bluuebunny/crossref_metadata_2025_split huggingface dataset:
The effect of stored blood on mesenteric oxygen extraction during endotoxin shock
Authors: Garg Dinesh K. , Kaldis Louise G. , Miller Warren C. , Jacobson Eugene D. , Bowen John C. 
Published: May 2005

AbstractStorage of blood in acid‐citrate‐dextrose (ACD) solution gradually depletes red cell 2,3‐diphosphoglycerate (DPG) and increases the affinity of hemoglobin for oxygen. We examined the effect of exchange transfusion of DPG‐depleted blood on mesenteric blood flow and oxygen consumption in dogs subjected to endotoxin shock. Two groups of 6 dogs each were anesthetized and subjected to exchange transfusion with either fresh ACD blood or 21‐day‐old ACD blood prior to administration ofEscherichia coli endotoxin (2 mg/kg). Mesenteric blood flow, arteriovenous oxygen content difference and systemic arterial blood pressure were monitored continuously before and for 60 min after endotoxin. Mesenteric blood flow was reduced from 250±21 ml/min before endotoxin to 114±15 ml/min at 5 min, 157±29 ml/min at 30 min, and 112±17 ml/min at 60 min after endotoxin in the dogs exchanged with fresh blood. Corresponding values for intestinal oxygen consumption were 10.4±1.0, 7.5±0.8, 8.4±1.0, and 6.8±0.7 ml/min. In dogs transfused with 21‐day‐old blood, pre‐endotoxin blood flow was 208±2 ml/min and declined to 115±12, 93±5, and 80±8 ml/min at 5, 30, and 60 min post‐endotoxin. Corresponding values for intestinal oxygen consumption were 8.1±0.9, 6.6±0.7, 6.2±0.5, and 5.5±0.7 ml/min. There was no significant difference (p>0.1) in responses of blood flow or oxygen consumption to endotoxin shock between the two groups of dogs. These findings indicate that exchange transfusion with DPG‐depleted blood does not impair oxygen extraction by the ischemic intestine.
The effect of glucagon on pancreatic secretion and plasma secretin in dogs
Authors: Miller Thomas A. , Watson Larry C. , Rayford Phillip L. , Thompson James C. 
Published: May 2005

AbstractThe inhibitory effect of glucagon on pancreatic exocrine secretion induced by endogenously released secretin was studied in 4 dogs with chronic pancreatic fistulas and open gastric fistulas. After a constant level of pancreatic secretion was established by intraduodenal hydrochloric acid perfusion (9 mEq/hr), glucagon (30Μg/kg‐hr) was administered intravenously for 1 hr. Compared to a separate control study in which dogs received intraduodenal HCl alone, glucagon caused a significant decrease in both pancreatic volume flow and bicarbonate output. Glucagon had no effect on pancreatic protein secretion, and circulating levels of endogenously released secretin remained unchanged. It is concluded that the inhibitory effect of glucagon on pancreatic secretion is not mediated through inhibition of secretin release. The chemical homology between glucagon and secretin suggests that glucagon may mediate its inhibitory action by competing with secretin at the level of the pancreatic receptor site.
Epidemiology of cancer of the stomach
Authors: Yamagata Shoichi , Hisamichi Shigeru 
Published: May 2005

AbstractThe epidemiologic study of cancer is based primarily on mortality, morbidity, clinical, and autopsy statistics. The analysis of the results of a mass survey examination of the stomach has contributed considerably to the epidemiologic study of gastric cancer. We present a survey of the literature on stomach cancer mortality and incidence in relation to geography, age, sex, race, and environment. Thereupon, we offer the results and evaluate the effects of a mass survey examination of the stomach which was begun in 1960 in Miyagi Prefecture, Japan. It is to be noted that the mortality rate from stomach cancer per 10,000 persons per year in the nonexamined group was approximately 2.4 times higher than that of the examined group.
Precancerous lesions of the stomach
Authors: Yamagata Shoichi , Hisamichi Shigeru 
Published: May 2005

AbstractThe etiology of stomach cancer in relation to preexisting mucosal alterations is described and discussed from a review of the literature and our own previously reported experience. The incidence of “cancerization” or malignant change of gastric polyp, chronic gastric ulcer, and chronic gastritis varies considerably from researcher to researcher. Clinical follow‐up studies in many cases of gastric polyp and chronic ulcer discovered in the mass survey examination of the stomach revealed incidences of malignant degeneration of 2.3% of the gastric polyp cases and 2.06% of the gastric ulcer cases.
Diagnosis of advanced gastric cancer
Authors: Nagao Fusahiro , Takahashi Nobuhiro 
Published: May 2005

AbstractA series of 536 patients who underwent gastric resections for advanced gastric cancer has been reviewed with regard to the diagnostic procedures for detecting gastric cancer. There were no characteristic symptoms of gastric cancer, but weight loss was a frequent complaint. Variation in the type and frequency of symptoms did not appear to depend on the presence or absence of metastases. Patients whose operations were delayed more than one year after the onset of symptoms accounted for 33% of the series, and 38% of these had visited their physicians within 6 months after the onset of symptoms but were misdiagnosed as having chronic gastritis or benign ulcer. The results of various laboratory examinations were not specific. Gastric acidity was found to be distinctly lower than in patients with benign gastric disease. Techniques of radiology, endoscopy, and endoscopic biopsy of the stomach have greatly improved, and the overall rates of correct diagnosis of gastric cancer were 96% by x‐ray, 98% by endoscopy, and 90% by biopsy. These rates were slightly lowered when only Borrmann type IV lesions were considered. Celiac angiography was useful to determine the extent or depth of cancerous invasion and to detect liver metastases. The frequency of positive PPD or DNCB skin tests appeared to decrease as the stage of cancer advanced, indicating immunologic impairment in advanced gastric cancer.
Stump cancer following gastric surgery
Authors: Nicholls John C. 
Published: May 2005

AbstractThis paper reviews the literature regarding the development of gastric cancer in the stomach remnant following gastric resection. Although there is as yet little supporting experimental evidence, clinical studies suggest that the risk of developing gastric cancer is increased, perhaps as much as 6‐fold, following partial gastrectomy for benign lesions. It also appears that the risk of developing cancer is greatest if the lesion for which the gastrectomy was originally performed was a gastric ulcer rather than a duodenal ulcer. The type of gastrectomy does not seem to influence this increased risk. Hypotheses are reviewed concerning the role of changes in gastric morphology following partial gastrectomy in the development of cancer.
Cimetidine and the gastric surgeon
Authors: Clark Charles G. , Boulos Paul B. 
Published: May 2005

AbstractA study of the effects of cimetidine has been made in patients referred to a surgical clinic. Cimetidine is undoubtedly useful in aiding the healing of acute duodenal ulcers, but once treatment is stopped, the majority recur. After healing, maintenance treatment is useful in preventing ulcer recurrence, but once the drug is stopped, recurrence soon follows. At present the evidence suggests that treatment with cimetidine may have to be life‐long. Most surgeons would not accept this as an alternative to surgery in the treatment of chronic duodenal ulcer. However, in the treatment of recurrent ulceration after surgery, and where symptoms are relieved by cimetidine, the patient may prefer drugs to further operation.
Radiotherapy for esophageal carcinoma
Authors: Pearson James G. 
Published: May 2005

AbstractDuring the last 30 years, there have been improvements in radiotherapy not matched by improvements in earlier diagnosis. The screening program in the People's Republic of China is an exception. For lower incidence areas, greater patient and physician awareness and the addition of brushings, washings, and cytology to improved barium studies and endoscopy for the earlier investigation of dysphagia may contribute to earlier diagnosis and thus more effective radiotherapy.There are no experimental data to prove that either surgery or radiotherapy is preferable in the management of the various categories of esophageal cancer; however, close teamwork between the disciplines is fruitful. Neither radio‐therapy nor surgery for esophageal cancer is optimal in the hands of the occasional practitioner. In communities where radiotherapy and surgery are both highly developed and closely associated, optimal benefit is likely to be achieved if patients with squamous carcinoma of the middle and upper thirds of the esophagus are treated initially by radiotherapy with surgery held in reserve for local recurrences, and patients with squamous carcinoma of the lower third and all adenocarcinomas are treated surgically unless medically unfit. For the patients treated primarily by surgery, preoperative radiotherapy may help.Patients with more advanced disease can usually be helped by palliative radiotherapy, with intubation held in reserve until an adequate fluid diet can no longer be swallowed.Prevention is conceivable and would be unquestionably preferable.
Parenchymal cell mass determination in parathyroid glands and its application in a material of hyperparathyroidism
Authors: åkerström G. , Grimelius L. , Johansson H. , Pertoft H. , Lundqvist J. 
Published: May 2005

AbstractParencbymal cell mass determination with a density gradient technique was used as a supplement to the histological examination of parathyroid glands in a series of patients operated on for hyperparathyroidism. The parenchymal cell mass was easily determined intraoperatively and constituted an objective parameter in the differentiation between normal and abnormal parathyroid glands. It is suggested that such objective determinations of the parenchymal cell mass should be considered in parathyroid histological diagnosis.
Clinical characteristics and surgical results in hyperparathyroidism caused by water‐clear cell hyperplasia
Authors: Tisell Lars ‐Eric , Hedman Ingmar , Hansson Göran 
Published: May 2005

AbstractTwenty‐nine patients were treated for water‐clear cell hyperplasia (WCCH) of the parathyroid glands and 531 for single adenoma during a 26‐year period ending in 1978. The annual incidence of WCCH did not change during the period, whereas the number of adenoma cases markedly increased. Patients with WCCH had higher serium calcium levels and more severe disease than did those with adenoma. Mental symptoms and impaired renal function were especially common, and 4 patients later died of renal failure. The reversed sex ratio, with more men than women among the WCCH patients, can explain their higher prevalence of renal calculi. Operative treatment resulted in a cure of hyperparathyroidism (HPT) in 24 WCCH patients, 7 of whom developed hypocalcemia. Five patients remained hypercalcémie. Because of the morbidity of WCCH, persistent HPT should be avoided and more radical surgery performed than is currently recommended.
Trauma severity scoring to predict mortality
Authors: Champion Howard R. , Sacco William J. , Hunt Thomas K. 
Published: May 2005

AbstractThe evaluation of the care of the multiple trauma patient requires indices that predict survival or death and that reveal the presence or absence of complications. This article reviews briefly the different scales that have been developed. It is concluded that both anatomic and physiologic injury scores are required. A methodology of patient care evaluation is then developed based upon preliminary method (PRE), a state transition screen (STS), and a definitive method (DEF). The preliminary method is illustrated by use of the Trauma Score and the Injury Severity Score to predict patient outcome. This is then compared with the actual patient outcome. The STS methodology reveals patients who are better or worse than expected in their course in the hospital. The DEF method is used for comparison between institutions or for different time periods at a given institution.
The injury severity score
Authors: Goris R. J. A. 
Published: May 2005

AbstractThe assets and drawbacks of ISS are documented, utilising 2 groups of patients with blunt multiple trauma. Group I consisted of 80 patients with 417 fractures and 163 major associated injuries. Group A had early fracture stabilization and prophylactic ventilation, Group B had early fracture stabilization without prophylactic ventilation, Group C had delayed fracture stabilization and prophylactic ventilatory support. Utilising the ISS, subgroups of A and C were constructed that had injury severity scores ≥ 50 (means 57 and 58.7) containing 19 and 11 patients. Group A had a 10% mortality rate, a late sepsis mortality rate of 6%, and ARDS incidence of 26%, and a mean duration of ventilation of 6 days, while group C had a late sepsis mortality rate of 55%, and ARDS incidence of 82%, and a mean duration of ventilation of 26 days. It is concluded, that early operative stabilization of fractures is safe, and in significant part is associated with a reduced number of late sepsis deaths while reducing the duration of ventilator support required, and that prophylactic ventilator support (i.e., continued support after surgery significantly reduces the incidence of ARDS).Group II consisted of all blunt trauma patients with an ISS greater than 20, admitted during 1981. Sixty‐eight patients were admitted and the correlation was sought between ISS and mortality. It was concluded, that death exclusively from central nervous system injury should be analyzed separately from death from other causes in multiply injured patients. Reference is made to other applications of ISS than the documentation of mortality and suggestions are made for improving ISS by including the Glasgow‐coma scale and including patients related risk data. A plea is made to devise a standard method for ISS calculation.
The pulmonary response to trauma and mechanical ventilation: Its consequences on hemodynamic function
Authors: Laver Myron B. 
Published: May 2005

AbstractThe lung and heart, including the right ventricle (RV) and left ventricle (LV), must be regarded as an integrated system. A change in function of any one, including the addition of mechanical ventilation, will induce a change in function of the other. Interaction between RV and LV primarily via the septum and initially independent of pericardial constraints, is now a fact of life that complicates the evaluation of either left or right ventricular function as an isolated system. In this setting, an increase in LV filling pressure at constant stroke volume need not reflect straightforward myocardial depression. A change in motion of the interventricular septum represents an important variable that modifies the usual evaluation of function based on the Frank‐Starling relationship.The RV is susceptible to large changes in volumes with small changes in filling pressure. These variations can have a significant effect on LV end‐diastolic compliance and may result in RV ischemia due to an excessive elevation of RV free wall stress when right coronary artery disease or an inadequate systemic perfusion pressure is present.
Brain injuries in polytrauma
Authors: Bakay Louis 
Published: May 2005

AbstractThe magnitude of the cerebral injury is the ultimate determining factor in survival versus death and ability versus disability in most multiple trauma patients. The acute failures of oxygen transport that occur in these patients can clearly increase the magnitude of the brain injury. This occurs either via cardiopulmonary failure or prolonged epileptic seizures. Both sources must be quickly reversed. The magnitude of the brain injury may also be increased by delayed diagnosis of expanding intracranial lesions. The rapid availability of computed tomography (CT) scans of the head is of great importance in the early diagnosis of intracranial lesions. In the absence of CT scans, skull x‐rays and cerebral angiography in association with sequential evaluations of consciousness and neurological function are useful. Medications that change the state of consciousness interfere with such follow‐up and should be avoided if at all possible.Acute extradural hematomas are generally not associated with much initial brain damage and produce rapidly progressive brain damage. Therefore, their treatment constitutes an absolute neurosurgical emergency. If these coexist with intra‐abdominal bleeding, then 2 operating teams should proceed simultaneously. In contrast, both intracerebral and subdural hematomas reflect relatively severe initial brain damage which cannot be changed and produce a slower rise in pressure and thus a slower rate of destruction of additional brain tissue. The time scale for treatment of these lesions is, therefore, longer than that for extradural hemorrhages.Additional brain damage may also be produced by cerebral edema. The intracranial pressure is best monitored in trauma cases by pressure monitoring bolt. The preferred agents for therapy are clearly mannitol acutely (0.5 to 1.5 g/kg body weight as a single dose) followed by a continuous infusion with an osmolality maintained at 315 to 320 mOsm. Lasix® may also be used. In the absence of control of intracranial pressure, then barbiturate coma may be utilized (3 to 5 mg/kg as an initial dose followed by maintenance of plasma levels at 2.5 to 3.5 mg/100 ml).
Intra‐abdominal injuries in polytrauma
Authors: Polk Hiram C. , Flint Lewis M. 
Published: May 2005

AbstractThe most important preoperative objective in the management of the patient with abdominal trauma is to ascertain whether or not a laparotomy is needed and not the diagnosis of a specific organ injury. This objective is complicated in multiple trauma patients by the extra‐abdominal injuries which change the abdominal findings. Peritoneal lavage is of great help in making this decision. The second important decision relates to whether or not the control of abdominal blood loss is to be achieved as a part of or after cardiopulmonary resuscitation. Clearly, the blood bank must be alerted and sufficient personnel must be available to pump the blood. Such surgery must always be conducted under full physiologic monitoring of cardiopulmonary function, with a warming blanket to prevent hypothermia, and with x‐ray facilities. The third decision concerns the role of the laparotomy in the treatment of the other injuries the patient has received. It is usually wise to have 2 operating teams at work.Given the nature of blunt trauma it is wise to prepare the patient from the sternal notch to mid‐thighs so that any surgical eventuality may be managed. This is associated with a long midline incision. The first operative objective is control of hemorrhage; the second, prevention of further contamination; and the third, a precise diagnosis of the anatomy of each injury. The subsequent objectives for liver, pancreaticoduodenal, gastrointestinal, and splenic injuries are discussed in detail. In the severely contaminated abdomen, delayed primary closure of the wound above the fascia is utilized.
Vascular injuries in polytrauma
Authors: Heberer G. , Becker H. M. , Dittmer H. , Stelter W. J. 
Published: May 2005

AbstractIn our surgical clinic, from January 1, 1978, to May 15, 1982, a total of 41 patients with polytrauma exhibited 45 concomitant vascular injuries requiring operation. This group of patients represents 10% of the 407 multiple trauma patients treated during this period. The incidence of vascular lesions of shoulder, neck, and upper extremities was 2.7% (n=11); lower extremities, 4.7% (n=19); within the abdominal cavity, 1% (n=4); and of acute thoracic aortic rupture, 2.7% (n=11). Seven patients (17%) died: 4 from additional brain trauma, 3 from hemorrhage by aortic ruptures. There were 6 major amputations (2 primary, 4 secondary) and 2 borderline amputations. In the remaining 26 patients, a good result following vascular repair was achieved. Angiologic examination, including computed tomography and angiography, is of great importance. Vascular repair deserves high priority since bleeding and/or ischemia threatens the patient's limbs, organs, or even life. This is especially true for the acute thoracic aortic rupture as a typical vascular injury in polytrauma. The incidence of peripheral vascular injuries in polytrauma is twice as high (7.3%) as in isolated extremity fractures (3.6%).
Osteosynthesis of major fractures in polytrauma
Authors: Tscherne H. , Oestern H. J. , Sturm J. 
Published: May 2005

AbstractThe treatment of multiple trauma patients is subdivided into pre‐hospital and hospital periods. The hospital period is divided according to diagnostic and therapeutic measures into acute, primary, secondary, and tertiary periods. In the acute period, all life‐threatening injuries, e.g., severe abdominal bleeding, are treated. In the primary period, visceral injuries such as bowel rupture and fractures with vessel injuries, open fractures, open joints, severe compartment syndromes, and closed femoral fractures require surgery. In the secondary period, prolonged joint reconstructions, closed fractures of the forearm, and partially reconstructive surgery are performed. In the tertiary period, reconstructive surgery is done (e.g., cancellous bone grafts). Using this regimen in multiple trauma patients, we not only obtain restoration of vital function, but also good restoration of the extremities is achieved.
Maxillofacial injuries in polytrauma
Authors: Spiessl B. 
Published: May 2005

AbstractMaxillofacial surgery can make a substantial contribution to the optimal care of the multiple trauma patient when it is integrated into a coordinated, interdisciplinary overall treatment scheme. With regard to the priority of indication (i.e., reanimation, first surgical phase, stabilization phase), we seldom (1% of cases) have to perform emergency surgery (priority 1) to stop bleeding from the maxillary artery. Clinical and radiographic diagnostic measures can be kept to a minimum, since treatment of the facial skeleton is generally indicated at the end of the stabilization phase (priority 3). As a basic rule, the treatment should be definitive and should be aimed at early mobilization. This requires the uncompromising application of rigid internal fixation.
The neuroendocrine response to multiple trauma
Authors: Gann Donald S. , Lilly Michael P. 
Published: May 2005

AbstractThe neuroendocrine response to multiple trauma is a coordinated, complex, changing response which has as its objective maintenance of life by preserving oxygen delivery and the mobilization and utilization of the synthetic and energetic substrates required by the body.The afferent system is composed of neural input from the various chemoceptors, nociceptors, and baroceptors which monitor normal bodily function, in addition to the effects of plasma factors directly on the brain (e.g., glucose and amino acids). The efferent system is composed of the autonomic nervous system and the output of the anterior and posterior pituitary and other hormones. The efferent response is shown by measurements of ACTH, arginine vasopressin, growth hormone, prolactin, norepinephrineepinephrine, and opiate peptides. This efferent output then modulates the response of the pancreatic islets with the observed changes in glucagon and insulin and of the adrenal glands with additional changes in the catechol‐amines and cortisol. The renin‐angiotensin‐aldosterone system involving the kidney and adrenal gland is another responding system.The preceding relationships are discussed in some detail. Restoration of normal neuroendocrine function is best achieved by prompt restoration of blood volume, relief of pain and anxiety, restoration of normal food intake, excision of damaged tissue, and prevention of subsequent organ failure (e.g., pulmonary).