timing of fistula surgery had little impact on rates of fistula cure, but survival was highest when such surgery could be deferred beyond 6 weeks from fistula onset. Improvement in survival has been noted since 1970.While many factors influence mortality rates, inadequately treated sepsis assumes primary importance. In favorable circumstances, intestinal resection and anastomosis is the procedure of choice. However, staging procedures such as resection of the fistula‐bearing segment without anastomosis or enterostomy with wide drainage of associated sepsis should be considered when local conditions in the abdomen indicate a likelihood of anastomotic breakdown. These local conditions invariably improve with adequate drainage and prevention of further contamination; total parenteral nutrition has provided a mechanism of sustaining the patient while this improvement occurs, allowing for elective intestinal reconstruction.
Long‐term experience with transection choledochoduodenostomy
Authors: Cuschieri A. , Wood R. A. B. , Metcalf M. J. , Cumming J. G. R. 
Published: May 2005

AbstractA technique of choledochoduodenostomy involving transection of the bile duct at its junction with the trans‐pancreatic segment and an end‐to‐side anastomosis with the duodenum is described. The operation has been performed in 46 patients over a period of 14 years, 26 patients having had a follow‐up of 5 years or more. There has been no instance of anastomotic stenosis in the series, although one patient had a single episode of jaundice 3 years after operation.
Liver alveolar hydatidosis in the Xinjiang autonomous region
Authors: Ping‐li Yao 
Published: May 2005

AbstractFive cases of human alveolar hydatidosis caused by the cestodeEchinococcus multilocularis in China were reported by us in 1965. Since that time, 31 male and 12 female patients, ages 14 to 52 years, have since been admitted and treated in our surgery department; 27 patients are of minority nationalities. The chief clinical manifestations were firm, round, and rough masses found on the upper right abdomen from 2 months to 7 years prior to admission. Jaundice developed in 10 of the 43 patients. Immunological diagnosis was done; all the 43 patients showed positive reactions in the Casoni intradermal test and 8 in the indirect hemagglutination test and immunoelectrophoresis. The patients also had eosinophilia. Other examinations were also done with ultrasound exploration, roentgenography, and radioisotope liver scan.Radical resection of the mass with a portion of normal liver is commonly suggested; hemihepatectomy is usually performed in our cases if resectable. However, the resectability rate was low (5 cases), and a great number of cases had palliative resections when the mass was too large or if both lobes of liver were involved. Prognosis was good, and no recurrence was seen with the patients followed up for 4–17 years. Remarkable relief was achieved in 6 patients with palliative resection plus irrigation and drainage of the necrotizing cavity. Formalin (2–4%), 3% boric solution, or 0.1% Bromo‐Germinum was used as irrigation solution. The general condition of the patients improved with partial resection of the hepatic mass and the toxic symptoms were relieved, as seen in the 4 patients who had palliative resection.Since the advent of the drug mebendazole in the trial treatment of hydatidosis, 13 patients in our series were given mebendazole. The dosage was 1,200–1,500 mg for adults, 3 times a day for 30 days as a course, with intervals of 1 week to 1 month. Mebendazole was administered as long as 16 months in 1 patient with no apparent side effects. The patient showed adequate improvement but was not radically cured. We stress high dosage and long, repeated courses of the mebendazole treatment. Praziquantel trials will be reported in a separate paper.Although early diagnosis and radical hemihepatectomy constitute the most effective treatment of alveolar hydatidosis, it is hoped that efficacious drugs will be developed as adjuncts to surgical treatment, as numerous problems remain in the resection or enucleation of either the cyst or the hepatic mass in hydatidosis.