bluuebunny/crossref_metadata_2025_split huggingface dataset:
Splenic artery aneurysms
Authors: Trastek Victor F. , Pairolero Peter C. , Bernatz Philip E. 
Published: May 2005

AbstractThe cause of splenic artery aneurysms and the indications for their treatment remain controversial. Splenic artery aneurysms occur more frequently in women and are associated with pregnancy and multiparity. Whether arteriosclerosis is the cause of the aneurysm or is a secondary phenomenon is unknown. Patients not treated do well, especially if the aneurysm is less than 2 cm in diameter. The rate of rupture is approximately 3%, and it appears to be decreasing as more patients are found to have this type of aneurysm. The mortality rate for ruptured splenic artery aneurysm is greatly increased if the patient is pregnant. Indications for removal include presence of symptoms, pregnancy or plan to become pregnant, increasing size, and a diameter of 2 cm or greater. Depending on the medical condition of the patient, aneurysms that are less than 2 cm in diameter can be removed electively, or they can be left and the patient followed closely. The risk of elective removal is extremely low and has minimal morbidity. In the treatment of this type of aneurysm, the spleen should be preserved if possible; splenectomy is reserved for those aneurysms found in the hilus of the spleen or during emergency situations.
Surgery of the traumatized spleen
Authors: Bongard Frederic S. , Lim Robert C. 
Published: May 2005

AbstractBecause of the increased awareness of the risk of over‐whelming sepsis following splenectomy, we have attempted splenorrhaphy in trauma victims whenever possible. Among 75 patients with splenic injuries, 44 (58.7%) were treated with splenorrhaphy. These patients were critically ill, and frequently had multiple associated injuries. We found that unless physiologic or anatomic considerations precluded its use, splenorrhaphy could be performed readily with minimal blood loss and no increase in operating time. The majority of patients undergoing repair (63.6%) had simple lacerations which were controlled either with topical hemostatic agents or repaired with absorbable sutures. The early complication and operative mortality rates for splenorrhaphy and splenectomy were similar. One patient undergoing splenorrhaphy required reoperation for bleeding. There were no episodes of delayed hemorrhage or capsular disruption. We conclude that splenorrhaphy is a viable and safe alternative to splenectomy under certain circumstances, and may be beneficial by reducing the risk of subsequent overwhelming postsplenectomy sepsis.
Accessory spleens: Clinical significance with particular reference to the recurrence of idiopathic thrombocytopenic purpura
Authors: Rudowski Witold J. 
Published: May 2005

AbstractOne of the important stages during splenectomy is the search for accessory spleens. The average frequency of accessory spleens is an estimated 11%. In our own material in 611 patients who had splenectomy in hematological disorders, accessory spleens were found in 110 patients (18%). The surgical anatomy, embryology, and clinical significance of the accessory spleens, with particular reference to the recurrence of idiopathic thrombocytopenic purpura (ITP) are discussed. The group of 177 patients with ITP treated by splenectomy 2–25 years ago is analyzed. Recurrence of thrombocytopenia after a good immediate response to splenectomy developed in 52 patients. In 13 patients the recurrence was transient, but in 19 it was longlasting. In these patients the presence of the accessory spleens was suspected by the absence of Howell‐Jolly bodies in the peripheral blood. The accessory spleen was demonstrated by splenic scan in 16 cases and confirmed in 13 of the 15 patients who underwent reoperation. Removal of the accessory resulted in permanent disappearance of thrombocytopenia in 12 patients.
Splenectomy for malignant lymphomas
Authors: Mitchell Andrew , Morris Peter J. 
Published: May 2005

AbstractSplenectomy may be indicated in malignant lymphoma for diagnosis, staging of the disease, or therapy. In the majority of cases of otherwise undiagnosed splenomegaly, it will allow histological diagnosis. A proportion of those who remain undiagnosed will subsequently develop lymphoma. Staging laparotomy has an established place in the management of Hodgkin's disease, but its role in non‐Hodgkin's lymphoma is very limited. Despite the poor general condition and long‐term prognosis of most patients with hypersplenism due to advanced lymphoma, splenectomy has a low morbidity and mortality, and usually results in correction of the hematological cytopenia which allows appropriate chemotherapy for the disease.During the past 10 years, 287 patients had their spleen removed under the care of one surgeon. One hundred and forty of these splenectomies were carried out as part of a staging laparotomy for Hodgkin's disease and 20% were for hypersplenism complicating malignant lymphoma. A further 34 patients (12%) had a splenectomy to establish a diagnosis and 26 of these patients proved to have a lymphoma. Forty‐six patients, who are not discussed further in this paper, had a splenectomy for various hematological disorders. There was 1 hospital death (0.3%) as a result of splenectomy and the overall morbidity rate for splenectomy was 14% in this series.
Postsplenectomy sepsis: Historical background and current concepts
Authors: West Karen W. , Grosfeld Jay L. 
Published: May 2005

AbstractAlthough most common in infancy and early childhood, susceptibility to postsplenectomy infection is not limited by age or underlying pathological condition. Postsplenectomy sepsis is a fulminant, rapid process which often begins with vague symptoms. Death may follow in hours unless appropriate fluid resuscitation and antibiotic therapy is promptly instituted. Experimental evidence suggests that spienectomy results in a loss of both mechanical and humoral protective factors. Elective spienectomy should be postponed until after age 4 years. Preoperative immunization with pneumococcal vaccine and prophylactic antibiotics may play a role in preventing postsplenectomy sepsis. In instances of trauma, all or part of the spleen should be preserved when possible.Postsplenectomy sepsis is a life‐long risk. Patient and parent education and long‐term follow‐up are essential.
Donor‐specific transfusions in living‐related transplantation
Authors: Salvatierra Oscar 
Published: May 2005

AbstractTwo‐hundred thirty‐nine transplants have been performed following donor‐specific blood transfusions (DSTs) from 1978 through 1984 at the University of California, San Francisco (UCSF). The results of this experience show that DST provides excellent long‐term graft survival in 1‐haplotype mismatched pairs. Excellent graft survival has also been obtained in a limited 0‐haplotype matched experience. These results are comparable to those achieved with concurrent HLA‐identical sibling transplants. Azathioprine coverage during DST administration does appear to decrease DST sensitization to the blood donor in unsensitized patients undergoing a first transplant, encouraging early DST and transplantation in this group. The majority of patients formerly excluded from transplantation because of a post‐DST positive B‐warm crossmatch can now be successfully transplanted with the use of flow cytometry analysis to rule out previously undetectable low levels of anti‐class I antigen activity. The DST protocol by itself does not appear to preclude subsequent cadaveric transplantation in patients sensitized to their blood donor by the DST procedure. Preliminary results of cyclosporin treatment in 1‐haplotype matched living‐related donor‐recipient pairs is reported with a 1‐year graft survival rate that is similar to that obtained following cadaveric transplantation at this same center. In summary, the long‐term immunologic effect of DST has been confirmed, and the indications and considerations for the optimum use of the DST protocol appear to be more clearly defined.
Total lymphoid irradiation in renal transplantation
Authors: Myburgh J. Albertus , Smit Jacobus A. , Meyers Anthony M. , Botha J. René , Browde Selma , Thomson Peter D. 
Published: May 2005

AbstractTotal lymphoid irradiation (TLI), used in the treatment of some patients with Hodgkin's disease, produces profound immunological changes. In small rodents, mice and rats, a modified version of TLI results in transplantation tolerance for skin and heart allografts. The concept has been expanded to large outbred animals. In baboons transplantation tolerance has been produced for kidney and liver transplantation. The tolerance meets the in vivo and in vitro immunological requirements of durability and specificity. Baboons are currently surviving with normal graft function more than 6 years after kidney transplantation. Kidney‐donor derived skin grafts are accepted permanently, and third‐party skin and kidney grafts are rejected by these tolerant animals. Late chronic rejection occurs in a minority of animals between 6 and 12 months after transplantation. No grafts have been rejected by baboons with normal graft function at 1 year. The most successful protocol in baboons has involved a low cumulative dose (800 cGy), twice a week fractionation regimen of irradiation administered to a wider field than that used in the treatment of Hodgkin's disease. Up to two‐thirds of such animals are rendered tolerant. The role of adjuvant immunosuppressive drug therapy in increasing the tolerant fraction obtained is currently under evaluation. Encouraging results with the use of several methods of TLI in clinical renal transplantation are emerging from 5 centers. The prospect of achieving transplantation tolerance with TLI in the clinical context may be realized with further experience and modification of techniques.
Renal transplantation between identical twins: A review
Authors: Tilney Nicholas L. 
Published: May 2005

AbstractThe experience of transplantation between identical twins, occurring primarily at the Peter Bent Brigham Hospital, is reviewed. The remarkable success of this human experiment beginning in 1954 and ending, at least for the present in our hospital, in 1976, has confirmed early hopes that clinical renal transplantation may be an extremely effective treatment for end‐stage renal failure. Based largely on this seminal experience, investigations into experimental aspects of transplantation immunology, autoimmunity, and the general host responses, as well as developments in the field of nephrology and overall care of patients with endstage renal disease, have burgeoned. Indeed, during recent years, transplantation of several organs including heart, heart‐lung, liver, and kidney have proven remarkably successful. As knowledge and application in this field continues to expand, increasing numbers of patients with organ failure can expect to return to relatively normal lives.
Progress in segmental pancreatic transplantation
Authors: Tydén G. , Lundgren G. , Öst L. , Kojima Y. , Gunnarsson R. , Östman J. , Groth C. G. 
Published: May 2005

AbstractTwenty‐nine patients with type I diabetes mellitus and end‐stage diabetic nephropathy were subjected to combined renal and pancreatic transplantation. The 2‐year actuarial patient survival rate was 87% and the renal graft survival rate was 78% for the whole series. The 1‐year and 2‐year actuarial pancreatic graft survival rates were 54% and 40%, respectively. A substantial improvement in the pancreatic graft survival has occurred with time. Thus, in the first part of the series (1981–1983, n = 13), the 1‐year pancreatic graft survival was 31%, whereas in the second part of the series (1984–1985, n = 16), the figure was 75%. The improvement in results was probably due to a reduction in the cold ischemia time and the adoption of an aggressive anticoagulant treatment; using these measures the incidences of pancreatitis and graft thrombosis were much reduced. In all patients with functioning pancreatic grafts, insulin therapy was discontinued and an essentially normal glucose homeostasis was achieved. Among the patients whose pancreatic transplant has survived for a longer period, no further deterioration in retinopathy or neuropathy was found. Furthermore, biopsies from the simultaneously transplanted kidneys in 2 patients 3 years after transplantation have failed to show any increase in the thickness of the glomerular basement membrane indicative of a recurrence of diabetic nephropathy.
Liver transplantation in the adult
Authors: Calne R. Y. , Williams Roger , Rolles Keith 
Published: May 2005

AbstractA total of 216 orthotopic liver transplants have been carried out in the Cambridge/King's College Hospital series. Over 16 years, changes in patient selection, immunosuppression, and surgical and anesthetic techniques have led to an improvement in results. These aspects are described and discussed. Although at considerable risk during the operation, patients with nonmalignant cirrhotic diseases who survive 1 year have a good long‐term chance of survival. A slow but steady improvement in survival after liver grafting has resulted from multiple and interesting factors. These include patient selection, technical changes, particularly regarding biliary drainage, increased availability of donors with transport of livers between different centers, and new immunosuppressive management. Although patients with primary carcinoma of the liver are better operative risks, the incidence of recurrent growth is about 60%. Patients with nonmalignant cirrhotic disease are more apt to develop perioperative complications. If they survive the first few weeks, their chances of long‐term rehabilitation are better than those of patients with malignant conditions. Many of the earlier patients in our series would now be considered too ill for the procedure, but still patients accepted for grafting die before a donor liver becomes available, and some patients who are suitable when first seen are gravely ill by the time a liver graft can be performed. The results and experience gained from the 216 orthotopic liver transplants performed in our series from May 1968, to August 1985, are described.
Liver transplantation in the child
Authors: Flye M. Wayne , Jendrisak Martin D. 
Published: May 2005

AbstractLiver transplantation has become the accepted mode of therapy for the patient with end‐stage liver disease, with a 1‐year success rate of approximately 70%. This is particularly true in the child in whom the indications are sometimes more clear cut than in the adult patient. The limiting factor to transplantation, however, remains the availability of suitable pediatric donor livers. Presently, the major indication for pediatric liver transplantation is extrahepatic biliary atresia. Other diseases in the pediatric patient treatable by this modality are chronic obstructive liver diseases, primary tumors of the liver, and a variety of metabolic disorders such as alpha‐1‐antitrypsin deficiency, Wilson's disease, Crigler‐Najjar syndrome, and tyrosinemia, as well as acute and subacute hepatic failure resulting from viral or toxin insult. Liver transplantation is no longer an experimental procedure but now is an accepted therapy. This has resulted in large part because of improved surgical techniques, perioperative management, and immunosuppressive therapy with cyclosporin.
Current status of heart and lung transplantation
Authors: Starnes Vaughn A. , Jamieson Stuart W. 
Published: May 2005

AbstractFrom March 1981, to August 1985, twenty‐eight heart‐lung transplants in 27 patients were performed at Stanford University. The actuarial survival at 1, 3, and 4 years was 64%, 55%, and 39%, respectively. In these 28 transplants, there were 8 perioperative deaths (29%) and 4 late deaths. Four of the perioperative deaths were related to previous operations and extensive adhesions which resulted in massive blood transfusion requirements. Of the 4 late deaths, 3 were attributed to primary pulmonary dysfunction resulting from obliterative bronchiolitis. One additional late death was due to cardiac allograft atherosclerosis with an anteroseptal myocardial infarction. The majority of the patients who have been discharged from the hospital have assumed normal lifestyles, with 3 of our patients participating in physically demanding athletic events.Heart‐lung transplantation continues to offer promise to patients with end‐stage heart and lung disease. Improvement in perioperative mortality may reasonably be anticipated with the refinement of patient selection and continued improvement of techniques of monitoring pulmonary rejection. Cyclosporin has made possible an effective method of immunosuppression without compromising the tracheal anastomosis. Presently, suitable donors for heart‐lung transplantation are difficult to acquire and will continue to be the limiting factor in the foreseeable future.
What happens to the parietal cell following truncal vagotomy?
Authors: Argov Samuel , Hershlag Avner , Mordohovich Daniel 
Published: May 2005

AbstractThe mechanism of gastric acid reduction following vagotomy is still unclear: does this reduction result from a decrease in parietal cell mass, or is the reduction just functional? In an attempt to settle the question, we used a litter of puppies, in which rapid multiplication of parietal cells takes place. We performed truncal vagotomy (histologically proven) on 4 puppies, using 3 puppies as a control group. Open gastric biopsies were taken every month from birth uncil 12 months of age. Parietal cells were counted and correlated with age. We found a significant reduction in the parietal cell mass in the vagotomized group during 4 months after delivery. The possible mechanisms explaining this phenomenon, as well as assumed clinical correlation, are discussed.
Intra‐atrial extension of renal and adrenal tumors: Diagnosis, management, and prognosis
Authors: Hugh Thomas B. , Jones Robert M. , Shanahan Mark X. 
Published: May 2005

AbstractIntra‐atrial tumor thrombus arising from a renal or adrenal tumor is a serious development. Preoperative recognition by computed tomographic scanning and cavography is important, and these investigations should be considered even in patients without symptoms of venous obstruction, especially if the tumor is right‐sided and greater than 7 cm in diameter.We report here our experience with the management of 3 patients with intra‐atrial tumor thrombus (2 adrenal, 1 renal). A combined midline and median sternotomy approach is preferred and cardiopulmonary bypass is essential. Moderate hypothermia and liver inflow occlusion may also be necessary. This technique provides effective vascular control for resection of the tumor and its intravascular extension, and is simpler than profound hypothermia, total body exsanguination, and complete circulatory arrest. Perioperative endoscopic examination of the interior of the inferior vena cava and hepatic veins, under bloodless conditions, helps to ensure that there has been complete removal of the thrombus.A review of 28 reported patients who have had removal of intra‐atrial thrombus suggests that long‐term survival is rare, but the possibility of symptom relief makes this procedure worthwhile.
What's new in the Federal Republic of Germany: A survey
Authors: Heberer G. , Teichmann R. K. 
Published: May 2005

AbstractA survey of the field of surgery in the Federal Republic of Germany finds numerous developments hi clinical, experimental, and professional activities within the country. For example, in 1985, a questionnaire found that almost all university hospitals and 70% of other hospitals now perform proximal gastric vagotomy without pyloroplasty on patients with duodenal ulcer. Further developments within clinical surgery include increased use of staplers, a resurgence in the use of pancreatic duct occlusion for chronic pancreatitis, the establishment of transplantation units, and the multidisciplinary approach to the care of multiple trauma patients.Clinical research is actively engaged in developing a new continent colostomy; in perfecting intraoperative biochemical localization of insulinomas and gastrinomas; in expanding the use of intraoperative ultrasound; and in monitoring transplant patients. The most noteworthy experimental research project at present is the use of extracorporeal shock wave treatment to fragment gallstones.Professional trends include a decline in the number of inpatient pediatric cases, an increased interest in quality control programs, and the expansion of postgraduate training in surgical subspecialities.
Fluid therapy in shock
Authors: Arturson Gösta , Thorén Lars 
Published: May 2005

AbstractThree principal factors must be considered in initial fluid therapy in the treatment of shock: (a) blood volume deficit; (b) oxygen transport capacity; and (c) metabolic requirement of water and electrolytes. For the calculation of the initial volume to be used in compensatory blood volume loss, patients may be categorized thusly: group A—impending or slight loss [assumed loss of 20% of total blood volume (TBV)]; group B—moderate shock (20–35% of TBV); and group C—severe shock (>35% of TBV). These groups are treated initially with 20%, 30%, and 50% of TBV replacement, respectively. Treatment is individualized by continuous observation and changes are made as required. The relative merits and indications for use of crystalloid and colloid solutions are outlined. Oxygen delivery to the tissues must be guaranteed. The flow properties of the blood improve and the oxygen carrying capacity decreases with reducing hematocrit levels; a hematocrit reading of about 30 or slightly above is adequate. In determining the metabolic requirements, 3 factors must be considered: the physiologic daily requirement of water and electrolytes; the increased extrarenal fluid losses; and the reduction of the extracellular volume in trauma.
Intraoperative fluid therapy
Authors: Thorén Lars , Wiklund Lars 
Published: May 2005

AbstractThe principles for intravenous administration of water, carbohydrates, and electrolytes during operations in adults, who were considered to be “in balance” prior to surgery, are detailed. The problem of blood replacement is likewise surveyed, with a view to coordinating these 2 clinical areas. A practical fluid therapy program is presented.
How do clinical results after proximal gastric vagotomy compare with the Visick grade pattern of healthy controls?
Authors: Muller C. , Engelke B. , Fiedler L. , Marrie A. , Mühe E. , Schmitz‐Harbauer W. , Zumtobel V. 
Published: May 2005

AbstractRecently, the 5‐year results of a multicenter trial on proximal gastric vagotomy (PGV) have been reported. Symptomatic results in 415 duodenal ulcer patients, according to the Visick grading, were as follows: grade 1, 64%; 2, 28%; 3, 4%; and 4, 4%. It appears that one‐third of the patients are symptomatic, and the question arises as to which standard such a Visick grade pattern should be compared.Five hundred sixty‐one healthy controls (blood donors), without history of peptic ulcer or previous gastric operation, have been examined according to a standard questionnaire identical to that used for follow‐up interrogation in the PGV trial. The control group was matched for sex and age with the trial population. Answers to 3 screening questions were compared with the result of detailed interrogation. The control group's Visick pattern was as follows: grade 1, 64.5%; 2, 28.9%; 3, 6.4%; and 4, 0.2%. Symptoms most frequently encountered were those of dyspepsia (pain, epigastric fullness) and gastroesophageal reflux. Dumping (2%) and diarrhea (4%) were also noted. Our conclusions are these: (1) The Visick grade pattern 5 years after PGV is almost identical with that of healthy controls. (2) Dull pain, epigastric fullness, and reflux symptoms are not specific signs after PGV. (3) Screening questions are misleading and follow‐up examinations must be based on a standard questionnaire to provide valid information. (4) The separation between Visick grade 1 and 2 should be abandoned, as it has no clinical importance. (5) PGV has virtually no specific long‐term sequelae except recurrence.