bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pelvic recurrence rate after abdominoperineal resection and low anterior resection for rectal cancer before and after introduction of the stapling technique
Authors: Luke Michael , Kirkegaard Preben , Lendorf Axel , Christiansen John 
Published: May 2005

AbstractPelvic recurrence rates after abdominoperineal resection (APR) and low anterior resection with the EEA stapler (LAR) for rectal cancer were compared. Since a controlled trial is not possible, we have compared the pelvic recurrence rate over a 2‐year period before and after introduction of the EEA stapler. Before introduction of the stapler, standard treatment for midrectal tumors was APR while LAR has been the standard treatment of these cancers after introduction of the EEA stapler. A total of 164 patients underwent surgery for rectal cancer in this 4‐year period, 85 in the first 2‐year period and 79 in the last 2‐year period. No difference could be demonstrated in pelvic recurrence rate after APR and LAR in the 2 periods [22.7% (95% confidence limits: 10.1–39.1%) and 22.2% (11.5–37.8%), respectively]. The recurrence rate was highest among Dukes' C tumors, but was unrelated to the type of operation.It is concluded that the increased use of low anterior resection for rectal cancer after introduction of the EEA stapler has not been followed by a higher pelvic recurrence rate.
A posterior approach to the presacral mass
Authors: Geelhoed Glenn W. , Kotz Herbert L. 
Published: May 2005

AbstractMass lesions in the presacral space are not readily accessible from the transabdominal approach. The posterior transcoccygeal technique is a nearly ideal approach to the presacral mass, and allows the combined use of abdominosacral resection for more extensive tumors.Four patients with presacral mass, which later proved to be benign cystic teratomas, each had transcoccygeal operation for resection. The technique gave adequate exposure, satisfactory margins, minimal patient morbidity, and no recurrence of the primary presacral teratomas.The diagnostic evaluation of the presacral mass and the operative technique of a modified Kraske approach are described with suggestions for resection technique. The utility, flexibility, and limitations of the posterior transcoccygeal approach are reviewed in application to the management of the presacral mass.
Transcaval posterocranial resection of the liver as treatment of the Budd‐Chiari syndrome
Authors: Senning Åke 
Published: May 2005

AbstractIn 3 patients with a Budd‐Chiari syndrome the suprahepatic caval vein was incised during extracorporeal circulation and the suprahepatic hindrance for the hepatic venous runoff abolished. By resection of the juxta caval hepatic tissue the thrombotically occluded parts of the main vein stems were removed and a free hepatic venous flow to the caval vein was established in 2 patients. In the third patient, who had a caval stenosis at the diaphragmatic level (web) and thrombosis of even smaller hepatic veins and a retrograde flow to the portal vein, the resection resulted in an abundant blood flow from the resected liver area. It is assumed that this flow originates not only from the smaller hepatic veins, but to a great extent from arterio‐ and portovenous shunting. Angiography has shown that such shunting can take place after resection.The first 2 patients are healthy and working full‐time at 2 1/2 and 2 years postoperatively, respectively. Nine months postoperatively, the third patient is in good condition, jaundice has disappeared, and bleeding from esophageal varices has not occurred.
Fat and carbohydrate metabolism during and following hemorrhagic shock in puppies: A comparison of different resuscitation protocols
Authors: Coran Arnold G. , Connors Robert H. 
Published: May 2005

AbstractShock states continue to carry a high mortality rate in the pediatric age group. Using a puppy model, we measured the initial metabolic response to hemorrhagic shock and to 3 resuscitation regimens: whole blood 1∶1 (replacement∶shed), lactated Ringer's 3∶1, and 5% albumin in lactated Ringer's 1∶1. Despite the immature nature of the puppy's enzyme, cardiovascular, and nervous systems, responses very similar to those in adult animals were seen. Serum glucose and free fatty acids rose during shock and declined with resuscitation as cardiac output returned toward normal. Serum lactate levels rose similarly but continued to rise for a short period after resuscitation and were associated with a further fall in pH consistent with “hidden acidosis.” Only small changes were noted in triglyceride and cholesterol levels. The metabolic responses noted following each of the 3 resuscitation protocols were similar. This study suggests that the immature animal responds to hemorrhagic shock in ways similar to the adult. The better initial hemodynamic response to resuscitation with high‐volume lactated Ringer's or lactated Ringer's with 5% albumin was offset by the better buffering capacity of blood resuscitation. All 3 regimens were equally efficacious in providing initial metabolic recovery in this experimental hemorrhagic shock model.
Pituitary apoplexy—An endocrine emergency
Authors: Laws Edward R. , Ebersold Michael J. 
Published: May 2005

AbstractSuccessful therapy for pituitary apoplexy depends on prompt recognition of the clinical syndrome, accurate anatomic evaluation of the lesion with the CT scan, intensive steroid replacement therapy, and effective transphenoidal decompression of the tumor. Successful long‐term management of patients who have suffered pituitary apoplexy requires recognition by the complex interrelationships of the pituitary with adrenal, thyroid, gonadal, pancreatic, and gut physiology. Such patients often require multiple medications for replacement therapy. Surgical treatment is often supplemented with radiation therapy, and prolactin‐ and growth hormone‐secreting adenomas may require long‐term management with bromocriptine. Careful follow‐up evaluations and appropriate post‐surgical therapy enable most of these patients to live normal lives.
Management of tracheal obstruction from thyroid diseases
Authors: Cady Blake 
Published: May 2005

AbstractTracheal or laryngeal obstruction in thyroid disease is such a severe, though uncommon, threat that constant awareness of its occurrence and prevention should be the hallmark of the experienced thyroid surgeon. A high index of suspicion, thoughtful analysis of cases, willingness to accept that such a complication does not reflect on the surgeon's competence, and prophylactic elective use of tracheostomy in patients at high risk will afford safety to the patient and peace of mind to the surgeon.
Early postoperative angiographic control of the warren procedure in 40 patients
Authors: Saubier E. C. , Partensky C. , Gouillat C. 
Published: May 2005

AbstractBetween December 1975 and December 1980, a total of 43 patients with portal hypertension due to intrahepatic block underwent the Warren procedure for distal splenorenal anastomosis. Forty of them were submitted to celiomesenteric arteriography between the 10th and 90th postoperative days to assess the efficacy of the procedure and to estimate its effects on the portal flow to the liver. On the late venous phase of the celiac angiogram, the patency of the shunt was demonstrated in 37 patients (92.5%), along with a consistent reduction of splenic volume; there was a clear flattening of esophageal varices at esophagoscopy. The shunt was not patent in the other 3 patients (7.5%), all of whom had anatomic venous abnormalities (diameter of the splenic vein smaller than 10 mm and/or abnormal renal vein). Two of these patients rebled soon after the operation, while the third subject underwent a prophylactic renoportal shunt.The effects of the procedure on the mesentericoportal flow were studied on the late phase of the superior mesenteric arteriogram. Venous flow to the liver was unaltered in 28 patients, substantially reduced by a latent partial portal thrombosis in 10 (25%), and totally suppressed in 2. Of these 2 complete portal thromboses, one resulted in early recurrent bleeding, while the other has remained asymptomatic. In spite of the portogastric disconnection, reverse flow in large veins from the portal vein to the cardial varices was observed in 14 patients (35%). Thus, after the Warren procedure, esophageal varices are efficiently decompressed by a patent shunt but portal flow is not always preserved.
Bronchobiliary fistula due to stones in the biliary tree: Report of two cases
Authors: Wei W. I. , Choi T. K. , Wong John , Ong G. B. 
Published: May 2005

AbstractTwo patients with bronchobiliary fistula are reported. Each had a history of biliary disease with operations done prior to the onset of bilioptysis. Obstruction of the biliary tree by stones was the etiology in both cases. The diagnosis was made by detection of bile in the sputum. The definitive treatment consisted of removal of the obstructing stones and excision of the fistula. If emergency surgery is required because of sepsis, external drainage of the abscess and T‐tube drainage should be performed first, followed by definitive procedure after recovery.
The continent colostomy
Authors: Schmidt E. 
Published: May 2005

AbstractHistological and electron microscopic studies, perfusion manometry, and electromyography document the suitability of using intestinal smooth muscle to construct a sphincteroplasty. Postoperative results, surgical experience, and enterostomal therapy over the past 4 years are discussed. Of 509 patients, 231 underwent surgery in the Surgery Department of Würzburg University Hospital, Würzburg, West Germany, Postoperative functional results are so favorable and complications so few, that the author unreservedly recommends the use of smooth muscle for the creation of a sphincteroplasty, e.g., a continent colostomy.
Postoperative adaptation of the small intestine
Authors: Bristol James B. , Williamson Robin C. N. 
Published: May 2005

AbstractFor nearly 100 years, the small intestine has been known to compensate for partial tissue loss. For only some 20 years has the phenomenon been studied in any depth, and a small proportion of these investigations has been undertaken in humans. Experimental and clinical data show that enteric mucosal hyperplasia in the remaining small bowel after enteric resection or bypass is accompanied by cytokinetic and functional adaptation. In general, the degree of adaptation depends on 3 factors: the amount of tissue excised or excluded, the particular enteric segment involved, and the presence or absence of a normal luminal stream. Thus, massive enterectomy can overwhelm the adaptive capacity of the gut, loss of jejunum is better tolerated than loss of terminal ileum, and total parenteral nutrition will abolish the compensatory response. The mechanisms that govern adaptive change are complex and interrelated. They involve both luminal agents (food, alimentary secretions) and humoral influences, of which enteroglucagon appears to be the most important. Wherever possible, small bowel operations should take account of adaptive phenomena in order to minimize metabolic and nutritional sequelae.
Massive enterectomy: Indications and management
Authors: Hill Graham L. 
Published: May 2005

AbstractMassive enterectomy in adults may be necessary for Crohn's disease in young patients or for intestinal infarction in older patients. Other indications are rare. When less than 3 m of small bowel remain, a number of serious metabolic and nutritional abnormalities occur. When 2 m or less remain, most patients have a limited work capacity as well, and many patients with less than 1 m of small bowel need parenteral nutrition at home on an indefinite basis. Correct management depends on an understanding of the disordered physiological state brought about by the resection and a realization that adaptation may occur. Based on these principles, the management of these patients in the operating room and during their subsequent rehabilitation is discussed.
An epilogue to jejunoileal bypass
Authors: Baddeley R. Michael 
Published: May 2005

AbstractThe advantages of jejunoileal bypass performed for morbid obesity have been well reported, as have its undesirable side effects. Both early and long‐term weight reduction are generally satisfactory. Problems can arise from an increased enteric circulation of bile salts, liver dysfunction, metabolic bone disease, malnutrition and metabolic failure, diarrhea and electrolyte disturbances, enteric colonization and its consequences, and renal calculi and failure. In the author's personal series of 255 patients, 62 have required restoration of intestinal continuity, largely for the complications of bacterial colonization of the blind loop. Half the patients studied (55%) developed increasing hepatic steatosis during the first postoperative year, while 9% developed micronodular cirrhosis. Some degree of osteomalacia occurred in 35% of patients within 5 years of bypass.
Enteric ulceration and its complications
Authors: Thomas W. E. G. , Williamson R. C. N. 
Published: May 2005

AbstractUlceration of the small bowel is uncommon and difficult to diagnose. Many patients require operation for the complications of perforation, hemorrhage, and obstruction. There is a wide differential diagnosis, and in a few cases of enteric ulceration (nonspecific, idiopathic) no etiological cause can be defined. Ten unusual cases of complicated small bowel ulceration are presented to illustrate the investigation and management of these obscure conditions.
Tropical diseases of the small bowel
Authors: Archampong E. Q. 
Published: May 2005

AbstractTyphoid and tuberculosis still account for the bulk of small bowel diseases encountered in surgical practice in most parts of the tropical world. In the emergency setting, these conditions present with perforation or obstruction of the intestine. Against this background must be considered the occasional appearance of conditions that lead to perforation or obstruction in temperate countries, e.g., lymphoma and regional enteritis. Children with infestations with parasites such as ascaris present a puzzling picture with acute abdominal signs. Tropical diseases affecting the small bowel are thus predominantly preventable. Their continued prevalence among causes of an acute abdomen indicates an unrealistic allocation of priorities in the mass control of endemic disease.
Small bowel carcinoid tumors
Authors: Woods H. F. , Bax N. D. S. , Smith J. A. R. 
Published: May 2005

AbstractDuring the last 7 years we have managed 48 cases of carcinoid tumor. Of these 15 have been tumors of the small bowel. In this article we describe and discuss the presentation of small bowel carcinoid tumors, the carcinoid syndrome, and its treatment. The content reflects our clinical experience.
Small intestinal lymphoma
Authors: Cooper B. T. , Read A. E. 
Published: May 2005

AbstractThis paper reviews small intestinal lymphoma. Although a major emphasis is placed on primary small intestinal lymphoma of the “Western” type, the important topic of lymphoma in celiac disease is discussed. Our own recent experience of 7 patients with lymphoma in celiac disease is presented. The lymphoma of immunoproliferative small intestinal disease (“Mediterranean” lymphoma) and the associated α‐chain disease are also reviewed, with emphasis on the differences from the “Western” type of primary small intestinal lymphoma.
Roux‐en‐Y
Authors: Kirk R. M. 
Published: May 2005

AbstractIn Roux's modification of gastroenterostomy, the bowel is transected at the duodenojejunal junction. The proximal jejunum is united to the stomach. The duodenum is joined, end‐to‐side, into the jejunum at a distance from the gastrojejunostomy. Jejunal peristalsis is unidirectional, and contents entering its proximal end are removed and passed distally since jejunum is a transmitting—not a capacitance—part of the intestine. The loop can be used to drain away contents and also acts as a one‐way valve, preventing reflux. A single segment of intestine can be extended much farther than an intact loop, while retaining an adequate blood supply. Originally used to prevent intragastric bile reflux, the technique has been exploited to allow esophagojejunal anastomosis and drainage of the biliary and pancreatic ducts. The ability of a Roux‐en‐Y loop of jejunum to remove and pass on contents makes it a valuable means of draining cysts and fistulas. Preparing a Roux‐en‐Y segment demands careful preliminary assessment of the vascular supply to the upper jejunum since the pattern is inconstant. The technique of dividing the arterial and venous arcades to increase the reach of the jejunal segment is described, together with some of the more frequently used modifications of Roux's method.
Conservative operations for Crohn's disease of the small bowel
Authors: Alexander‐Williams John , Haynes Ian G. 
Published: May 2005

AbstractRadical excision of the small bowel and affected lymph nodes was originally advocated for Crohn's disease of the small bowel. Subsequently, intestinal bypass became popular, either in continuity or by exclusion of the diseased segment. Bypass in turn was superseded by limited resection, which remains the procedure of choice in most patients. Recognition that Crohn's disease is both panintestinal in nature and incapable of surgical cure has led to increasingly conservative operations aimed solely at overcoming the complications of the disease. Balloon catheters have been used to assess luminal stenosis in 20 patients and to undertake dilatation of strictures between 20 and 25 mm in diameter. Tighter strictures have been treated by strictureplasty. In 3 years, 37 patients have had 43 operations and 106 strictureplasties. Rates for anastomotic leakage episodes of pain and fever and overt wound infection have all been below 10%. Six patients have required reoperation, usually for strictures elsewhere.
The continent ileostomy (Kock's pouch) versus the restorative proctocolectomy (pelvic pouch)
Authors: Hultén Leif 
Published: May 2005

AbstractThe Kock continent ileostomy and the ileoanal anastomosis with a pelvic ileal reservoir are each alternatives to conventional ileostomy in patients undergoing proctocolectomy for ulcerative colitis and polyposis coli. Problems associated with construction of the nipple valve have been the chief factor limiting the popularity of continent ileostomy, but these can be minimized by strict attention to technique. The cumulative revision rate for nipple valve dysfunction over a 7‐year period has been below 30%, and continence can usually be restored by reoperation. A successful pelvic reservoir procedure maintains both the normal defecation pathway and satisfactory continence, although rectal sensation is impaired; pelvic sepsis is the major postoperative risk (15–20%). Both types of operation are associated with nonspecific inflammation of the reservoir (“pouchitis”) in some 20% of patients. The pelvic pouch procedure is likely to become the chief method for preserving fecal continence after proctocolectomy, but the Kock pouch should be considered for inappropriate or unsuccessful cases.
Prognostic value of nuclear DNA content in medullary thyroid carcinoma
Authors: Bäckdahl Martin , Tallroth Eva , Auer Gert , Forsslund Gun , Granberg Per ‐Ola , Lundell Göran , Löwhagen Torsten 
Published: May 2005

AbstractThe prognostic value of nuclear DNA content in medullary thyroid carcinoma was studied in 36 patients. Eleven patients are still living 13–35 years after diagnosis. Twenty‐five patients died of medullary thyroid carcinoma between 10 months and 23 years following diagnosis. DNA measurements in morphologically identified single tumor cells were performed either on fine‐needle aspiration biopsy material or on histologic sections from the primary tumor. Metastases or local recurrences were also examined in 18 cases. In the survivors, the majority of tumors exhibited cells with DNA amounts approximating the normal diploid value, whereas the tumors of the nonsurvivors had significantly higher DNA values. The primary tumors and their metastases or local recurrences exhibited in all cases essentially similar DNA content. The data suggest that DNA measurements in medullary thyroid carcinoma contribute valuable prognostic information that adds to standard clinical and morphological parameters.
Secretory disturbance in hyperplastic parathyroid nodules of uremic hyperparathyroidism: Implication for parathyroid autotransplantation
Authors: Wallfelt Chris H. , Larsson Rolf , Gylfe Erik , Ljunghall Sverker , Rastad Jonas , Åkerström Göran 
Published: May 2005

AbstractPathophysiological characteristics of dispersed parathyroid cells were investigated in vitro with the principal aim of examining dominating hyperplastic parathyroid nodules in uremia. Ten large nodules were macroscopically dissected from the glands of 8 hypercalcemic patients with uremic hyperparathyroidism (HPT). Histologic examination revealed that the remaining parts of these glands were composed of a diffuse or slightly nodular parathyroid hyperplasia. Parathyroid hormone (PTH) concentrations were estimated with a mid‐C regional immunoassay and the calcium indicator quin‐2 was utilized to measure cytoplasmic calcium concentrations (Ca2+i) of the parathyroid cells. Ambient calcium control of PTH release and Ca2+i was significantly more abnormal in cells from the nodules while the less nodular tissue demonstrated a regulation similar to normal bovine parathyroid cells. Since an aberrant secretory regulation of the parathyroid tissue has been shown to greatly influence serum calcium concentrations in HPT, the findings substantiate a functional importance of hyperplastic parathyroid nodules in uremia. The results imply that parathyroid autotransplants should be excised from essentially nonnodular parts of the parathyroid glands since this may reduce the incidence of graft‐dependent recurrences after total parathyroidectomy in uremic HPT.
Secondary thyroidectomy: A twenty‐year experience
Authors: Reeve Tom S. , Delbridge Leigh , Brady Peter , Crummer Patsy , Smyth Christine 
Published: May 2005

AbstractSecondary thyroidectomy is an operation generally considered to be associated with a significantly increased risk of damage to the recurrent laryngeal nerves and parathyroid glands. During a 20‐year period, to December, 1986, a total of 408 secondary thyroidectomies were performed. The majority (n=227) were for recurrent nodular goiter, followed by reoperations for thyroid cancer (n=151), and operations for secondary thyrotoxicosis (n=30). The incidence of operative recurrent laryngeal palsy was 1.5% over the 20‐year period, while the incidence of permanent hypoparathyroidism fell from 3.5% during the first 15 years to 1.6% over the last 5 years, with a similar fall in the incidence of transient hypocalcemia (8.4% down to 4.8%). The risk of complications can be minimized by careful attention to operative detail, employing the technique of capsular dissection with preservation of the vascular supply to the parathyroid glands while protecting the recurrent laryngeal nerve.