bluuebunny/crossref_metadata_2025_split huggingface dataset:
Laparoscopic Cholecystectomy for Acute Cholecystitis in the Elderly
Authors: Lo Chung‐Mau , Lai Edward C.S. , Fan Sheung‐Tat , Liu Chi‐Leung , Wong John 
Published: August 2002

AbstractThis study reviewed the results of laparoscopic cholecystectomy for acute cholecystitis in the elderly. Among 557 patients who underwent laparoscopic cholecystectomy, 70 (12.6%) had a clinical diagnosis of acute cholecystitis confirmed by ultrasonography. There were 28 men and 42 women with a mean age of 59.9 years (range 20–87 years). Thirty patients ≥ 65 years of age were compared to 40 patients < 65 years old. Elderly patients had a higher female predominance (p< 0.05), a higher incidence of intercurrent diseases (p< 0.05), and a higher serum urea level (p< 0.001). The proportions of patients who underwent early or delayed surgery were comparable. There was no difference in operation time, postoperative analgesic requirements, or complications. Elderly patients, however, had a significantly higher conversion rate (23.3% versus 2.5%;p< 0.05). Even after successful laparoscopic cholecystectomy, there was a longer delay before ambulation (p< 0.05) and resumption of normal diet (p= 0.08) with resulting prolonged postoperative (p= 0.08) and total hospital stay (p< 0.05). Laparoscopic cholecystectomy is a safe, effective treatment for acute cholecystitis in the elderly. When compared to younger patients, elderly patients are at greater risk for conversion, delayed recovery, and prolonged hospital stay.
Effect of Supplemental l‐Arginine in a Chemical‐Induced Model of Colorectal Cancer
Authors: Ma Qingyong , Hoper Margaret , Anderson Neil , Rowlands Brian J. 
Published: August 2002

Abstractl‐Arginine inhibits the development of spontaneous, transplantable solid tumors and chemically induced mammary tumors. The aim of the present study was to investigate the effect of l‐arginine on chemically induced colorectal cancer in male Wistar rats. Colorectal cancer was induced in all animals by weekly subcutaneous injections of the colonic procarcinogen 1,2‐dimethyhydrazine (DMH) at a dosage of 20 mg/kg body weight. Arginine was given in a 1% solution of drinking water. Group I was the DMH control; group II, arginine for 22 weeks; group III, arginine for the first 10 weeks only. Lymphocyte function was evaluated by measuring the thymic lymphocyte proliferative response to the T cell mitogen phytohemagglutinin. The results show that tumor incidence and tumor burden (tumors/rat and tumors/tumor‐bearing rat) were significantly reduced in both groups of animals receiving arginine compared to DMH controls (p< 0.05). The tumor areas and volumes were also reduced in both arginine groups (p< 0.05). Thymic lymphocyte stimulation indices were significantly increased by arginine supplementation (p< 0.05). These results would be in keeping with the reduction in colorectal tumor production due to a “nonspecific” stimulation of the host immune system by l‐arginine.
Clinical Development of Human Polymerized Hemoglobin as a Blood Substitute
Authors: Gould Steven A. , Moss Gerald S. 
Published: August 2002

AbstractAlthough the efficacy of hemoglobin‐based oxygen carriers was established more than 60 years ago, all prior clinical trials have demonstrated significant toxicity characterized by renal dysfunction, gastrointestinal distress, and systemic vasoconstriction. The mechanisms of these toxicities now appear to be understood. Tetrameric forms of the hemoglobin molecule extravasate from the circulation and interact with endothelium‐derived relaxing factor, leading to unopposed vasoconstriction. Although numerous efforts are under way to chemically modify the native tetramer, it is likely that all tetrameric forms of the hemoglobin molecule will continue to extravasate. We have focused on developing a polymerized form of hemoglobin that is virtually free of unreacted tetramer. The development and characterization of this polymerized pyridoxylated hemoglobin solution (Poly SFH‐P) is described. Clinical trials have been completed successfully in volunteers and are now under way to assess the safety and efficacy of Poly SFH‐P as a clinically useful red blood cell substitute for treatment of acute blood loss in the setting of trauma and surgery.
Overview on Compression Anastomoses: Biofragmentable Anastomosis Ring Multicenter Prospective Trial of 1666 Anastomoses
Authors: Thiede A. , Geiger D. , Dietz U.A. , Debus E.S. , Engemann R. , Lexer G.C. , Lünstedt B. , Mokros W. 
Published: August 2002

AbstractThis study represents a European prospective clinical multicenter trial and was undertaken to evaluate the applicability of the biofragmentable anastomosis ring (BAR) as a routine anastomotic tool in teaching hospitals. The trial results analyzed consisted of 1666 BAR anastomoses performed in 1360 patients from March 1989 to May 1996 in the upper (1042 anastomoses) and lower (624 anastomoses) gastrointestinal (GI) tract. Only patients selected for elective procedures and having previously undergone orthograde bowel cleansing were entered into the trial. In the upper GI tract six anastomoses (0.58%) developed clinically relevant and radiologically detectable leaks with indications for reoperation. In the lower GI tract 42 (6.73%) anastomoses showed a radiologically detectable leak with clinical manifestations in 28 cases (4.48%). Reoperation was performed in 18 cases (2.80%). The overall leakage rate with clinical relevance was 2.04%. Three gastrojejunostomy episodes of bleeding were observed (0.18%) at the BAR anastomotic site. During the early postoperative course there was no ileus due to obstruction of a BAR anastomosis. Reintroduction of diet after the operation was not delayed. In two centers a follow‐up evaluation reported no BAR‐related late anastomotic stenoses. There were no intraoperative deaths, but 54 patients died postoperatively. Peritonitis following anastomotic leakage was responsible for postoperative deaths in four cases; three of them were related to BAR anastomoses. In conclusion, the BAR anastomotic procedure is an established, rapid, simple to learn, highly standardized, safe technique with the advantage of no persistent foreign material in the anastomotic region and therefore no induction of stenosis. At present, the application of anastomoses in various segments of the GI tract, from the stomach to the middle third of the rectum, can be recommended.
Quality of Life of Patients with Inflammatory Bowel Disease after Surgery
Authors: McLeod Robin S. , Baxter Nancy N. 
Published: August 2002

AbstractQuality of life is an important outcome measure following surgery for ulcerative colitis. Quality of life incorporates not only the physical or functional outcome; it also considers the emotional and social well‐being of patients. Quality of life may be measured using disease‐specific or generic quality of life measures or by utility measurement. Although the pelvic pouch procedure is preferred by most patients, there are data to suggest that the quality of life is excellent irrespective of the procedure, possibly because physical well‐being is improved and is the main determinant of outcome. Those who have a pelvic pouch may be less restricted in some activities. Compared to medically treated patients, quality of life is usually superior in surgical patients, although it varies depending on the activity of the disease and the surgical outcome. Despite more publications on this topic in recent years, there is a need for further studies comparing quality of life in patients receiving medical and surgical treatment as well as assessing outcome following the various surgical procedures.
Adrenocortical Carcinoma: Surgery and Mitotane for Treatment and Steroid Profiles for Follow‐up
Authors: Khorram‐Manesh A. , Ahlman H. , Jansson S. , Wängberg B. , Nilsson O. , Jakobsson C.E. , Eliasson B. , Lindstedt S. , Tisell L.E. 
Published: August 2002

AbstractAdrenocortical carcinoma (ACC) is a rare disease with a poor prognosis. It has been difficult to establish a strict treatment program for ACC, and better treatment alternatives and diagnostic tools must be sought. Even though surgery is the treatment of choice, the role of surgery in advanced disease has been questioned. Eighteen consecutive patients were treated at our unit over a 22‐year period (1975–1997). All patients underwent surgery and were followed by our protocol, which includes urinary steroid profiles, clinical examinations, analysis of steroid hormones, and radiologic investigations. Twelve patients received mitotane with drug concentration measurements to deliver an effective, nontoxic dose. The median duration of mitotane treatment was 12 months. Few side effects were observed. Four patients with low‐stage tumors underwent second‐look operations with no pathologic findings. Five patients were subjected to repeat operations, and the mean duration of the disease‐free interval before repeat surgery for these patients was 59 months. There was a significant positive correlation between the disease‐free interval and the observed survival after repeat surgery. Eleven patients with intentionally curative surgery had their urinary steroid profiles tested several times postoperatively. For five patients preoperative urine samples were also available. Steroid profiles indicated recurrent disease despite normal radiologic findings in two of these five patients. The follow‐up ranged from 6 weeks to 24 years. The predicted 5‐year survival was 58% according to the Kaplan‐Meier method. We conclude that monitoring serum concentrations of mitotane makes long‐term treatment possible with few side effects; steroid profile analysis can be used for early detection of tumor recurrence; and repeat surgery for recurrence is of value for patients with long disease‐free intervals.
Efficacy of Single‐voided Urine Metanephrine and Normetanephrine Assay for Diagnosing Pheochromocytoma
Authors: Ito Yukio , Obara Takao , Okamoto Takahiro , Kanbe Masako , Tanaka Reiko , Iihara Masatoshi , Okamoto Joji , Yamazaki Kiyomi , Jibiki Kazuko 
Published: August 2002

AbstractUrinary catecholamines (CAs) and their metabolites are usually measured during the process of diagnosing pheochromocytoma (pheo), but a 24‐hour urine collection is not convenient for outpatients. Since 1987 we have utilized “spot” urine metanephrine (MN) and normetanephrine (NMN) assays for management of patients with pheo or adrenal incidentaloma. MN and NMN were measured by radioimmunoassay in 82 patients with surgically proved pheo and 15 patients with incidentaloma. In 10 patients with pheo, MN and NMN were measured with fractional every‐3‐hour urine samples, which were accumulated and then measured as a 24‐hour urinary specimen. Fractions of 3‐hour MN and NMN excretion were constant (MN 98.5 ± 9.6%, NMN 97.6 ± 10.8%; 24‐hour MN and NMN 100%). The average levels of MN and NMN in patients with pheo were 6801 ng/mg creatinine (Cr) (range 93–88,248, median 1426) and 5627 ng/mg Cr (range 219–31,528, mean 3190), whereas the MN and NMN levels in patients with incidentaloma were 123 ng/mg Cr (range 36–246, mean 133) and 251 ng/mg Cr (range 84–472, mean 220), respectively. When we selected a cutoff value for MN + NMN of 1000 ng/mg Cr, the sensitivity was 97.6% and the specificity 100% for diagnosing pheo. When the standard was set as > 500 ng/mg Cr for either MN or NMN, both the sensitivity and specificity were 100%. The assay for MN and NMN is simple and effective, not only for screening but for diagnosing pheo and managing incidentaloma.
Repeat Hepatectomy for Recurrent Colorectal Metastases
Authors: Kin Tatsuya , Nakajima Yoshiyuki , Kanehiro Hiromichi , Hisanaga Michiyoshi , Ohyama Takao , Nishio Kazushi , Sho Masayuki , Nagao Mitsuo , Nakano Hiroshige 
Published: August 2002

AbstractRecurrence rates after hepatic resection in patients with colorectal metastases are reported to range from 47% to 80%. Hepatic recurrence is seen in 35% to 50% of patients. Aggressive surgical resection appears to be a worthwhile treatment in patients with recurrent hepatic metastases to promote longer patient survival because surgical resection remains the only curative therapy available. This is a retrospective review of our experience with 15 patients undergoing repeat hepatic resection culled from 67 patients undergoing initial hepatectomy for metastatic colorectal cancer. Of 67 patients who underwent hepatectomy for colorectal hepatic metastases, 33 developed hepatic recurrence at a median interval of 23 months (range 1–176 months) after the first hepatectomy. The second hepatectomy was performed in 15 patients 5 to 29 months after the first hepatectomy, with no mortality. The mean operating time and blood loss at the second hepatectomy were similar to those at the first hepatectomy. The mean hospital stay at the second hepatectomy was significantly shorter than that at the first hepatectomy. The cumulative survival rate for the 15 patients was 42.4% at 3 years and 21.2% at 5 years, respectively, which compared favorably with the survival rate of the 67 patients who underwent initial hepatectomy. Patients who underwent the second hepatectomy had significantly higher survival rates from the first hepatectomy than the 18 patients with unresectable hepatic recurrence. Repeat hepatectomy can be performed safely and provides long‐term survival rates similar to those of first hepatectomies. In appropriately selected patients, repeat hepatectomy for colorectal metastases is a worthwhile treatment.
Evidence‐based Surgery: A Passing Fad?
Authors: Black Nick 
Published: August 2002

AbstractRecent years have witnessed the development of a new movement within health care: the promotion of “evidence‐based medicine” (EBM). EBM is about integrating individual clinical expertise and the best external evidence derived from scientific research. Advocates claim that much medical practice is based too much on opinion and experience and insufficiently on research evidence. Their approach would increase the quality of care and its efficiency. This paper describes the principal steps in the evidence‐based approach—systematic reviews of the literature and meta‐analyses—and its shortcomings in surgery. These include the reliance of EBM on randomized trials, the lack of generalizability of scientific evidence to individual patients, the lack of attention to third party interests, the threat to the “art” of medicine, and the dangers of an oversimplistic approach. Although EBM clearly has a place, it does not have all the answers.
Operative Management of Civilian Rectal Gunshot Wounds: Simpler Is Better
Authors: Velmahos George C. , Gomez Hugo , Falabella Andres , Demetriades Demetrios 
Published: August 2002

AbstractExtraperitoneal rectal gunshot wounds have been managed with a variety of methods from simple diverting colostomy to combinations of rectal repair, proximal diversion, transperitoneal or presacral drainage, and distal bowel irrigation techniques. Treatment methodology is chosen based on anecdotal experience, and there is no clear evidence that any technique is superior to the others. The objective of this study was to compare 3 methods of managing civilian extraperitoneal gunshot wounds. Retrospective analysis of 30 consecutive patients with extraperitoneal rectal gunshot wounds was undertaken. Patients were treated with 1 of these 3 techniques: (1) simple diverting colostomy without rectal repair (group A, 12 patients); (2) diverting colostomy and rectal repair (group B, 12 patients); and (3) diverting colostomy and presacral drainage without repair (group C, 6 patients). Injury, hospital course, and outcome data were compared. The 3 groups were similar in age, injury severity, admission hemodynamics, preoperative and intraoperative time, blood loss, fecal contamination, and associated injuries. The overall incidence of complications was 27% (8/27): 25% (3/12) in group A, 33% (4/12) in group B, and 17% (1/6) in group C (p= NS). Complications directly associated with the rectal injury were found in 2 cases (7%): 1 group A patient developed a vesicorectal fistula and 1 group B patient developed a rectocutaneous fistula. For 10 patients with both rectal and bladder injuries, the complication rates for groups A, B, and C were 50%, 20%, and 0%, respectively (p= NS). No patient died. In conclusion, diverting colostomy without rectal repair or drainage appears to be safe for the management of most civilian retroperitoneal rectal gunshot wounds. Additional surgical maneuvers may be required for combined rectal and urinary trauma or other complex rectal injuries. Sound surgical principles, tailored to the individual case, should overrule any unproven dogmas.
Incisional Hernia after Laparotomy: Prospective Randomized Comparison between Early‐absorbable and Late‐absorbable Suture Materials
Authors: Hsiao Wei‐Chiang , Young Kung‐Chia , Wang Shan‐Tair , Lin Pin‐Wen 
Published: August 2002

Abstract.Incisional hernia is a serious postoperative complication of laparotomy. Selecting an appropriate suture material may lessen such morbidity. This study undertook a prospective, randomized comparison of early‐absorbable polyglactin 910 suture versus late‐absorbable polydioxanone loop suture for fascial closure after abdominal surgery. A series of 340 consecutive patients undergoing elective laparotomy were randomized to have fascial closure with either polyglactin 910 suture or polydioxanone loop suture between October 1993 and August 1996. A 2‐year follow‐up revealed that 23 patients had died, and the overall mortality rate was 6.8% (23/340). Ten (10/340, 2.9%) patients, including seven with polyglactin 910 suture and three with polydioxanone loop suture, developed incisional hernias. The early postoperative evaluation revealed an incidence of wound infection of 4.1% (14/340). The development of incisional hernia was not secondary to postoperative wound infection in this study. Among these 340 patients, 192 had malignant diseases and 148 had nonmalignant ones. Fascial closure with polyglactin 910 suture was associated with more incisional hernias than that with polydioxanone loop suture, with marginal significance for patients in the malignant group (4.7% versus 0%, p= 0.07) but not in the nonmalignant group (2.6% versus 4.2%, p= 0.67). In conclusion, abdominal closure with a late‐absorbable polydioxanone loop suture may be beneficial to patients with a malignant disease for preventing incisional hernia.
Obesity and the liver transplant recipient
Authors: Pruett Timothy 
Published: August 2002

Abstract

Objective:
Severely obese patients who undergo orthotopic liver transplantation are likely to have higher morbidity, mortality, costs, and a lower long-term survival.

Methods:
This case-control study was done at a university hospital. One hundred twenty-one consecutive patients who underwent liver transplantation between 1994 and 1996 were studied. Severe obesity was defined as body mass index (BMI) more than 95th percentile (>32.3 for women and >31.1 for men), and moderate obesity was defined as BMI between 27.3 and 32.3 for women and 27.8 and 31.1 for men. The outcome measures were intraoperative complications, postoperative complications (wound infections, bile leak, vascular complications), length of hospital stay, costs of transplantation, and long-term survival.

Results:
The baseline characteristics, UNOS status, and cause of liver disease at the time of transplantation were similar in severely obese (n = 21, BMI = 37.4 ± 4.8 kg/m2), obese (n = 36, BMI 28.7 ± 0.9 kg/m2), and nonobese patients (n = 64, BMI 23.8 ± 2.5 kg/m2). The intraoperative complications and transfusion requirements were similar in all three groups. The postoperative complications such as respiratory failure (p = 0.009) and systemic vascular complications (p = 0.04) were significantly higher in severely obese patients. The overall perioperative complication rate was 0.61 (39 of 64 patients) in nonobese patients, 0.77 (28 of 36 patients) in obese patients, and 1.43 (30 of 21 patients) in severely obese patients (p = 0.01). Infections were the leading cause of death in all groups accounting for 57-66% of deaths. The length of hospital stay was significantly higher in obese patients. The hospital costs of transplantation were higher ($30,000-$40,000) in severely obese patients than in nonobese patients. The long-term patient survival was similar between the groups (Kaplan-Meier analysis).

Conclusions:
Despite higher postoperative complications, severely obese patients have an acceptable long-term survival, which is comparable to nonobese patients. The cost of transplantation is higher among severely obese patients. There was no increased incidence of cardiovascular mortality among severely obese patients during the follow-up period.
Ischemic Bandage Injuries: A Case Series and Review of the Literature
Authors: Anderson Davina M. , White Richard A.S. 
Published: August 2002

Objective—To determine the prognosis and distribution of ischemic injuries caused by inappropriate bandaging of the lower limb in dogs and cats.Study Design—Retrospective clinical study.Animal Population—Eleven client‐owned animals, including 9 dogs and 2 cats with a history of injuries consistent with incorrect application of a bandage.Methods—Medical records for dogs and cats referred to the Queen's Veterinary School Hospital with limb wounds between 1995 and 1999 were reviewed for clinical history and referring veterinary surgeons' reports, indicating that the injury was directly related to the application of a bandage to the limb.Results—The indications for bandage application included 2 postoperative cruciate ligament ruptures, 2 lacerations, 3 internal fixations, an onychectomy, a shoulder dislocation, a dog bite, and a tendon strain. None of the patients had other body systems involved or underlying or concurrent diseases. Five different types of bandage were described (support, Robert Jones, pressure, splint, and Velpeau), and no particular age or breed was overrepresented. Of the 11 animals, 5 required full‐thickness skin grafts, 3 had to have digits amputated, and 2 required limb amputations. Nine animals survived, but only 4 became fully functional on the affected limb.Conclusions—Bandage‐related injuries are potentially serious sequelae to a routine procedure. A guarded prognosis should be given when there is loss of deeper structures.Clinical Relevance—A review of bandaging principles is presented. Method of application, choice of materials, and close monitoring of the bandage are important factors in preventing iatrogenic injury.
Preparation and Properties of High Molecular Weight Polyamic Ester Having a Cyclobutane Moiety in the Main Chain
Authors: Hasegawa Masaki , Miura Hirohiko , Haga Naoki , Hayakawa Akira , Saito Kiyoshi 
Published: August 2002

Preparation and properties of the polyimide derived from cyclobutanetetracarboxylic dianhydride (CBDA) with diamines are investigated, focusing on the interfacial polycondensation of cyclobutanetetracarboxylic acid dimethylester dichloride (2a) with diamines. Dimethylester was conveniently prepared from CBDA by refluxing in methanol solution. Dimethylester consists of two regio isomers; one is α-type (1a) with centrosymmetry, the other is β-type (1b) with plane symmetry. Separation of the mixture into each of pure 1a and 1b was successfully performed by fractional crystallization. The structure of the first fraction is 1a, which was determined by x-ray crystal analysis. The second fraction was necessarily assigned to 1b. 1a was converted into 2a by the reaction of thionyl chloride. The interfacial polycondensation of 2a with diamines afforded a high molecular weight polyamic ester. Polyimide was obtained only by heating the polyamic ester to about 230–280 °C. The cyclobutane polyimide thus obtained was thermally stable up to 400 °C, and less stable under hydrolysis than polypyromellitic imide.