bluuebunny/crossref_metadata_2025_split huggingface dataset:
Endovascular Repair of Aortic Aneurysms, Arteriovenous Fistulas, and False Aneurysms
Authors: Parodi Juan C. 
Published: August 2002

AbstractBetween September 1990 and June 1995, 103 patients were treated with transluminal placed endovascular grafts: 87 had abdominal aortic aneurysms (AAA), two had iliac artery aneurysms (one in association with an AAA), 3 had thoracic aneurysms, and 12 had vascular injuries in various localization of the arterial tree. The AAAs were excluded from the blood flow with a device composed of a balloon‐expandable stent (modification of the Palmaz stent) attached to a Dacron graft designed to expand at both ends of the accompanying stent extension. An 18F sheath containing the stent–graft device was introduced through a small cut‐down in the common femoral arteries and advanced under fluoroscopic guidance. Color duplex, contrast‐enhanced computed tomography (CT) scanning and angiography were performed before the procedure and then every 6 months. (Arteriography was performed once during the follow‐up period and whenever other studies disclosed an abnormal finding.) A total of 87 patients (75 men, 12 women) harboring an AAA were treated: Forty‐five patients underwent an aortoaortic procedure (8 patients had only a proximal stent implanted, and 37 had proximal and distal stents). Forty‐two patients were treated by implanting an aortoiliac graft, completing the procedure with a femorofemoral bypass. The contralateral common iliac artery was occluded by means of an occluding stent. One type A dissecting aneurysm and two descending thoracic aneurysms were successfully treated by the endovascular technique. The longest follow‐up period was 60 months and the shortest 1 month. Initial success was obtained in 84% of the aortoaortic cases and in 75% of the aortoiliac procedures. Long‐term follow‐up (> 12 months) disclosed 78% success for the aortoaortic cases and 90% for the aortoiliac procedures. Late failures included distal aortic dilatation, distal leak into the aneurysmal cavity, and proximal leak into the aneurysm. All trauma cases were successful over the short and long terms. Trauma cases included false aneurysms (common carotid, subclavian, common femoral arteries) and arteriovenous fistulas (subclavian, aortocava, common iliac‐cava and superficial femoral artery and vein). We concluded that stent–graft combination devices appear to be an alternative for treating vascular trauma and aneurysms. Initial success for treating AAAs is almost 100%, and late success in aortoiliac cases is also high (90%) for aortoaortic reconstruction. However, late failures are frequent and require further evaluation in relation to a persistent increase in the diameter of the proximal neck and distal cuff.
Endovascular Repair of Aortoiliac Occlusive Disease
Authors: Marin Michael L. , Veith Frank J. , Sanchez Luis A. , Cynamon Jacob , Lyon Ross T. , Suggs William D. , Bakal Curtis W. , Parsons Richard E. 
Published: August 2002

AbstractOcclusive disease of the aorta and iliac and femoral arteries may lead to limb‐threatening ischemia when multiple levels of disease are present. The combined treatment of severe aortoiliac and infrainguinal disease using standard techniques may be hazardous or contraindicated in patients with multiple, previous reconstructions or severe co‐morbid medical illnesses. This report summarizes the technical feasibility and early results of aortoiliac endovascular stented grafts (ESGs) in combination with conventional surgical reconstructions for the treatment of multilevel arterial occlusive disease. Forty‐two patients with multilevel aortoiliofemoral limb‐threatening occlusive disease had an ESG inserted to treat long‐segment, multilevel, occlusive disease. ESGs originated from either the aorta or the common iliac artery and were inserted into one of the femoral arteries. ESG lengths ranged from 16 to 30 cm (mean 21 cm). Conventional surgical bypasses were constructed, when necessary, from polytetrafluoroethylene (PTFE) or saphenous vein and were extended using standard techniques to the popliteal, tibial, or contralateral femoral arteries. Technical success of graft insertion was achieved in 39 of 42 attempted ESG procedures (93%). The 18‐month primary and secondary cumulative patency rates for ESGs were 89 ± 9 (SE) and 100%, respectively. Limb salvage was achieved in 94% of patients at 24 months. Four patients had minor postprocedure complications (10%), and there was one death. Endovascular aortoiliac grafts, often in combination with conventional surgical infrainguinal bypasses, are a technically feasible, potentially safe option for the treatment of limb‐threatening aortoiliofemoral occlusive disease and have demonstrated encouraging early patency. Long‐term follow‐up is necessary before widespread application of this technique is instituted.
Sacrococcygeal Chordoma: Review of 50 Consecutive Patients
Authors: Chandawarkar Rajiv Y. 
Published: August 2002

AbstractFifty consecutive patients with sacrococcygeal chordomas treated during 1941–1991 at the Tata Memorial Hospital in India were studied retrospectively. Pain was the commonest presenting symptom (82%). An average time lapse of 14 months between the onset of pain and definitive diagnosis emphasizes the importance of a high index of suspicion and prompt use of sophisticated imaging techniques leading to an early diagnosis. All patients underwent a partial sacrococcygectomy, through a sacral approach in 22 patients (44%) and an abdominosacral approach in 28 (56%). Postoperative complications included urinary incontinence (14%), rectal incontinence (6%), hemorrhage (4%), and rectal injury (2%). Radiotherapy offered significant pain relief to patients with widespread recurrence. A total of 38 patients were ambulatory, and 12 needed support. The average disease‐free survival was 63 months, and the overall survival was 7 years. Aggressive resection through a combined abdominosacral approach offers the best results. Because postrecurrence salvage rates are poor, the primary surgery must be complete and curative.
Surgery in Hemophilia A Patients with Factor VIII Inhibitor: 10‐Year Experience
Authors: Scharf Romuald , Kucharski Witold , Nowak Tomasz 
Published: August 2002

AbstractPatients with hemophilia A and circulating anticoagulant (factor VIII inhibitor) present a difficult, even unsolvable problem, particularly if they require surgical treatment and the inhibitor titer is high. During the 1986–1995 period 29 surgical procedures on inhibitor hemophilia A patients were performed in our center. Each of the cases had an individual character, and all demanded special clinical treatment. Based on this experience we present the possibilities of hemostasis maintenance during the perioperative period with high doses of human or porcine factor VIII, aPCC, plasmapheresis, and extracorporeal antibody adsorption to protein A–Sepharose. In some patients hemostasis maintenance requires combined treatment. To induce immunotolerance in patients with inhibitor is the gold standard treatment because it is then possible to achieve proper hemostasis after factor VIII infusion. Various methods of immunotolerance induction have been discussed and compared with our experience with immunotolerance induction in 11 patients with small factor VIII doses (25 IU/kg twice a week) and the modified Malmö protocol in 15 patients.
Intraoperative Secretion of Intact Parathyroid Hormone and Amino‐Terminal Parathyroid Hormone Fragments from Normal Parathyroid Glands Associated with Solitary Parathyroid Adenoma
Authors: Bergenfelz Anders , Ahrén Bo 
Published: August 2002

AbstractThe nonadenomatous parathyroid glands associated with parathyroid adenoma in patients with primary hyperparathyroidism (pHPT) are assumed to exhibit suppressed secretion of parathyroid hormone (PTH). Because the function of these glands is of clinical importance for calcium homeostasis after surgery for pHPT, we studied the decrease of serum levels associated with intact PTH (i‐PTH) and amino‐terminal PTH (N‐PTH) after excision of a parathyroid adenoma. Blood samples were obtained from the cubital vein and the inferior thyroid vein in six patients with pHPT. The results show that the levels of both i‐PTH and N‐PTH decreased after removal of the parathyroid adenoma (p< 0.05 for both). Because the reduction was more pronounced for i‐PTH than for N‐PTH, the N/i ratio increased from 0.54 ± 0.33 to 3.76 ± 1.62 (p< 0.05). Furthermore, the levels of i‐PTH and N‐PTH were higher centrally than peripherally both before and after adenoma excision (p< 0.05). The results therefore suggest that the secretion of i‐PTH and N‐PTH in the remaining normal‐size parathyroid glands is not completely suppressed. Furthermore, in these parathyroid glands the secretion of amino‐terminal PTH fragments is relatively predominant when compared to the release of the intact PTH. The findings underscore the importance of the N‐terminal PTH fragment for maintaining calcium homeostasis during the early postoperative period after surgery for pHPT and may explain the rarity of prolonged hypocalcemia after parathyroidectomy.
Impact of Intraoperative Ultrasonography on Surgery for Cystic Lesions of the Pancreas
Authors: Kubota Keiichi , Noie Tamaki , Sano Keiji , Abe Hideki , Bandai Yasutsugu , Makuuchi Masatoshi 
Published: August 2002

AbstractThe impact of intraoperative ultrasonography (IUS) on surgery for cystic lesions of the pancreas (CLPs) has not been fully clarified. Twenty patients with CLPs, including 5 pseudocysts and 15 true cysts, were scanned intraoperatively to evaluate the utility and practicality of IUS for CLPs. In four of the five patients with pseudocysts and two with retention cysts, the operative procedures were performed under IUS guidance. In one with a pseudocyst, IUS showed that the cyst did not involve the pancreas, and subsequently cystectomy without pancreatic resection was necessary. In one of the two patients with mucin‐producing cystadenocarcinomas, IUS demonstrated a skip lesion in the duct of the pancreatic tail, which contributed to changing the operative procedure from pancreatoduodenectomy to total pancreatectomy; in the other, IUS showed that the lesion was localized in the body of the pancreas, and subsequently segmental pancreatectomy was carried out instead of scheduled pancreatoduodenectomy or distal pancreatectomy. Thus in these three patients the operative procedures were changed in light of the IUS findings. In the remaining 11, although IUS visualized CLPs clearly, it added no new information relevant to the operations. We conclude that IUS contributes to performing surgery for certain types of CLP, such as pseudocysts with severe inflammation, retention cysts with nonpalpable or invisible small cysts, mucin‐producing cystadenocarcinomas, and possibly other lesions.
Early Limb Salvage: Open Tibia Fractures of Ambroise Paré (1510–1590) and Percivall Pott (1714–1789)
Authors: Kocher Mininder S. 
Published: August 2002

AbstractAmbroise Paré and Percivall Pott were preeminent clinicians, writers, and educators who advanced the cause of surgery through their independent thinking and insightful observations. In addition to their legacies and numerous enduring contributions, both men sustained open tibial fractures that were successfully managed during times when most often amputation was prescribed for such injuries. This article explores their lives and their fractures.
Natural course of acute pancreatitis
Authors: Beger H. G. , Rau B. , Mayer J. , Pralle U. 
Published: August 2002

AbstractAcute pancreatitis comprises, in terms of clinical, pathologic, biochemical, and bacteriologic data, four entities. Interstitial edematous pancreatitis and necrotizing pancreatitis are the most frequent clinical manifestations; pancreatic pseudocyst and pancreatic abscess are late complications after necrotizing pancreatitis, developing after 3 to 5 weeks. Determinants of the natural course of acute pancreatitis are pancreatic parenchymal necrosis, extrapancreatic retroperitoneal fatty tissue necrosis, biologically active compounds in pancreatic ascites, and infection of necrosis. Early in the course of acute pancreatitis multiple organ failure is the consequence of various inflammatory mediators that are released from the inflammatory process and from activated leukocytes attracted by pancreatic injury. During the late course, starting the second week, local and systemic septic complications are dominant. Around 80% of deaths in acute pancreatitis are caused by septic complications. The infection of pancreatic necrosis occurs in 8% to 12% of acute pancreatitis and in 30% to 40% of patients with necrotizing pancreatitis. Bacteriologic analysis of intraoperative smears and aspirates reveals predominantly gram‐negative germs deriving from the intestine, most frequently Escherichia coli. It has been confirmed that after necrotizing pancreatitis a considerable large group of patients suffer long‐lasting exocrine and endocrine insufficiency.
Tailored Antireflux Surgery for Gastroesophageal Reflux Disease: Effectiveness and Risk of Postoperative Dysphagia
Authors: Wetscher Gerold J. , Glaser Karl , Wieschemeyer Thomas , Gadenstaetter Michael , Prommegger Rupert , Profanter Christoph 
Published: August 2002

AbstractThe Nissen fundoplication is not the proper antireflux procedure for patients with poor esophageal peristalsis as it does not strengthen impaired esophageal peristalsis. The aim of this study was to investigate if tailoring of antireflux surgery according to esophageal contractility is an effective treatment of gastroesophageal reflux disease (GERD) with a low incidence of postoperative dysphagia. The Toupet fundoplication was laparoscopically performed on 32 patients with poor esophageal peristalsis and the Nissen fundoplication on 17 patients with normal peristalsis. After a median follow‐up of 15 months, only 1 of the 49 patients (2.04%)
complained of heartburn. Acute esophagitis was found in none of them on endoscopy. Of 40 patients tested postoperatively, 2 (5%) underwent pathologic esophageal pH monitoring. Postoperative dysphagia was found in two patients (4.1%) compared with 25 (51%) preoperatively
(
p < 0.05). There was a significant reduction of dysphagia following the Toupet fundoplication. Both procedures increased the resting pressure of the lower esophageal sphincter (LES)
significantly, which was more pronounced following the Nissen fundoplication. Relaxation of the LES was significantly better following the Toupet than after the Nissen fundoplication. There was significant improvement of esophageal peristalsis following the Toupet fundoplication. Tailored antireflux surgery is an effective strategy for treatment of GERD. The incidence of postoperative dysphagia is low owing to improvement of impaired esophageal peristalsis following the Toupet fundoplication. It may be due to the fact that the Toupet fundoplication causes less esophageal outflow resistance than the Nissen fundoplication.
Fundoplication Avoiding Complications of the Nissen Procedure: Prospective Evaluation
Authors: Pélissier Edouard P. , Ottignon Yves , Deschamps Jean‐Paul , Carayon Pierre 
Published: August 2002

AbstractThe purpose of this study was to evaluate the results of a fundoplication aimed to avoid complications of the Nissen procedure. The procedure combined a posterior hemifundoplication and a short circular fundoplication and their fixation to crura. A total of 67 consecutive patients were prospectively evaluated before and after surgery (median follow‐up 24 months). Typical and atypical signs of reflux were present in 96.9% and 28.1% of cases, respectively, before operation versus 12.5% and 6.3% after. Patients alleged dysphagia in 26.6% of cases before surgery and 20.3% after. After operation belching and vomiting were impossible in 6.3% and
29.7% of cases, respectively. The pH test did not demonstrate any pathologic acid esophageal exposure in 93.3% cases after surgery. The mean duration of acid esophageal exposure was 45.1 ± 21.8%
(10–100%) before operation versus 1.9 ± 4.9% (0–30%) after
(
p < 0.001). The mean lower esophageal sphincter pressure increased from 12.4 ± 6.1 cm H2O (0–28 cm H2O) before operation to 20.5 ± 7.3 cm H2O (11–50 cm H2O) after (p< 0.0001). The velocity of esophageal waves increased from 2.8 ±
1.1 cm/sec (1.2–5.5) before surgery to 3.1 ± 1.5 cm/sec
(1.4–7.7 cm/sec) after (p < 0.001). None of the Nissen complications were observed, and it was not necessary to reoperate any patient. In conclusion, this procedure is effective, improves esophageal motor activity, and prevents the occurrence of complications of the Nissen procedure. It does not, however, alleviate side effects.
Femoral Pseudoaneurysms in Drug Addicts
Authors: Ting Albert C.W. , Cheng Stephen W.K. 
Published: August 2002

AbstractFemoral pseudoaneurysm is a serious complication in drug addicts who habitually inject via the groin. A total of 33 drug addicts presenting with 34 infected femoral pseudoaneurysms were treated in the Department of Surgery, the University of Hong Kong, Queen Mary Hospital from July 1993 to June 1996. There were 27 men and 6 women, with ages ranging from 23 to 76 years (mean 39.6 years). Positive intraoperative tissue cultures were seen in 29 (85%), with 17 being pure growth of methicillin‐sensitive Staphylococcus aureus (MSSA). Twenty‐four pseudoaneurysms involved the femoral bifurcation and were treated by triple ligation of the common femoral, superficial femoral, and profunda femoris arteries. Seven other limbs underwent ligation of the common femoral artery alone, and three had superficial femoral artery ligation. Nineteen limbs had the external iliac artery ligated in addition to the femoral ligation for better proximal control. The mean postoperative ankle–brachial index (ABI) was 0.43 and 0.52 in those with triple ligation and those with single‐vessel ligation, respectively. There was no hospital mortality, and all patients were discharged with a viable limb. The duration of follow‐up ranged from 2 to 36 months (mean 15.5 months). Four patients were asymptomatic, but the rest suffered some degree of intermittent claudication. No delayed limb loss was identified. We conclude that systemic antibiotics active against MSSA are the antibiotics of choice in drug addicts with infected femoral pseudoaneurysms. Ligation and excision of the pseudoaneurysm without revascularization is safe, with acceptable morbidity and a low limb loss rate.
Patterns of Intestinal Motility Recovery during the Early Stage following Abdominal Surgery: Clinical and Manometric Study
Authors: Shibata Yoshihisa , Toyoda Sumio , Nimura Yuji , Miyati Masahiko 
Published: August 2002

AbstractThe purpose of this study was to evaluate the pattern of recovery of intestinal motility using manometric and clinical assessment in the postoperative ileus following abdominal surgery. We reviewed the charts of 18 patients who underwent partial colectomy for colon cancer (group A, without vagotomy) and compared them to those of 15 patients who underwent gastrectomy with truncal vagotomy and reconstruction by the Billroth I technique (group B, with vagotomy). A three‐lumen catheter was inserted via the nose into the proximal jejunum for drainage of intestinal fluids and to record intestinal motility at laparotomy. The first appearance of a burst activity following a silent period and a migrating motor complex (MMC) was at 3.8 hours (mean) and 16.4 hours, respectively, in group A, and at 2.5 and 14.3 hours, respectively, in group B. The first audible bowel sounds and the time of feeling abdominal fullness and passage of flatus was at 34.8, 47.5, and 62.9 hours (group A), and at 43.0, 53.8, and 77.9 hours (group B), respectively. The peak volume of nasointestinal drainage was recorded at 16 to 24 hours in group A and 40 to 48 hours in group B (p < 0.05). As measured by manometric examination, an MMC reappeared within a few hours after surgery. Physiologic postoperative ileus was ended when MMCs extended throughout the gastrointestinal (GI) tract with forwarding GI fluids.
Intraperitoneal Dissemination Probably Caused by Needle Biopsy of Alveolar Echinococcosis of the Liver: Experimental Study
Authors: Yamashita Kenichiro , Furuya Koji , Namieno Tsutomu , Sato Naoki , Shimamura Tsuyoshi , Une Yoshie , Uchino Junichi 
Published: August 2002

AbstractAlveolar echinococcosis of the liver (AEL) is a parasitosis with a potential for malignant tumor‐like behavior. The disease is diagnosed by a combination of serologic tests, diagnostic images, and the histology of needle biopsy specimens. It remains unresolved whether the biopsy induces subsequent troubles. We designed this study to investigate critical problems after needle biopsy of AEL lesions using an experimental model. Five samples were prepared from the resected lesions of AEL patients: (A) 10% suspension of trypsin digests of the minced lesion; (B) 10% suspension of mesh‐filtered sediment of the minced lesion; (C) 10% sediment suspension after washing the nonminced lesion; (D) supernatant after centrifuging intracystic fluid; (E) 10% sediment suspension after centrifuging intracystic fluid. A 1‐ml aliquot of each sample was injected intraperitoneally into jirds (gerbils) or cotton rats, respectively. The animals were sacrificed 12 weeks later, and intraperitoneal metacestodes were observed. All samples except D developed metacestodes, and their histologies were all lesions of typical alveolar echinococcosis. These results suggest that a needle biopsy may cause intraperitoneal dissemination or tracial implantation of the parasites along the track of the needle.
Absorption Kinetics of Rectal Formalin Instillation
Authors: Myers Jonathan A. , Mall Julian , Doolas Alexander , Jakate Shriram M. , Saclarides Theodore J. 
Published: August 2002

AbstractFormalin instillation has become an accepted treatment of radiation‐induced hemorrhagic cystitis and proctitis since the initial report by Brown in 1969 (Med. J. Aust. 1:23, 1969). Although its use is widespread, no studies have been performed to determine the safest volume or duration of formalin exposure. The purpose of our study was to determine the optimum technique for instillation and the safety margin regarding the maximum time that formalin can be in contact with the rectal mucosa without causing serum toxicity. In a pilot canine study, 4% neutral buffered formalin was instilled into the rectum in 30 ml aliquots for 60 seconds each after which each aliquot was withdrawn; a total volume of 400 ml was used. Our subsequent experiment involved rectal instillation of a single formalin bolus of 100 ml for 1 hour without removal during this time. Formalin metabolites were measured in the blood and urine to assess toxicity. Results indicate that with the latter technique serum formic acid reaches toxic levels within 15 minutes of instillation and may stay elevated for several hours. Metabolites in the urine similarly increase within 15 minutes, lagging only shortly behind the rise in serum levels. Performing formalin instillation in a series of 30 ml aliquots appears to be a safer treatment, as toxic serum levels were not reached and their slight rise above baseline returned to normal within 3 hours.