bluuebunny/crossref_metadata_2025_split huggingface dataset:
Postoperative wound infections and surgical face masks: A controlled study
Authors: Tunevall Th. Göran 
Published: May 2005

AbstractIt has never been shown that wearing surgical face masks decreases postoperative wound infections. On the contrary, a 50% decrease has been reported after omitting face masks. The present study was designed to reveal any 30% or greater difference in general surgery wound infection rates by using face masks or not.During 115 weeks, a total of 3,088 patients were included in the study. Weeks were denoted as “masked” or “unmasked” according to a random list. After 1,537 operations performed with face masks, 73 (4.7%) wound infections were recorded and, after 1,551 operations performed without face masks, 55 (3.5%) infections occurred. This difference was not statistically significant (p> 0.05) and the bacterial species cultured from the wound infections did not differ in any way, which would have supported the fact that the numerical difference was a statistically “missed” difference.These results indicate that the use of face masks might be reconsidered. Masks may be used to protect the operating team from drops of infected blood and from airborne infections, but have not been proven to protect the patient operated by a healthy operating team.
CEA and CA 15‐3 in primary and recurrent breast cancer
Authors: O'Dwyer P. J. , Duffy M. J. , O'Sullivan F. , McDermott E. , Losty P. , O'Higgins N. J. 
Published: May 2005

AbstractTo evaluate CA 15‐3, a new breast cancer associated antigen, and to compare it with carcinoembryonic antigen (CEA), all patients presenting with breast cancer had preoperative and serial (3‐monthly) postoperative levels measured. Of 124 patients with primary breast cancer, 23% had an elevated CA 15‐3 (>25 units/ml) while 11% had an elevated CEA (>5 ng/ml) (p=not significant). Neither marker was an indicator of spread to regional lymph nodes in primary breast cancer. In 45 recurrences of breast cancer, CA 15‐3 was elevated at the time of first recurrence in 58% while CEA was elevated in 47% (p=not significant). Of 17 patients with locoregional recurrence alone, none had a CA 15‐3 above 40 units/ml while 11 of 12 with synchronous locoregional and distant recurrence had a CA 15‐3 level greater than 40 units/ml (χ2∶ 21.36,p < 0.0001). This study shows that CA 15‐3, like CEA, is of little clinical value in primary breast cancer. CA 15‐3, however, is an accurate indicator (overall accuracy, 97%) of synchronous distant metastases in patients with locoregional recurrence from breast cancer. This information has important implications for further investigation and management of such patients.
Changing trends in surgery for acute cholecystitis
Authors: Reiss Raphael , Nudelman Israel , Gutman Chaim , Deutsch Alexander A. 
Published: May 2005

AbstractSurgery for acute cholecystitis has become the most frequent abdominal surgery in most hospitals, yet aspects of its management remain controversial. The aim of this study was to focus on the recent trends by demonstrating the principal differences between 2 series of patients operated on during 10‐year intervals.Two hundred fifty‐six consecutive operations for acute cholecystitis were performed from 1970 to 1977 (group O) and were compared to 260 cases operated from 1980 to 1987 (group N). Thirty‐six variables were recorded in each case. All data obtained were computer recorded and analyzed. Several trends were observed in group N:
The population was significantly older with a higher proportion of males and diabetics.
There was a marked increase in common bile duct stones, acalculous cholecystitis, and gangrenous changes in the gallbladder.
There was a significant increase in patients operated on within 48 hours of admission.
There was a significant increase in the number of patients without previous history of biliary symptoms.
There was a significant decrease in the rate of wound infections and no statistically significant differences in mortality (N: 3.0%, O: 2.7%).
A decrease of the average postoperative hospital stay of 3.2 days was observed.
In spite of the older and sicker population in group N, no significant increase in mortality occurred and the postoperative hospital stay was reduced.
Adenocarcinoma of the stomach: A review of 35 years and 1,710 cases
Authors: Breaux John R. , Bringaze Walter , Chappuis Charles , Cohn Isidore 
Published: May 2005

AbstractThe records of 1,710 patients with adenocarcinoma of the stomach treated at Charity Hospital over a 35‐year period were reviewed to note any trends which might help in understanding the decreasing incidence and poor prognosis of the disease.The yearly number of gastric cancer patients has dropped from 234/100,000 in the 1950's to 195/100,000 in the 1960's to 108/100,000 patients in the last decade. The percentage of affected white males is decreasing at a rate equal to the increasing frequency of black female patients, while the ratios for black males and white females remain constant. The median age rose from 61.5 years to 66 years over the study period.The operability rate decreased from 82.4% to 72.8% and the resectability rate was 49%. Subtotal gastrectomy was the most common procedure, but radical subtotal gastrectomy gave the best 5‐year survival.There are fewer lesions of the antrum today, but the highest number of 5‐year survivors had antral lesions. Long‐term survival of patients with lesions of the cardia improved from zero in the first 25 years to 14% in the last decade.For the last 2 decades, patients with stage III and IV lesions comprised one‐half of the 5‐year survivors.Our overall 5‐year survival was 7.9%, but in the last decade it was 8.9%. Our 5‐year survival for all patients who underwent a resection was 17.9%, but increased to 24.8% for the last decade. These improvements, in combination with a decrease in incidence, have dropped the overall mortality from gastric cancer.
Dilatation of intrahepatic biliary strictures in patients with hepatolithiasis
Authors: Jeng Kuo‐Shyang , Yang Fi‐Sh , Ohta Ikuho , Chiang Hsein‐Jar 
Published: May 2005

AbstractTo investigate the role of balloon dilatation in the management of complicated hepatolithiasis with intrahepatic biliary stricture, 57 consecutive patients who received 208 sessions of dilatation in addition to the usual treatment were analyzed. The strictures were located in the right intrahepatic ducts (84.2%), left intrahepatic ducts (12.3%), or both (3.5%). Dilatation began 3–4 weeks after surgery. The routes of dilatation included the matured T‐tube tract (3 cases), percutaneous transhepatic biliary drainage tracts (42 cases), and both (12 cases). The immediate overall success rate of complete stone clearance increased significantly from 0% predilatation to 94.7% postdilatation. The main complications of dilatation therapy consisted of septicemia (10.5%), hemobilia (10.5%), and mild diarrhea (80%). Eight patients (14%) with long‐segment strictures received 11 postdilatation biliary stentings. Complications were 1 patient with occlusion and 2 patients with “spontaneous” hemobilia. Severe multiple strictures and coexistent secondary biliary cirrhosis were the contributing factors to complications. During the follow‐up of 3.4±1.2 years, recurrence of strictures was found in 4 patients. Two of them belonged to the stenting group. The cumulative probability of restricture was low: 4% at 2 years, 6% at 2.5 years, and 8% at 3 years. We conclude that in complicated cases of hepatolithiasis with intrahepatic biliary stricture, dilatation and stenting are good adjuvant therapies.
Previous abdominal colectomy affects functional results after ileal pouch‐anal anastomosis
Authors: Zenilman Michael E. , Soper Nathaniel J. , Dunnegan Dee , Becker James M. 
Published: May 2005

AbstractWe assessed the effect of previous abdominal colectomy on functional results after ileal “J” pouch‐anal anastomosis (IPAA) in patients with ulcerative colitis. Twenty‐five patients with colectomy prior to IPAA were compared with 22 patients who underwent noncolonic abdominal operations prior to IPAA. No differences were observed in pre‐ or postoperative resting anal sphincter pressure, squeeze pressure, or rectal inhibitory reflex. Previous colectomy was associated with a greater incidence of postoperative small bowel obstruction. Mean ± SEM daily stool frequency at 1 and 12 months postoperatively, respectively, was 8.9±0.8 and 5.7±0.3 for patients who had undergone previous colectomy, and 8.2±0.7 and 6.0±0.5 for the no previous colectomy group (p=not significant). At the same postoperative intervals, nocturnal stool frequency was 1.9±0.3 and 1.1±0.2 for the colectomy group and 1.5±0.3 and 0.6±0.1 for the no colectomy group (p=0.05 at 1 year). More patients in the previous colectomy group had greater than or equal to 1 nocturnal stool after 1 year (71% versus 33%,p=0.03). Although pouch capacity at 1 year was not different in the 2 groups, pouch capacity was directly related to stool frequency in the no colectomy group (r2=0.48,p=0.01), but not in the previous colectomy group (r2= 0.08,p=not significant). We conclude that previous abdominal colectomy may be associated with a higher overall incidence of small bowel obstruction. Moreover, previous colectomy is a determinant of postoperative nocturnal stool frequency after IPAA, most likely due to altered ileal pouch function. When possible, single‐stage colectomy, mucosal proctectomy, and endorectal ileal pouch‐anal anastomosis should be performed in patients requiring colectomy for ulcerative colitis.
Cervical node metastases in early squamous cell carcinoma of the floor of the mouth: Predictive value of multiple histopathologic parameters
Authors: Nason Richard W. , Castillo Nieva B. , Sako Kumao , Shedd Donald P. 
Published: May 2005

AbstractA semiquantitative assessment of multiple histological parameters was applied retrospectively to 66 patients with stage I and II squamous cell carcinoma of the floor of the mouth to determine if prognostic information relative to cervical node metastases could be obtained. Three parameters relating to the tumor cell population and 5 describing the tumor‐host interface were evaluated on a point scale from 1 to 3 with the highest score going to the most threatening characteristic. Twenty of the 66 patients had either occult metastases identified by elective lymphadenectomy (n=11) or developed metastases to the neck (n=9). There was no correlation between traditional histological grading as recorded at the time of presentation and the frequency of cervical metastases (p> 0.05). Histological reevaluation defined 3 groups of patients with low (<14), moderate (14–16), and high scores (>16) with an incidence of cervical metastases of 5/39 (12.8%), 6/17 (35.3%), and 9/10 (90%), respectively (p<0.001). The results suggest that microscopic grading could be a useful adjunct to the present TNM staging system in selecting patients likely to benefit from elective treatment of the neck.
Multifactorial analysis of survival in primary extremity liposarcoma
Authors: Chang Helena R. , Gaynor Jeffrey , Tan Claire , Hajdu Steve I. , Brennan Murray F. 
Published: May 2005

AbstractThe treatment of extremity soft tissue sarcoma is now directed at limb preservation with the addition of various adjuvant therapies to improve treatment results. To achieve this goal, a knowledge of prognostic factors for extremity soft tissue sarcoma becomes increasingly critical. The object of this study was to analyze prognostic factors for survival in patients with extremity liposarcoma.Eighty‐three patients with primary localized extremity liposarcoma, admitted from 1968 to 1978, were retrospectively reviewed. Surgical resection was the primary mode of treatment. Eleven prognostic factors were analyzed. Tumor factors included: histologic subtype, tumor grade, size, depth, invasion of vital structures, and site; operative factors included: type of operation, and surgical margins; and patient factors included: symptoms, age at diagnosis, and sex. Kaplan‐Meier survival curves, and univariate and stratified log‐rank tests of association were performed. Independent factors for predicting survival were identified using the Cox model stepwise regression technique.In univariate analysis of the entire group of patients, 5 factors were significant for tumor mortality: tumor grade (p=0.00005), histologie subtype (p=0.00025), tumor size s≥5 cm (p=0.005), type of surgery/ margin (p=0.0001), and invasion of vital structures (p=0.008). When associations among all factors were analyzed, it was found that many factors were interdependent. The independent prognosticators were, therefore, determined according to the Cox model technique. For the multivariate analysis, well‐differentiated and lipoblastic liposarcomas were excluded because of lack of survival variation within each group. The former group had no tumor‐related deaths and the latter group showed 80% tumor mortality. The remaining patients with myxoid, high‐grade fibroblastic and pleomorphic liposarcoma were subjected to multivariate analysis. Three factors emerged as independent prognostic predictors: high‐grade tumor (p=0.013), inadequate resection/amputation (p=0.003), and tumor≥cm (p=0.04).
The “Kergin pneumonectomy”
Authors: Gozzetti Giuseppe , Mastrorilli Mario , Bragaglia Romano B. , D'Abruzzo Giulio Cipolla , Romualdi Anna , Villani Silvia , Liberatore Gian Luca , Spolaore Renato 
Published: May 2005

AbstractOut of a series of 211 stage III (A and B) lung cancers radically resected with routine lymphadenectomy from 1971 to 1987, a total of 11 were squamous cell carcinomas invading the right main bronchus and lateral portion of the trachea. These patients were managed using a particular technique that we have always arbitrarily called, “Kergin pneumonectomy, ” after the Toronto surgeon who described it in 1952. These patients, today, are staged III B. There was no operative mortality and only 2 minor complications. Two patients survived 3 years and 1 is alive and free of disease 7 years from surgery. This technique should be considered before embarking on more perilous surgery such as “sleeve pneumonectomy,” a procedure which still carries high mortality and morbidity rates and requires special equipment and intensive postoperative care.
Suppression of the human mucosal‐related colonic microflora with prophylactic parenteral and/or oral antibiotics
Authors: Smith Mark B. , Goradia Vipool K. , Holmes James W. , McCluggage Samuel G. , Smith Jeffrey W. , Nichols Ronald Lee 
Published: May 2005

AbstractThe purpose of this investigation was to assess the effects of preoperative administration of parenteral antibiotics with or without concomitant preoperative administration of oral antibiotics on the colonie mucosal‐related microflora. Thirty‐one patients were studied in a prospective fashion. Group A patients (n=8) had colonoscopic mucosal biopsies performed after mechanical bowel preparation. Group B patients (n=5) received neomycin and erythromycin (NE), 1 g each following mechanical bowel preparation, at 1,2, and 11 p.m. the evening prior to either elective colon resection (n=2) or prior to colonoscopic biopsy (n=3). Emergent trauma patients who had left colon or sigmoid perforations due to gunshot wounds requiring segmental resection comprised group C (n=7). These patients received cefoxitin or cefotetan 2 g intravenously preoperatively. Individuals in group D (n=11) all had elective left hemicolectomies or sigmoid resections due to nonobstructing malignancies. These patients underwent the same regimen as group B patients in addition to receiving intravenous cefoxitin perioperatively. Quantitative and qualitative bacterial cultures as well as scanning electron microscopy (SEM) were used to study the mucosa‐associated flora. Tissue for culture and SEM were obtained from the pathologic specimen immediately after removal. The interval between the dosage of parenteral antibiotics to tissue removal was 3 hours in both groups. Anaerobic and aerobic counts were suppressed the greatest in patients receiving both oral and parenteral antibiotics (p=0.0001). Mean anaerobic counts decreased from 3.4×107 in group A to 1.8×102 (mean cfu/g) in group D patients. Mean aerobic counts in group A decreased from 3.7×106 to 64 (mean cfu/g) in group D. This study documents the effectiveness of oral NE to suppress the mucosa‐associated flora when administered preoperatively and suggests that parenteral antibiotics suppress the mucosa‐associated bacteria in addition to providing therapeutic serum levels.
Evaluation of effectiveness of mass screening for colorectal cancer
Authors: Fujita M. , Sugiyama R. , Kumanishi Y. , Ota J. , Horino T. , Nakano Y. , Taguchi T. 
Published: May 2005

AbstractAs the first step in the epidemiological evaluation of the effectiveness of mass screening for colorectal cancer, we compared clinicopathological features and survival rates of patients with cancer detected by mass screening (screened group) with those for patients treated in our outpatient clinic in the same period (outpatient group). The screened group consisted of 53 patients with colorectal cancer detected by 2‐day or 3‐day screening for fecal occult blood by guaiac slides. Their background factors were comparable to those of 120 patients of the outpatient group in regard to age, sex ratio, location of cancer, and histological type of cancer.In the screened group, 90% of patients had no complaints, and positive occult blood tests led to the detection of cancers. More than 60% of the patients had Dukes' A and B1 early cancers while only about 30% had advanced cancers. In the outpatient group, nearly 90% of patients were symptomatic, most commonly from rectal bleeding. Early‐stage cancers made up only 20%, and large, advanced‐stage cancers accounted for 80%. The 5‐year survival rate of the screened group was 91.5%, being significantly higher than the 60% survival rate for the outpatient group.It is anticipated that mass screening for colorectal cancer by guaiac fecal occult blood testing will significantly reduce the mortality due to this neoplasm.
West Germany: Still an underdeveloped country in the diagnosis and early treatment of primary hyperparathyroidism?
Authors: Dotzenrath Cornelia , Goretzki Peter Erich , Röher Hans‐Dietrich 
Published: May 2005

AbstractEarly diagnosis of asymptomatic patients with primary hyperparathyroidism (primary HPT) has been achieved in Scandinavia, the United States of America, and the United Kingdom during the last 20 years. Comparable results have been reported from some medical centers from West Germany; however, clinical manifestations were pronounced and patient symptoms were high in our population with primary HPT (N=128) operated on at the University of Düsseldorf from April, 1986 to July, 1989. Only 19 patients (14.8%) were asymptomatic while the others suffered from nephrolithiasis (39%), osteopathy (32%), gastrointestinal disturbances (28.9%), and depression (11.7%). In 46 (35.9%) of our patients, the duration of these clinical symptoms exceeded 10 years, in 27 patients (21%) 15 years, and in 12 patients (9.3%) even 25 years.We, therefore, conclude that primary HPT is still a grossly underdiagnosed illness in parts of West Germany, presently, with patients suffering from severe clinical symptoms for more than 1–2 decades before definitive treatment.
Acquired and congenital clotting syndromes
Authors: Blaisdell F. William 
Published: May 2005

AbstractAlthough Virchow postulated 100 years ago that hypercoagulability states exist, it has only been in recent years that methods of documenting hypercoagulability have been developed. These clotting tendencies can be acquired or congenital. The common causes of acquired clotting tendencies include conditions which result in tissue and cellular damage, shock, transfusion reactions, and tissue necrosis. Certain drugs and drug reactions, and certain disease states which include blood dyscrasias and cancer are also associated with clotting problems. In certain diseases such as homocystinuria, hyperlipidemia, and lupus erythematosus, abnormal clotting tendencies may also develop.Important advances in the recognition of hypercoagulability have come with the documentation that congenital clotting abnormalities exist. Moreover, these abnormalities are proving to be more common than are congenital bleeding syndromes. Patients who appear to have spontaneous clotting manifestations and are under 40 years of age should be screened for one of these abnormalities.These congenital clotting tendencies can be classified as defects in thrombosis inhibitors, dysfibrinogenemias, or defects in fibrinolysis. The first thrombotic inhibitor defect recognized was antithrombin III deficiency which was reported in 1965. Subsequently, Protein C, Protein S, and Heparin cofactor II deficiencies have been recognized as contributing to thrombotic tendencies.Dysfibrinogenemias are relatively rare and most are associated with bleeding problems; however, 11% of the abnormal fibrinogens are associated with a clotting tendency. The reason appears to be that these fibrins are resistant to fibrinolysis.The most common defects which are associated with thrombotic tendencies appear, at the present time, to be due to defects in fibrinolysis. These include hypoplasminogenemia, decreases in plasminogen activator, increases in plasminogen activator inhibitor, and Factor XII deficiency.
Prophylaxis of venous thromboembolism
Authors: Kakkar Vijay V. , Stringer Mark D. 
Published: May 2005

AbstractThe objective of prophylaxis in venous thromboembolism is, first, to prevent fatal pulmonary embolism and, second, to reduce the morbidity associated with deep vein thrombosis (DVT) and the postphlebitic limb. This should now be standard practice for most patients over 40 years of age undergoing major surgery and for younger patients with a history of venous thromboembolism. Particularly high‐risk groups include patients over 60 years of age undergoing major surgery, those with malignancy, and those requiring hip operations.Low‐dose subcutaneous heparin 5,000 IU commencing 2 hours preoperatively and continuing 12 hourly until the patient is fully mobile is unequivocally effective in preventing DVT in medical and surgical patients and, most importantly, significantly reduces the incidence of fatal postoperative pulmonary embolism and total mortality. Such prophylaxis, in the presence of established DVT, also limits proximal clot propagation, which is the precursor of major pulmonary embolism. Low‐dose heparin prophylaxis is associated with a small risk of bleeding complications, evidenced mostly by an increased frequency of wound hematoma rather than major clinical hemorrhage.Low molecular weight heparin fragments (e.g., Fragmin®, Choay®, Enoxaparine®) are emerging as useful alternative agents, having the advantage of once daily administration and yet providing similar efficacy in the prevention of DVT. Mechanical methods of prevention which counteract venous stasis, such as graduated elastic compression stockings, are also useful in protecting against DVT but have not been shown to prevent fatal postoperative pulmonary embolism. They are recommended particularly for patients in whom heparin prophylaxis is best avoided (e.g., neurosurgery) and possibly in combination with heparin in very high‐risk patients.