bluuebunny/crossref_metadata_2025_split huggingface dataset:
Radiological anatomy of the biliary tract: Variations and congenital abnormalities
Authors: Puente Sergio G. , Bannura Guillermo C. 
Published: May 2005

AbstractA series of 3,845 operative cholangiograms performed at Hospital Paula Jaraquemada are analyzed. Normal cholangiograms were found in 57.6% of the cases. Anatomical variations were demonstrated in 24% and congenital abnormalities of the biliary tree in 18.4%.The anatomic variations and congenital abnormalities are described and discussed. The importance of operative cholangiography and the valuable aid it provides the surgeon are emphasized.
Diagnosis of traumatic diaphragmatic hernia: Analysis of 63 cases
Authors: Christophi C. 
Published: May 2005

AbstractSixty‐three cases of traumatic diaphragmatic hernia due to blunt abdominal trauma are reviewed. Diagnosis based on clinical suspicion and plain chest x‐ray was achieved in only 39 cases (62%); 14 cases (22%) were diagnosed at laparotomy; and 4 cases (6%) were diagnosed at postmortem. Six cases (9%) were not initially diagnosed and re‐presented at varying intervals with symptoms of intermittent intestinal obstruction. Overall mortality rate was 14%. Possible methods of diagnosis are suggested.
Cancer of the male breast
Authors: Axelsson Jan , Andersson Åke 
Published: May 2005

AbstractThirty‐nine cases of male breast cancer were reported to the Swedish Cancer Registry in 1962–1963, and sufficient information was gained from 34 of them for inclusion in this study. Male breast cancer constitutes 0.7% of the total number of breast cancers. The average age at time of diagnosis was 65 years. Many of the patients had complicating diseases. The patient's delay in seeking medical attention was an average of 7.9 months. Fifty‐nine percent of the tumors were situated in the left breast. Four patients (12%) had gynecomastia. Fifteen percent of the cancers were clinical stage I, 38% stage II, 35% stage III, and 12% stage IV at the time of diagnosis. Twenty‐one percent had histologically proven nodal metastases. Twenty‐seven patients underwent a more or less radical operation. Most patients received radiotherapy after operative treatment. The overall corrected 5‐year survival is 54% and 10‐year survival 37%. A review of the literature is given.
Fournier's gangrene: A general surgery problem
Authors: Diettrich Nancy A. , Mason James H. 
Published: May 2005

AbstractFournier's gangrene is a specific form of synergistic gangrene involving the scrotum and perineum. The disease may follow a variety of clinical conditions or occur without an apparent precipitating cause. It is associated with severe systemic toxicity and a significant mortality rate, and it demands prompt recognition and urgent, aggressive surgical intervention. Its treatment calls on the full armamentarium of the general surgeon. Preoperative resuscitation is often required. Operative debridement can be extensive, involving the buttocks and on occasion the upper thighs and abdominal wall. Postoperative management consists of wound care with eventual grafting or flap rotations. Colostomy may be required. Three cases illustrating the salient features of this disease are presented, together with a review of the literature.
A simple method to prevent celestin tube regurgitation
Authors: Pimenta Amadeu P. A. , Cardoso Valdemar M. B. , Rodrigues Joaquim S. , Ramos Isabel 
Published: May 2005

AbstractThe incidence of esophageal carcinoma, the high mortality and morbidity rates, and the socioeconomic implications associated with the disease have stimulated a great deal of interest and controversy regarding the relative roles of surgical and palliative therapy. Intubation of the esophagus as a palliative for carcinoma is well established and is often useful in relieving symptoms of dysphagia. A simple technique is described which prevents regurgitation of the Celestin tube by use of a rubber “mushroom.” A case is presented in which this technique proved satisfactory in avoiding gastric laceration by the tube.
A fourteenth‐century description of rectal cancer
Authors: Swain C. P. 
Published: May 2005

AbstractIn 1376 John Arderne, an English surgeon with a special interest in proctology (Fig. 1), wrote this perceptive description of rectal cancer [1]. The stress that he places on the diagnostic value of digital examination, the clarity with which he differentiates the presentation of rectal cancer from that of inflammatory bowel disease, his simple and sensible recommendations for its palliation, his astute observations on its natural history, and the unequivocal recognition of its prognosis give his account the high quality of a classic description of disease.
Tissue oximetry: An interim report
Authors: Hunt Thomas K. , Rabkin John , Jensen J. Arthur , Jonsson Kent , von Smitten Karl , Goodson William H. 
Published: May 2005

AbstractTissue oximetry, already a practical reality in some centers, holds considerable promise for clinical use. It has the capacity to monitor the oxygen delivery system and estimate perfusion of tissues; and we suspect it can add considerably to prevention of surgical complications and treatment of surgical infections. Present instruments are relatively difficult to use, but their potential is not being utilized largely because of misconceptions about the transport of oxygen in tissue and the significance of peripheral perfusion. Oximetry measures perfusion, whereas currently popular indices such as urine output are indirect indicators and are often misleading.The basic concepts of tissue oxygenation, the relevance of partial pressure of oxygen in tissue, the connection with perfusion, various technologies for measuring tissue oxygenation, and the currently available methods are discussed.
A new approach to physiology, monitoring, and therapy of shock states
Authors: Shoemaker William C. 
Published: May 2005

AbstractDescriptions of the sequence of hemodynamic and oxygen transport patterns in the various types of shock syndromes have shown reduced oxygen consumption (VO2) as the earliest pathophysiologic event that precedes the initial hypotensive crisis. Inadequate VO2 may be produced by low flow, as in hemorrhagic and cardiogenic shock, by increased metabolic need, as in traumatic and septic shock, and/or by maldistribution of flow in all types of shock. These physiologic patterns are also related to the degree of the shock state and its outcome; the patterns of the survivors and nonsurvivors can be predicted from these patterns with a high degree of sensitivity and specificity by multivariate analysis.Therapy directed toward optimizing the VO2 and its compensations to the range of survivors of life‐threatening shock was shown to improve outcome in prospective clinical trials. A branched chain decision tree was developed for fluid resuscitation of critically ill postoperative patients. The algorithm was developed from decision rules based on objective physiologic heuristic data from survivors as the criteria.The improved mortality in prospective studies supports the hypothesis that compensatory responses of the survivors are major determinants of outcome. Therefore, therapy that supports these compensations and produces the survivor pattern will improve survival rates. These prospective studies confirm the validity of an organized, coherent physiologic approach in contrast to the traditional approach, the objectives of which are to restore hemodynamic and biochemical abnormalities to normal if and when they are discovered.The use of a branched chain decision tree helps to achieve these therapeutic goals expeditiously by providing a coherent, organized patient management plan. It is not necessary to wait for patients to develop cardiorespiratory deficits before initiating therapy. Therapy should be started to optimize the important variables as soon as possible after the onset of accidental trauma or before, during, and immediately after surgery in the high‐risk patient.
Right ventricular function in the surgical patient
Authors: Raper R. , Sibbald W. J. 
Published: May 2005

AbstractIt has long been appreciated that the cardiovascular system plays a vital role in surgical illnesses. Although attention has, historically, been largely focused on the left ventricle, it has become apparent in recent years that the right ventricle may contribute significantly to an absolute or relative failure of cardiovascular adaptation to acute and chronic disease states. Many of the physiological principles governing left ventricular function also determine right ventricular function. Thus, the right ventricle is affected by changes in afterload, preload, and contractility. Since many surgically relevant disease states may potentially alter such determinants of right ventricular function, some consideration of right ventricular function and its effect on global cardiac function in the surgical patient is warranted. In this review, we have attempted to provide a brief overview of normal right ventricular physiology as well as the pathophysiology and therapy of right ventricular dysfunction that may be seen in the surgical patient.
Current concepts in the management of the adult respiratory distress syndrome
Authors: Weigelt John A. 
Published: May 2005

AbstractThe adult respiratory distress syndrome is the most severe pulmonary complication that can follow multiple trauma and critical illness. It is caused by an insult to the pulmonary circulation which results in an increased capillary permeability and subsequent interstitial edema. An increased venoarterial shunt occurs resulting in arterial hypoxemia. The mortality rate is at least 50% if treatment is not begun before profound hypoxemia occurs. Recognition of abnormal cardiopulmonary function before overt hypoxemia develops is important. This is best accomplished by attentive monitoring of arterial blood gases. Sequential arterial oxygen tensions obtained on 40% and 100% inspired oxygen concentration are the best guides to selecting patients who have a high probability of pulmonary deterioration. Aggressive cardiovascular monitoring and early treatment with low levels of positive‐end expiratory pressure offer this group of patients an improved change of survival.
High‐frequency ventilation
Authors: Enderson Blaine L. , Rice Charles L. 
Published: May 2005

AbstractHigh‐frequency ventilators (HFV) use increased respiratory rates and decreased tidal volumes to achieve gas exchange similar to conventional mechanical ventilators (CMV). This reverses the relative importance of convection and diffusion to gas exchange. There are currently 3 major types of HFV. They differ from each other in how gas is delivered, how they work, and what physiological effects they have. Conclusions drawn using one type of HFV cannot necessarily be applied to the others. This review examines the different types of HFV as well as the studies that have been conducted using HFV. It stresses the role that HFV may play in the surgical intensive care unit. The one certain indication presently for HFV is in patients with a bronchopleural fistula. It may also be useful as an adjunct to endoscopy and in adult respiratory distress syndrome (ARDS). If the underlying lung disease cannot be reversed (i.e., end‐stage fibrotic ARDS), HFV has little to offer.
Physiology and metabolism in closed head injury
Authors: Deutschman Clifford Scott 
Published: May 2005

AbstractStudies on metabolism in head injury have indicated the presence of some degree of elevation in metabolic rate associated with extensive nitrogen wasting. Cardiodynamics are consistent with an adaptive increase in substrate delivery in an effort to meet the increased tissue demands. Most studies suffer from lack of longitudinal data and an inability to separate the effects of the injury from the effects imposed by some frequently utilized treatment modalities. In this article, the existing literature on metabolism and cardiodynamics is reviewed and contrasted with the findings of a study intended to focus on changes over time as well as to eliminate as many of the contaminating modalities as possible.
Nutritional support in the management of critically ill patients in surgical intensive care
Authors: Streat Stephen J. , Hill Graham L. 
Published: May 2005

AbstractNutritional support is given to many patients in surgical intensive care after major trauma and serious sepsis but rarely after major elective surgery. We have quantified the changes in body composition that occur in these patients and have found that serious losses of body protein still occur after trauma and sepsis despite nutritional support. Correct nutritional management of critically ill patients in surgical intensive care depends on an understanding of the underlying physiology, drainage of sepsis, a high standard of general intensive care measures, and appreciation of sound principles of administration of intravenous nutrition.
Adequacy and support of physiological functions in the acutely ill cirrhotic patient
Authors: Giovannini Ivo , Boldrini Giuseppe , Chiarla Carlo , Castagneto Marco , Sganga Gabriele , Tramutola Giuseppe , Caracciolo Francesco , Castiglioni Giancarlo 
Published: May 2005

AbstractThe cirrhotic condition is characterized by a series of changes in physiological functions and of subclinical alterations that imply an abnormal and fragile adaptive pattern with reduced resistance to superimposed distress. In the care of the critically ill cirrhotic patient, the supportive measures aimed at maintaining physiological stability through the control of such debilitating factors have a key role and are not secondary in importance to the more obvious measures needed to treat clinically evident and specific alterations or complications. The relationship between hepatic malfunction and the development of these physiological abnormalities is not fully understood. Our knowledge of the problem, however, has been recently improved and the need for supportive measures motivated by a series of notions on cardiorespiratory and metabolic abnormalities and interactions in hepatic decompensation.
Pharmacokinetics and pharmacodynamics in critically ill patients
Authors: Mann Henry J. , Fuhs David W. , Cerra Frank B. 
Published: May 2005

AbstractThe rapidly changing physiology of critically ill patients causes variations in the absorption, distribution, metabolism, excretion, and pharmacodynamic effect of drugs used to treat these patients. Alterations in fluid status, cardiac, renal and hepatic function, and circulating serum proteins necessitate increased attention to drug selection and dosage modification. Cardiac failure results in decreased absorption, metabolism, and excretion of drugs while renal failure results in parent drug and metabolite accumulation, increases in unbound drug, and changes in distribution volume. The changes in hepatic blood flow and protein binding, and decreases in hepatocellular mass and enzyme function that occur in hepatic failure may alter the clearance of several drugs. Serum drug concentrations are helpful in defining the pharmacokinetics and ultimately the pharmacodynamic effect of the drugs used in critically ill patients. The serum drug concentrations must be interpreted in association with their pharmacodynamic effect and the clinical situation. Adjusting drug therapy based on pharmacokinetic principles is discussed in detail with specific suggestions for dosage modifications in renal and hepatic failure.
Reintervention in abdominal surgery
Authors: Krause Rudolph 
Published: May 2005

AbstractThe literature on reinterventional abdominal surgery is confusing. The incidence and mortality rates are greatly affected by the type of surgery reported. There is also a difference between recent and older studies with regard to definitions and indications for relaparotomy, rendering comparison of these studies rather useless.Reinterventional laparotomy is reported to occur in 0.5–15% of all laparotomies. The highest incidence is seen in gastrointestinal surgery and the lowest in vascular surgery. The indications are infection and disruption of anastomoses, wound dehiscence, hemorrhage, obstruction, ischemia and necrosis, multiple system failure, and miscellaneous indications. The overall mortality rate after reinterventional laparotomy is over 40%, ranging from 24 to 71%. Factors that appear to correlate with mortality are age over 50, peritonitis at initial procedure, and multiple system failure. Criteria leading to relaparotomy are usually clinical (tenderness, fever, and absence of bowel sounds) and, to a minor extent, depend on radiological procedures of which computed tomographic scanning has the highest accuracy (97%).Multiple system failure carries the highest mortality rate (80% if treated, 100% if untreated) and presents the greatest number of negative laparotomies. Arguments for accepting this criterion are discussed. Mortality rates apparently will not be lowered limiting technical failures. A better yield could be gained by improving perioperative management and inducing a shift toward second‐look or elective procedures within a fully developed protocol.
Immunotherapeutic advances in the treatment of gram‐negative bacterial sepsis
Authors: Dunn David L. 
Published: May 2005

AbstractGram‐negative bacterial sepsis with the frequent sequelae of shock, multi‐system organ failure, and death represents one of the most severe infections that can occur in the surgical patient. Fatality in most series has paralleled the presence and severity of underlying host disease processes, polymicrobial bacteremia, shock, and lack of early appropriate antimicrobial therapy. Even patients with no underlying disease state have a significant mortality (10–20%). Therapy of gram‐negative bacterial sepsis and shock at present consists of antimicrobial agents, hemodynamic monitoring, aggressive fluid resuscitation, and metabolic support. The use of these treatment modalities in concert has reduced, but not eliminated, the severe consequences that may ensue. Administration of antibody directed against the comon core lipopolysaccharide antigen of gramnegative microorganisms to patients with gram‐negative sepsis represents a means by which the morbidity and mortality of this disease process may be further reduced. This is supported by a large body of experimental evidence, as well as several preliminary clinical studies. It is necessary to determine how the clinical efficacy of such antibody preparations can be maximized. This will entail rigorously controlled studies in which the timing of antibody administration and dose utilized can be correlated with clinical efficacy. Should such antibody preparations continue to prove efficacious as an additive form of therapy, it may be possible to identify high‐risk groups of patients who would benefit from antibody prophylaxis.
Cost‐effective use of the surgical intensive care unit
Authors: Eyer Steven D. , Cerra Frank B. 
Published: May 2005

AbstractThe intensive care unit (ICU) continues to be a large user of resources. There is a continued need for a balance of cost‐effective utilization and quality patient care. A data base of information currently exists that defines those groups of patients in whom reasonable success in resource allocation can be anticipated. In other cases, attempts are being made to define variables that adequately predict survival so they can be used to effect care decisions. Although some progress has been made, considerable work is needed to achieve both of these.For surgeons, the ICU has become an essential “part of the knife.” It is a necessity in modern high‐technology care and has become an essential element in surgical training programs. The use of the ICU for currently conceived high‐risk patients is now commonplace. A growing database supports this preoperative use of ICU resources. Techniques are now available to make ICU care more cost‐effective. Tools such as not having routine orders, daily rewriting of all orders, review of drug orders, and the utilization of the laboratory and radiographic resources have already reduced significantly the real cost of using these life‐saving facilities.
Prognostic index: prediction of operative mortality in geriatric patients by use of stepwise logistic regression analysis
Authors: Reiss R. , Haddad M. , Deutsch A. , Lilos P. , Fuchs C. 
Published: May 2005

AbstractThe decision‐making process with regard to surgery in geriatric patients is of great importance, requiring consideration of ethical, medicolegal, and economic factors in addition to the purely medical ones. An important component in the decision‐making process is the precise knowledge of the expected mortality. Clearly, such knowledge helps the surgeon as well as the patient and family to make the final decision whether to operate.Twelve hundred major laparotomies in elderly patients were used as a data base. Thirty‐six preoperative variants were noted for each patient as well as the occurrence of postoperative mortality or morbidity. All data were loaded into a 6,000 CDC computer and subjected to Multifactorial Stepwise Logistic Regression Analysis (MSLRA). The method allowed a choice of the 5 most significant factors in the prediction of mortality, as well as calculation of a numerical coefficient for every factor. A formula (MIX Formula) was devised to calculate the mortality in percentile terms using the factor coefficient. The results of this study show that the use of statistical multifactorial analysis permits an accurate preoperative prediction of postoperative mortality in geriatric candidates for major abdominal surgery. The accuracy of the prediction was confirmed by both retrospective and prospective analysis.
Serum gastrin, calcitonin, and prolactin as markers of multiple endocrine neoplasia syndromes in patients with primary hyperparathyroidism
Authors: Farndon John R. , Geraghty John M. , Dilley William G. , Handwerger Stuart , Leight George S. 
Published: May 2005

AbstractSince primary hyperparathyroidism (PHPT) is a component of the multiple endocrine neoplasia syndromes types I and II (MEN I and MEN II), patients presenting with PHPT might represent a population at increased risk for either of the 2 syndromes. To test this hypothesis, serum gastrin, prolactin, and calcitonin concentrations were measured pre‐ and postoperatively in 100 consecutive patients undergoing surgery for PHPT. Mean preoperative serum gastrin concentrations were within the normal range and did not decrease postoperatively, and there was no correlation between serum gastrin and calcium preoperatively. A high proportion of females (16%) had abnormally high serum gastrin concentrations but no evidence of MEN I. Six females had abnormal secretin stimulation of gastrin release but had achlorhydria or hypochlorhydria with other features suggestive of type A atrophic gastritis. No abnormal calcitonin concentrations were detected. Two elderly females had insignificant elevations of serum prolactin concentrations. These results suggest that serum gastrin, prolactin, and calcitonin are needless determinations in patients who are undergoing surgery for PHPT and who have no clinical indication of MEN syndromes. The interpretation of secretin‐stimulated gastrin concentrations in the diagnosis of a gastrinoma may need to be reevaluated. It would appear that a high proportion of females with PHPT have atrophic gastritis and secondary hypergastrinemia.