bluuebunny/crossref_metadata_2025_split huggingface dataset:
Indications and Complications of Latissimus Dorsi Myocutaneous Flaps in Oncologic Breast Surgery
Authors: Apffelstaedt J. 
Published: November 2003

AbstractThe use of the latissimus dorsi myocutaneous flap (LDMF) in reconstructive breast surgery is well documented. Few reports exist of its use in oncologic breast surgery. This series describes indications and complications of the LDMF in locally advanced cancer. The records of 83 patients were analysed for age and sex, menstrual status, stage, indication, margins of resection, chemotherapy, radiotherapy, complications, and survival. The indication was to cover defects caused by resection of locally advanced breast cancer (67 cases), recurrent breast cancer (13 cases), radiation damage (2 cases), and surgical complications (1 case). The mean age of the patients was 50.2 years; 52% were postmenopausal. The flaps had mean diameters of 32 by 14 cm. The donor site was skin grafted. Clear margins were achieved in 83%. At the LDMF insertion site, wound infection required drainage in 1 case; flap necrosis required reintervention in 7 cases. In 2 cases a second skin graft was done for the LDMF donor site. The proportions of wound infections and incomplete skin graft take were significantly greater in patients receiving preoperative cyclophosphamide/methotrexate/5‐fluorouracil (CMF) versus cyclophosphamide/doxorubicin/5‐fluorouracil (CAF) chemotherapy (p <0.001 and p <0.05, respectively). The late complication rate was 7.2%. The mean follow‐up is 40.0 months. The complication rates for CMF versus CAF chemotherapy suggest an adverse effect of methotrexate, which warrants further investigation. The use of the LDMF made wide resection of locally advanced lesions and radionecrosis possible; major complications were rare. LDMF has its place in the armamentarium of the surgeon who regularly sees locally advanced breast cancer.
Gastrointestinal Recovery and Outcome after Laparoscopy‐assisted versus Conventional Open Distal Gastrectomy for Early Gastric Cancer
Authors: Mochiki Erito , Nakabayashi Toshihiro , Kamimura Hitoshi , Haga Norihiro , Asao Takayuki , Kuwano Hiroyuki 
Published: November 2003

AbstractLaparoscopy‐assisted gastrectomy has been increasingly reported as the treatment of choice for early gastric cancer. However, there is little information regarding the benefits of laparoscopy‐assisted distal gastrectomy (LADG). LADG and conventional open distal gastrectomy (DG) for early gastric cancer were compared in terms of operative outcome, recovery of bowel function, complications, and changes in body weight. Thirty‐four patients underwent LADG for early gastric cancer. These patients were compared with 31 patients who underwent DG during the same period. For estimating gastrointestinal motility recovery, 20 radiopaque markers were inserted into the duodenum during surgery, and abdominal X‐rays were taken daily until all markers were seen in the ascending colon. Age, gender, and histologic differentiation of the lesions were matched. The LADG group required a significantly longer operative time and the dissection of fewer lymph nodes. Postoperative hospital stay and the occurrence of postoperative complications (ileus) were significantly shorter and less frequent in the LADG group. The LADG group showed a more rapid recovery of gastrointestinal motor function compared with the DG group during the early postoperative period. Body weight 24 months after LADG was about 100% of pre‐illness weight, but no further weight change was encountered in the DG group. For selected patients with early gastric cancer, LADG with lymphadenectomy can provide a rapid recovery and good quality of life without compromising the cure rate.
Dehydroepiandrosterone Sulfate and Growth Axis Hormones in Patients after Surgery
Authors: Osorio Alvaro , Vara‐Thorbeck Rafael , Rosell Jorge , Osorio Carlos , Ortega Esperanza , Ruiz‐Requena Estrella 
Published: November 2003

AbstractWe selected 38 patients scheduled for cholecystectomy and studied their serum concentrations of dehydroepiandrosterone (DHEA) and growth axis hormones [growth hormone/insulin‐like growth factor‐1 (GH/IGF‐1)]. We aimed to determine whether alterations in these concentrations resulted from surgical stress or, on the contrary, preceded surgery and were themselves a cause of chronic diseases that reduce life expectancy. We measured the serum concentrations of DHEA sulfate (DHEA‐S), ACTH,
cortisol, human GH (hGH), IGF‐1, and IGF‐1 binding protein‐3 (IGFBP‐3)
preoperatively and then 2 and 7 days after surgery; we also compared the preoperative findings with those of a healthy control group. The results were analyzed by gender because DHEA and GH/IGF‐1 are known to present sexual dimorphism. There were no significant differences between the preoperative and control results for any of the parameters studied. We found a significant reduction in the concentrations of DHEA‐S and IGF‐1 on days 2 and 7 after surgery versus the preoperative values. We conclude that the decrease in DHEA‐S in patients after surgery is a result of surgical trauma and does not precede surgical stress. The decrease in hormone levels observed in patients with chronic disease may therefore be a result, not a cause, of disease, as some have claimed. Further studies with a later endpoint would be of interest to assess any subsequent return of DHEA‐S levels to baseline measurements.
Clinical Outcome of Proximal versus Total Gastrectomy for Proximal Gastric Cancer
Authors: Shiraishi Norio , Adachi Yosuke , Kitano Seigo , Kakisako Kenji , Inomata Masafumi , Yasuda Kazuhiro 
Published: November 2003

AbstractTumors in the upper one‐third of the stomach has been increasing. Although the standard operation for proximal gastric cancer has been total gastrectomy, some have used proximal gastrectomy reconstructed by jejunum or gastric tube. The aim of this study was to evaluate the surgical results, hospital costs, and quality of life after gastrectomy for cancer. A consecutive series of 51 patients with stage I or II proximal gastric cancer was studied: 14 underwent proximal gastrectomy reconstructed by gastric tube (direct anastomosis between esophagus and remnant of tube‐like stomach), 17 proximal gastrectomy reconstructed by jejunum, and 20 total gastrectomy in Roux‐en‐Y fashion. Quality of life was estimated by a 24‐item questionnaire with a scoring system of 1 to 3, and hospital costs covered all charges during the hospital stay. Operating time, blood loss, and hospital stay for the gastric tube group were less than those for the jejunum group or the total gastrectomy group. Hospital charges for the gastric tube group were lower than those for the jejunum group or the total gastrectomy group (141 × 10 4 yen, 179 × 10 4 yen, 211 × 10 4 yen, respectively). Although the total score for quality of life was not significantly different among the three groups (35.9, 39.5, 37.6), the number of meals per day was less and the performance status was better in the gastric tube group. Jejunal interposition was less favorably accepted by the patients as a good operation they would recommend to others. The results indicate that, in patients with proximal gastric cancer, proximal gastrectomy reconstructed by gastric tube provides a shorter operating time, earlier recovery, lower hospital charge, and better performance status when compared with proximal gastrectomy reconstructed with jejunum or total gastrectomy.
One Hundred Citation Classics in General Surgical Journals
Authors: Paladugu Ramesh , Schein Moshe , Gardezi Syed , Wise Leslie 
Published: November 2003

AbstractThe number of times an article is cited in scientific journals reflects its impact on a specific biomedical field or specialty and reflects the impact of the authors’ creativity. Our objective was to identify and analyze the characteristics of the 100 most frequently cited articles published in journals dedicated to general surgery and its close subspecialties. Using the database (1945–1995) of the Science Citation Index of the Institute for Scientific Information, 1500 articles cited 100 times and more were identified and the top 100 articles selected for further analysis. The 100 articles were published between 1931 and 1990, with more than two‐thirds of them published after 1960. The mean number of citations per article was 405, (range 278–1013). Altogether, 84 of the articles originated from North America (USA 78, Canada 6) and the UK (12). New York State led the list of U.S. states with 14, and Harvard and Columbia University led the list of institutions with 6 articles each. The 100 articles were published in 10 surgical journals led by theAnnals of Surgery (n = 40), followed bySurgery (n = 15), Archives of Surgery (n = 12), Surgery, Gynecology and Obstetrics (n = 11), and British Journal of Surgery (n = 10). A total of 80 of the articles reported clinical experiences, 6 were clinical review articles, and 14 dealt with basic science. Eighteen articles reported a new surgical technique and six a prosthetic device. Gastrointestinal surgery and trauma and critical care led the list of the surgical fields, each with 25 articles, followed by vascular surgery (n = 15). Thirty‐four persons authored two or more of the top‐cited articles. This list of the top‐cited papers identifies seminal contributions and their originators, facilitating the understanding and discourse of modern surgical history and offering surgeons hints about what makes a contribution a "top‐cited classic." To produce such a "classic" the surgeon and his or her group must come up with a clinical or nonclinical innovation, observation, or discovery that has a long‐standing effect on the way we practice—be it operative or nonoperative. Based on our findings, to be well cited such a contribution should be published in the English language in a high‐impact journal. Moreover, it is more likely to resonant loudly if it originates from a North American or British "ivory tower."
Pedunculated Hepatocellular Carcinoma: Clinicopathologic Study of 18 Surgically Resected Cases
Authors: Yeh Chun‐Nan , Lee Wei‐Chen , Jeng Long‐Bin , Chen Miin‐Fu 
Published: November 2003

AbstractWe present the clinical features and outcomes of 18 surgically treated pedunculated hepatocellular carcinomas (P‐HCCs). Hepatocellular carcinoma is a notorious, hyperendemic disease in Taiwan. Pedunculated HCC, although not a novel finding, has been recognized and diagnosed early by various imaging modalities. However, the clinicopathologic picture has not been fully clarified, and the prognosis varies in each report. From 1986 to 1998 the clinical features of 18 surgically treated cases of P‐HCC were reviewed, including demographics, laboratory data, operative findings, pathologic features, and follow‐up results. Factors that may influence the outcomes were also analyzed. Clinical features and outcomes of 414 patients with nonpedunculated hepatocellular (HCC) were summarized for comparison. Of 432 surgical resected hepatocellular carcinomas, 18 (4.2%) were P‐HCCs. Larger tumor size, more capsule formation, less vascular invasion, and wider resection margins were significantly prominent in the patients in P‐HCC group compared with those in the NP‐HCC group. Multivariate stepwise logistic regression analysis revealed that the P‐HCC group had significantly larger tumors and wider resection margins. The 1‐, 3‐, and 5‐year survival rates of P‐HCC patients were 88.3%, 77.4%, and 45.6%, respectively. A significant difference in survival was found between the P‐HCC and NP‐HCC groups. P‐HCC patients without vascular invasion might have a significantly better survival demonstrated by log‐rank analysis stratified by capsular invasion, vascular invasion, resection, and tumor size. We present the clinical features and outcomes of 18 surgically treated pedunculated HCCs. Pedunculated HCCs might have a better survival than conventional HCCs after hepatic resection, especially if there is no vascular invasion.
Surgical Correction of Main Stem Reflux in the Superficial Venous System: Does It Improve the Blood Flow of Incompetent Perforating Veins?
Authors: Al‐Mulhim Abdulrahman Saleh , El‐Hoseiny Hamdoun , Al‐Mulhim Faisal Mohammed , Bayameen Omar , Sami Mohamad Mahmoud , Abdulaziz Khalid , Raslan Mahmoud , Al‐Shewy Ali , Al‐Malt Majid 
Published: November 2003

AbstractFifty‐seven limbs (33 patients) with chronic venous ulceration were selected for this study. The criterion for selection was the presence of isolated superficial venous reflux. Long saphenous vein reflux alone was observed in 39 (68.4%) limbs, short saphenous vein reflux alone in 4 (7.0%) limbs, and both long and short saphenous vein reflux in 14 (24.6%) limbs. Surgical correction of the refluxing saphenous system has allowed 46 (80.7%) ulcers to heal. The healing rates for all the ulcerated legs that had long saphenous vein reflux, short saphenous vein reflux, or a combination of the two were 85.4%, 75.0%, and 66.7%, respectively. Incompetent perforating veins (IPVs) were observed in 51 (89.5%) limbs; 74.5% of them regained their competence postoperatively (189 preoperatively vs. 59 postoperatively; p < 0.001), with a significant reduction in their mean diameter (p < 0.001). IPVs remained in 13 (25.5%) limbs: 3 limbs with persistent reflux in the tributaries of the saphenous system, 1 limb with a fixed ankle joint, and nine limbs with no evidence of macrovascular venous disease. In patients with a competent deep venous system, reflux in perforating veins is often abolished after eradication of saphenous reflux.
18‐Fluorodeoxyglucose‐Positron Emission Tomography in Inflammatory Breast Cancer
Authors: Baslaim Muna M. , Bakheet Siema M. , Bakheet Razan , Ezzat Adnan , El‐Foudeh Mahmoud , Tulbah Asma 
Published: November 2003

AbstractInflammatory breast cancer (IBC) is the most aggressive form of locally advanced breast cancer. It can be diagnosed based on a clinical or pathologic basis. We evaluated the usefulness of 18F‐fluorodeoxyglucose‐positron emission tomography (FDG‐PET) scans for diagnosing and staging IBC. We retrospectively reviewed the medical records of seven consecutive patients with IBC who underwent FDG‐PET scanning for the initial staging. Four patients had follow‐up PET scans after chemotherapy. All seven patients presented with diffuse breast enlargement, redness, and peau d’orange for 1 to 5 months’ duration. In addition, four patients had a palpable breast mass, and three had axillary lymph node enlargement. Mammography showed diffuse, increased parenchymal density and skin thickening in 85% and parenchymal distortion in 43%. There was no evidence of distant metastasis on computed tomography of the chest or abdomen. Pathologic examination of breast biopsy specimens showed infiltrating ductal carcinoma in six patients, and one had lobular carcinoma. All patients had prechemotherapy whole‐body PET scans that showed diffuse FDG uptake in the breast with superimposed intense foci in the primary tumor. Furthermore, there was skin enhancement in 100%, axillary lymph node in 85%, and skeletal metastases in 14% of the patients, confirmed by bone scintigraphy. Postchemotherapy FDG‐PET scans performed in four patients showed response in the primary tumor, axillary lymph nodes, and skeletal metastases. The FDG‐PET scan is thus useful for displaying the pattern of FDG breast uptake that reflects the extent of the pathologic involvement in IBC (i.e., diffuse breast involvement and dermal lymphatic spread). It can also detect the presence of lymph node and skeletal metastases, demarcating the extent of the disease locally as well as distally.
Expression of Elastic Components in Healthy and Varicose Veins
Authors: Buján Julia , Gimeno María J. , Jiménez Jose A. , Kielty Cay M. , Mecham Robert P. , Bellón Juan M. 
Published: November 2003

AbstractThis study evaluates possible changes in the synthesis/degradation of elastic components of the vein wall in an attempt to explain the development of varicosis. Healthy and varicose saphenous veins were subjected to immunohistochemical analysis using anti‐elastin, anti‐fibrillin‐1, anti‐elastase, anti‐transforming growth factor (TGF)‐β and anti‐latent TGFβ binding protein (LTBP)‐2 monoclonal antibodies. In situ hybridization was performed using specific probes for tropoelastin and fibrillin‐1. In healthy veins, elastin and fibrillin‐1 showed even, overlapping distribution patterns indicating their particular abundance in the adventitia and at the intima/media interface. The expression of tropoelastin and fibrillin‐1 was high in smooth muscle cells bordering the elastic laminae. Elastin, fibrillin‐1, and cells expressing fibrillin‐1 and tropoelastin mRNA showed a patchy disorganized pattern, particularly in the proximal varicose segments of patients under 50 years of age. Enhanced elastase activity was noted in both control and varicose specimens from elderly subjects. Varicose veins specimens showed greater LTBP‐2 and TGF expression. Both molecules were detected in the subendothelium and the media, particularly in areas of marked injury. Our findings suggest that the development of the varicose condition involves a restructuring of the elastic component of the vein wall, perhaps as a consequence of changes in the transcription mechanisms of muscle layer cells.
Laparoscopic and Thoracoscopic Partial Hepatectomy for Hepatocellular Carcinoma
Authors: Teramoto Kenichi , Kawamura Tohru , Takamatsu Susumu , Noguchi Norio , Nakamura Noriaki , Arii Shigeki 
Published: November 2003

AbstractSeveral trials have been reported examining laparoscopic liver resections for the treatment of various kinds of liver tumors. However, there are no detailed reports on the use of laparoscopic (LH) and thoracoscopic (TH) hepatectomy for the treatment of hepatocellular carcinoma (HCC). Eleven laparoscopic and thoracoscopic partial liver resections were attempted for treating HCC. The indications for performing a laparoscopic or thoracoscopic partial hepatectomy were as follows: (1) the tumor was located on the surface of the liver; (2) the tumor was less than 3 cm in diameter; and (3) the tumor was not located adjacent to any large vessels. A TH was performed if the tumor was located in segment 8; an LH was performed if the tumor was located in segment 3, 4, or 5. Hand‐assisted operations were performed in two patients. The mean operating time was 186.1 ± 44.0 minutes (range 130–310 minutes). The operative blood loss was 218.3 ± 197.6 ml (range 20–650 ml). The mean postoperative hospital stay was 11.3 ± 5.7 days (range 7–26 days). Two patients experienced postoperative complications (wound infection and ascites). No local recurrences have occurred to date. The overall 5‐year survival rate and disease‐free 5‐year survival rate were 75.0% and 38.2%, respectively. Laparoscopic and thoracoscopic hepatic resections are less invasive than conventional surgical techniques and are useful for treating HCC in select patients.
Stress Response to Hepatectomy in Patients with a Healthy or a Diseased Liver
Authors: Lan Albert Kuo‐Mao , Luk Hsiang‐Ning , Goto Shigeru , Chen Shyr‐Ming Sheen , Eng Hock‐Liew , Chen Yaw‐Sen , de Villa Vanessa H. , Wang Chih Chi , Cheng Yu‐Fen , Chen Chao‐Long , Lee Ju‐Hao , Jawan Bruno 
Published: November 2003

AbstractPartial hepatectomy is a major upper abdominal operation associated with certain stress to the patient. Successful adaptation to such stress is a prerequisite for survival. Donor hepatectomy with maximal safety is a principal concern during living donor liver transplantation. The purpose of the study was to compare the stress response by assessing cytokines and the acute‐phase response induced by hepatectomy in patients with a healthy liver and those with a diseased liver. Fourteen patients undergoing partial right hepatectomy were enrolled in this study. Seven of them were donors for living related liver transplantation (group I, or GI); the other seven were patients with hepatocellular carcinoma due to chronic hepatitis B (Child’s class A) (GII). Blood samples for interleukin‐6 (IL‐6), tumor necrosis factor‐α (TNFα), and C‐reactive protein (CRP) assays were collected before the operation, at the beginning and end of the operation, and 24 and 48 hours after the operation. The data were analyzed and compared in the same group using the Friedman test and between groups using the Mann‐Whitney U‐test. A value of p < 0.05 was regarded as significant. Results showed that resection of the liver in patients with both healthy and disease livers leads to significant increases in IL‐6 and CPR but not TNFα. Significantly lower levels of IL‐6 before and after operation in GI patients compared to those in GII patients suggests that GI patients adapted to surgical stress more easily than did the GII patients.
Medical and Radiation Oncology for Breast Cancer in Developing Countries with Particular Reference to Locally Advanced Breast Cancer
Authors: Murray Elizabeth M. 
Published: November 2003

AbstractThe first part of this review outlines the extent of the problem of breast cancer in developing countries, with particular reference to the difficulties surrounding breast cancer treatment in these countries. The second part is devoted to discussion of chemotherapy, hormonal therapy, and radiotherapy treatments suitable for developing countries. The goals of the review are to show how treatment strategies can be adapted in poorer countries and how oncologists from the developed world can play a role in developing countries. This review should be relevant to the developing world in general, but as the author comes from South Africa, many of the examples are from that country which has features of the developed and developing world.
Approach to Early Barrett’s Cancer
Authors: Stein Hubert J. , Feith Marcus , Rahden Burkhard A.H. v. , Siewert J. Rüdiger 
Published: November 2003

AbstractBecause of effective surveillance programs in patients with known Barrett’s esophagus, adenocarcinoma of the distal esophagus is increasingly diagnosed at early stages. With the introduction of limited surgical and endoscopic treatment modalities, the need for radical esophagectomy and extensive lymphadenectomy in such patients has been questioned. When selecting the approach to early Barrett’s cancer, the precancerous nature of the underlying Barrett’s esophagus, the frequent multicentricity of neoplastic alterations within the Barrett mucosa, the inaccuracy of current staging modalities, and the presence of lymph node metastases should be taken into account. Invasiveness and morbidity of the procedures, as well as quality of life aspects, should also be considered. From an oncologic point of view the minimum extent of a resection for early Barrett’s cancer should include a full‐thickness removal of the entire segment of the distal esophagus covered by intestinal metaplasia together with a regional lymphadenectomy. In appropriately selected patients this can be achieved by a limited surgical procedure involving transhiatal resection of the distal esophagus, but not by endoscopic mucosal ablation or endoscopic mucosa resection. Our experience with 49 limited surgical resections with regional lymphadenectomy indicates that this procedure is oncologically adequate and safe. Reconstruction with an interposed jejunal loop prevents postoperative gastroesophageal reflux and is associated with good quality of life. In contrast, endoscopic interventions are plagued by a high tumor recurrence rate, probably from persistence of Barrett’s mucosa and gastroesophageal reflux.