bluuebunny/crossref_metadata_2025_split huggingface dataset:
The surgical management of primary carcinoma of the liver
Authors: Lee N. W. , Wong J. , Ong G. B. 
Published: May 2005

AbstractFrom 1964 to 1981, a total of 165 patients with primary carcinoma of the liver underwent various types of hepatic resections. Eighty‐five percent of tumors were found in cirrhotic livers. In 78.4%, HBsAg could be demonstrated by the reverse passive hemagglutination technique, while 85.7% had positive alpha‐fetoprotein in the serum. The complication rate was high (42.1%), while the hospital death rate was 20%. The most frequent operations were a right hemihepatectomy (42.4%) and a left hemihepatectomy (34.5%), while 22 patients (13.3%) underwent extended right hepatectomy. The longest survival (a patient operated on in 1962) is now 20 years, and the 5‐year survival rate, as shown in the actuarial survival curve, is 20%.
Liver transplantation for liver cancer
Authors: Calne R. Y. 
Published: May 2005

AbstractResults in the first 100 orthotopic liver allografts performed in the Cambridge‐King's College Hospital series (1968–1980) are reported. Twenty‐two patients survived beyond a year (age range, 16–59 years). Of these, 12 were cirrhotics and 10 were primary malignancies. Of the cirrhotics, 10 are alive, with the 2 deaths resulting from cholangitis. Two patients who had primary hepatic carcinoma are alive at 1 and 5 years following transplantation; the 8 deaths in this group were attributed to tumor recurrence (5 patients), sepsis (2 patients), and secondary cirrhosis possibly due to non‐A non‐B hepatitis (1 patient). Patients who survive for 6 months have a greatly increased chance of surviving the second 6 months and subsequently. Of the last 14 liver allografts (12 for cirrhosis and 2 for primary malignancy), there are 9 survivors. This mortality (36%) probably represents the results of better selection of the cirrhotics before they were too sick to withstand the operation; better control of rejection; and refinements in surgical procedure and anesthesia. For those patients surviving the first year, there is a 40% chance of the tumor's being eliminated. The late tumor recurrence rate is unacceptably high at 60%, however, and our criteria for patient selection have become increasingly selective.
Total hepatectomy and liver replacement (orthotopic liver transplantation) for primary hepatic malignancy
Authors: Iwatsuki Shunzaburo , Klintmalm Goran B. G. , Starzl Thomas E. 
Published: May 2005

AbstractThere has been a high incidence of tumor recurrence after liver transplantation for primary hepatic malignancy. Nevertheless, a small but significant palliation has been possible with this approach, even in patients who eventually died of recurrence. Two patients with incidental malignancies in their excised livers apparently have been cured. Further gains will be possible only with extremely discriminating selection of prospective recipients.
Low‐risk thoracic vagotomy for anastomotic ulceration
Authors: Lehr Leo , Pichlmayr Rudolf 
Published: May 2005

AbstractTransthoracic truncal vagotomy for anastomotic ulceration was performed in 47 patients. In 24 cases, the risk for any procedure requiring a transabdominal approach was considered high because of the presence of multiple risk factors, the majority of which involved complicated prior laparotomies. The high virulence of the underlying ulcer diathesis was demonstrated by the number of previous unsuccessful reresections. In 17 patients 1 reresection; in 4 patients 2 reresections; and in 1 patient a reresection plus abdominal vagotomy had failed.No mortality and only minor local complications were observed after thoracic vagotomy. Within 3 months ulcer healing was found in 46 patients. In 1 patient the ulcer persisted for 5 months, then healed under additional cimetidine treatment. Uniform healing was also achieved in 6 cases of retained gastric antrum. Complaints of gastric outlet obstruction resolved in 3 patients and persisted in one.Thirty‐seven patients were followed for up to 10 years: 31 personally, with gastroscopy in 26; 6 were followed by their house physicians. In no case was ulcer recurrence detected. Visick grading of those 31 patients reexamined in the clinic showed 27 in groups I and II, 4 in III, none in IV. Of the complaints requiring a classification as Visick III, only 2 syndromes are a direct consequence of cutting the vagus at the truncal level; these are 1 case each of moderate diarrhea and dumping, both controlled by conservative measures.Thus thoracic vagotomy has proven to be a low‐risk procedure as well as a potent therapy for anastomotic ulceration. The morbidity seems acceptable. We recommend this method for standard surgical treatment for anastomotic ulcer in place of any transabdominal procedure.
Cytological diagnosis of pancreatic tumors
Authors: Bodner Ernst , Schwamberger Klaus , Mikuz Gregor 
Published: May 2005

AbstractCytological diagnosis of carcinomas as well as of other pancreatic tumors is of high validity. By use of the modified Papanicolaou staining method, the procedure is adaptable for rapid intraoperative diagnosis. In order to obtain representative cell material, we have tried both preoperative endoscopic fluid collection and intraoperative fine needle biopsy. Whereas the first procedure often fails because of its technique, the latter is suitable in all cases. No serious complication arose in the 181 patients studied. In 152 diagnostic‐ally proven cases, the cytological result was correct 135 times (88.8%). Forty of 44 resectable malignomas were diagnosed correctly. Consequently, the success rate is remarkably high with small tumors for which the indication for resection should be based on microscopic diagnosis.
A Glucagon‐secreting alpha‐cell carcinoma of the pancreas
Authors: Goto Hiraaki , Yamaji Yoichi , Konno Toshimitsu , Murata Etsuo , Tashiro Seiki , Yokoyama Ikuzo 
Published: May 2005

AbstractA case of alpha‐cell carcinoma of the pancreas with classic manifestations of glucagonoma syndrome and hepatic metastasis is reported. A diagnosis of glucagonoma was made by the characteristic dermatological findings of necrolytic migratory erythema and hyperglucagonemia. Operative removal of the metastatic tumors resulted in rapid regression of the skin rash and hyperglucagonemia. But a primary focus 1 cm in diameter, with central necrosis, had been left in the head of the pancreas. This was verified by autopsy.
Nonpalpable breast lesions: Mammographic wire‐guided biopsy and radiologic‐histologic correlation
Authors: Blichert‐Toft M. , Dyreborg U. , BØgh L. , KiÆr H. 
Published: May 2005

AbstractDuring a 1‐year period, 2,909 symptomatic women were referred for physical examination of the breast and mammography. In 44 women (1.5%), mammography discovered a total of 45 impalpable breast lesions that might represent an early cancer. Mammographic wire‐guided biopsy was performed using a self‐retaining hook wire for the marking of the lesion. The radiographic localization was facilitated by using a perforated compression plate with holes visible on the mammograms. The biopsy method showed high precision and accuracy. Only 1 guide wire was needed in each instance. In 96% of cases, the wire transfixed the lesion or was placed in close proximity (within 1 cm) to the lesion. Correct biopsy was achieved in all instances, but in some cases more than 1 biopsy was necessary. The malignancy rate was 29% of biopsies and 30% of patients. The metastatic rate to axillary lymph nodes was 17%. Generally, the histologic pattern showed great variety with several different components in most specimens. The radiologic‐histologic correlation is tabulated and the significance of preclinical breast cancer detection is emphasized. The biopsy method described is reliable and highly recommended. We found the procedure easy to handle and time‐saving. The method was fully acceptable to patients and the cosmetic results were excellent.
Pericardial tamponade caused by central venous catheters
Authors: Krog M. , Berggren L. , Brodin M. , Wickbom G. 
Published: May 2005

AbstractThree cases of pericardial tamponade caused by central venous catheters are reported. Two essential factors have been recognized. First, the catheter material should be extremely soft and remain soft. Today the best material available seems to be a silicone rubber elastomer. Polyvinylchloride or polyethylene, which is widely used, is too rigid. These materials also contain phthalate esters to soften the plastic, and these softeners are gradually washed out into the bloodstream, rendering the catheters even more rigid in time. Second, a central venous catheter should enter the venous system proximal to the shoulder. When the catheter is inserted through a vein in the arm, the tip of the catheter will be able to progress 6–10 cm farther down in the venous system by extreme movements of the arm. This occurs regularly when a patient is turned in bed and his or her arm is elevated 108‡ at the shoulder. The internal jugular vein and the subclavian vein are the most suitable veins for catheterization. Veins in the arm should not be used.
Surgical procedures for gastric substitution
Authors: Herfarth C. , Schlag P. , Buhl K. 
Published: May 2005

AbstractThe most serious of the problems that arise after total gastrectomy and reconstruction of a continuous gastrointestinal tract by means of a simple esophagojejunostomy can be ascribed to the lack of primary reservoir formation and to alkaline reflux esophagitis. These difficulties can be overcome by means of pouch formation, low insertion of the bile duct, and jejunal plication. Personal follow‐up examinations in patients (over 1 year after gastric substitution have yielded both subjective and objective findings that are almost identical with those recorded in a subject with intact stomach. The one striking finding to emerge remains an elevated fat excretion.
Pouch versus esophagojejunostomy after total gastrectomy: A randomized clinical trial
Authors: Troidl Hans , Kusche Jürgen , Vestweber Karl ‐Heinz , Eypasch Ernst , Maul Ulla 
Published: May 2005

AbstractThis is an interim report of a randomized clinical trial on esophagojeju‐nostomy (EJ) versus Hunt‐Lawrence‐Rodino (HLR) pouch as reconstruction techniques following total gastrectomy and systematic lymphadenectomy for gastric cancer treatment.The randomized trial preceded a pilot study comparing the Longmire‐Gütgemann interposition and the HLR. The pilot study included 7 patients, the randomized trial 38 patients (60 planned). The main outcome variables in the pilot study were food resorption, caloric intake, and body weight. Survival probability and general well‐being (quality of life) were measured in the randomized trial. A score was composed of disease‐specific and socio‐personal variables with well‐being ranging from 0 (worst) to 14 (best) points.Concerning food resorption in the pilot study, no relevant advantage of the duodenal passage was found. The main postoperative disorder was insufficient food intake. Despite a radical operation, a hospital mortality rate of 16%, and a complication rate of 37%, gastric cancer still has a poor prognosis. In the randomized trial only 15 (39%) of 38 patients were alive 1 year after operation, but the survival probability was higher (58%) after HLR than after EJ (24%) (p<0.05). Hunger and appetite were strongly reduced during the first 6 months after operation. Food intake was less than half of the preoperative values, which was reflected by an average decrease in body weight of 7 kg.Patients dying within the first year after total gastrectomy suffered an irreversible loss of quality of life (scoring 7 points). They had no objective benefit from the operation. Patients surviving this period regained quality of life and exceeded preoperative values, especially after HLR.We conclude that HLR‐operated patients who have a chance of surviving for at least 1 year benefit from total gastrectomy in regard to quality of life.
The continent ileostomy
Authors: Myrvold Helge E. 
Published: May 2005

AbstractThe object of this article is to evaluate the results with the continent ileostomy and to define its place as a therapeutic alternative after proctocolectomy. In the past, the method has been affected by a high incidence of complications, but technical developments, simplifications, and improvements in surgical techniques have reduced the incidence of early complications from 20–25% to less than 10%, and that of late complications from 45–54% to 10–22%. The mortality rate in several recently published series of 1,142 patients was 0–1% (mean 0.2%), none of the deaths being directly pouch related. Fifteen to 20% of patients develop ileitis, which is usually successfully treated with antibiotics. Eighty‐nine to 97% of the patients never require external ileostomy appliances, indicating perfect continence. No serious adverse effects have been found after 19 years' experience with the method, but a few patients have developed subnormal values of vitamin B12. More than 90% of patients who have previously had a conventional ileostomy claim improvements in social life and sports activities and 68–85% found that the quality of their sexual life had improved. There is no doubt that a well‐functioning continent ileostomy offers the patients a quality of life superior to that with a conventional ileostomy. Despite the increasing popularity of the pelvic reservoir and ileoanal anastomosis, the continent ileostomy remains a therapeutic alternative for proctocolectomized patients undergoing conversional procedures and for patients in whom ileoanal anastomosis with pelvic reservoirs are contraindicated or impossible to construct.
Motor function of the ileal J pouch and its relation to clinical outcome after ileal pouch‐anal anastomosis
Authors: O'Connell P. Ronan , Pemberton John H. , Kelly Keith A. 
Published: May 2005

AbstractThe motor function of the ileal J pouch after ileal pouch‐anal anastomosis has a key role in the clinical outcome. The pouch forms a neorectum that aids in the maintenance of reasonable continence. The maximum capacity of the pouch (mean, 320 ml) is similar to that of the healthy rectum (330 ml). The pouch accommodates to distension, keeping intrapouch pressure low as the pouch gradually fills with stool. The change in pouch volume with each change in pressure (15 ml/mm Hg) approximates that of the healthy rectum (19 ml/mm Hg). When a threshold volume of about 150 ml is reached, large‐amplitude (>25 mm Hg), prolonged (40–60 sec), propulsive waves appear in the pouch. They initiate the call to stool. With continuing distention of the pouch to its functional capacity, which is about 200 ml, reflux of stool into the distal ileum begins, the large pressure waves become more frequent, and the urge for defecation more intense. Defecation is voluntary, spontaneous, and rapid (11 ml/sec), with the pouch and distal ileum emptying concurrently. About 60% of the pouch content, a volume of about 100 ml of stool, is discharged with each bowel movement. The greater the threshold volume and the more complete the evacuation, the fewer the bowel movements per day. After evacuation, the large pressure waves subside, and the next cycle of pouch filling and emptying begins.
Biological effects of a reservoir at the end of the small bowel
Authors: Phillips Sidney F. 
Published: May 2005

AbstractSubstitution of the anorectum by a reservoir fashioned from the distal ileum can achieve the highly desirable goal of enteric continence after proctocolectomy and, not surprisingly, appears to enhance significantly the patient's quality of life. The potential price to be paid for this advance relates largely to uncertainties concerning the absence of the usual barriers to coloileal reflux and the presence of a stagnant, fecal pouch at the end of the small intestine. Moreover, positive experiences with conventional incontinent ileostomies over many years dictate that the Brooke ileostomy still remains the standard against which all other procedures must be judged. In the majority of patients, the presence of an ileal reservoir does not appear to have major adverse consequences; fecal volumes, fat excretion, overall gut function, and general health appear to be well maintained for the 10–15 years that patients with continent ileostomies have been followed. The follow‐up for ileo‐anal anastomoses is somewhat shorter. The pouches develop a fecal flora and mucosal histology is altered but, in most, no adverse sequelae have been noted. Nonspecific inflammation (“pouchitis”) occurs and is sometimes of major clinical significance, especially when also associated with systemic symptoms. The etiology of these conditions is unknown but bacterial overgrowth is suspected since antimicrobial therapy is often curative.
Supravesical urinary diversion via the continent ileal reservoir: Experience in 250 cases
Authors: Skinner Donald G. , Boyd Stuart D. , Lieskovsky Gary 
Published: May 2005

AbstractFrom August, 1982, to August, 1985, a total of 250 patients have undergone diversion by means of a continent ileal reservoir. One hundred seventyone were in conjunction with radical cystectomy for the management of invasive bladder cancer; 19 underwent cystectomy and Kock pouch diversion to resolve complications of neurogenic bladder; and 60 patients were converted to a continent ileal reservoir from an unsatisfactory form of conduit, 10 from ureterosigmoidostomy and 2 patients from either a suprapubic tube or cutaneous ureterostomy.Early complications occurred in 42 patients (16%) resulting in 5 (2%) postoperative deaths. The complication rate was 18% among the 190 undergoing cystectomy with Kock pouch construction and 13% among the 60 undergoing conversion.Late complications have occurred in 77 (31%) of the 245 patients surviving the operation. Most late complications are due to leakage, parastomal hernia, and/or difficulty with catheterization. During this experience continuing modifications have developed that we feel will reduce the late complication incidence and improve results. These modifications will be discussed in detail.
Coexistence of hyperthyroidism and thyroid cancer
Authors: Wahl Robert A. , Goretzki Peter , Meybier Hinrich , Nitschke Jörg , Linder Malte , Röher Hans ‐Dietrich 
Published: May 2005

AbstractAmong 702 patients who underwent surgery for hyperthyroidism, thyroid cancer was demonstrated histologically in 18 patients (2.6%). A higher incidence of cancer occurred in patients with multinodular toxic goiter (3.3% of 317 patients) and uninodular toxic goiter (2.9% of 207 patients), whereas only 1.1% of 178 patients operated for Graves' disease had coexistent thyroid cancer. In addition, 5 patients who underwent surgery for thyroid cancer were found preoperatively to be hyperthyroid, increasing the total number of patients with coexistent thyroid cancer and hyperthyroidism to 23. Among 554 patients with thyroid cancer operated upon during the same period, 4.2% were hyperthyroid (8.6% of patients with papillary thyroid carcinoma, 4.5% with follicular thyroid carcinoma, and only 0.5% with undifferentiated thyroid carcinoma).Thyroid cancer was identified within a toxic nodule in 6 patients, in surrounding tissue suppressed by solitary toxic nodules in 4 patients, in cold nodules coexisting with multinodular toxic goiters in 8 patients, and microscopically disseminated in diffuse toxic goiters in 2 patients; 3 patients presented large inoperable and metastatic tumor masses. Although in 8 of the 23 patients (35%) the thyroid cancer was advanced (extrathyroid growth of the primary tumor and/or regional metastases and/or distant metastases), cancer was diagnosed preoperatively in only 5 patients (22%).This study demonstrates that hyperthyroidism does not prevent thyroid cancer and that patients with nodular toxic goiters in particular must be carefully evaluated with regard to risk factors, history, and clinically suspicious signs. Needle biopsy should not be restricted to cold nodules. Surgery rather than radioactive iodine or antithyroid therapy is the treatment of choice in toxic nodular goiter.
Nodular goiter—Is thyroxine medication of any value?
Authors: Persson C. Peter A. , Johansson Henry , Westermark Kerstin , Karlsson F. Anders 
Published: May 2005

AbstractIn a cohort of 197 patients operated on for non‐toxic nodular goiter, 71 patients had been given preoperative thyroxine. In 31%, the medication afforded some symptomatic relief, but did not reduce the goiter enough to abolish the need for surgery. Postoperatively, 17 of the 197 patients developed supranormal TSH levels and were placed on thyroxine. In addition, 151 patients were placed on thyroxine “prophylaxis,” 121 of whom remained on this medication for the entire follow‐up period. Thirty patients discontinued medication at various times during the follow‐up period and 29 subjects received no medication at all. During a 5‐year follow‐up period, goiter recurred in 11 of the 197 patients, 8 of whom had been on continuous thyroxine medication.In the second part of this report, results of TRH tests and hormone measurements in a group of 56 consecutive patients with nodular goiter are examined. A “flat” pathological TSH response to TRH was found in 43%. This group of patients exhibited significantly higher thyroid hormone levels and a significantly higher mean age than the group with normal TRH tests.The results suggest that, apart from being a necessary substitute in postoperative hypothyroidism, the use of thyroxine medication in nodular goiter could be restricted.
Persistent and recurrent pheochromocytoma: The role of surgery
Authors: Brennan Murray F. , Kaiser Harry R. 
Published: May 2005

AbstractPheochromocytoma is a rare malignancy. The opportunity to gain experience with persistent and recurrent pheochromocytoma is extremely limited. We have, therefore, reviewed our experience with 8 patients with persistent and recurrent pheochromocytoma treated during the last 6 years. In patients with multiple endocrine neoplasia, the recurrent or persistent adrenal tumor is usually situated in the contralateral adrenal, whereas in other patients the tumor is usually situated in an ectopic position or is due to recognized or unrecognized malignant disease.Survival from diagnosis ranged from 1.5 to 23 years in these patients. Because long‐term survival may occur following removal of both benign and malignant pheochromocytomas, an aggressive surgical approach is recommended.
Gastric partition for morbid obesity: Greater curvature gastroplasty or gastrogastrostomy
Authors: Buckwalter Joseph A. , Herbst Charles A. 
Published: May 2005

AbstractGastric partition is advocated as a better operation than gastric bypass for treatment of morbid obesity (although this is poorly documented) because it is simpler and faster to perform; has a lower complication rate; is more physiologic; and because it is possible to examine the distal stomach by endoscopy and barium contrast studies after operation. It has not been established which of the different gastric partition operations is the best. Greater curvature gastroplasty (GP) was performed upon 47 and gastrogastrostomy (GG) upon 144 patients between May, 1979, and May, 1981, at North Carolina Memorial Hospital. The techniques used in performing the operations are described and illustrated. Postoperative complications occurred in 25.5% of the GP and 10.4% of the GG patients. There were no deaths. Reoperation was required because of stomal obstruction in 14.9% of the GP compared with 1.4% of the GG patients. The percentage of excess weight lost in 12 months following GP was 60.5% and 51.3% after GG, and at 18 months was 68.7% following GP and 53.9% after GG. These differences in weight loss following GP and GG are not statistically significant. Because of the statistically significant lower incidence of stomal obstruction requiring reoperation after GG, although weight loss appeared to be better with GP, GG is currently our preferred operation for the treatment of morbid obesity. The changes in the technique of GG introduced to improve weight loss are discussed and illustrated.