bluuebunny/crossref_metadata_2025_split huggingface dataset:
Curability of patients with invasive breast carcinoma based on a 30‐year study
Authors: Robbins Guy F. , Berg John 
Published: April 2005

AbstractA 30‐year follow‐up study of 1458 women who were treated by standard radical mastectomy for potentially curable invasive breast cancer at Memorial Hospital, New York, showed 12.6% of the patients alive and free of cancer, 24% dead of other causes without breast cancer, 56.6% dead of breast cancer and 6.8% lost to follow‐up. Small primary lesions, negative axillary lymph nodes and histologic types of cancer other than infiltrating duct carcinoma were all associated wih higher survival rates. Patients with low grade cancers developed a second cancer in the remaining breast much more frequently than patients with infiltrating duct carcinoma. Of the 184 30‐year survivors, 34 had metastases to axillary lymph nodes at levels II and III at the time of operation. It is concluded that radical mastectomy is capable of controlling local disease and curing a substantial number of patients.
Urinary hydroxyproline in the management of breast cancer
Authors: Cuschieri A. 
Published: April 2005

AbstractTurnover of collagen in the body, 50% of which occurs in bone, results in the excretion of substantial amounts of hydroxyproline in the urine. Urinary hydroxyproline excretion and, in particular, the hydroxyproline/creatine ratio increase in the presence of primary and secondary neoplasms of bone. There is a good correlation between elevated urinary hydroxyproline excretion and metastases to bone from breast cancer. Moreover, in “early” breast cancer without demonstrable metastases we have found a good correlation between elevated levels of hydroxyproline in urine and axillary lymph node metastases at operation, subsequent development of bone metastases, and survival. In patients with disseminated disease undergoing hormone manipulation therapy, we have observed that urinary hydroxyproline excretion correlates with the response to treatment. Measurement of urinary hydroxyproline excretion appears to be a useful tool in staging breast cancer and monitoring the activity of the disease.
Subclavicular biopsy as a guideline for the treatment of breast cancer
Authors: van Dongen Johannes A. 
Published: April 2005

AbstractTo better select patients with breast cancer for radical surgery, all operable patients at the Netherlands Cancer Institute are subjected to exploration of the medial apex of the axilla as the initial step in the mastectomy operation, and lymph nodes in the subclavicular fat pad are examined by frozen section. Patients with positive apex biopsies are treated by primary radiotherapy rather than by mastectomy, since the 10‐year survival rate of such patients who were treated by mastectomy in our previous series was only 5%. In about 1600 cases of operable breast cancer treated by our staff since 1956, the incidence of positive apex biopsy has been 16%. In 6% of the cases with a positive apex biopsy, the tumor was small and there were no suspicious lymph nodes on clinical examination. Survival rate and duration of survival of patients with a positive apex biopsy has been the same after treatment by primary irradiation as after treatment by radical mastectomy.
Cancer research campaign study of the management of “early” breast cancer
Authors: Greig Murray J. , MacIntyre John , Simpson John S. , McDonald Alexander M. 
Published: April 2005

AbstractBetween 1970 and 1975, 2268 patients with clinical stages I and II breast cancer were assigned by random sample to receive either simple mastectomy plus postoperative radiotherapy or simple mastectomy followed by a watch policy, with further treatment employed only for recurrent disease. After 5 years of follow‐up there is no evidence that postoperative radiotherapy increases the survival rate or decreases the incidence of distant metastases, although it is clearly advantageous in preventing local recurrence. Histological examination of the lymph nodes from the tail of the breast or pectoral region in 350 patients showed that postoperative radiotherapy did not influence survival, local recurrence or the occurrence of distant metastases in patients with negative nodes. However, in patients with positive nodes postoperative radiotherapy was associated with a decreased incidence of local recurrence, but a 10% increase in mortality rate during the first year after treatment.
Estrogen receptors in breast cancer
Authors: Jensen Elwood V. , Block George E. , Ferguson Donald J. , DeSombre Eugene R. 
Published: April 2005

AbstractOf 1100 women whose primary and/or metastatic breast cancers have been analyzed for estrophilin, 30% are receptor‐rich and 70% receptor‐poor. On the basis of 134 treated patients, nearly two‐thirds of the receptor‐rich group can expect objective benefit from endocrine therapy, whereas few if any of the receptor‐poor patients will respond. Thus, estrophilin assay indicates the proper type of therapy for 85 to 90% of women with advanced breast cancer. Analysis of the primary tumor in the mastectomy specimen offers promise in predicting hormone dependency in metastases that appear up to 5 years later.
Screening for “early” breast cancer
Authors: Strax Philip 
Published: April 2005

AbstractThe only means available today to reduce the mortality from breast cancer is by detection of localized disease. So doing involves mass screening of apparently well women. For best results, both the clinician and the radiologist must be involved and develop expertise because early cancers are often detectable on palpation alone or on mammography alone. Cooperation of the clinician and the radiologist is needed to motivate women to receive as complete a breast examination as is available in their community. This should include, if possible, an interview for demographic data, palpation, mammography and thermography. New radiological methods are available which produce improved resolution, detail and contrast with radiation dosage reduced to 0.3 R or less per skin exposure. Indoctrination of women in breast self‐examination by the clinician or trained personnel, preferably at the time of breast palpation, is a vital step. The validity of this approach has been demonstrated by the mass screening programs of the Health Insurance Plan of Greater New York and the Guttman Institute.
The surgeon's problem with breast cancer screening programs
Authors: Snyder Ruth E. 
Published: April 2005

AbstractAny decision to biopsy a breast on the basis of findings discovered in a screening program must carefully consider the expertise of the clinical examination, the technical quality of the mammograms, and the skill and experience of the radiologist reading them. A positive clinical examination with or without mammographic confirmation is indication for biopsy. However, the surgeon must sometimes be governed solely by the report of the radiologist. On the basis of competent mammographic interpretation, patients without clinical evidence of disease face at least a 25% chance of having cancer. The area of concern must be carefully localized preoperatively and the specimen radiographed, particularly if it contains calcifications. This requires a clear understanding of the problem and complete cooperation between the surgeon, the radiologist, and the pathologist.
Bile induced chronic gastric ulcer in swine
Authors: Rokkjaer Mogens , Søgaard Helmer , Kruse Aksel , Amdrup Erik 
Published: April 2005

AbstractThe role of bile in the pathogenesis of chronic gastric ulcer was studied in 10 grown‐up miniature pigs. After an observation period of 14–186 days, 4 pigs out of 5 with total diversion of bile into the stomach developed peptic ulcers in the glandular part of the stomach, whereas none of 5 sham operated pigs developed ulcers after an observation period of 150–196 days. This difference was significant (p<0.05). In all 5 pigs with bile diversion the pyloric gland area enlarged at the cost of the fundic gland area, whereas this was not the case in the 5 controls. This difference was also significant (p<0.01). There was no significant change in gastric emptying after the operations. It is concluded that bile can cause gastric ulcer in the pig.
A case report of hepatoblastoma treated by chemotherapy and hepatic lobectomy
Authors: Fegiz Gianfranco , Rosati Domenico , Tonelli Francesco , Donfrancesco Alberto 
Published: April 2005

AbstractA hepatoblastoma in a 2‐year‐old child was considered unresectable at exploratory laparotomy because of diffuse liver involvement. The treatment of the patient with intravenous 5‐fluorouracil for 5 months resulted in a remarkable reduction in the size of the tumor so that it became resectable and was removed by right hepatic lobectomy. The child is alive and well 26 months after surgery. Several similar cases have been reported in which an unresectable hepatoblastoma was made resectable by chemotherapy, and operation was then followed by long‐term survival without recurrence.
Microvascular neurosurgical arterial bypass for cerebral ischemia: A decade of development
Authors: Mehdorn H. Maximilian , Hoffman William F. , Chater Norman L. 
Published: April 2005

AbstractThe microsurgical extracranial‐intracranial arterial bypass (EIAB) procedure, usually performed to anastomose the superficial temporal artery to a cortical branch of the middle cerebral artery, offers a therapeutic alternative in treating patients who present with symptoms of cerebral ischemia varying from transient ischemic attack (TIA) to stroke‐in‐evolution, and who have intracranial or otherwise inaccessible high cervical carotid lesions. Preoperative diagnostic steps include angiography, computer‐assisted tomography (CT) scan, and measurements of regional cerebral blood flow (rCBF).A comparison of our series of 172 patients with series reported in the literature suggests that EIAB is more effective than medical therapy in preventing the development of permanent neurological deficit after a series of TIA and in treating cases of stroke‐in‐evolution. It also can prevent further deterioration in selected patients after stroke. An analysis of patients who had an unfavorable outcome suggests that bilateral EIAB should be performed in a greater number of patients who have generalized low‐perfusion syndrome; that low doses of heparin should be administered intraoperatively and postoperatively in patients who have high‐grade siphon stenosis; and that aspirin should be given to patients experiencing TIA after EIAB.
Effect of vasopressin on portal pressure during volume replacement after acute hemorrhage
Authors: Skivolocki William P. , Sirinek Kenneth R. , Pace William G. 
Published: April 2005

AbstractThis study evaluated both the isolated and combined effects of intravenous vasopressin and volume replacement on cardiac output and portal pressure in hypovolemic dogs. Following acute hemorrhage and sustained hypotension (60 mm Hg for 45 min), 20 anesthetized dogs received either: no treatment; intravenous vasopressin (20 units/30 min); Ringer's lactate (volume equal to shed blood/30 min); or intravenous vasopressin and Ringer's lactate. At 30 minutes after hypotension, cardiac output decreased 52% and portal pressure decreased 61% in control animals. Hypovolemia plus intravenous vasopressin resulted in significant reductions in cardiac output (41%) and portal pressure (62%) compared to baseline recordings, but not compared to control animals. Following hypovolemia and Ringer's lactate, cardiac output and portal pressure increased to prehemorrhage levels. With vasopressin and Ringer's lactate, portal pressure remained decreased (39%), while cardiac output returned to prehemorrhage levels. This study demonstrates that administration of intravenous vasopressin during hypovolemia does not cause an added reduction in cardiac output and does not prevent restoration of the normal cardiac output by volume replacement. Moreover, administration of vasopressin during volume replacement prevented a return of portal venous pressure to prehemorrhage levels.
Should hyperthyroidism be treated by surgery?
Authors: Heimann Peter 
Published: April 2005

AbstractAlthough radioactive iodine has been shown to be an effective nonsurgical treatment for hyperthyroidism, surgery remains a major treatment methodology. Nodular goiters with hyperthyroidism, which are still common in Scandinavia and elsewhere in Europe, are most effectively treated with surgery. The carcinogenic effects of131I have not been fully determined; until a large‐ scale, long‐ term controlled study of patients treated with131I is performed to establish the role of radioactive iodine in the development of carcinoma, its complete worldwide use is not recommended. There is low postoperative recurrence, mortality and morbidity with surgery for hyperthyroidism as performed in Scandinavia.
Choice of preoperative treatment in hyperthyroidism
Authors: Heimann Peter 
Published: April 2005

AbstractFrom our knowledge of thyroid pathophysiology and from morphological studies, preoperative treatment of hyperthyroidism should consist of:
A period of treatment to control hyperthyroidism by giving the patient antithyroid drugs (carbimazole) and, if necessary, propranolol.
An attempt to keep the patient euthyroid. It seems reasonable to add thyroxine to a relatively high dosage of carbimazole in order to be sure of both euthyroidism and a hormone‐free gland.
Inhibition of all stimulation of the gland by TSH in order to minimize the risk of bleeding. A bloodless operation guarantees the best anatomical dissection, which gives the best results with an absolute minimum of damage to the parathyroid glands or recurrent nerves.
This treatment fulfills the objectives of an ideal preoperative treatment of hyperthyroidism.
Indications for peritoneo‐jugular shunt for ascites
Authors: LeVeen Harry H. , Wapnick Simon , Guinto Roy , Kinney Michael 
Published: April 2005

AbstractIn the past, refractory ascites was considered to be the only indication for insertion of an ascites valve with a peritoneo‐jugular shunt. Such patients required a prolonged hospital stay prior to surgery and often succumbed to acute renal failure. In the present study, every patient entering with massive ascites was placed on a low‐salt diet for 2 weeks. Eleven patients did not respond in a 2‐week period and were placed on a regimen of continued medical therapy starting with aldactone. Although most of these patients lost weight, onehalf of them died within 6 months. Only 1 patient in the entire group survived more than a year.Sodium clearance is a simple measurement which differentiates hepatorenal syndrome from acute tubular necrosis. The absence of natriuresis on diuretic therapy is an indication that surgery is required. Sodium and water retention are no longer problems in postshunt patients.In the absence of contraindications, failure of a patient to lose weight on a salt‐restricted diet would appear to be a useful guide for the shunt operation.
The recognition and management of gastroesophageal reflux without hiatal hernia
Authors: Hiebert Clement A. 
Published: April 2005

AbstractSince 1969, 40 additional patients with gastroesophageal reflux without demonstrable hiatal hernia have been identified, treated, and followed. Diagnosis is established from the clinical history of posturally aggravated symptoms plus the identification of a relaxed and incompetent lower esophageal sphincter on esophagoscopy. Esophageal pH studies and manometry may provide supporting evidence when necessary. Twenty‐five of the 31 patients treated by the Mark IV Belsey procedure had a good to excellent result when scored on the basis of durable relief from preoperative reflux symptoms, as well as the ability to swallow easily, belch, and, when necessary, vomit.
Mark IV repair of hiatal hernia by the transthoracic approach
Authors: Belsey Ronald 
Published: April 2005

AbstractFollowing 10 years of clinical evaluation of various surgical techniques for control of gastroesophageal reflux, the Mark IV repair was developed and has now been used in over 2,000 patients. The operation is performed through a left posterolateral thoracotomy and entails extensive mobilization of the esophagus up to the aortic arch with preservation of the vagus nerves, and a 240 degree semi‐fundoplication between the stomach and esophagus. The lower esophagus and its sphincter are returned to the abdomen when possible, and the two halves of the right crus of the diaphragm are gently approximated to create a posterior buttress. When indicated, surgical treatment of associated upper abdominal disorders can be accomplished through the thoracic approach. A review of 892 patients who had undergone Mark IV repair during a 10‐year period showed that 84% had an excellent or good result with an 86% follow‐up rate. The over‐all recurrence rate was 11%, with indications that a significant number of failures were due to deviations from the standard Mark IV technique. Surgical treatment of recurrent hiatal hernia by the Mark IV technique is technically difficult. Of the 892 patients reviewed in 1972, the late results in 98 were classified as unsatisfactory. Of these, 45 required further surgical treatment which consisted of a second Mark IV repair, resection of the cardia and reconstruction, or gastric resection. The late results of reoperation were excellent or good in 75% of patients. Dilatable strictures may be treated by the Mark IV repair, but there is only a 50% chance of success. Undilatable strictures require resection followed by interposition of left colon or jejunum. Prevention of stricture by recognition and treatment of reflux esophagitis is the best management.
Indications and techniques for the use of heparin in the treatment of thromboembolism
Authors: Deykin Daniel 
Published: April 2005

AbstractHeparin acts by binding to antithrombin, thereby potentiating its ability to destroy activated clotting factors. There are two distinct, mutually exclusive modes of heparin therapy. These are (a) full‐dose intravenous heparin for treatment of established venous thromboembolic disease, and (b) low‐dose subcutaneous heparin for prevention of venous thrombosis in patients at risk. Substantial evidence from prospective clinical trials indicates that heparin is the single most effective agent in both the prevention and treatment of venous thromboembolic disease. Although the administration of heparin necessarily increases the risk of bleeding, attention to details of treatment can minimize that risk. In the appropriate clinical setting, heparin is truly a lifesaving drug.
The aarhus county vagotomy trial
Authors: Amdrup Erik , Andersen Daniel , Høstrup Hans 
Published: April 2005

AbstractSince June, 1972 a total of 830 patients have been consecutively operated on electively for proven duodenal, pyloric, or prepyloric ulcer. For various reasons 82 patients were excluded, while 748 were allocated at random to parietal cell vagotomy (PCV) or selective gastric vagotomy (SGV). A drainage (D) was added to PCV in 68 patients with gastric retention. In the SGV group, a secondary randomization between antrectomy (A) and drainage was performed when the peak acid output response to pentagastrin was 45 mEq/h or more. The patient material comprised 353 SGV + D, 54 SGV + A, 273 PCV, and 68 PCV + D. Five patients died postoperatively from cardiovascular disease (0.7%). Splenectomy was necessary in 4%, and 5 patients sustained an operative perforation of the esophagus or the cardia which was recognized at operation and successfully treated. Postoperative complications were evenly distributed, but were milder after PCV. Only 11% of patients with PCV were discharged from the hospital later than the 10th postoperative day, compared to 19% of patients after SGV + D. No patients had postoperative gastric retention after PCV, while 20 patients had retention after SGV + D, and in the following years vomiting was less frequent after PCV than after the other operations. A transitory dysphagia occurred in 9% of all patients and subsided in a couple of months. Dumping occurred significantly less frequently after PCV without D than after the other operations and was considerably milder. The addition of D to either PCV or SGV led to a similar incidence of dumping. It is concluded that it is unnecessary to add a drainage procedure to PCV and that PCV without D is followed by milder postoperative complications and a lower rate of sequelae than other operations for duodenal ulcer.
The role of staging laparotomy in combined modality therapy of Hodgkin's disease: A new treatment plan based on a 6‐year experience
Authors: Wilson Richard E. , Osteen Robert T. , Rosenthal David S. , Mauch Peter M. , Goodman Robert L. 
Published: April 2005

AbstractFrom 1969 to 1974, staging laparotomy was performed on 187 consecutive patients with Hodgkin's disease. Laparotomy changed the type of therapy in 59 of 187 patients (32%). Major staging revisions were: IIA to IIIA, 20 patients; IIIA to IA, 6 patients; IIIA to IIA, 12 patients; IIB to IIIB, 14 patients; and IIIB to IIB, 4 patients. Of stage II patients, 32 of 101 (32%) became stage III and of stage III patients, 24 of 61 (39%) became stage I or II. Forty‐four patients with stage IIIA disease received 3,600–4,000 rad total nodal irradiation and their probability of relapse‐free survival at 5 years was 52%. No relapses occurred in 11 stage IIB patients given combination of mantle and periaortic irradiation plus MOPP. Only 3 of 19 stage IIIB patients treated with total nodal irradiation and MOPP relapsed. Stage IIB patients with combined therapy had a diseasefree survival of 100%, while stage IIIB patients had a relapse‐free survival of 77%. These striking results have led to a new treatment plan. Clinical stage IIA, pathological stage IIIA patients, and those with stage IIB disease now receive a combination of mantle and periaortic irradiation plus MOPP. Clinical stage IIIA, pathological stage IIIA patients, as well as those with stage IIIB disease, receive total nodal irradiation and MOPP. Surgical staging in this series has proved essential for effective and precise therapy.
A closed system surgical isolator for major elective abdominal operations
Authors: Joffe Stephen N. , Thomson William O. , McGavigan James , Trexler P. C. 
Published: April 2005

AbstractThis prospective unranclomized study examined the usefulness of a closed system disposable surgical isolator that provided a germ‐free environment for abdominal surgical procedures. In 30 patients who underwent clean and clean‐contaminated operations, only 1 patient (3.3%) developed a stitch abscess compared to an 11.2% incidence of major wound infection in 170 similar operations performed under conventional operating room conditions (p<0.05). The surgical isolator did not delay the operation, gave excellent visibility, and did not interfere with surgical access. The surgical isolator provided a sterile environment despite environmental contamination with a variety of organisms, especially penicillinase‐producingS. aureus, and deserves further assessment in high‐risk patients in general surgery including transplantation surgery.