bluuebunny/crossref_metadata_2025_split huggingface dataset:
Decision‐making process in abdominal surgery in the geriatric patient
Authors: Reiss Raphael , Deutsch Alexander A. , Eliashiv Avinoam 
Published: May 2005

AbstractThe high rates of abdominal disorders in a growing population of geriatric patients and the greater willingness of the surgeon to cope with major problems in the elderly are factors contributing to a steady increase in abdominal procedures in this group. Four hundred consecutive major abdominal surgical procedures in patients over 70 years of age were submitted for computer analysis, the purpose of which was to determine the principal factors affecting mortality and morbidity. The etiological profile of abdominal surgery in the elderly was characterized by a high percentage of procedures related to the biliary tract, with the second largest group being those for intestinal obstruction due to benign and malignant conditions.The decision‐making process in geriatric surgery is of great importance, requiring consideration of ethical, medico‐legal and economic factors in addition to the purely medical ones. Analysis of data presented in this series leads to the following conclusions:
There is a declining mortality rate in all elective operations in the elderly, in the absence of widespread malignancy.
Timing is all important in abdominal emergencies in the elderly, and early operations are usually more successful than either immediate or delayed operations.
Definitive procedures are sometimes both safer and more cost effective than minimal procedures performed under such circumstances.
The principal factors leading to high mortality rates are the presence of malignancy, generalized peritonitis, and moderate‐to‐severe involvement of life‐support systems.
Selection of a treatment plan in chronic atheromatous limb ischemia
Authors: Courbier R. , Bergeron P. 
Published: May 2005

AbstractThe treatment plan in chronic atheromatous limb ischemia can only be established after quantifying functional problems by noninvasive techniques and after comparing the risk of the natural progression of the disease with the risk and possible outcome of surgical intervention. When claudication is at an advanced stage, reconstructive surgery is indicated. Aortofemoral bypass is preferable to thromboendarterectomy, its mortality rate being lower (2–3%) and long‐term patency rate better (82% after 5 years and 72% after 10 years). Thromboendarterectomy must be reserved for segmental lesions of the common iliac artery. The extra‐anatomical bypass has a similar patency rate, but it should be reserved for patients in whom a direct approach is contraindicated. Direct surgery below the inguinal ligament gives satisfactory results when the internal saphenous vein can be utilized.There is little difference in patency rate among the types of prostheses in use; it depends on the preoperative outflow and it decreases from 76% to 42% after 5 years if peripheral lesions are present.In the case of rest pain or trophic problems, reconstructive surgery is obligatory. The revascularization of the profunda femoris artery ensures limb salvage. It is possible to avoid amputation of the leg if distal disease is present provided that 1 pedal arch is functioning. Indications for primary amputation still depend on the patient's age and general state of health.
What is Buerger's disease?
Authors: Shionoya Shigehiko 
Published: May 2005

AbstractIn analyzing our observations of 115 patients with Buerger's disease during a recent 4‐year period, the following results were obtained. First, Buerger's disease is primarily a disease of the small‐ and medium‐sized vessels of the extremity. The disease commences peripherally and reaches the infrapopliteal or forearm arteries within a short time after the onset of symptoms. The majority of the patients have 3‐ or 4‐limb involvement. Although the first ischemic manifestation is variable, a trophic lesion is the chief symptom at the first examination.Second, in contrast to an incessant deterioration of the peripheral circulation, proximal extension is less frequent. The skip lesion plays an important role in proximal progression of the obstructive lesion in the main artery.Third, although direct arterial surgery is infrequently feasible because of the distal occlusive process, successful arterial revascularization is most effective for healing of ulceration. All efforts should be concentrated on limb salvage.Furthermore, microabscess consisting of giant cells, epithelioid cells, and leukocytes lends the most characteristic appearance to the thrombotic lesion at the early stage. General architecture of the vessel wall is well preserved at the healed stage.Finally, the etiology remains unknown. In this regard, however, we have a very strong clue in the astoundingly close relationship between the use of tobacco and the occurrence of the disease. If the patient absolutely abandons smoking, the natural history of the disease is uneventful.
Acute necrotizing pancreatitis after distal splenorenal shunt
Authors: Mosimann François 
Published: May 2005

AbstractTwo cases of fatal acute necrotizing pancreatitis shortly after distal splenorenal shunt are presented. Instrumental injury to the pancreas during operation may have caused this complication. It is suggested that distal splenorenal shunt should not be performed when mobilization of the splenic vein is technically difficult.
How to use abdominal wall retractors at laparotomy in grossly obese patients
Authors: Tera Harry 
Published: May 2005

AbstractA simple technique for applying laparotomy retractors to obese patients has been successfully applied in 25 patients. The procedure involves creating a “tunnel” through the subcutaneous fat tissue from a midline incision to a second skin incision, through which the retractor is introduced. No complaints were reported in 20 patients followed for 6–18 months, and except for slight redness in one wound, no complications from the extra incisions occurred.
The pancreatic cancer problem
Authors: Livstone Elliot M. , Spiro Howard M. 
Published: May 2005

AbstractPancreatic cancer has become a major diagnostic and therapeutic problem. The increasing incidence over the past decade seems to be real, but by the time the patient has symptoms and the physician begins to think about the possibility of pancreatic cancer, the disease has spread beyond hope of cure by resection, radiation, or chemotherapy. At present, no therapeutic program does more than extend life, and then only for short periods of time. It, therefore, makes more sense to use 2‐year survival rates rather than 5‐year survival rates to assess the impact of new treatments since no therapies to date reproducibly produce 5‐year survivors. We hope that the newer radiologic imaging techniques will lead to the earlier recognition of pancreatic cancer and an improved outlook.
Epidemiology of pancreatic cancer
Authors: Gordis Leon , Gold Ellen B. 
Published: May 2005

AbstractIn the United States the incidence of and mortality from pancreatic cancer have increased over the past several decades but have tended to level off in recent years. The rates are higher in blacks than in whites and higher in males than in females. Mortality rates increase with age but there appears to be a decline in elderly blacks, possibly on an artifactual basis. There is a suggestion that rates are higher in Jews. No consistent differences by socioeconomic status or by geographic location within the United States have been identified. Both genetic and environmental factors may be playing significant roles in this disease. Cigarette smoking may be etiologically related, or at the very least, may help to identify a group of patients at increased risk of pancreatic cancer. However, the relative risk estimated for cigarette smoking is much lower than that found for cancer of the lung. The leveling off in incidence and mortality rates for pancreatic cancer in recent years also differs from the time trends observed for lung cancer. However, this could result from differences in site‐specific carcinogens and from the fact that the lung is the first organ to be exposed to cigarette smoke in the highest concentrations and prior to the metabolism of any of its components.Dietary factors may have an important role in pancreatic cancer, but further research is needed to clarify this relationship. In particular, the possibility that dietary fats may be implicated and that vitamins or fiber may be protective in this disease remains to be explored. Finally, there is suggestive evidence that specific chemical exposures may be carcinogenic for the pancreas. Many of the data are from animal studies, and the findings from human studies are not entirely consistent.
Serologic markers in the diagnosis and management of pancreatic carcinoma
Authors: Podolsky Daniel K. 
Published: May 2005

AbstractThe low prevalence of pancreatic cancer remains an inherent obstacle to the development of effective screening tools in an asymptomatic population. However, these difficulties do not warrant nihilism. Development of effective serologic markers still offers the potential for improvement in our diagnostic capabilities. The accurate identification of patients with pancreatic cancer and the exclusion of disease in those with benign disorders remain important goals. While alpha‐fetoprotein (AFP), human chorionic gonadotropin (HCG), carcinoembryonic antigen (CEA), and ribonuclease (RNase) can be largely dismissed as useful markers of pancreatic cancer, leukocyte adherence inhibition (LAI), pancreatic oncofetal antigen (POA), and galactosyltransferase isoenzyme II (GT‐II) continue to show promise. Each of these markers currently requires further technical improvements to permit more widescale evaluation. The further refinement of monoclonal antibody defined markers such as gastrointestinal cancer antigens (GICA) may provide even more useful markers in the future. The development of effective serologic markers may help identify patients with early disease, and provide an impetus to develop more effective therapeutic strategies. It remains to be seen whether improvements in diagnostic modalities can be translated into improvement in clinical outcome.
Contribution of computed tomography to patients with pancreatic adenocarcinoma
Authors: Wittenberg Jack , Ferrucci Joseph T. , Warshaw Andrew L. 
Published: May 2005

AbstractWhile computed tomography provides an excellent non‐invasive evaluation of the pancreas, its utilization should be restricted to selected clinical problems in patients with suspected pancreatic malignancy. Computed tomography is the preferred initial examination in the nonjaundiced patient because of its high specificity and sensitivity and its capacity for providing valuable staging information. Furthermore, computed tomographically guided percutaneous biopsy will establish a pathologic diagnosis in 85% of patients, thereby avoiding exploratory surgery in the majority of patients. Alternatively, this examination has far less utility in the patient with jaundice since alternative noninvasive and/or invasive radiologic tests provide comparable accuracy and greater functional flexibility. In this group of patients, computed tomography plays only a limited role in defining the incurability of some malignant tumors.
Suspected pancreatic cancer presenting as pain or weight loss: Analysis of diagnostic strategies
Authors: Silverstein Marc D. , Richter James M. , Podolsky Daniel K. , Warshaw Andrew L. 
Published: May 2005

AbstractComprehensive strategies for the diagnosis of pancreatic cancer were evaluated with decision analysis for accuracy, cost, and invasiveness. An optimal strategy began with ultrasonography followed by a combination of computerized tomography, needle aspiration biopsy, endoscopic retrograde cholangiopancreatography, and laparotomy. The refined strategy established or excluded the diagnosis of pancreatic cancer with sufficient reliability for clinical decisions. This strategy had an overall sensitivity of 92% and specificity was greater than 99%. The number of invasive tests increased with the prevalence of disease in the population, but the frequency of diagnostic laparotomy was only 1–9%. The comprehensive strategy could not be significantly improved without marked increases in the utilization of invasive technology.
Preoperative and operative diagnosis of pancreatic cancer
Authors: Ihse Ingemar , Isaksson Gunnar 
Published: May 2005

AbstractThe aim of the investigation in the case of pancreatic cancer is to establish the diagnosis and to evaluate resectability. Improved diagnostic methods have made it possible in most cases to diagnose accurately the symptomatic patient with pancreatic cancer. Ultrasonography, computed tomography, endoscopic retrograde cholangiopancreatography (ERCP), and cytology are methods that often complement each other in the diagnostic workup. Percutaneous transhepatic cholangiography (PTC) is useful in the jaundiced patient, but is not as safe for the patient as ERCP. For patients in whom resection is contemplated, angiography is also of interest, as signs of major vessel involvement contraindicate surgery. Pancreatic function tests, tumor markers, and scintigraphy do not contribute enough to be used as diagnostic aids, and laparoscopy is only rarely indicated. At operation the final assessment of resectability is determined by documentation of spread to lymph nodes or to other organs and the invasion of neighboring vessels.
Endoscopic methods for relief of malignant obstructive jaundice
Authors: Cotton P. B. 
Published: May 2005

AbstractSeveral endoscopic methods have potential value in the management of patients with biliary obstruction due to malignant disease. Jaundice can be relieved either as definitive palliation, or as preparation for surgery, by endoscopie placement of indwelling prostheses, or by sphincterotomy of tumors at the papilla of Vater. Blockage of prostheses remains a problem in some patients who survive for more than a few months, and improvements in materials are anticipated. Late duodenal obstruction is surprisingly uncommon. These techniques are valuable in many elderly and frail patients. The results of ongoing randomized trials will help define indications for their use in other contexts and for their roles relative to surgery and percutaneous methods.
Pancreatic resection for carcinoma of the pancreas: Whipple versus total pancreatectomy—An institutional perspective
Authors: van Heerden Jon A. 
Published: May 2005

AbstractThe collective term “pancreatic cancer” should be replaced by more specific terminology indicating the histological subtype, e.g., pancreatic ductal adenocarcinoma, ampullary adenocarcinoma, duodenal carcinoma, pancreatic cystadenocarcinoma, cholangiocarcinoma, and malignant islet cell carcinoma. Each of these tumors has its own inherent prognostic and therapeutic characteristics‐95% of ampullary lesions being resectable in contrast to ±10% of pancreatic ductal malignancies and comparable 5‐year survival figures for these two subtypes are 40% and 5%, respectively.Since the results of adjuvant therapy (chemo‐ and/or radiotherapy) have been dismal, the only chance of cure remains resective therapy, either by the performance of a total or subtotal pancreatectomy (Whipple procedure). The operative mortality rate for these procedures at our institution has been 12% and 4%, respectively, with corresponding 5‐year survival rates of 2% and 4%. Despite earlier promise that total pancreatectomy only would be a superior procedure (elimination of the pancreatojejunal anastomosis, wider lymphadenectomy, irradication of multicentric disease), the operation has thus far not fulfilled these expectations.The Whipple procedure remains the resective procedure of choice at our institution—total pancreatectomy being performed principally in those patients in whom a safe pancreatojejunal anastomosis cannot be constructed.Value of early diagnosis in patients with ductal adenocarcinoma does not appear to imply improved prognosis. Energies should be diverted toward etiological identification of this lethal malignancy which is steadily increasing in incidence.
The place of total and extended total pancreatectomy in pancreatic cancer
Authors: Moossa A. R. , Scott Michael H. , Lavelle‐Jones Michael 
Published: May 2005

AbstractThe results of surgical treatment of pancreatic exocrine cancer are poor. There exists a definite small group of patients with early cancers in the head of the pancreas that are potentially curable. It is generally agreed that prolonged survival is obtained only with resection as opposed to a palliative bypass procedure. The only real controversy that remains concerns the extent of the resection. The 3 options available to the surgeon are Whipple pancreatoduodenectomy, total pancreatectomy, and the more radical regional pancreatectomy. Our opinion, based on previous experience, is that total pancreatectomy is the operation of choice for cancer in the head of the pancreas. This operation excludes many of the risk factors associated with the Whipple operation, with no evidence of increased morbidity or mortality. We feel that the case for extended total pancreatectomy is tenuous and yet to be proven, and that there is little or no place for this operation.
Surgical palliation of unresectable carcinoma of the pancreas
Authors: Sarr Michael G. , Cameron John L. 
Published: May 2005

AbstractThe results of palliative surgery for pancreatic carcinoma were reviewed in over 10,000 patients from the English‐language literature from 1965 to 1983. This collected series suggests that biliary‐enteric bypass relieves the sequelae of chronic extrahepatic biliary obstruction, prolongs survival, and provides symptomatic palliation. The more easily constructed loop cholecystojejunostomy is preferred over choledochojejunostomy unless malignant obstruction of the cystic duct is imminent. Chronic percutaneous internal biliary drainage offers reasonable palliation in the poor‐risk patient who is not a candidate for surgery. Routine concomitant gastroenterostomy is recommended in all patients with a reasonable life expectancy since operative mortality is unaffected, and the incidence of future duodenal obstruction is at least 16%. Intraoperative chemical splanchnicectomy is easily performed and appears beneficial in relief of pain related to advanced pancreatic carcinoma.
Treatment of pancreatic cancer by radiation therapy
Authors: Dobelbower Ralph R. , Milligan Andrew J. 
Published: May 2005

AbstractThe role of radiation therapy in the management of pancreatic malignancy was expanded dramatically in the last decade. Development of new tumor localization and dose delivery techniques permits safe delivery of increased radiation dose to upper abdominal tumors. Interstitial implantation of radioisotopes directly into tumors has increased the local control rate for pancreatic cancer as high as 80%, but the perioperative mortality rate of this procedure is as high as 25%, except in highly controlled situations. Early data from the high linear energy transfer (LET) treatment programs suggest higher than expected complication rates, yet survival seems no better than that reported from precision high‐dose (PHD) external beam regimens. Radiation as an adjuvant to surgery has been inadequately tested, but initial reports from preoperative and postoperative trials are encouraging. Intraoperative irradiation poses theoretical advantages over external beam therapy for pancreatic cancer. Chemotherapy seems an effective adjuvant to external beam radiation therapy for pancreatic cancer. Drugs other than 5‐FU have not been adequately evaluated in adjuvant studies, nor have newer radiation treatment methods been fully evaluated in combination with drugs.
Chemotherapy of pancreatic carcinoma
Authors: Harvey Jimmie H. , Schein Philip S. 
Published: May 2005

AbstractApproximately 23,000 cases of carcinoma of the exocrine pancreas will be identified in the United States this year, and nearly all will die within 12 months. Surgery with curative intent has a 5‐year survival of less than 4%. In unresectable tumors, combination chemotherapy with 5‐FU and mitomycin‐C appears to have activity and increased survival duration. New combination regimens and trials of chemotherapy combined with radiation are currently under study and appear to offer survival benefit. The development of chemotherapeutic trials and future directions are discussed.
Cholangitis
Authors: Kinoshita Hiroaki , Hirohashi Kazuhiro , Igawa Sumito , Nagata Eiichi , Sakai Katsuji 
Published: May 2005

AbstractComparative study of the clinical features of 125 cases of acute cholangitis revealed that acute obstructive suppurative cholangitis (AOSC, 19 cases) was characterized by leukocytosis, high transaminase levels, bilirubinemia, and a marked thrombocytopenia. Most species of bacilli isolated from the purulent bile were gram‐negative and in 9 of 12 cases of AOSC that we checked, the same species were found in the blood as in the bile. In 12 of the 19 cases of AOSC, plasma endotoxin levels were assayed by theLimulus test and found to be elevated. Of the 22 cases of cholangitis other than AOSC, only 5 showed transitory positive results. Laparotomy decompression of the bile duct in 8 patients with AOSC resulted in 4 deaths from post‐operative complications. However, 7 of the 11 patients placed on emergency percutaneous transhepatic cholangio‐drainage (PTCD) recovered from shock and underwent successful surgery later. We confirmed in an experimental study the initiation of cholangiovenous reflux in mongrel dogs. The cholangiovenous reflux of bacteria or endotoxin seems to induce the state of shock in patients with AOSC. In conclusion, we recommend that emergency decompression of the biliary tract even for AOSC patients in shock be performed by a procedure less risky than laparotomy, such as PTCD.
Anomalies of pulmonary venous return
Authors: Stark Jaroslav 
Published: May 2005

AbstractTotal anomalous pulmonary venous return is a rare but life‐threatening congenital heart lesion. We present our experience with 48 consecutive infants operated on from 1977 to 1983. Improved results are due to earlier diagnosis, improved surgical technique, and meticulous postoperative care. Since 1980 some patients with this lesion were submitted to surgery on the basis of two‐dimensional echocardiography, thus avoiding cardiac catheterization and angiocardiography. The operative procedure should achieve a large unobstructed anastomosis between the pulmonary veins and the left atrium. Details of operative techniques currently used in our unit are discussed for each anatomic type of total anomalous pulmonary venous drainage. Although the results are improving, the overall mortality rate (hospital and late) remains around 30% in most series. Very young age (neonates), poor preoperative condition, and presence of associated cardiac and noncardiac congenital anomalies increase the risk. There were 12 hospital and 2 late deaths in our series of 48 infants (29%). Detailed analysis of the causes of death is presented.
Coarctation of the aorta: Current surgical management
Authors: Campbell David B. , Pae Walter E. , Waldhausen John A. 
Published: May 2005

AbstractProgress in the management of coarctation of the aorta over the past 40 years is truly impressive. Nonoperative management of this condition has uniformly met with failure; however, a variety of surgical options is now available for the treatment of children and adults with coarctation. In recent years, significant advances have emerged in the treatment of neonates and infants that have resulted in low operative mortality rates. In addition, our own results with the subclavian flap angioplasty in these young patients indicate that the problem of failure of the repaired area to grow has been all but eliminated. The use of prostaglandin E1 has dramatically improved our ability to stabilize the decompensated neonate. Repair of coarctation in infancy is not only safe but desirable to minimize the late cardiovascular morbidity and premature death associated with hypertension.