bluuebunny/crossref_metadata_2025_split huggingface dataset:
Total repair of annulo‐aortic ectasia with composite graft and reimplantation of coronary ostia: A consecutive series of 41 patients
Authors: Inberg Markku V. , Niinikoski Juha , Savunen Timo , Vänttinen Esko 
Published: May 2005

AbstractReplacement of the ascending aorta and the aortic valve with a composite graft, including reimplantation of the coronary ostia, was carried out in 41 consecutive patients with annulo‐aortic ectasia from 1975 to 1984. Thirty‐seven patients were operated on electively and 4 of these had a chronic dissection. Four patients underwent an emergency operation, 1 for a ruptured aneurysm and 3 for an acute dissection. The operative procedure was identical in each case. The aortic valve and the aneurysm were resected, the coronary ostia were dissected free, mobilized, and then implanted to the tube prosthesis. There was no hospital mortality. Re‐sternotomy was done in 3 patients for excessive postoperative bleeding. Two patients required a permanent pacemaker owing to a total atrioventricular block. No pseudoaneurysms at the coronary ostia or the distal aortic anastomosis were observed at control aortography carried out in each patient 6 months after surgery. One patient died 3 months after the operation because of multiple emboli. All the other patients have been symptom free during follow‐up. It is concluded that total repair using the technique described is feasible in all patients with annulo‐aortic ectasia and gives good early and late results.
Total parathyroidectomy and parathyroid autograft for renal osteodystrophy: Analysis of the cause of failure
Authors: Kinnaert Paul , Vanherweghem Jean ‐Louis , Fuss Michel , Schoutens André , Bergmann Pierre , Dratwa Max , Van Geertruyden Jean 
Published: May 2005

AbstractBetween September, 1979, and December 31, 1983, thirtyone patients with renal osteodystrophy and high serum immune parathyroid hormone (iPTH) levels underwent total parathyroidectomy with parathyroid autograft. Three failures (10%) were due to residual parathyroid tissue. In 2 of these patients, 4 and 6 glands respectively, had been removed. This indicates the need for thorough dissection of the neck even when 4 glands have been found. Painful symptoms and vitamin D3 intolerance persisted after surgery in 3 other patients (10%), although iPTH levels dropped significantly. Further work‐up disclosed aluminum intoxication.
Hepaticojejunostomy using the left biliary trunk for iatrogenic biliary lesions: The French connection
Authors: Hepp Jacques 
Published: May 2005

AbstractThis paper deals with the utilization of the left main hepatic trunk in secondary repair of the bile ducts which was described by the author 28 years ago following the anatomic works of Couinaud. The reasons for choosing this duct are discussed: usual anatomic integrity, extraphepatic disposition of the trunk, and ease of location by intraoperative cholangiogram (which is considered indispensable by the author). The technical details of the operation are given: subcostal S‐shaped incision, lowering of the left trunk after a transverse incision of Glisson's capsule, opening of the trunk, instrumental exploration in the search for intrahepatic stones, and Roux‐en‐Y hepaticojejunostomy usually without a transanastomotic stent. Precise technical modifications are given for involvement of the bifurcation or morphological variations of the liver.
Complications of cyclosporin therapy
Authors: Kahan Barry D. , Flechner Stuart M. , Lorber Marc I. , Jensen Chris , Golden Debbie , Van Buren Charles T. 
Published: May 2005

AbstractCyclosporin (CsA) therapy has improved the outcome of allotransplants. Because of a relatively selective action on T lymphocytes, CsA therapy causes fewer immunosuppressive complications of infection or malignancy compared to previous chemical agents, which were relatively nonspecific in their spectrum of action on lymphoid versus nonlymphoid cells. Gastrointestinal complaints after oral administration and vasomotor reactions after intravenous administration represent pharmacologic toxicities rarely of major clinical import. Drug‐induced complications involve primarily the neuroectodermal, or the mesenchymal hepatic and renal, systems. While the former group of complications are rarely severe, mesenchymal nephrotoxicity poses a major limitation of drug therapy. On the one hand, reductions by 33% of normal renal function in patients treated with CsA for autoimmune disease appear to be reversible on discontinuance of therapy. On the other hand, severe renal dysfunction occurs in transplant recipients, particularly in the presence of concomitant therapy with nephrotoxic drugs. In the kidney transplant setting, numerous factors exacerbate the druginduced injury, including adverse donor procurement conditions, prolonged graft storage, and allograft rejection. Since the clinical and histologic findings in CsA nephrotoxicity tend to be pleiomorphic, no single diagnostic or therapeutic strategy has emerged. However, insights gained through pharmacologic monitoring of renal allograft recipients suggest that the group at increased risk for nephrotoxicity can be identified by elevated serum drug trough levels, increased area under the plasma time concentration curve, prolonged elimination half‐life, and heightened pharmacodynamic sensitivity to CsA. Analysis of pharmacologic data in conjunction with clinical results should provide drug regimens of maximal therapeutic index with minimal risk of complications.
Renal transplantation in the diabetic
Authors: Rohrer Richard J. , Madras Peter N. , Sahyoun Anthony I. , Monaco Anthony P. 
Published: May 2005

AbstractThe practices and recent results from a transplant center servicing a large proportion of uremic diabetics were reviewed to highlight modern management issues. The focus is taken off the diabetic as a “high‐risk” renal transplant recipient and brought to bear on the laborintensive aspects of his or her management. With special attention to perioperative cardiovascular status, operative mortality (30 day) can be less than 3.5% and morbidity minimized. Living related donors continue to offer advantages in terms of organ availability, early postoperative function, and most likely long‐term function, but in the cyclosporin era cadaver renal transplants have evolved competitive 1‐year patient survival rates of 96% and 1‐year graft survival rates of 88%. Still, the proportion of graft losses due to death of the patient from nonimmunologic causes, chiefly cardiac and cerebrovascular events, remains relatively high in the diabetic at 35.8%. Rehabilitation of the diabetic post‐transplant is less complete than that of the nondiabetic transplant recipient, but is clearly superior to that of alternative modes of therapy for the uremic diabetic.
Prospects for pancreatic islet transplantation
Authors: Gray Derek W. R. , Morris Peter J. 
Published: May 2005

AbstractIt is over a decade since the first description of cure of experimental diabetes in rats by transplantation of isolated adult islets of Langerhans. Despite a remarkable number of experimental studies, clinical islet transplantation is still not a reality, raising questions about the feasibility of this approach. Experiments in rodents have demonstrated the potential of isolated islet transplantation. It is possible to cure experimentally induced diabetes and restore normal glucose metabolism with prevention or even reversal of diabetic complications. The problem of allograft rejection, while formidable, is not insurmountable and a number of techniques are now available to achieve this aim.Studies in animals larger than the rodent have been less successful and no repeatable method for isolated islet transplantation has so far emerged. Attempts at clinical purified islet transplantation have also proven unsuccessful. Transplantation of unpurified dispersed pancreatic tissue has been used successfully in dogs, but the technique has proven dangerous and inefficient when applied clinically. These disappointing results suggest, superficially, that the prospects for clinical islet transplantation are bleak. In reality, the problem in all the studies conducted in large mammals and humans has been the lack of an efficient method for separation of viable purified islets from the human and large mammalian pancreas. The recent description of more efficient islet separation methods allows new hope for clinical transplantation.
Cancer of the gastric stump: Analyses of 819 patients and comparison with other stomach cancer patients
Authors: Viste Asgaut , Eide Geir E. , Glattre Eystein , Søreide Odd 
Published: May 2005

AbstractThe clinical characteriscics and prognosis of 819 patients with cancer in a previously resected stomach are described. The data were obtained from the Cancer Registry of Norway from the period 1970–1979. Median age was 69.2 years (range 31–91), with a male‐to‐female ratio of 4.4:1. The predominant symptoms were general weakness, abdominal pain, and dyspepsia; the majority of patients had a short duration of symptoms. The median cime interval from the primary operation to cancer diagnosis was 28.7 years. Twenty‐one percent of the patients had localized disease; 25%, regional disease; and 39%, distant metastatic disease. In 15% of the patients the stage of the disease could not be ascertained. The resectability rate was 41%, with a postoperative mortality rate of 11%. The overall 5‐year survival was 10%, but 40% for patients with localized disease having a resection. Pacients younger than 40 at the primary operation had a 5‐year survival of 14% as compared to 7% for those older than 40 (p< 0.001). Pacients younger than 70 at cancer diagnosis had a 5‐year survival of 13% as compared to 7% for those older than 70 (p< 0.001). Analyses showed that the apparent poor prognosis for patients with stomach stump cancer relacive to patients with other stomach cancer was due to differences in patient characteristics, and when corrected for these variables, the 2 populations had the same prognosis.
Adenocarcinoma of the cardia: A 10‐year regional review
Authors: Allum W. H. , Roginski Claudia , Fielding J. W. L. , Jones B. G. , Ellis D. J. , Waterhouse J. A. H. , Brookes V. S. 
Published: May 2005

AbstractAdenocarcinoma of the gastric cardia has the worst prognosis of all sites, and treatment is often palliative. This study has reviewed 736 patients with carcinoma of the cardia registered with the Birmingham Cancer Registry during 1960–1969. Fifty‐eight percent of the patients presented with advanced disease. Radical resection was accomplished in 265 (36%). The age adjusted 5‐year survival for all patients was 4.5% and 9.8% for those undergoing radical resection. In patients with advanced disease, palliative resection was associated with a longer survival than for those treated by intubation (p < 0.001) and this difference was maintained even in the presence of liver or peritoneal metastases. There was no difference in the 30‐day mortality rates for those undergoing palliative resection or intubation and it is suggested that resection be undertaken whenever possible.
Rapid turnover proteins as nutritional indicators
Authors: Cavarocchi Nicholas C. , Au Francis C. , Dalal Fram R. , Friel Karen , Mildenberg Budd 
Published: May 2005

AbstractMany of the commonly employed nutritional parameters are inadequate indices of malnutrition since they are relatively nonspecific, focused on depletion, have limited validity, and do not always reflect improvements after repletion. Recent studies have focused on the rapid turnover proteins (RTP), particularly thyroxin‐binding prealbumin (TBPA) and retinol‐binding protein (RBP) as more sensitive indicators of malnutrition. Twenty patients with protein‐calorie malnutrition who were given total parenteral nutrition were evaluated by routine nutritional parameters and rapid turnover protein assays for comparison.Results show statistically significant increases in mean values of TBPA (p < 0.001) and RBP (p < 0.0001) when compared in negative versus positive nitrogen balance (NB). Serum albumin levels decreased (p < 0.03), while transferrin (p < 0.03) and total lymphocyte count (p < 0.3) demonstrated less significance when compared in negative versus positive NB. Overall RBP and TBPA levels increased 2.8–3‐fold from negative to positive nitrogen balance. In mildly malnutritioned patients TBPA levels increased from 6.14 (±3.84) mg/100 ml to 22.42 (±9.62) mg/100 ml (p < 0.001); in moderately malnutritioned patients the TBPA increased from 7.2 (±6.68) mg/100 ml to 23.6 (±16.59) mg/100 ml (p < 0.04); and in severe forms, TBPA increased from 6.0 (±4.58) mg/100 ml to 18.66 (±7.37) mg/100 ml (p < 0.06). No such correlation could be found with the other routine nutritional parameters.We conclude that TBPA and RBP levels can be used as serum markers of mild to severe malnutrition and that there exists a numerical range of values for TBPA and RBP which correlates with negative and/or positive nitrogen balance.
Factors affecting quality of life with a conventional ileostomy
Authors: McLeod Robin S. , Lavery Ian C. , Leatherman Judith R. , Maryland Patricia A. , Fazio Victor W. , Jagelman David G. , Weakley Frank L. 
Published: May 2005

AbstractTwo hundred seventy‐three patients with inflammatory bowel disease and permanent conventional ileostomies were surveyed to determine which factors affect the health and quality of life of the ileostomate. Physical and emotional health were considered good or excellent by 79% and 78%, respectively. Only a small number of patients (approximately 20%) felt they were more restricted with the ileostomy with regard to diet, clothing selection, leisure and work activities, and travel than they were preoperatively. Despite these restrictions, 74% stated they led normal, unrestricted lives; 23% experienced some restrictions and had some difficulties psychologically but were glad they had surgery. Only 3% regretted having surgery. Only one factor, function of the ileostomy, affected patients' physical and emotional well‐being, ability to perform work and daily activities, and their overall outlook on life. Other factors such as age, sex, duration of the disease preoperatively, duration since surgery, and disease etiology and activity seemed to make no difference. Thus, it appears that the surgeon plays an important role in determining the well‐being and quality of life of the conventional ileostomate.
Nodular goiter: Effects of surgery and thyroxine medication
Authors: Westermark Kerstin , Persson C. Peter A. , Johansson Henry , Karlsson F. Anders 
Published: May 2005

AbstractIn a prospective investigation, thyroid function was studied in 43 patients before and after surgery on a nontoxic nodular goiter. Prior to surgery, 11 patients displayed a flat thyroid‐stimulating hormone (TSH) response to thyrotropin‐releasing hormone (TRH), suggesting subclinical hyperthyroidism. Thyroid autoantibodies (microsomal/thyroglobulin) were found in low titers in 7 of 43 patients, and in no patient were TSH‐receptor antibodies found. Three months following surgery, 32 patients were chemically euthyroid and 11 patients had elevated TSH values. Seven of the latter had additional signs of hypothyroidism and were given continuous thyroxine substitution. Starting 3 months after surgery, increasingly higher doses of thyroxine were administered to patients with a normal TRH test until an abnormal TSH response was observed. Four patients had a flat TSH response to TRH without administration of thyroxine and in 9 patients a daily dose of only 0.1 mg resulted in such a response. The 32 euthyroid patients developed flat TSH responses at an average dose of 123 μg of thyroxine. The data indicate that following surgery, the thyroid hormone production from the nonnodular thyroid remnant has low suppressibility, suggesting that, in nodular goiter, tissue with abnormal hormone production is widely distributed within the gland. It appears then that thyroxine medication in nodular goiter has a place mainly in patients developing hypothyroidism following surgery.
Treatment of unresectable hepatocellular carcinoma : Results of a randomized controlled trial
Authors: Lai Edward C. S. , Tong S. W. , Ong G. B. , Wong John 
Published: May 2005

AbstractMost patients with hepatocellular carcinoma present late with unresectable disease and, to date, an effective and safe palliative treatment has not been found. From December 1971, to December 1981, a randomized controlled trial was conducted to evaluate the following treatments against a control group receiving only symptomatic therapy (group I) : hepatic dearterialization (group II), hepatic artery ligation and cannulation for infusion of chemotherapeutic agents (group III), hepatic artery ligation and portal vein cannulation for chemotherapeutic agents infusion (group IV), and external irradiation (group V). Response to various treatments was assessed with respect to symptomatic relief and duration of survival. A total of 166 patients with histologically confirmed tumor confined to the liver were studied. All patients had similar preoperative general status and biochemical findings. Patients in group IV had the best symptomatic improvement; 58.6% responded to some degree. Hepatic artery ligation intraportal infusion (group IV) offered significantly longer survival than infusion via the intra‐arterial route (group III) (p= 0.023). However, when compared with the control group, the survival times in the 4 treatment groups were not significantly different. Hepatic dearterialization (group II) had the highest 7‐day mortality rate, 33.3%. The results of this trial suggested that none of the modalities of treatment studied offered patients with unresectable hepatocellular carcinoma any better survival and symptomatic palliation than did symptomatic treatment alone.
Repair of bile duct defect with full‐thickness vascularized jejunal patch
Authors: Bengtsson Henrik J. O. , Broomé Albert E. A. , Rimér Ulf 
Published: May 2005

AbstractThe use of a vascularized jejunal patch for the reconstruction of bile duct injuries is presented. The method has been used in 1 patient with a common bile duct stricture and in 1 patient with a noncircumferential bile duct defect. The procedure has the advantages of technical simplicity, primary mucosal coverage, lasting elasticity, and minimal risk for stricture formation.
Perioperative transfusions associated with colorectal cancer surgery : Clinical judgment versus the hematocrit
Authors: Tartter Paul Ian , Quintero Sandra , Barron Deborah 
Published: May 2005

AbstractWe prospectively studied 123 patients with colorectal cancer in order to identify determinants of perioperative blood transfusions and unnecessary transfusions. Transfusions were considered unnecessary if the preoperative hematocrit reading exceeded 36% or the discharge hematocrit level exceeded 33%. Age, sex, admission hematocrit reading, operative procedure, specimen length, duration of surgery, estimated blood loss, tumor size, tumor differentiation, nodal status, Dukes' staging, and attending surgeon were evaluated in relation to perioperative blood transfusion using stepwise logistic regression. Fifty‐one (41%) of the 123 patients in the study were transfused and 35 patients (28%) received at least 1 unnecessary unit of blood. Advanced age, low admission hematocrit reading, high estimated operative blood loss, prolonged procedures, and lengthy specimens were significantly related to the administration of blood. Excessive intraoperative transfusions and the practice of administering blood in pairs of units accounted for the unnecessary transfusions. This study indicates that factors that influence clinical judgment and thereby the decision to transfuse a patient are not accurate indicators of when blood should be given. Greater use of pre‐transfusion hematocrit testing, especially in the operating room and before transfusing a second unit of blood, will dramatically reduce blood usage in elective colorectal cancer surgery.
Fluid and electrolyte resuscitation of the thermally injured patient
Authors: Reaves Larry E. , Antonacci Anthony C. , Shires G. Thomas 
Published: May 2005

AbstractFluid and electrolyte management of thermal injury continues to undergo evolution. The goal of resuscitation is optimal maintenance of vital organ function, and during the first 24 hours after injury, resuscitation is best accomplished with isotonic balanced salt solution. Colloid‐containing solutions do not offer any advantage and may be deleterious. In the second 24 hours, fluid replacement should account for free water losses, maintaining serum sodium at 140 mEq/L. The use of colloid‐containing solution may be of benefit during this time period after capillary integrity is reestablished. Several formulae are available for initial guides, although clinical evaluation of adequate intravascular expansion is necessary. This is best accomplished using urine output as an indication of renal perfusion. Special attention is necessary in the resuscitation of children, the elderly, patients with inhalation or electrical injuries, and patients having a delay in initial resuscitation.
Effects of changes in endocrine function on water and electrolyte metabolism
Authors: Johnston Ivan D. A. 
Published: May 2005

AbstractThe effects of a number of hormones on fluid and electrolyte balance are reviewed, first under normal physiological conditions and then under pathological conditions associated with loss of function or with overactivity due to the presence of hyperplasia or functioning tumors. Some of the most pronounced changes may occur with ectopic hormone production by certain neoplasms of nonendocrine origin.
Denervation of the greater curvature in proximal gastric vagotomy
Authors: Martinez‐Ramos Carlos , Sanz Mario G. , Pardo Pilar , Nuñez Jose R. , Soriano Eduardo , Escobar Santiago T. 
Published: May 2005

AbstractThis report concerns a study of the role of the gastroepiploic nerves at the greater curvature in gastric acid secretion and the influence of its section in proximal gastric vagotomy (PGV) in the prevention of ulcer recurrence.Thirty‐two patients who had surgery for duodenal ulcer were randomly divided into 4 groups. Group 1 had PGV; group 2, PGV plus section of the right gastroepiploic nerve; group 3, PGV plus section of the left gastroepiploic nerve; and group 4, PGV plus section of both gastroepiploic nerves. BAO and MAO values were determined in all patients pre‐ and postoperatively.The statistical analysis of the results shows that the percent reduction of the BAO and MAO values obtained when performing a gastroepiploic nerve section, whether one of them or both, is not significantly different from those obtained when PGV alone is done. We have observed no differences in the rate of ulcer recurrence in the patients of the 4 groups; there was no ulcer recurrence after a minimum follow‐up time of 4 years.We conclude that the denervation of the greater curvature, which is recommended by some authors when performing a PGV, is of little importance in obtaining a satisfactory reduction of gastric acid secretion and in reducing the ulcer recurrence risk.