bluuebunny/crossref_metadata_2025_split huggingface dataset:
HIV infection and surgeons
Authors: Lin Eric Y. , Brunicardi F. Charles 
Published: October 2004

AbstractThe human immunodeficiency virus (HIV) causes acquired immunodeficiency syndrome, which remains uniformly fatal in affected individuals. A common route of HIV transmission is via inoculation of contaminated blood, which may occur during surgical procedures. Surgeons may estimate their risk of HIV infection over a 30‐year surgical career based on HIV prevalence among surgical patients, percutaneous injury rate per operation, and seroconversion rate. Surgeons can reduce their risk by various means, but the most pragmatic is by reducing the rate of percutaneous injury through optimal surgical technique and proper precautions.
Anterior lesser curve seromyotomy with posterior truncal vagotomy versus proximal gastric vagotomy: Results of a prospective randomized trial 3–8 years after surgery
Authors: Walia H. S. , El‐Karim Hassan Abd 
Published: October 2004

AbstractIn a prospective randomized trial, anterior lesser curve seromytomy with posterior truncal vagotomy (ASPTV,n=50) was compared with proximal gastric vagotomy (PGV,n=50). Most of our patients were young men with ASA grade I risk, and 80% were expatriates. They were followed up for 3 to 8 years after surgery. The mean reductions of basal acid output (BAO) and insulin‐stimulated peak acid output (IPAO) were 85% and 88%, respectively, soon after surgery for both ASPTV and PGV groups. These values remained at 70% and 60% of their preoperative level for 1 year. Good to excellent results (Visick I and II) were recorded in 76% of cases in both groups. The recurrent ulcer rate was 14% for PGV and 12% for ASPTV. This trial suggests that for the treatment of duodenal ulcer ASPTV is as good an operation as PGV.
Endoscopic injection sclerotherapy for esophageal varices in the elderly
Authors: Ohta Masayuki , Hashizume Makoto , Kamakura Tatsuro , Ueno Kiichiro , Tomikawa Morimasa , Tanoue Kazuo , Kitano Seigo , Sugimachi Keizo 
Published: October 2004

AbstractA group of 1127 patients who underwent sclerotherapy for esophageal varices were compared for outcome in terms of age: over and ander age 70 years. Esophageal varices were completely eradicated in 81 of 110 patients >70 years (73.6%) and in 791 of 1017 patients <70 years (77.8%). Gastrointestinal bleeding after sclerotherapy occurred in 9 patients >70 years (8.2%) and in 84 of those <70 years (8.3%). Complications occurred in 16 patients >70 years (14.5%) and in 141 <70 years (13.9%). Liver failure and hepatoma accounted for more than 80% of the causes of death in both groups (80.3% versus 83.8%). The 5‐year cumulative survival rates in patients with bleeding esophageal varices (bleeders) without hepatoma were 21.8% in those >70 years and 58.7% in those <70 years (p<0.01), the relative survivals being 25.3% versus 66.6%. Patients without hepatoma and treated by prophylactic sclerotherapy accounted for 66.2% of patients >70 years and 61.7% of those <70 years, the relative survivals being 75.9% versus 71.9%. As analyzed by the Cox proportional‐hazards model, age >70 years was a prognostic factor in the bleeders (p<0.01) but not in the nonbleeders. We recommend that elderly patients with esophageal varices be given prophylactic sclerotherapy, as the outcome for these patients is poor once bleeding has occurred.
Clinicopathological study on carcinoma of the extrahepatic bile duct with special focus on cancer invasion on the surgical margins
Authors: Ogura Yoshifumi , Takahashi Koji , Tabata Masami , Mizumoto Ryuji 
Published: October 2004

AbstractTo clarify the clinical significance of the status of surgical margins, especially the dissected margin in the transverse direction, a clinicopathologic study was performed on 60 patients with carcinoma of the bile duct who underwent radical resection. The patients in group A (n=28) had no cancer invasion within 5 mm of the dissected margiu in the transverse direction. They had a higher incidence of the well differentiated type of carcinoma and a lower incidence of lymph node metastasis and microscopic tumor extension than the patients in group B. Group B (n=32) included patients with cancer involvement within 5 mm of the dissected margin in the transverse direction. Some group A patients were found to have advanced carcinoma of the lower bile duct, but they were the only ones whose lesions were at an early stage (e.g., lesion restricted to subserosal involvement or less) among those with carcinoma of the hepatic duct and the upper and middle bile ducts. Local recurrence was found to occur more frequently as the tumor approached the liver, and the incidence of local recurrence was significantly higher in patients in group B than in group A (75.0% versus 28.5%). These results indicate that patients with cancer invasion within 5 mm of the surgical margin develop early recurrence of tumor even after conventional radical resection and that further radical dissection of the hepatoduodenal ligament with hepatectomy or pancreatoduodenectomy may be required to improve survival for these cases.
Current status and future possibilities of transjugular intrahepatic portosystemic shunts in the management of portal hypertension
Authors: Radosevich Paul M. , LaBerge Jeanne M. , Gordon Roy L. 
Published: October 2004

AbstractTransjugular intrahepatic portosystemic shunt (TIPS) is an exciting new method for treating complications of cirrhosis. Technical advances have allowed TIPS to be widely applied in the treatment of variceal bleeding. This article presents and discusses the results of recent experiences in TIPS placement. TIPS can be successfully placed in almost all patients. The complication rate of the procedure is low. TIPS is an effective means of controlling variceal bleeding and is especially useful for controlling bleeding in patients awaiting liver transplantation. It may also have a role in the treatment of ascites and other conditions related to portal hypertension. The most important issue facing TIPS is the long‐term patency of the shunt. Potential solutions to the problem of long‐term shunt patency are discussed.
Squamous cell carcinoma of the esophagus: Therapeutic dilemma
Authors: Altorki Nasser K. , Girardi Leonard , Skinner David B. 
Published: October 2004

AbstractSeventy‐five patients with squamous cell carcinoma of the esophagus were evaluated over a 5‐year period. Most of the patients had advanced‐stage cancer when first seen. Only 50% were surgically explored, and 33% underwent resection. Operative mortality was 8%. Despite the immediate and durable palliation provided by surgical resection, survival rates were poor. Early diagnosis and aggressive surgical resection are the main hopes for improved long‐term results.
Esophageal squamous cell carcinoma: Pathology and prognosis
Authors: Ide Hiroko , Nakamura Tsutomu , Hayashi Kazuhiko , Endo Takeshi , Kobayashi Ataru , Eguchi Reiki , Hanyu Fujio 
Published: October 2004

AbstractBetween 1985 and 1992 a total of 403 patients with resected thoracic esophageal squamous cell carcinoma were evaluated histopathologically, and various pathologic findings related to survival were examined. Concerning depth of tumor invasion, 8 (2%) cases were pTis, 110 (27%) were pT1, 48 (12%) were pT2, 202 (50%) were pT3, and 35 (9%) were pT4. Lymphatic invasion was detected in 299 cases (74%), blood vessel invasion in 200 cases (49%), intramural metastasis in 45 (11%), and lymph node metastasis in 232 (58%). In pT1 carcinoma cases, 4% of mucosal carcinomas and 30% of submucosal carcinomas had lymph node metastasis. Tumors with deeper invasion had a higher incidence of lymph node metastasis: 74% of pT3 carcinomas and 83% of pT4 carcinomas. The sites of lymph node metastasis were divided into mediastinal, cervical, and abdominal fields; and rates of lymph node metastasis were 49%, 14%, and 41%, respectively. In all resected cases, the operative mortality rate was 3.2%, and the overall 5‐year survival rate was 44.8%. The 5‐year survival rate of patients with curative resection (R0and R1) was 49.5%, whereas patients with palliative resection (R2) did not survive more than 3 years. There was no significant difference in survival relative to tumor location. In curatively resected cases, the significant prognostic factors by multivariate analysis were pT category, vascular invasion, lymph node metastasis, and intramural metastasis. Prognosis of lymph node‐positive cases did not depend on the positive node site. Patients with only one positive node had a better prognosis, and those with six or more positive nodes had a poor prognosis. Concerning lymph node metastasis, other factors that worsened prognosis were a positive node larger than 1 cm, two‐ to three‐field metastasis, and positive cervical nodes in cases of lower‐third esophageal carcinoma.
Risk analysis in resection of squamous cell carcinoma of the esophagus
Authors: Law Simon Y. K. , Fok Manson , Wong John 
Published: October 2004

AbstractA study of risk factors that affect morbidity and mortality in 523 patients with squamous cell cancer of the esophagus who had one‐stage resection was undertaken. The 30‐day and hospital mortality rates were 5.0% and 15.5%, respectively. Pulmonary complications, malignant cachexia, and surgical complications accounted for 42%, 25%, and 21% of hospital deaths, respectively. Major pulmonary complications occurred in 23% of patients. Multivariate analysis identified six factors that predicted major pulmonary complications: age, mid‐arm circumference, percent of predicted FEV1, abnormal chest radiograph, amount of blood loss, and palliative resection. Three risk groups of pulmonary complications were identified: low, median, and high risk group with complications in 3%, 17%, and 43% of patients, respectively. Significantly, patients with curative resection had a lower hospital mortality rate (9%) than those with palliative resection (20%), p=0.001. Patients with stage I, IIa, or IIb disease had a lower hospital mortality rate (9%) than those with stage III or IV disease (18%), p=0.026. Multivariate analysis identified six factors that predicted hospital death: age, mid‐arm circumference, history of smoking, incentive spirometry, number of stairs climbed, and amount of blood loss. Three risk groups of hospital death were identified: low, median, and high risk groups with death in 7%, 30%, and 38%, respectively. Anastomotic leakage rate was 4%. Technical faults were identified in 53% of patients with leakage. Together with other surgical complications, a presumed or apparent technical error was noted in 63% of patients. The identification of high‐risk patients and prevention of technical faults can help improve surgical outcome.
Operable esophageal carcinoma: Current results from Hong Kong
Authors: Fok Manson , Law Simon Y. K. , Wong John 
Published: October 2004

AbstractOver an 11‐year period 1158 patients with esophageal cancers were managed by the Department of Surgery, The University of Hong Kong, Queen Mary Hospital, 857 (74.0%) of whom had confirmed squamous cell carcinoma. Operation was carried out in 76.5% of patients: 25.4% underwent curative resection, 36.2% underwent palliative resection, 13.8% had bypass operations, and 1.2% had a simple exploration. In the resection group, the mean age was 62.6 years with a strong male predominance of 6.4:1.0. Most patients were heavy smokers and heavy drinkers; 27.9% had increased pulmonary risks, and 8.3% had increased cardiac risks for resection. Most (56%) of the tumors were located in the middle third of the esophagus; 70.4% of patients had operative stage III disease, and 7.2% had stage IV disease. The 30‐day mortality and hospital mortality after resection were 4.9% and 15.9%, respectively. The primary cause of 30‐day mortality was cardiopulmonary‐related complications (65.2%), and the commonest causes for hospital deaths were from pulmonary complications (40.0%) and advancing malignancy (23.6%). The median survivals for stages I, IIA, IIB, III, and IV were 83.5, 24.3, 37.8, 8.6, and 5.0 months, respectively. Of the survivors, at 1, 6, and 12 postoperative months, respectively, 63%, 76%, and 83% of patients were able to take a full solid meal similar to the normal diet consumed before their disease.
Anastomosis
Authors: Bardini Romeo , Asolati Massimo , Ruol Alberto , Bonavina Luigi , Baseggio Serena , Peracchia Alberto 
Published: October 2004

AbstractEsophageal anastomosis is still associated with a high rate of complications even though they have decreased considerably in recent years. Anastomotic leaks are more frequent in the neck than in the chest, and related mortality rate is not different. The leakage incidence does not depend on suture materials or on technical modalities used to perform the anastomosis. In fact, there is no difference between the leakage rate when comparing manual and mechanical anastomoses. The leak incidence after both mechanical and manual anastomoses is much higher in collective reviews than in reports coming from leading centers. “Frequent” esophageal surgeons can learn from their previous experience and therefore avoid technical errors, whereas “casual” esophageal surgeons do not have this opportunity. Performing an esophageal anastomosis is a technical matter, and suture healing is independent of the patient's biologic situation. Anastomotic fibrotic stricutures are frequent after both manual and mechanical anastomoses, and most can be avoided by meticulous suturing technique.
Adjuvant therapies for cancer of the thoracic esophagus
Authors: Nishihira Tetsuro , Nakano Tatsuya , Mori Shozo 
Published: October 2004

AbstractDuring the past four decades, especially in recent years, various active adjuvant therapies combined with surgery have improved the outcome in cases of cancer of the esophagus. However, no optimum adjuvant therapy has been determined. From 1981 to 1992, 341 patients with regional and distant node metastasis who underwent curative surgery were treated with postoperative radiotherapy (RT), postoperative radiochemotherapy (RC), and postoperative aggressive chemotherapy (AGC) in a controlled study in our department of surgery. Five‐year survival rates, including operative deaths and unrelated diseases of the former group, were 0% for RT, 19.9% for surgery alone, 39.8% for RC, and 48.2% for AGC. Such rates for the latter group were 6.8% for AGC, 13.3% for surgery alone, and 33.3% for RC. In addition, results of a group study on the effectiveness of three‐field node dissection in 715 cases of thoracic esophageal carcinoma by 10 institutions were analyzed. This analysis showed that there were no differences in the 5‐year survival rate of curative surgery in cases with positive nodes among the groups treated with surgery alone (SA), with postoperative radiotherapy (PR), and with postoperative chemotherapy (PC). As to the 91 cases with positive cervical nodes, the 3‐year survival rates in cases treated with SA (n=22), PR(n=20), and PC (n=49) were 25.3%, 48.1%, and 53.6%, respectively; a significant improvement of survival in these patients. Summaries of studies of preoperative or postoperative radiotherapy, and both multimodal therapies are introduced.
Outcome of peptic ulcer hemorrhage treated according to a defined approach
Authors: Mueller Xavier , Rothenbuehler Jean‐Marc , Amery Anthony , Meyer Beat , Harder Felix 
Published: October 2004

AbstractThe short‐ and long‐term bleeding recurrence and mortality of 157 consecutive patients admitted emergently over a period of 2 years with in actively bleeding peptic ulcer were analyzed. They were treated uniformly according to a defined approach where suitable candidates for surgery were operated on early. The data of the 5‐year follow‐up were analyzed by constructing life tables. There were 94 men and 63 women with a median age of 72.3 years; 83 ulcers were gastric and 74 duodenal. Thirty‐one patients underwent an operation. Eleven patients (7%) died within the first month, one in the surgical group. During the follow‐up 13 patients rebled and 54 died, two of the deaths related to peptic ulcer disease. The life table for rebleeding and ulcer‐related deaths showed a cumulative risk of 11.8% at 5 years, and the cumulative risk was not statistically different between patients according to their age (60 years and older versus younger), sex, the site of their ulcer (gastric versus duodenal), or the type of treatment (conservative versus surgical). With a well defined approach and early selective surgery, the short‐term mortality compares favorably with the usual 10% or more reported. The high mortality rate during the follow‐up reflects the advanced age of patients with coexisting disease. This long‐term follow‐up study could be used as a comparison against future studies evaluating new therapies.
Prospective nonrandomized study of conventional versus laparoscopic appendectomy
Authors: Reiertsen Ola , Trondsen Erik , Bakka Arne , Andersen Ove K. , Larsen Stig , Rosseland Arne R. 
Published: October 2004

AbstractWith the introduction of laparsocopic appendectomy a prospective study was started. Patients with suspected appendicitis were selected for conventional appendectomy or laparoscopy according to the preference of the surgeon on call. During a 1‐year period 233 patients were included, of whom 97 underwent conventional appendectomy and 136 laparoscopy. Among the patients selected to lasparoscopy, laparoscopic appendectomy was carried out in 72 cases, conventional appendectomy in 32, and only diagnostic laparoscopy in the remaining 32. Removal of a normal appendix was significantly more common in the group of patients directly selected for conventional appendectomy compared to laparoscopy (p<0.01). The duration of the operation was shorter (p<0.05) and the postoperative hospital stay and the convalescence longer (p<0.05) with conventional than with laparoscopic appendectomy. Peroperative problems and minor postoperative complications were more common (p<0.01) with laparoscopic than conventional appendectomy. However, the clinical impact of these problems were limited. The difference between the procedures regarding major complications was not significant. Laparoscopic appendectomy seems to be at least as good as conventional appendectomy. However, randomized controlled trials are needed to decide which of the procedures to recommend.
DNA ploidy and biologic aggressiveness of gastric adenocarcinoma in Chinese
Authors: Shen Kuo‐Liang , Chu Chi‐Hong 
Published: October 2004

AbstractThe mortality rate of gastric cancer in the Chinese population has reached a plateau. The main prognostic factor for gastric adenocarcinoma is recognized as tumor stage. Recently, abnormalities in DNA content have been considered as a new prognostic factor. Whether abnormal DNA content can be used as a prognostic tool for Chinese patients with gastric cancer is unknown. To investigate this relation DNA ploidy and prognosis of gastric cancer patients were studied using paraffin‐embedded specimens. A group of 104 newly diagnosed and surgically resected gastric cancer specimens obtained from January 1984 to December 1986 were examined for DNA content by flow cytometry. The quality of flow cytometry was acceptable with a mean coefficient of variance of 5.45. The results showed that 38 cases (36.5%) had DNA aneuploidy; 42 cases had metastatic lymph nodes with enough tumor cells, and 31.0% of these cases had DNA aneuploidy. DNA aneuploidy of primary tumors was correlated to lymph node metastasis and patient's age, whereas DNA aneuploidy of metastatic lymph nodes was significantly correlated to the serosal invasion of the gastric wall at the primary site. The important parameters for prognosis were curability of surgical resection, serosal invasion, tumor size, and distant metastasis. DNA aneuploidy of both primary tumors or metastatic lymph nodes appeared to be unrelated to the prognosis of gastric adenocarcinoma in Chinese patients. We therefore propose that DNA aneuploidy of gastric cancer is associated with tumor growth but not biologic aggressiveness.
Symmetry properties for the extremals of the Sobolev trace embedding
Authors: Fernández Bonder Julian , Lami Dozo Enrique , Rossi Julio D. 
Published: October 2004

In this article we study symmetry properties of the extremals for the Sobolev trace embedding

H^1(B(0,μ))↪L^q(∂B(0,μ))

with

1⩽q⩽2(N−1)/(N−2)

for different values of

μ

. These extremals

u

are solutions of the problem

\begin{cases}
\Delta u = u & \text{in } B(0,\mu ), \\
\frac{\partial u}{\partial \eta } = \lambda \left|u\right|^{q - 2_{u}} & \text{on }\partial B(0,\mu ).
\end{cases}

We find that, for

1⩽q<2(N−1)/(N−2)

, there exists a unique normalized extremal

u

, which is positive and has to be radial, for

μ

small enough. For the critical case,

q=2(N−1)/(N−2)

, as a consequence of the symmetry properties for small balls, we conclude the existence of radial extremals. Finally, for

1<q⩽2

, we show that a radial extremal exists for every ball.

Résumé

Dans cet article nous étudions des propriétés de symétrie des extrémales de l’immersion de Sobolev

H^1(B(0,μ))↪L^q(∂B(0,μ))

, où

1⩽q⩽2(N−1)/(N−2)

en fonction du rayon

μ

. Ces extrémales sont solutions du problème

\begin{cases}
\Delta u = u & \text{dans } B(0,\mu ), \\
\frac{\partial u}{\partial \eta } = \lambda \left|u\right|^{q - 2_{u}} & \text{sur }\partial B(0,\mu ).
\end{cases}

Nous trouvons que, pour

1⩽q<2(N−1)/(N−2)

, il existe une extrémale normalisée unique

u

, qui est positive et radiale, pour

μ

suffisamment petite. Dans le cas critique

q=2(N−1)/(N−2)

, comme conséquence des propriétés de symétrie pour des petits rayons, nous déduisons l’existence d’extrémales. Finalement, pour

1<q⩽2

, nous montrons qu’une extrémale radiale existe pour toute boule.