bluuebunny/crossref_metadata_2025_split huggingface dataset:
A decade of experience with a left heart assist device in patients undergoing open intracardiac operation
Authors: Litwak Robert S. , Koffsky Robert M. , Jurado Roy A. , Mitchell Bennett A. , King Philip 
Published: May 2005

AbstractOver a decade has elapsed since the first clinical application of our left heart assist device (LHAD). The basic concepts underlying its development evolved from prior experience in which, given adequate support time, less than total left heart bypass (LHB) was found to result in gradual improvement of depressed left ventricular function. Hence, the long‐held view that functional recovery of the heart could occuronlyunder conditions of total LHB seemed unsupportable by clinical realities. As a result, a simple LHAD was devised. Requiring only special silicone elastomer cannulas, the system uses a roller (or other continuous flow) pump and diverts blood from the left atrium to the ascending aorta. We believe a major asset of the system is the ability to separate the patient subsequently from the LHAD without need to re‐enter the thorax. This is accomplished by permanently occluding each cannula lumen with an obturator, thereby allowing the biocompatible cannulas to remain permanentlyin situ.To date, 27 patients have undergone LHAD support. Of 18 patients who could be separated from the device, half (9) were discharged from the hospital. Seven remain alive and well, the longest now more than 10 years after the operation. Although rarely needed, broadening operative indications in patients with severely compromised left ventricular function suggests that there will be continued need for a method of LHB for the foreseeable future.
Use of a centrifugal pump without anticoagulants for postoperative left ventricular assist
Authors: Magovern George J. , Park Sang B. , Maher Thomas D. 
Published: May 2005

AbstractFollowing experimental studies using the vortex pump (Bio‐Medicus) for left heart assist (LHA) in dogs and lambs for periods up to 3 weeks without anticoagulation and minimal thromboemboli, we initiated the clinical work without anticoagulation in 21 patients. All previous clinical attempts at LHA using anticoagulation eventually resulted in intracerebral or other hemorrhagic complications. The key factors we experienced to prevent bleeding or microthrombus were to omit heparin, but to maintain flows constantly around 2 liters or more per minute. At lower levels, fibrin split products became elevated and microthrombus could be detected in the pump. To further safeguard against thromboembolism, the commercial pump was changed every 24 hr. No clinical intracerebral or thromboembolic complications occurred.From February 18, 1980, to February 4, 1983, three thousand patients underwent cardiopulmonary bypass at Allegheny General Hospital. Twenty‐one patients required prolonged postoperative LHA. The patients were predominantly male and ranged in age from 38 to 74 years (mean age 56.2 years). The Bio‐Medicus, asynchronous, vortex pump was used on all cases, and decompression was performed via a left atrium/left ventricle cannula and arterial return via a Sarns arch cannula. During LHA the sternum was open, but the skin was approximated. The activated clotting time was maintained at 140, but heparin or anticoagulation was not routinely employed. Only 4 patients received one 10,000‐unit dose. Bleeding was controlled by using fresh frozen plasma, autotransfusion, and platelets. Serum calcium (Ca), sodium (Na), chloride (Cl), potassium (K), total protein, serum osmolality, white blood cell count (WBC), red blood cell count (RBC), hematocrit (Hct), platelets, serum hemoglobin (Hgh), fibrinogen, prothrombin time (PT), partial thromboplastin time (PTT), and fibrin split products (FSP) were measured every 4–8 hr, as indicated. Intracardiac pressures and cardiac output (CO) were measured every 2–4 hr as indicated. Hematologic and physiologic results are discussed. Ten patients were successfully weaned from LHA. Five hospital deaths occurred later (2–9 days) from low cardiac output and arrhythmia (2), septicemia (1), and pulmonary complications (2). Five patients were discharged from the hospital and are alive 1–3 years following surgery (22%). The longest assist was 144 hr, and the patient died of pulmonary complications 2 days after the assist was discontinued. The marked simplicity of using a commercially available pump, without anticoagulation, was a salient feature of this series and has led us to employ this method routinely for resection or repair of the thoracic aorta in acquired aneurysms or traumatic tears or dissection as well as temporary left ventricular assist up to 5–7 days.
Reduction of blood trauma in roller pumps for long‐term perfusion
Authors: Noon George P. , Kane Larry E. , Feldman Louis , Peterson Julia A. , DeBakey Michael E. 
Published: May 2005

AbstractAs part of an attempt to develop a roller pump for long‐term (2 weeks) cardiac assist, factors generating blood trauma in roller pumps were re‐examined. Fresh human blood was pumped for 4 hr in a simple closed circulatory loop. Samples drawn at regular intervals were examined for plasma hemoglobin, lactate dehydrogenase, platelet function, and activation of coagulation factors. Experiments were performed in which tubing diameters were varied (polyvinyl chloride, 1/2‐ and 3/8‐inch internal diameters), roller diameters were varied (3/4, 1 1/8, and 1 3/4 inches), and roller occlusion was varied from total occlusion to 0.020‐inch underocclusion. The results showed more hemolysis when the roller diameters and the tubing diameters were smaller and when the rollers were more occlusive. Changes in platelet function and activation of coagulation factors were observed, but were not correlated with occlusion. These results suggest that when roller pumps are used for long‐term cardiac support, the diameter of the rollers should be as large as possible, the tubing diameter should be as large as practical, and the occlusion setting should be as open as possible while still maintaining required flow rates. New techniques for setting occlusion are suggested.
Right heart interaction with the mechanically assisted left heart
Authors: Farrar David J. , Compton Peter G. , Hershon James J. , Fonger James D. , Hill J. Donald 
Published: May 2005

AbstractRight ventricular (RV) failure has been reported to be a problem in 49 of 213 patients who received left ventricular assist devices (LVAD) at 12 different centers. Although the pathology of the problem is not understood, it is clear that the effect of an LVAD on hemodynamic ventricular interactions due to the right and left hearts being in series, and on mechanical ventricular interactions due to the anatomic coupling between the ventricles, could play a role in determining the ultimate fate of the right ventricle. Six hypotheses were generated concerning beneficial and detrimental effects of an LVAD on the determinants of right ventricular function (preload, afterload, contractility). The major potential effect on RV preload is increased venous return produced by the LVAD which can overload a marginal RV; but beneficial effects on RV preload and filling also can be produced by the LVAD unloading a dilated LV, thereby shifting the interventricular septum, which had encroached into the RV, back to the left. A significant beneficial effect on RV afterload can be produced with an LVAD by passive reductions in pulmonary artery (PA) pressure secondary to reductions in left atrial pressure; with pulmonary obstructive disease, however, PA pressures can increase due to the greater blood flow through the fixed pulmonary vascular resistance. The major effects on RV contractility produced by an LVAD are significantly beneficial since aortic and, therefore, coronary perfusion pressure is maintained. There also is a potential detrimental effect on RV contractility produced by decreased septal contribution to RV contraction during complete LV unloading with an LVAD. The initial therapy for the failing right ventricle in patients with an LVAD is volume loading. Isoproterenol, dobutamine, and dopamine can be used for inotropic support, and atrial pacing can improve the atrial contribution to filling. If these modalities fail, surgical techniques including pulmonary artery balloon pump or extracorporeal membrane oxygenation can be tried, but the recommended mechanical support is a right ventricular assist device.
New applications of total parathyroidectomy and autotransplantation: Use in proximal renal tubular dysfunction
Authors: Kinder Barbara K. , Rasmussen Howard 
Published: May 2005

AbstractTotal parathyroidectomy with autotransplantation is frequently used in the treatment of hyperparathyroidism associated with renal osteodystrophy because of the high incidence of recurrent disease following subtotal resection. A similar argument has been made to support the application of this technique to cases of recurrent or persistent hyperparathyroidism and to familial polyendocrine syndromes with parathyroid hyperplasia. We have recently had occasion to apply this approach in a new clinical setting of metabolic bone disease. Three patients with congenital hypophosphatemic rickets and 1 with pseudohypoparathyroidism were treated with total parathyroidectomy and autotransplant into the forearm. All 4 had developed secondary hyperparathyroidism with hypercalcemia while being treated with 1,25(OH)2D3(with or without inorganic phosphate). Each had a history of previous vitamin D intoxication. Reduction of parathyroid mass permitted effective treatment of severe bone disease in each case. Two patients developed graft‐dependent hypercalcemia which required resection of graft tissue from the forearm under local anesthesia. Both have shown a further recurrence. Total parathyroidectomy and autotransplantation may be useful in the management of selected patients with metabolic bone disease due to familial hyophosphatemic rickets or pseudohypoparathyroidism.
Proximal gastric vagotomy and pyloroplasty for duodenal ulcer with pyloric stenosis: A thirteen‐year experience
Authors: Lunde Ole ‐Christian , Liavåg Ivar , Roland Magne 
Published: May 2005

AbstractBetween 1970 and 1983, seventy‐eight patients with duodenal ulcer and pyloric stenosis causing gastric outlet obstruction have been operated on with a proximal gastric vagotomy (PGV) and a Heineke‐Mikulicz pyloroplasty. The mean observation time was 90 months. There was no operative mortality or major complications. The reduction in mean acid output was greater after PGV and pyloroplasty than after PGV without drainage in patients with duodenal ulcer without stenosis. The clinical results were excellent or good in 93% of the patients (Visick I and II). Only 1 patient (1.3%) developed a recurrent ulcer, while 5 patients (6.4%) had symptoms of slight or moderate dumping.It is concluded that PGV and pyloroplasty is a good operation in patients with duodenal ulcer and pyloric stenosis. There is a low incidence of ulcer recurrence, a low risk of serious complications, and good long‐term symptom control.
Progress in pediatric trauma
Authors: Eichelberger Martin R. , Randolph Judson G. 
Published: May 2005

AbstractThe handling of trauma victims in the pediatric age group has undergone change and improvement in a number of ways. First, receiving facilities, emergency rooms, medical centers, and tertiary pediatric care facilities have all been brought together by community, state, regional, and national planning which has taken into account population needs and the resources of each facility. Communication by telephone, radio, and computerized information transmitters has linked together a series of medical facilities which now assures that each child is treated appropraitely or passed along to a different unit in the chain. The education of all members of the emergency medical services to the special techniques, equipment, and needs of pediatric patients has been essential to proper handling of injured children.Improvement in body imaging, which allows details of injured sites intracranially and in other body cavities, has changed radically the diagnosis and early clinical management of all injured patients. This, in turn, has allowed more precise surgical decisions such as splenic salvage, and conservative handling of such organs as the liver and brain. All of these advances have taken place on a stage and in a time in which the handling of infection and the response to nutritional needs have improved so dramatically. Much has been done, but accidents still kill more children ages 1 to 14 years than all other causes combined. Thus, prevention holds the real solution for future progress.
Surgical treatment of high imperforate anus
Authors: Peña Alberto 
Published: May 2005

AbstractOne hundred thirty‐two operations for congenital anorectal malformations have been done employing a new surgical procedure. A sacroperineal approach through the midline with division of the external sphincter and levator muscle groups is used. The rectourinary fistula is separated by a submucosa dissection. The rectum is tapered to a smaller calibre and placed within the open levator system. The entire sphincter complex is reconstructed posterior to the pulled‐through rectum.The approach provides excellent exposure of the important anatomical and functional structures of the pelvis. Our operative experience indicates that a reassessment of traditional concepts of the surgical anatomy of the perineum is necessary. The operation was used in 53 patients with high imperforate anus and rectourethral fistula, 19 patients with repair of previous imperforate anus operations, 14 patients with persistent cloaca, and 46 patients with similar anorectal conditions. The preliminary results are highly encouraging in regard to early continence and toilet training.
Progress in the treatment of biliary atresia
Authors: Ohi Ryoji , Hanamatsu Masahiro , Mochizuki Izumi , Chiba Tsuneo , Kasai Morio 
Published: May 2005

AbstractAlthough the surgical results of biliary atresia have markedly improved following the introduction of hepatic portoenterostomy, further improvement is necessary. In a 31‐year period, from 1953 through 1983, we performed corrective surgery on 214 patients. In the first 18 years the disease was successfully treated in only 13% of 96 patients. In the next 7 years (1971 to 1977), jaundice was cleared in 55% of 65 patients, now 29 patients are alive without jaundice. In the last 6 years, the jaundice was cleared in 66% of 53 patients; more than 50% of patients are now without jaundice. Retrospective analysis revealed several important factors contributing to the improvement of operative results: (1) early diagnosis and operation, (b) precise dissection and adequate transection of the bile duct remnant, (c) progress in the postoperative management, (d) prevention of postoperative cholangitis, and (e) early reoperation whenever necessary. Corrective surgery performed within 60 days after birth can achieve sufficient bile drainage to normalize serum bilirubin level in more than 80% of the patients.
Emergent and therapeutic upper gastrointestinal endoscopy in children
Authors: Van Stiegmann G. , Stellin G. P. 
Published: May 2005

AbstractPediatric patients with upper gastrointestinal disorders have benefited significantly from recent advances in endoscopic technology. Improved techniques of esophageal endosclerosis and dilatation have reduced the morbidity associated with these 2 procedures. Twenty‐five patients underwent 136 endosclerosis treatments, with effective control of bleeding in all. Three of four deaths were caused by primary organ failure and one was due to a complication of endosclerosis. Fifty‐seven patients with esophageal stricture have undergone successful dilatation with uniformly good results and no major complications. Virtually all foreign bodies may now be successfully removed endoscopically from the esophagus or stomach and formerly unrecognized mucosal lesions have been defined as a common source of gastrointestinal hemorrhage. Continued advances in therapeutic pediatric endoscopy will be limited only by the imagination of the pediatric endoscopist.
Pediatric microsurgery
Authors: Pardo Juan A. Diez 
Published: May 2005

AbstractThe contemporary status of microsurgical techniques in different pediatric surgical categories is summarized. Employment of microsurgical techniques permits autografts of jejunum to be used for esophageal replacement and vascularized bone grafts to be used for bridging defects in long bones. The same techniques improve overall results in creating vascular access for hemodialysis. Combined with temporary nephrectomy, extracorporeal hypothermic organ preservation, and autotransplantation, microsurgery makes possible repair of injured kidneys, partial nephrectomy for bilateral Wilm's tumor, and correction of renal vascular hypertension.Microsurgical techniques facilitate correction of hypospadia, thereby reducing the complication of fistulas. These methods make possible the reimplantation of an accidentally amputated extremity or a traumatically amputated testicle or penis. Vas deferens injured during herniorrhaphy can be repaired and intra‐abdominal testes can be relocated. Improved drainage for congenital lymphedema of the extremities and varicocele are possible. Remnants of hilar bile ducts can be more accurately identified in children with biliary atresia and may thereby improve the results of Kasai portoenterostomy operations.With the smaller size of organ structures in the pediatric age group, microsurgical techniques play an especially prominent increasing role in this particular population.
Training in pediatric surgery
Authors: O'Donnell Barry 
Published: May 2005

AbstractPediatric surgery is a small, popular specialty with a limited number of formal, structured training programs. Basic training should place emphasis on the general principles of surgery. Picking a trainer and working in a program that gives a genuine mix of training and experience with adequate supervision are the next steps. The importance of research, the discipline of writing, and the character‐building experience of ensuring publication are emphasized. Examinations are a necessary part of development. Depending on career objectives, a varied experience in a number of institutions is a valuable long‐term investment.
Research in pediatric surgery
Authors: Stolar Charles J. H. , Altman R. Peter 
Published: May 2005

AbstractPediatric surgical research continues to expand along technical avenues while addressing issues of basic science.Splenic salvage is an established goal which can ordinarily be achieved without surgical intervention. Operative approaches, when indicated, can be done with minimal moribidity. Although the spleen acts as a bacterial monitor under normal circumstances by direct phagocytosis, opsonization, and modulation of macrophage function, our understanding of how the injured spleen resumes these activities remains fragmentary.Extracorporeal membrane oxygenation shows increasing promise for newborns with refractory respiratory failure. New applications of pulmonary vasoactive meidators will yield a better understanding of how this radical therapy affects cardiopulmonary homeostasis. The lungs either synthesize, modify, or pass on a number of substances including eicosanoids, vasoactive amines, and carboxypeptidases which form a resonating feedback network that controls pulmonary vascular tone. Disturbed homeostasis results in the various disease states that have pulmonary hypertension and lung injury as common features.Developments in fetal surgery have permitted creation of improved models of in utero conditions. These models variably mimic the human condition, particularly obstructive uropathy, congenital diaphragmatic hernia, and neural tube defects. Complex problems remain for patient/fetus selection and timing of surgical intervention.
Dehiscence of a prosthetic graft nineteen years after coarctation repair
Authors: Snow Norman 
Published: May 2005

AbstractTotal dehiscence of a prosthetic graft 19 years after coarctation repair is reported. This resulted in a large false aneurysm of the descending thoracic aorta, and at operation, no remnant of the suture material was apparent grossly or microscopically. Long‐term follow‐up is necessary in order to detect complications of thoracic aortic grafting.
Surgical anatomy and anatomical surgery of the liver
Authors: Bismuth Henri 
Published: May 2005

AbstractThe morphologic anatomy of the liver is described as 2 main and 2 accessory lobes. The more recent functional anatomy of the liver is based on the distribution of the portal pedicles and the location of the hepatic veins. The liver is divided into 4 sectors, some of them composed of 2 segments. In all, there are 8 segments. According to the anatomy, typical hepatectomies (or “réglées”) are those which are performed along anatomical scissurae. The 2 main technical conceptions of typical hepatectomies are those with preliminary vascular control (Lortat‐Jacob's technique) and hepatectomies with primary parenchymatous transection (Ton That Tung's technique). A good knowledge of the anatomy of the liver is a prerequisite for anatomical surgery of this organ.
Major and minor segmentectomies “réglées” in liver surgery
Authors: Bismuth Henri , Houssin Didier , Castaing Denis 
Published: May 2005

AbstractIndividualization of the segment as the functional anatomical unit of the liver permits the performance of surgical segmentectomies. These segmental resections are “réglées” because the plane of cleavage of the hepatic parenchyma follows the anatomical scissurae. From the technical point of view, liver segmentectomies are characterized by an exclusive transparenchymatous approach to the vascular pedicles of the segment to be removed. We have performed this type of surgery in 22 patients with no mortality. These operations are indicated in: (1) some benign tumors; (2) some liver trauma; (3) biliary operations above the hilus, where anterior resection of segment IV can be necessary; and (4) carcinomas of the gallbladder discovered histologically after cholecystectomy. Liver segmentectomies can also be indicated for malignant tumors when the liver is cirrhotic, or when an extended resection is likely to expose the patient to the risk of liver failure. Indeed, one of the main advantages of liver segmentectomies is that they permit an economical but safe surgical resection of the hepatic parenchyma.
Temporary liver dearterialization in patients with metastatic carcinoid disease
Authors: Bengmark S. , Ericsson M. , Lunderquist A. , Mårtensson H. , Nobin A. , Sako M. 
Published: May 2005

AbstractThe surgical treatment of liver metastases from carcinoid tumors is burdened by a relatively poor symptomatic relief and a high mortality rate. Temporary liver dearterialization, separating the operative trauma from the temporary hepatic occlusion, may have advantages. We have utilized this treatment in 16 patients. The effect of treatment was registered in symptomatic relief, changes in urinary 5‐HIAA, serotonin in platelet‐poor plasma, and morphologic changes shown by angiography.Fourteen patients, who underwent only the dearterialization procedure, survived the immediate postoperative period, while 2 patients who had concomitant small bowel resection both died of complications, 1 and 3 months postoperatively, respectively. One patient died, 14 months postoperatively, of the carcinoid disease. All but 1 patient were free from symptoms for at least 6 months. Two patients have had no recurrence of the carcinoid syndrome for 34 and 42 months, respectively. A decrease in urinary 5‐HIAA was seen after 6 months in 10 patients, serotonin declined in 7 patients, and angiography showed regression in 7 patients. The results of this study indicate that temporary liver dearterialization is a safe procedure with low mortality and good symptomatic relief from the carcinoid syndrome.