bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical treatment of acute deep venous thrombosis
Authors: Lord Reginald S. A. , Chen Frank C. , Devine Terence J. , Benn Ian V. 
Published: May 2005

AbstractIn patients with venous thrombotic disease and in whom anticoagulation or thrombolytic therapy is inappropriate, ineffective, or even contraindicated, insertion of vena caval filters or venous thrombectomy must be considered.The primary indication for the placement of vena caval filters is in patients who have developed a pulmonary embolus and in whom anticoagulation is either contraindicated or in whom anticoagulation must be discontinued because of the development of bleeding complications. At the present time, either the Greenfield filter placed through a jugular, femoral, or axillary venotomy or the bird's nest filter are appropriate and appear to be the most effective and least fraught with complications.The use of venous thrombectomy has waxed and waned over the last several decades. At the present time, the procedure is advocated mainly for lower limb venous thrombosis which is extensive enough to threaten limb viability. On occasion, it may be appropriate to extend the indications for venous thrombectomy to include femoral thrombosis of less than 10 days duration or iliac thrombosis of less than 3 weeks duration with floating thombi at that level. Technical modifications which improve the patency of the obliterated veins which are predisposed to rethrombosis include the creation of a temporary arteriovenous fistula and meticulous care in removing the entire clot. The patient should be treated with anticoagulants postoperatively to prevent a recurrence of the problem.The main theoretical advantage of venous thrombectomy is a reduced incidence of postthrombotic syndrome. Objective data to support this contention do not exist.
Cooper ligament repair: An update
Authors: Barbier Jacques , Carretier Michel , Richer Jean P. 
Published: May 2005

AbstractThis study had 4 objectives: first, to define the place of the Cooper ligament in hernial repairs by recalling its anatomic importance within the inguinal region; second, to describe our technique using the Cooper ligament, a technique based on suture of the conjoined tendon to the Cooper ligament without a relaxing incision into the rectus sheath and also to describe other authors' variants; third, to report the results obtained for 1,040 patients operated on by our technique from 1970 to 1978; fourth, to define the value and limits of these herniorrhaphy methods in repairs of groin hernias. These methods are inexpensive and virtually exclude the risk of serious infections because no foreign material is used. The procedures can be used in most patients. The only limits are suture tension during the repair and the presence of parietal deterioration. In such situations, it is necessary to perform a prosthetic repair or to reinforce the herniorrhaphy with prosthetic mesh.
Preperitoneal herniorrhaphy: A historical review
Authors: Read Raymonnd C. 
Published: May 2005

AbstractFrom ancient times, both the transabdominal (posterior) and the groin (anterior) approach have been used either singly or in combination in the management of inguinofemoral herniation. Development accelerated in the nineteenth century after Lister introduced antisepsis. Although Bassini and Halsted conducted their classic procedures in the preperitoneal plane, it was Cheatle, in 1920, who first performed transabdominal preperitoneal herniorrhaphy. In 1950, McEvedy described the lateral approach, which was made popular by Nyhus and Condon in the 1960's. The problem of relaxing incisions and the importance of prosthetic repair through this exposure are substantiated along with the anatomy of the preperitoneal fatty layer and the results of sutureless bilateral herniorrhaphy.
The recurrent groin hernia: Therapeutic solutions
Authors: Nyhus Lloyd M. 
Published: May 2005

AbstractAttention to the problem of groin hernia problems has focused on the primary type of operative repair. Because of this, major advances have been made in the surgical cure of these entities. It is important in the primary operation to individualize the type of operative procedure to the specific hernial problem.The results of treatment of recurrent groin hernia range from very poor to excellent. It appears that the use of prosthetic mesh, particularly if placed in the preperitoneal space, has markedly improved the cure rate for these difficult recurrent groin hernias.
The treatment of complicated groin and incisional hernias
Authors: Stoppa René E. 
Published: May 2005

AbstractOne hundred years ago, Edoardo Bassini said: “L'ernia é una malattia meccanica.” Before that, Ambroise Paré (1598) and Joseph‐Pierre Desault (1798) asserted the mechanical nature of strangulation. Beside strangulation, the most serious of all complications even today, I have studied huge hernias, which are natural complications, and recurrent hernias, which are the complications of suboptimal repairs. In this article, I consider the general features and diagnostic and technical consequences of the repair of groin and incisional hernias. The treatment of strangulating hernias, usually an emergency operation, has not seen any recent technical progress. Huge and recurrent hernias, however, usually allow time for adequate surgical preparation. These hernias are also amenable to modern prosthetic repairs. In prosthetic repairs, large pieces of polyester mesh are inserted beneath the muscular wall outside the peritoneum. They act as artificial, nonabsorbable endoabdominal fascia, making the abdominal wall instantly and definitively pressure tight. The state of hernial surgery has advanced to the point that one must consider the systematic surgical cure of all diagnosed hernias.
The use of the preperitoneal approach for the simultaneous repair of inguinal hernia during surgery on the bladder and prostate
Authors: Schlegel Peter N. , Walsh Patrick C. 
Published: May 2005

AbstractRepair of a hernia can be performed safely and expeditiously during a radical pelvic operation by the preperitoneal approach through a median longitudinal incision. We present the results of 41 preperitoneal herniorrhaphies performed simultaneously with 343 radical retropubic prostatectomies and 26 radical cystoprostatectomies. There was no evidence of hernial recurrence after a mean of 28 months and no complications attributable to the hernial repairs. We illustrate the preperitoneal anatomy, and the technique, which allows the safe and efficacious performance of a hernial repair during a urologic procedure.
Parastomal hernias
Authors: Pearl Russell K. 
Published: May 2005

AbstractParastomal hernia is a common complication of stoma formation, having an incidence of about 10%. As with many other ostomy‐associated complications, most parastomal hernias are related to inadequate preoperative planning or technical errors. Most of these hernias should be managed conservatively; only 10–20% of patients eventually require operative intervention. When an operation is indicated, relocating the stoma generally yields better long‐term results than does an attempt at local repair of the hernia.
The place for pneumoperitoneum in the repair of massive hernia
Authors: Raynor R. Winfield , Del Guercio Louis R. M. 
Published: May 2005

AbstractProgressive pneumoperitoneum before the repair of massive abdominal and inguinal hernias, first introduced in 1940, remains an important technique in preparing patients for the operation. Reports of its use have appeared sporadically in the surgical literature. This article recounts the technique of progressive preoperative pneumoperitoneum, its advantages and complications, and the variety of situations in which it is useful. Surgeons treating large hernias accompanied by loss of domain of abdominal viscera should consider preoperative progressive pneumoperitoneum as a helpful and often necessary adjunct to hernial repair.
Diagnosis and treatment of genitofemoral and ilioinguinal neuralgia
Authors: Starling James R. , Harms Bruce A. 
Published: May 2005

AbstractDuring the past 8 years, a total of 36 patients were diagnosed as having either ilioinguinal or genitofemoral neuralgia. A multidisciplinary approach (surgeon, neurologist, anesthesiologist) as well as local blocks of the ilioinguinal nerve or paravertebral blocks of L1,2 were essential to determine which nerve was likely to be entrapped. Seventeen of the 19 patients having a diagnosis of ilioinguinal neuralgia after previous inguinal herniorraphy were completely free of pain after resection of the entrapped portion of the nerve. Seventeen patients were diagnosed as having genitofemoral neuralgia after previous inguinal herniorraphy, blunt abdominal trauma, or another operation. Neurectomy of the genitofemoral nerve proximal to the entrapment controlled the persistent pain in 12 of 17 of these patients. Ilioinguinal or genitofemoral nerve entrapment neuralgias are rare complications of operations in the inguinal region. When the diagnosis is made by a multidisciplinary approach, neurectomy is frequently successful in relieving severe pain and paresthesias without serious morbidity.
Emergency endoscopy: A basis for therapeutic decisions in the treatment of severe gastroduodenal bleeding
Authors: Pimpl Wolfgang , Boeckl Oskar , Heinerman Michael , Dapunt Otto 
Published: May 2005

AbstractThis prospective study compares 3 different consecutive treatment protocols of gastroduodenal hemorrhage. Three hundred sixty‐one patients underwent emergency endoscopy as the basis for further treatment. Clinical and endoscopic findings, such as site and type of the bleeding source, bleeding activity and intensity, age, and concomitant diseases of the patient were scored between 0 and 6 points, the higher number indicating a higher risk. The mean values of the total score of the 7 risk factors were comparable in the 3 treatment protocols.In period I (n=77), a total of 16 patients (20.8%) underwent emergency operations because of severe bleeding, 27 (35%) were operated on after cessation of the bleeding, and 34 (44.2%) were treated conservatively. The mortality was 16.9%.In period II (n=116), patients with actively bleeding lesions (n=38) underwent endoscopic sclerotherapy, with a primary rate of hemostasis in 95%. As a result, the rate of emergency surgery could be reduced to 12.9% and the mortality for the entire group was reduced to 9.5%. The problem in this protocol was the rate of recurrent bleeding after primary endoscopic hemostasis: 13/116 (11.2%). Eleven of the 13 rebleeders presented with a lesion either on the back wall of the duodenum or with a visible vessel.In period III (n=168), a total of 83 patients (50%) underwent endoscopic injection therapy with a primary success in 93%. Sixteen patients (9.5%) with lesions of high rebleeding risk (duodenal ulcer on the posterior wall or visible vessel) were scheduled for urgent elective operation after volume resuscitation within 24 hours of emergency endoscopy (mortality, 6.3%). As a result, the frequency of emergency operations and the mortality for the entire group was reduced to 9.5% and 7.1%, respectively.It is concluded that emergency endoscopy provides superior information for selecting patients for surgery at the optimal time. Furthermore, endoscopic therapy can reduce the rate of emergency operations with the associated high mortality.
Limitations of percutaneous transhepatic cholangioscopy in the removal of complicated biliary calculi
Authors: Jeng Kuo‐Shyang , Chiang Hsein‐Jar , Shih Shou‐Chuan 
Published: May 2005

AbstractTo investigate the limitations of percutaneous transhepatic cholangioscopic lithotomy (PTCSL) in the management of retained or reformed biliary calculi, we conducted a retrospective study of 50 patients who had received PTCSL for complicated biliary calculi during a period of 32 months. The calculi were located in the common bile duct (24%), the intrahepatic bile ducts (60%), and in both the common bile duct and intrahepatic bile ducts (16%). The adjunctive techniques in PTCSL included balloon dilatation for the biliary stricture, electrohydraulic lithotripsy (EHL) for crushing large impacted stones, and flushing techniques, biliary spoons, and basket catheters for stone fragmentation and grasping. The overall percutaneous manipulations totaled 221 procedures, including 124 sessions of PTCS.In each patient, the number of sessions of PTCS varied from 1 to 7. In our series, the main complications of PTCS therapy, rarely reported in the literature, included pain intolerance in 7 cases (14%), minor bleeding in 7 cases (14%), and massive bleeding which needed angiographic diagnosis and therapy for hemostasis in 5 cases (10%). Secondary biliary cirrhosis, severe biliary stricture and angulations, previous shunt surgery, neovascularization surrounding the chronic inflammatory stenotic intrahepatic bile ducts, pseudoaneurysm formation, and coexistent cholangiocarcinoma contributed to the vulnerability of bleeding during manipulations. The complications resulted in treatment failure in 11 patients (22%). We conclude that PTCS is a useful alternative treatment to surgery for biliary calculi, but it has limitations that obviate complete stone clearance.
Segmental colonic resection is an appropriate operation for short skip lesions due to Crohn's disease in the colon
Authors: Allan A. , Andrews H. , Hilton C. J. , Keighley M. R. B. , Allan R. N. , Alexander‐Williams J. 
Published: May 2005

AbstractThirty‐six patients have had a segmental colonic resection for Crohn's colitis between 1948 and 1984. There were 2 deaths caused by intraabdominal abscesses present before operation. There were no cases of anastomotic dehiscence in the 29 patients having segmental resection and immediate anastomosis. The reoperation rate at 10 years was 66% (95% confidence interval, 48–84%), the majority of reresections being for recurrent large bowel Crohn's disease.The 10‐year reoperation rates were higher than after subtotal colectomy and ileorectal anastomosis (53%; 95% confidence interval, 37–69%) performed in a comparable group of patients with colonie Crohn's disease. The difference did not achieve statistical significance. These findings suggest that when a patient with Crohn's disease has a short segment of diseased large bowel, a segmental resection is feasible and safe.
The survival benefit of resection in patients with advanced stomach cancer: The norwegian multicenter experience
Authors: Haugstvedt Trond , Viste Asgaut , Eide Geir Egil , Söreide Odd ,   Members of the Norwegian Stomach Cancer Trial
Published: May 2005

AbstractFive hundred three of 1,165 patients with stomach cancer included in a national multicenter study received noncurative treatment. This study elucidates whether a palliative resection offered any survival advantage compared to nonresectional treatment. One hundred eighty‐two (36%) of 503 patients had gastric resection (including total gastrectomy in 64 patients), 70 (14%) had a bypass procedure, and an exploratory laparotomy was carried out in 156 (31%). Seventy‐eight patients (16%) were not subjected to surgery. Resection carried the same postoperative mortality rate as a nonresectional procedure (13% versus 12%). Univariate survival analysis demonstrated that median survival and 1‐ and 2‐year survival rates were significantly higher in resected patients; however, as basic patient characteristics (age, stage, etc.) differed between the 2 main treatment groups, survival and factors affecting survival were analyzed using the Cox proportional hazards model. Given similar age and preoperative weight loss, resection doubled median survival both for stage III disease (9 versus 4.5 mo) and for stage IV disease (6 versus 3 mo) compared to nonresection or no operation. In conclusion, resection seems justified in patients with advanced stomach cancer since a survival benefit is documented.
Surgical approach to early gastric cancer with lymph node metastasis
Authors: Sowa Michio , Kato Yasuyuki , Nishimura Masanori , Kubo Toshiaki , Maekawa Hisashi , Umeyama Kaoru 
Published: May 2005

AbstractThe clinicopathology of our series of patients (n=486) with early gastric cancer was reviewed with special reference to metastasis to the regional lymph nodes. The incidence of lymph node metastasis was 15.8% (19/120) in patients with the protruded type of carcinoma and 11.7% (42/360) in patients with the depressed type of carcinoma. It was especially high in carcinomas of the IIa + IIc type of the former group. The incidence of lymph node involvement was higher in the group with larger tumors (>30 mm) than in the group with smaller tumors (≤30 mm). Metastatic lesions were detected in as many as 25.0% (16/64) of the cases with large tumors (≥50 mm); however, of the 46 cases with small tumors (<10 mm), 1 case had metastases to the nodes of group 1. There were 4 cases of m‐cancer with metastasis to group 1 lymph nodes. Skip metastasis to group 2 lymph nodes was discovered in 4 cases. From these results, we feel that the standard operation for early gastric cancer is R2‐gastrectomy including the complete removal of group 1 and 2 lymph nodes. R1‐gastrectomy or local resection is thought to be sufficient for m‐cancer with a lesion smaller than 10 mm in maximum diameter.
The effects of blood transfusion on the prognosis of patients with gastric cancer
Authors: Kampschöer G. H. M. , Maruyama K. , Sasako M. , Kinoshita T. , van de Velde C. J. H. 
Published: May 2005

AbstractThe effect of perioperative blood transfusion on the survival rate of patients with gastric cancer was studied. One thousand patients with primary gastric cancer, who had curative surgery performed at the National Cancer Center Hospital in Japan from 1976 to 1981, were studied retrospectively. Overall comparison of transfused (n=371) versus nontransfused (n=629) patients by log rank analysis revealed a statistically significant adverse influence of blood transfusion on survival (p=0.0001). Fifty‐seven percent of transfused as compared to 80.8% of nontransfused patients survived for 5 years or more; however, after stratifying patients into stages and applying proportional regression analyses, blood transfusion did not appear to have any effect on prognosis: relative risk ratio, 1.16;p=0.28. Similarly, comparison of patients transfused with more than 600 cc of blood and those transfused with 600 cc of blood or less revealed no statistical difference in survival time.It is postulated that the possible adverse influence of blood transfusion on the survival of patients with gastric cancer is linked to other prognostic features rather than to the immunologic sequelae of the transfusion itself.
Metabolic basis for management of the septic surgical patient
Authors: Shaw J. H. F. , Koea J. B. 
Published: May 2005

AbstractThe physiologic events accompanying postoperative septic complications in surgical patients represent a coordinated response to bacterial invasion, which is aimed at maintaining the function of key organ systems. When sepsis is prolonged or overwhelming, physiologic dysfunction and multiorgan failure develop. This review outlines the pathophysiologic response to sepsis and correlates it with recent therapeutic advances in the metabolic management of the postoperative septic patient.
Underweight patients and the risks of major surgery
Authors: Windsor John A. 
Published: May 2005

AbstractThe relation between weight loss and the risks of major surgery have been investigated for more than 50 years. It can now be said, with some confidence, that the underweight patient has an increased risk of complications following major surgery. This understanding, however, is based on methods of nutritional assessment that are of limited relevance to hospitalized patients whose malnutrition might be due to sepsis, neoplasia, trauma, or starvation. A consequence is the widespread belief that protein‐energy malnutrition (PEM) has been overemphasized as a surgical risk factor, and that the many nonnutritional risk factors ought to be implicated more often. An argument is made for a fresh approach to nutritional assessment in order to better identify the individual patient who, by virtue of PEM, stands an increased risk of a complicated postoperative course. It is suggested that an evaluation of the impact PEM has on vital physiologic function provides a clinically relevant defect to identify and treat and a means of monitoring response to nutritional intervention.
Perioperative care of the immunocompromised patient
Authors: Yee John , Christou Nicolas V. 
Published: May 2005

AbstractImmunocompromised patients are increasingly common in modern surgical practice. Challenges related to their care include identifying the determinants of increased risk and selecting the appropriate therapy for individual patients. There are multiple and overlapping causes of immunosuppression in surgical patients that make the interpretation of clinical trials difficult. A clear understanding of these mechanisms guides the physician to choose the immunomodulatory agents that can be used for improving current rates of complication and mortality. The best practical approach to immunocompromised patients involves determining who is at risk, aggressive diagnosis, early therapy, and a high index of suspicion for infectious complications.
Postmastectomy morbidity after combination preoperative irradiation and chemotherapy for locally advanced breast cancer
Authors: Sauter Edward R. , Eisenberg Burton L. , Hoffman John P. , Ottery Faith D. , Boraas Marcia C. , Goldstein Lori J. , Solin Lawrence J. 
Published: May 2005

AbstractNeoadjuvant therapy for locally advanced breast cancer improves disease control, but the complications of treatment are not well established. The aim of this study was to assess the operative morbidity in 20 consecutive patients with locally advanced, noninflammatory breast cancer treated with preoperative chemotherapy and radiation. Patients received preoperative cyclophosphamide, methotrexate, 5‐fluorouracil, prednisone, and tamoxifen (CMFPT) to maximum response followed by concurrent chemotherapy and radiation to the involved breast and regional lymph nodes. Following modified radical mastectomy, chemotherapy was continued for a total of 10 cycles. Disease progressed in 3 of 20 patients (15%). Seventeen patients underwent mastectomy, 4 (24%) of whom demonstrated a pathologic complete response to chemoradiotherapy. Seven patients (41%) developed wound infections, 2 (12%) necrosis, 5 (29%) delayed healing, 2 (12%) upper extremity lymphedema, and 8 (47%) seromas. Postoperative chemotherapy was delayed in 4 (24%) patients. There was no mortality, and hospitalization was for less than 1 week. Only one patient required readmission. Although this treatment regimen is aggressive with attendant morbidity, complications are easily managed and generally do not delay therapy. Treatment modification to further reduce complications may be indicated.