bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prophylactic treatment of patients with esophageal varices: Is it ever indicated?
Authors: Greig James D. , Garden O. James , Carter David C. 
Published: October 2004

AbstractThe prognosis of patients who bleed from esophageal varices is dismal. Prophylactic treatment of the varix or the elevated portal venous pressure offers a possibility of improving the outlook for these patients. However, as only approximately one‐third of patients with varices bleed during their lifetime, correct identification of high‐risk patients is vital before embarking on prophylaxis. At present, neither European or Japanese selection criteria are perfect in this respect. The documented incidence of initial variceal bleeding varies between 27% and 48%, and most bleeding episodes occur within the first year after varices are diagnosed. Data from six randomized controlled trials comparing prophylactic β‐blockers with placebo demonstrated a decreased incidence of bleeding in propranolol‐treated patients, which in large measure may depend on patient compliance and did not significantly affect survival in all but one study. Early randomized studies of prophylactic sclerotherapy have shown significant reductions in both the incidence of bleeding and mortality, but this promise has not been sustained by subsequent trials, and indeed sclerotherapy was detrimental in two studies. The impressive results in highly selected patients treated in Japan by prophylactic surgery are unlikely to be repeated in a Western setting, involving patient populations that consist predominantly of alcoholic cirrhotics. At present prophylaxis with β‐blockade seems to offer the best therapeutic option, but the future may lie in the development of new interventional techniques such as tranjugular intrahepatic portosystemic stent shunting (TIPS) or variceal banding, and ultimately with hepatic transplantation.
Long‐term management of variceal bleeding: The place of varix injection and ligation
Authors: Terblanche John , Stiegmann Greg V. , Krige Jake E. J. , Bornman Philippus C. 
Published: October 2004

AbstractInjection sclerotherapy remains the most widely used long‐term management for patients after an esophageal variceal bleed. Sclerotherapy treatments should be repeated weekly until the varices are eradicated. Follow‐up endoscopy every 6 to 12 months is required for life. Whenever varices recur, further weekly injection treatments are administered until re‐eradication is achieved. Failure of sclerotherapy must be diagnosed early and an alternative salvage procedure performed. We currently recommend the distal splenorenal shunt. Although the complications of sclerotherapy are not great, they are cumulative with time. Unlike most surgical procedures for portal hypertension, the technique of performing sclerotherapy is not standardized, making the comparison of controlled trials difficult. The current status of controlled trials comparing sclerotherapy with other treatments is evaluated. We conclude that repeated injection sclerotherapy is at present the initial treatment of choice for patients after an esophageal variceal bleed. The technique of the new procedure of esophageal variceal ligation is described. As with sclerotherapy, weekly treatment sessions are recommended until the esophageal varices are eradicated, followed by long‐term endoscopic surveillance and repeat ligation treatment when varices recur. The four controlled trials that have compared variceal ligation with sclerotherapy favor ligation. Ligation eradicated esophageal varices with fewer treatment sessions and a lower complication rate. One trial demonstrated improved survival. Complications due to the overtube are being increasingly reported but were not a problem in the controlled trials. Although esophageal variceal ligation or ligation plus sclerotherapy may ultimately prove to be superior to sclerotherapy alone, more data are required before a final conclusion can be reached.
Narrow‐diameter portacaval shunts for management of variceal bleeding
Authors: Collins John Craig , Rypins Eric B. , Sarfeh I. James 
Published: October 2004

AbstractOver the past decade, we have developed and refined a method for partial portosystemic shunting for the control of bleeding esophageal varices in alcoholic cirrhotic patients. The narrow‐diameter interposition portacaval H‐graft using 8 mm polytetraffuoroethylene has been performed in 32 patients at our institution with low operativ mortality (16.3%) and nearly complete cessation of variceal bleeding (96.7%) over a mean follow‐up period of 43 months. In comparison with total shunts, diminished rates of postshunt encephalopathy (13% versus 40%) have been observed. Prograde portal blood flow has been preserved in 90% of 30 patients studied by perioperative portography. Shunt patency with continued prograde flow has been demonstrated at up to 9 years of follow‐up. Investigators at three other centers have studied partial shunting using substantially similar techniques, with similar findings. Based on these results, we conclude that narrow‐diameter shunts provide effective, long‐lasting treatment for variceal hemorrhage due to portal hypertension in the alcoholic.
Sugiura procedure for management of variceal bleeding in Japan
Authors: Idezuki Yasuo , Kokudo Norihiro , Sanjo Kensho , Bandai Yasutsugu 
Published: October 2004

AbstractDuring the last three decades the Sugiura procedure and other nonshunting operations have been widely performed as the operations of choice for bleeding esophageal varices in Japan. The Sugiura procedure (University of Tokyo method), a transthoracoabdominal esophageal transection, consists in paraesophageal devascularization, esophageal transection and reanastomosis, splenectomy, and pyloroplasty. The results have been satisfactory with low operative mortality and low rebleeding rate. The prognosis of the patients after this operation depended on the liver function at the time of operation but not on whether operation was done as an emergency, elective, or prophylactic measure. Although the Sugiura procedure has recently been performed in more selected cases with an advance in endoscopic injection sclerotherapy, this procedure remains the ultimate direct operation for portal hypertension in Japan.
Adult pancreatic tissue fate after pancreatic fragment autotransplantation into the spleen of the pancreatectomized dog
Authors: Madureira Mário L. C. 
Published: October 2004

AbstractAs far as we know, after adult enzyme‐digested pancreatic fragment autotransplantation, the fate of the inoculated pancreatic tissue has never been reported and the hypothetic engrafted islet mass growth by mitotic division or by a true islet neogenesis from ductular precursor cells has never been demonstrated. In dogs with total or near‐total (90%) pancreatectomy that preserves the duodenum and the common bile duct, morphologic study of the pancreatic tissue inoculated into the spleen has demonstrated an exuberant ductular‐acinar‐islet regenerative process, with progressive cystic degeneration of the newly formed ductular‐acinar structures occurring simultaneously with the selective survival and growing predominance of extraductal tissue scattered as distinct islets, clusters of islet cells, or single islet cells. In addition to the B, A2, and D cell types of the normal adult dog islet, we have also seen a peculiar ultrastructural pleomorphism of the insular B cells, frequently combined with their ductular or glandular arrangement in maturing islets. Rare or never before reported islet cell types in the adult dog's islets (G cells, mixed endocrine cells of the A2‐D, D‐B, and A2‐B types, and mixed acinar‐islet cells of the D‐acinar type) were also putatively identified. Using light microscopy we have identified many mitotic figures on ductular and centroacinar cells in ductules and ductular‐acinar structures. Moreover, we have ultrastructurally characterized a pluriendocrine nesidioblastic process identified in the most common islet cell types (B, A2, D) and in G cells and mixed acinar islet cells of the B‐ac, A2‐ac, D‐ac, F‐ac, and G‐ac types as well as “intermediary” or “transitional” cells of incipient ductular‐acinar, ductular‐islet, and ductular‐acinar‐islet differentiation. The characteristics of the extraductal islet tissue and the exuberant nesidioblastic process have demonstrated neogenesis of islets and islet cells from precursor ductular cells at several points after the autotransplant, and we suggest that this mechanism may be of fundamental importance for the engrafted islet mass growth—keeping in mind the age of the pancreatic tissue donors and the life‐span of the juvenile diabetic recipient receiving the transplant. This evolution has taken place simultaneously with the progressive rarefaction of the regenerated ductular‐acinar structures definitively deprived of an intestinal drainage route by virtue of their heterotopic location.
Lymph node metastasis and recurrence in patients with a carcinoma of the thoracic esophagus who underwent three‐field dissection
Authors: Fujita Hiromasa , Kakegawa Teruo , Yamana Hideaki , Shima Ichiro , Tanaka Hissaki , Ikeda Sumihiro , Nogami Shyuichi , Toh Yuhi 
Published: October 2004

AbstractThe indication, efficacy, and extent of extended lymphadenectomy for a carcinoma in the thoracic esophagus remain controversial and under clinical investigation. Here we report the frequency and mode of lymph node metastasis at operation and of lymph node recurrence after operation in 70 patients who underwent three‐field dissection and 75.7% of whom suffered from metastasis or recurrence in the lymph nodes (metastasis in 71.4% and recurrence in 21.4%). metastasis or recurrence in the cervical and cervicothoracic nodes were found in 18.6% and 41.4%, respectively. The frequency of cervical and cervicothoracic lymph node metastasis or recurrence was, respectively, 40.0% and 90.0% for a carcinoma in the upper thoracic esophagus, 21.6% and 37.8% for a carcinoma in the middle thoracic esophagus, and 4.3% and 26.1% for a carcinoma in the lower thoracic esophagus. Lymph node metastasis at operation was most frequently found in the right recurrent nerve nodes, right paracardiac nodes, periesophageal nodes, and lesser curvature nodes, whereas lymph node recurrence after operation was found in the left upper recurrent nerve nodes and the right supraclavicular, celiac, and abdominal paraaortic nodes. Metastasis or recurrence was rarely found in the internal jugular, pretracheal, greater curvature, common hepatic, or splenic nodes. This finding suggests the need for recurrent nerve node dissection for cases and for three‐field dissection for a carcinoma in the upper or middle thoracic esophagus.
Evaluation of two training programs for laparoscopic cholecystectomy: Incidence of major complications
Authors: Yamashita Yuichi , Kurohiji Toshihiko , Kakegawa Teruo 
Published: October 2004

AbstractTo determine the need for a training program for laparoscopic cholecystectomy, we evaluated two programs by surveying perioperative complications. The two programs were completed by eight surgeons in each. Program A consisted of 10 supervised operations and program B of only 2. A total of 1054 operations were performed, and 12 major complications required conversion to open surgery owing to transection of the bile duct in 5 cases, laceration of the common bile duct in 1 case, delayed perforation of the common hepatic duct in 1 case, bile leakage in 2 cases, duodenal injury in 1 case, and bleeding from the cystic artery in 2 cases. The incidence of a major complication was significantly higher in group B than in group A, and six of the nine major complications in group B occurred during the initial seven independent operations. Overall, the most common major complication was an injury during the operation to the common bile duct or to the hepatic duct. Four of the five transections of the bile duct required Roux‐en‐Y hepaticojejunotomy, and the other required end‐to‐end anastomosis with T‐tube drainage; one laceration required simple suture closure; and the one delayed perforation required T‐tube drainage. The mean duration of hospitalization for 7 patients with an injury to the bile duct was 74.4 days (range 16–151 days). We recommend that a training program for laparoscopic cholecystectomy should include at least 10 operations to prevent a major complication during the initial 10 operations.
Preoperative staging of gastric cancer as precondition for multimodal treatment
Authors: Sendler A. , Dittler H. J. , Feussner H. , Nekarda H. , Bollschweiler E. , Fink U. , Helmberger H. , Höfler H. , Siewert J. R. 
Published: October 2004

AbstractPreoperative staging of gastric cancer plays a crucial role in every multimodal treatment protocol. At present, staging intends to be far more than evaluation of the depth of tumor infiltration into the organ wall, that is, T stage, nodular status (N category), and the presence of distant metastases (M stage) according to UICC criteria. In modern surgical oncology it includes more often the evaluation of prognostic factors such as the RAS‐protein, p53 tumor suppressor gene, growth factor receptors, cell adhesion molecules, proteolytic factors, and proliferation‐associated antigens. Furthermore, evaluation of nodular status is possible by sophisticated computer programs. The conventional staging of gastric cancer using endoscopy and sonography, conventional ultrasonography, computed tomography, and magnetic resonance imaging is discussed. Possible improvements of staging in oncologic centers should include surgical laparoscopy, laparoscopic ultrasonography, and meticulous evaluation of an abdominal lavage including immunohistochemical detection of free tumor cells. The most promising tumor biology‐related prognostic factors in gastric cancer are briefly discussed.
Neoadjuvant chemotherapy for gastric cancer: Update
Authors: Fink U. , Stein H. J. , Schuhmacher C. , Wilke H. J. 
Published: October 2004

AbstractNeoadjuvant chemotherapy has recently received increasing attention in an attempt to increase the rate of complete tumor resections, combat systemic metastases, and prolong survival in patients with gastric cancer. The available data indicate that neoadjuvant chemotherapy is feasible and does not increase postoperative morbidity and mortality. Compared to the results that can today be obtained with primary resection and lymphadenectomy, however, preoperative chemotherapy has so far failed to show a clear increase in the rate of complete tumor removal in patients with resectable gastric cancer. In patients with locally advanced or unresectable gastric cancer, preoperative chemotherapy may cause substantial reduction in locoregional tumor mass and thus increase the resection rate. This finding appears to translate into a survival benefit for those who respond to chemotherapy and have subsequent complete tumor resection. Because of severe shortcomings in the study design of the published reports, definite conclusions cannot be drawn from the available studies. Randomized controlled prospective trials are therefore clearly warranted. Exact pretherapeutic tumor staging, standardized resection and lymphadenectomy techniques, diligent evaluation of the resected specimen, and close follow‐up are essential when designing these trials to identify subgroups of patients who may benefit from neoadjuvant chemotherapy for gastric carcinoma.
Modified treatment of early gastric cancer: Evaluation of endoscopic treatment of early gastric cancers with respect to treatment indication groups
Authors: Hiki Yoshiki , Shimao Hitoshi , Mieno Hiroyoshi , Sakakibara Yuzuru , Kobayashi Nobuyuki , Saigenji Katsunori 
Published: October 2004

AbstractThe results of endoscopic treatment of early gastric cancers were evaluated. The lesions were divided into two groups: the group with an absolute indication (AI) and the other with a relative indication (RI) for endoscopic treatment. Endoscopic mucosal resection (EMR) was performed on 106 lesions in 104 patients. In addition, 108 patients were treated by laser irradiation (LI). The status of the patients were serially assessed during the postoperative period. The residual rate in AI patients who underwent EMR was 30.3%, whereas the rate in RI patients was 80%. The residual rate in 70 AI patients who underwent LI was 0%. Although the recurrence rate was 4.2%, the cumulative curative rate after additional treatments was 100%. The residual rate in RI patients who underwent LI was 17.4%, and the recurence rate was 13.2%. The cumulative curative rate after additional treatments was 97.4%. In AI patients, the initial mode of treatment used was EMR. Patients who exhibited residual cancerous tissue after EMR or those in whom EMR was difficult to perform, either technically or otherwise, underwent LI. EMR was the first choice therapeutic technique because endoscopic specimens obtained could be subjected to histopathologic examination. In RI patients, the conventional operation was the therapeutic technique of first choice. The LI procedure was performed in those who either refused surgery or who could not undergo operative treatment for various reasons.
Problem of proximal third gastric carcinoma
Authors: Siewert J. R. , Böttcher K. , Stein H. J. , Roder J. D. , Busch R. 
Published: October 2004

AbstractThe prevalence of proximal third gastric carcinoma increases rapidly in the Western world. An analysis of prognostic factors indicates that the poor prognosis usually associated with these tumors is due at least in part to late presentation and advanced tumor stages. The current TNM classification usually understages these tumors because it does not take the partly retroperitoneal location of the proximal stomach into account. After correction of the TNM classification a proximal tumor location has no influence on survival. Because these tumors benefit most from radical lymph node dissection, the retroperitoneal lymphatic drainage must be taken into account when performing lymphadenectomy for proximal third gastric cancer. To avoid pancreatic fistulas and the associated morbidity, a pancreas‐preserving splenectomy and lymphadenectomy should be adapted if an extended lymph node resection of the retroperitoneum is performed. Because of the high prevalence of “intestinal type” tumors in the proximal third of the stomach the extent of the luminal resection margins can be limited; that is, a total gastrectomy with transhiatal resection of the distal esophagus usually suffices to achieve complete tumor removal at the oral margin.
Pancreas‐preserving total gastrectomy for proximal gastric cancer
Authors: Maruyama Keiichi , Sasako Mitsuru , Kinoshita Taira , Sano Takeshi , Katai Hitoshi , Okajima Kazuo 
Published: October 2004

AbstractLymph node (LN) dissection along the upper border of the pancreas is one of the essential parts of curative surgery for gastric cancer, and the distal portion of the pancreas was frequently resected for complete removal of LNs along the splenic artery. Hoever, pancreatic juice leakage, subphrenic abscess, and postoperative diabetes were common complications in patients treated by pancreatic resection. To avoid these problems a new surgical procedure, the pancreas‐preserving operation, was developed by Maruyama in 1979. We found that lymphatic channels from the stomach did not flow into the pancreas parenchyma, and that the spleen, splenic artery, and fatty connective tissue including nodes could be removed completely without dissection of the pancreas parenchyma and splenic vein. The preserved pancreas receives its arterial blood supply through the transverse pancreatic artery, and its preservation prevents postoperative diabetes. A total of 299 patients were treated by this procedure. The operative mortality rate was 0.3%, the hospital death rate 1.6%, and the surgical complications rate 19.6%. The cumulative 5‐year survival rate for those with stage II was 70.5% and for those with stage III 54.1%. These results were superior to those of the pancreas resection group.
Splenectomy for treatment of gastric cancer: Japanese experience
Authors: Okajima Kunio , Isozaki Hiroshi 
Published: October 2004

AbstractSurgery for gastric cancer in Japan has frequently been combined with resection of the spleen (splenectomy) or of the pancreatic body and tail and spleen (pancreatosplenectomy, PS). Splenectomy in patients with gastric cancer has been performed with two major purposes in mind: (1) curability of the cancer and (2) immunologic reasons. Direct cancerous invasion to the pancreas requires PS, although examination of these cases revealed that in 34.3% of such macroscopic invasions only fibrous adhesion to pancreas existed. Metastases to lymph nodes at the splenic hilus (no. 10) or along the splenic artery (no. 11) also required splenectomy. The incidences of no. 10 or no. 11 lymph node metastasis were as high as 26.7% and 22.2% respectively, for cancers of whole stomach, and 15.5% and 12.1% for cancers of the upper portion of stomach. Concerning the immunologic aspect of splenectomy for gastric cancer, the reports of fundamental research and clinical studies suggest that the spleen plays sometimes acts as a suppressor and at other times as a helper to the tumor activity, according to the number of tumor cells. From these data, we concluded that the spleen should be preserved in stage I, II, and III patients with curative operation; for stage IV patients the spleen should be resected. The immunologic significance of splenectomy should be clarified precisely in the near future.
Extended gastrectomy: Who benefits?
Authors: Köckerling F. , Reck T. , Gall F. P. 
Published: October 2004

AbstractIn the area of radical surgical treatment of gastric carcinoma, extended or multiorgan resection is—as is systematically extended lymph node dissection—becoming increasingly important. One indication for extended gastrectomy is intramural or transmural infiltration of neighboring organs or the gross presence of metastatic involvement of the lymph nodes associated with the celiac trunk, splenic artery, or splenic hilum. Because the mortality rate associated with extended gastrectomy is hardly any higher than that for nonextended gastrectomy, the indication for the former may be generously applied. The prognostically most unfavorable case is histologic evidence of transmural infiltration of neighboring organs (pT4). Multiorgan resection with improved systematic extension of lymph node dissection is of greatest benefit to patients with inflammatory adhesion of the stomach to neighboring organs or pN2 lymph node metastases. Intramural infiltration of the esophagus can be treated by including the thoracic part of the esophagus in the gastric resection done via an abdominothoracic approach, ensuring an appropriate margin of clearance, with no significant worsening of the prognosis.
Lymphadenectomy for gastric cancer in clinical trials: Update
Authors: Roder J. D. , Bonenkamp J. J. , Craven J. , van de Velde C. J. H. , Sasako M. , Böttcher K. , Stein H. J. 
Published: October 2004

AbstractThe controversy over the value of extended lymph node dissection for treatment of gastric cancer is fiercely debated. Whereas Japanese surgeons claim that the superior survival rates in their series are due to extensive resection (D2 resection), many Western authorities believe that their results only reflect differences in the prevalence of prognostic factors, inconsistencies between Japanese and Western staging systems, and the phenomenon of “stage migration,” which occurs with extensive resection. Two small randomized prospective trials from Hong Kong and Cape Town showed a tendency toward high morbidity with extensive lymph node dissection but no survival benefit. In contrast, the recently completed prospective German Gastric Carcinoma Study demonstrated a clear survival advantage with D2 resection for tumor stages II and IIIa with no increase in perioperative morbidity or mortality. The long‐term results of the still ongoing randomized MRC and Dutch trials are therefore eagerly awaited.