bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ultrasonic examination during surgery for abdominal abscess
Authors: Machi Junji , Sigel Bernard , Beitler Julio C. , Coelho Julio C. U. , Donahue Philip E. , Duarte Bernardo , Nyhus Lloyd M. 
Published: May 2005

AbstractReal‐time B‐mode high resolution ultrasound scanning was employed during 12 operations for abdominal abscess. These included: 5 hepatic, 2 splenic, 2 pancreatic, 2 retroperitoneal, and 1 intraperitoneal abscesses. In most instances, operative ultrasonography was considered to be helpful in operative management of abdominal abscesses. Ultrasound was valuable in: (a) localizing abscesses before tissue dissection; (b) establishing the diagnosis which had not been made preoperatively; (c) excluding the presence of abscesses suspected on preoperative studies or at operative exploration; (d) identifying adjacent structures such as blood vessels, biliary and pancreatic ducts, and intestines; and (e) guiding the needle for aspiration of abscess. Operative ultrasonography is a safe and simple technique, providing the surgeon with accurate information during surgery which may reduce the re‐drainage and mortality rates of abdominal abscess.
Inguinal hernia repair with silk or polyglycolic acid sutures: A controlled trial with 5‐years' follow‐up
Authors: Burcharth Flemming , Hahn‐Pedersen Jan , Andersen Bjørn , Andersen Jens R. 
Published: May 2005

AbstractPolyglycolic acid and silk sutures were used for repair of 321 direct inguinal hernias in 302 patients in a triple‐blind randomized trial. A standardized McVay repair was used. A total of 28 recurrent hernias were diagnosed. The cumulated recurrence rate increased gradually to 6.5% after 2 years and to 10.4% after 5 years. No difference was found between polyglycolic acid and silk sutures.It is concluded that repair of direct inguinal hernias may be performed with the same safety with polyglycolic acid as with silk sutures.
Therapeutic action of fructose‐1,6‐diphosphate in traumatic shock
Authors: Markov Angel K. , Oglethorpe Nicole , Grillis Michael , Neely William A. , Hellems Harper K. 
Published: May 2005

AbstractTraumatic shock was induced in 130 rats by tumbling them in a Noble‐Collip drum for a total of 600 revolutions at 40 rotations/min. The experimental protocol was designed to evaluate the therapeutic effectiveness of fructose 1,6‐diphosphate (FDP) in reducing the mortality rate when given both prior to and following the trauma, or only following the trauma. In the first group (n=50) in which the treatment was given prior to and after trauma, the animals were randomly assigned to 3 subgroups as follows: 20 rats received 350 mg/kg of FDP prior to and an additional 350 mg/kg after trauma; 20 other rats received in the same manner equal amounts of glucose; and 10 rats received no treatment. In the group treated only after inflicting the injury (n=80), 35 rats received 350 mg/kg of FDP after trauma; another 35 received glucose; and 10 received no treatment. The rats from the different subgroups were tumbled at the same time.Survival rates in the pretreated subgroups were 85% for those receiving FDP, 30% for glucose‐treated animals (p< 0.005), and 20% for the nontreated ones. In the animals that were treated after trauma, there was also a significant increase in survival rate for the FDP‐treated ones (66%), while for those receiving glucose it was 31% (p<0.01), and 20% for the nontreated ones.The results of the present study and those obtained in other etiological types of shock indicate that FDP has profound antishock therapeutic activity. This action appears to be metabolically mediated by augmenting the endogenous energy production via glycolysis.
Axillary transpleural sympathectomy: Indication, technique, and results
Authors: Linder F. , Jenal G. , Assmus H. 
Published: May 2005

AbstractThe indications and operative technique for high thoracic sympathectomy by the transaxillary approach are demonstrated. The late results and complications are referred to in a retrospective analysis of 159 patients on whom 193 sympathectomies have been performed over the last 15 years for peripheral vascular occlusive disease, vasospastic diseases such as Raynaud's phenomenon, and hyperhidrosis of the upper extremity.
Recurrent peptic ulcers
Authors: Johnston David , Blackett Richard L. 
Published: May 2005

AbstractThis article is concerned mainly with recurrent ulceration (RU) after vagotomy [truncal (TV), selective (SV), or highly selective (HSV)]. RU may be symptomatic or asymptomatic. Since few surgeons routinely perform endoscopy on asymptomatic patients, it is symptomatic RU that is being discussed.After all 3 types of vagotomy, without antrectomy, median incidences of RU are about 10% after 5–10 years, but there is wide variation, from 1% to 30%. There is no convincing evidence that TV denervates the parietal cell mass more effectively than does SV or HSV, or that it has a lower incidence of RU than SV or HSV. Claims that SV and HSV lead to fewer incomplete vagotomies and less RU than TV are, however, not convincing. Since SV + P (pyloroplasty) or gastrojejunostomy (GJ) carries the same risk of RU as HSV, but has more side effects because of loss of the pylorus, it has been abandoned. The choice of elective operation for duodenal ulcer (DU) thus lies among TV + D (truncal vagotomy + drainage procedure), HSV, and V + A (vagotomy + antrectomy).The results of 5 controlled trials suggest that HSV yields better overall clinical results than V + A, even though the incidence of RU is 1% after V + A compared with 10% after HSV. Even for patients with hypersecretion of acid, V + A should not be employed in preference to HSV, because incidences of RU after HSV are no higher among hypersecretors of acid than among normal secretors. Gastrin cell (G‐cell) hyperplasia and “antral dominance” are concepts still too nebulous to influence the choice of elective operation for DU.After complete vagotomy (TV, SV, or HSV), as shown by the Burge, Grassi, or Hollander tests, the incidence of RU is 2–5%. High incidences of RU are not related to any characteristic of the patient, the level of acid output, or the ulcer, but are related to the surgeon who operates. They are thus related to operative technique, and are preventable.Despite the advent of H2‐receptor antagonists, elective vagotomy (preferably in the form of HSV) still has a place in the management of DU because it is more effective than H2‐blockers in lowering intragastric acidity permanently and in preventing recurrent ulceration.
Bleeding gastroduodenal ulcers: Nonoperative treatment
Authors: Laurence B. H. , Cotton P. B. 
Published: May 2005

AbstractEarly endoscopy is now standard diagnostic practice in most institutions for assessment of patients with acute upper gastrointestinal bleeding. Definition of the cause of bleeding facilitates management, and the precise appearance of the lesion may give additional prognostic information about the risk of rebleeding.Many endoscopic tools have now been developed for use in attempts to stop bleeding directly, or to reduce the risk of rebleeding. This article reviews the methods that have been described, which range in expense and complexity from lasers, through diathermy and heater probes, to simple injection needles. Despite the difficulties in assessment and a relative lack of controlled trials, it is clear that most methods can be effective, but also that the experience of a team is probably more important than the choice of probe. Guidelines for selection of patients will continue to evolve. The concept of high‐risk patients with high‐risk lesions provides a valuable framework for stratification.Endoscopic hemostasis is simply a new way of applying surgery. Close collaboration between gastroenterology and surgical teams is essential for future progress in this field.
Bleeding gastroduodenal ulcers: Choice of operations
Authors: Herrington J. Lynwood , Davidson Jesse 
Published: May 2005

AbstractManagement of upper gastrointestinal tract hemorrhage continues to present a challenge in surgical judgment. Endoscopy is the mainstay to precise diagnosis and, although some authorities feel that this modality has not reduced overall mortality, it has, however, played an important role in overall patient management. A bleeding patient may be classified into 1 of 3 separate categories and the algorithms outlined in this article are useful in selecting patients for nonoperative and operative treatment. For the good‐risk patient with a massively bleeding duodenal ulcer (DU) who is hemodynamically stable, truncal vagotomy‐antrectomy, Billroth I reconstruction is our procedure of choice if the inflammatory process in the duodenum is conducive to a safe resection. Our operative method is described along with variations in technique which are used when conventional end‐to‐end gastroduodenostomy is not feasible. Closure of the duodenal stump and Roux‐en‐Y reconstruction or placement of a Roux limb on a severely diseased duodenum following resection is employed in highly selected cases. The Billroth II type of reconstruction is rarely used today in our experience. Truncal vagotomy and pyloroplasty (TV‐P) is reserved for the high‐risk patient who is bleeding massively. An increasing number of these patients are currently encountered as transfers from our intensive care units with associated multiple organ disease and organ failures. Proximal gastric vagotomy with ulcer undersewing has limited application, in our judgment, when faced with the massively bleeding patient. Gastric resection with or without vagotomy along with ulcer excision is our choice for the massively bleeding gastric ulcer (GU) located in the distal 50–60% area of the stomach. For the high‐risk patient with GU, ulcer excision followed by TV‐P is indicated. For the rarely encountered giant GU, gastric resection may be the only option even though the patient is high risk.The choice of the proper operative procedure for the individual patient with massive gastric or duodenal hemorrhage should rest on the experience and the judgment of the surgeon.
Perforated duodenal ulcers
Authors: Boey John , Wong John 
Published: May 2005

AbstractThe incidence of perforation, complicating about 5% of duodenal ulcers, has not decreased proportional to the overall decline in peptic ulcer disease. To define the role of immediate definitive surgery, we conducted several prospective studies to identify risk factors that increase operative mortality as well as predictive factors associated with relapse after simple closure. Among 613 consecutive patients, major medical illnesses, preoperative shock, and perforations exceeding 24 hours' duration were found to be determinant variables that allowed stratification of patients into different risk groups. Definitive surgery or simple closure in the absence of any risk factor had a mortality rate of less than 0.7%, whereas even closure alone incurred a mortality rate of 86.7% when all 3 risk factors were present.The need for definitive surgery was assessed by comparing relapse rates after closure in patients who differed in respect to the chronicity, age at onset, and family history of their ulcer disease. Multivariate analysis revealed chronicity and a positive family history to be the most useful independent predictors of the likelihood of relapse after closure. The benefits of definitive surgery for perforations in chronic lesions were corroborated by a prospective controlled trial in which proximal gastric vagotomy with closure or truncal vagotomy with gastric drainage each proved as safe as closure alone but significantly more effective in reducing the frequency of relapse after operation.Immediate nonresective definitive surgery is indicated in fit individuals who have perforations in chronic duodenal ulcers; however, closure alone is more prudent in patients who have any risk factor.
High gastric ulcer
Authors: Jensen Hans‐Eric , Hoffmann Jack , Wille‐Jørgensen Peer 
Published: May 2005

AbstractFifty‐six patients with high gastric ulcers were studied retrospectively. There were 38 women and 18 men. The mean age was 66 years. Findings were: 25% had ulcer histories of more than 5 years; 45% had illnesses in other systems making them poor operative risks; 34% were taking ulcerogenic drugs, and 36% were on antiulcer treatment prior to surgery; 43% presented with severe bleeding, 16% with perforation, and 2 patients had simultaneous bleeding and perforation; 38% had deeply penetrating ulcers and many ulcers were very large; 7 patients had ulcers in hiatus hernias. Sixty‐three percent of the procedures were emergencies. Half of the operations were nonresective, with or without vagotomy. The other half were gastric resections of various types. The overall mortality rate was 18%, but the mortality rate was 24% for emergency procedures and 9% for elective ones. The highest mortality rate, 45%, occurred after emergency resective procedures. Vagotomy did not increase postoperative mortality when added to a nonresective procedure. Beside the 10 patients who died, 6 others developed severe postoperative complications, usually respiratory failure or suture line leakage. Follow‐up of between 6 months and 12 years (average 3 years) was possible in 55% of the patients. Two developed recurrent ulcers and 2 had overlooked gastric carcinomas. An approach of management for high gastric ulcer is outlined recommending a Pauchet operation for good‐risk patients, and vagotomy and drainage for old and frail patients. Medical treatment should be pursued as long as possible to avoid an often hazardous operation.
Pyloric and prepyloric ulcers
Authors: Muller Claude , Liebermann‐Meffert Doris , Allgöwer M. 
Published: May 2005

AbstractIn a prospective multicenter trial, 560 patients with peptic ulcer were treated with proximal gastric vagotomy (PGV) without drainage. Four hundred ninety‐three patients had duodenal ulcer (DU), 35 pyloric (PU), and 32 prepyloric ulceration (PPU). Actuarial 5‐year recurrence rates were 14%, 35%, and 33%, respectively, and were significantly higher in PU and PPU than in DU. In a separate study, thickness of the pyloric and antral wall was assessed in the resection specimens of patients with similarly defined ulcer types and in controls. There was significant thickening of the muscular layer of the pylorus and antrum in patients with PU and PPU compared to those with DU and controls. It appears that this muscular hypertrophy and fibrosis could be one factor responsible for the failure of PGV without drainage in PU and PPU. Preliminary results indicate a possible beneficial effect of adding a drainage procedure to PGV when treating pyloric channel ulcers. Our results emphasize that pyloric channel ulcers must be considered as a particular entity of peptic ulcer disease and should no longer be assigned to the duodenal ulcer group.
Peptic ulcer complications in high‐risk patients
Authors: Stabile Bruce E. , Tzu‐Ming Chang , Hiatt Jonathan R. , Passaro Edward 
Published: May 2005

AbstractDistinct groups of patients at high risk for the development of peptic ulceration of the stomach and duodenum have been identified. As newer forms of treatment for critical illness evolve, it seems probable that other high‐risk groups will be described. The etiology of the ulcerations appear to be different for each group. The presence of intraluminal acid is correlated with the incidence of bleeding. Acid‐reducing therapy, whether intraluminal or intravenous, is effective in decreasing the risk of bleeding to variable degrees among the high‐risk groups but does not prevent or reduce the incidence of ulceration. When surgical therapy is needed, no operation is superior.
Assessment of the Angelchik prosthesis for treatment of symptomatic esophageal reflux
Authors: Starling James R. , Hamilton John W. , Reichelderfer Mark , Yamato Dennis T. , Pellet John R. , Belzer Folkert O. 
Published: May 2005

AbstractDuring a recent 5‐year period, 74 patients were fitted with an Angelchik antireflux prosthesis for symptomatic reflux esophagitis. Seventy‐five percent of 28 patients in the initial series (series 1) have had excellent to very good response to the prosthesis, as indicated by a clinical follow‐up of 36–60 mo. The main cause of failure in this series was prosthesis disruption (4 of 28 patients). Ninety‐two percent of 46 patients in the more recent series (series 2) have had excellent to very good response to prosthesis placement. The new prosthesis design, which includes a circumferential strap, has completely eliminated prosthesis disruption. Of the total series of patients, 19% of patients experienced transient dysphagia. This complication was no longer significant by 6 mo postoperatively, and no prostheses have had to be removed because of this complication. There have been no instances of erosion of the prosthesis. In addition to clinical data, lower esophageal sphincter measurements and recently, 24‐hr ambulatory pH monitoring have demonstrated a physiological effect of reflux protection after prosthesis placement. In our experience, the Angelchik prosthesis has been especially useful in high‐risk patients, patients who have recurrent esophagitis after previous antireflux or foregut surgery, and patients who would probably not have been referred for conventional antireflux surgery. In view of our data, we believe that the Angelchik prosthesis should continue to be commercially available as a surgical option for treating selected patients with medically refractory reflux esophagitis.
Bronchial carcinoids: An analysis of 91 cases
Authors: MÅrtensson Hans , Böttcher Gerhard , Hambraeus Göran , Sundler Frank , Willen Helena , Nobin Anders 
Published: May 2005

AbstractNinty‐one patients with bronchial carcinoids operated on during a 30‐year period were retrospectively studied regarding age, symptoms, diagnosis, tumor size and extent, treatment, and survival. In addition, an immunocytochemical study was performed on 69 tumors.The mean age at the time of diagnosis was 50 years with a slight predominance of women (64%). Common symptoms were cough, singular or recurrent pneumonias, and hemoptysis. Thirty‐one patients were discovered by chance at health control or investigation for other reasons. They were totally asymptomatic. Patient delay was insignificant, while doctor's delay exceeded 1 year in 30% of the cases. Bronchoscopy was performed in 83 patients but tumor was seen only in 60%. Biopsy from these tumors was positive in 82%. The tumor was solitary in 89 patients and was usually 10–30 mm in size. At the operation, 1 patient had lymph node metastases and 1 had a disseminated disease. The immunocytochemical analysis showed 5‐hydroxytryptamine in 37, peptide in 41, and no immunoreactive cells in 19 tumors. Gastrin‐releasing peptide was the most common peptide (21 tumors), followed by adrenocorticotropin hormone (19), human pancreatic polypeptide (17), calcitonin (15), metenkephaline (4), vasoactive intestinal polypeptide (1), and somatostatin (1). Endocrine symptoms were present only in 1 patient who suffered from a carcinoid‐like syndrome. Only 5 patients died from their endocrine tumor while 18 died from an intercurrent disease.
Iatrogenic bile duct injuries
Authors: Mathisen øystein , Bergan Anstein , Flatmark Audun 
Published: May 2005

AbstractDuring a 25‐year period (1959–1984), 42 patients with iatrogenic bile duct damage were referred. Before referral, 11 patients had no attempt at reconstruction, while 31 had undergone 41 operations to repair the damage. At admission, 4 patients had secondary biliary cirrhosis, 1 had portal vein thrombosis, and 1 had sepsis. The entire extrahepatic duct system had been resected in 1 patient, and operative treatment includes 41 patients. Fifty‐two operations have been performed, and 34 patients (83%) have had an excellent long‐term result, median 13 years. Five patients had 4 operations or more (before and after referral), and 3 are alive in good condition. Various methods of repair were employed, and 8 patients (20%) had recurrence of stricture. Restricture was lowest for hepaticojejunostomy Roux‐en‐Y (15%), in particular when no stent was used across the anastomosis (8%). The hospital mortality rate was 2 (5%) of 41 and overall mortality, 7 (17%) of 41. The lowest mortality rate (9%) was associated with hepaticojejunostomy Roux‐en‐Y. Low rate of recurrence and mortality are correlated to early referral. Patients who had restricture or died were referred a median 5 and 7 months, respectively, later than those who did well. Mortality was also related to serious complications at the time of referral and lack of follow‐up. Patients with iatrogenic bile duct injury should be referred early to a competent center, where adequate treatment of infection, reconstruction with a hepaticoje‐junostomy Roux‐en‐Y without stenting, and lifelong follow‐up can be performed.
Supernumerary parathyroid glands: Implications for the surgical treatment of secondary hyperparathyroidism
Authors: Edis Anthony J. , Levitt Michael D. 
Published: May 2005

AbstractOf 20 patients who underwent parathyroidectomy for secondary hyperparathyroidism between 1978 and 1985, recurrent hypercalcemia occurred in 4. Three of the 4 patients had initially undergone total parathyroidectomy with autotransplantation (TP‐A) and the fourth had been subjected to removal of 3 parathyroids with autotransplantation of a portion of 1 of these glands. None of the 5 patients treated by subtotal parathyroidectomy (STP) developed recurrence. One of the 3 cases of recurrent hyperparathyroidism after TP‐A was due to graft overgrowth. Another was caused by supernumerary parathyroids subsequently removed at the time of reexploration of the neck. The third remains hypercalcemic after autograft excision and presumably still has a supernumerary gland in situ. The patient who developed recurrent hypercalcemia after removal of only 3 glands and autotransplantation remains hypercalcemic even after radical graft excision and reexploration of the neck and mediastinum.One patient treated early in the series by total parathyroidectomy without autotransplantation now has measurable levels of serum immunoreactive parathyroid hormone, presumably due to a small residual supernumerary gland. There is, thus, at least presumptive evidence of supernumerary parathyroid glands in 3 (15%) of the 20 patients in this series. The implications of this finding are discussed.
Complications of radiation therapy and factors in their prevention
Authors: Cox James D. , Byhardt Roger W. , Wilson J. Frank , Haas Judith S. , Komaki Ritsuko , Olson Laird E. 
Published: May 2005

AbstractRadiation therapy of most malignant tumors requires dose‐fractionation regimens near the tolerance of the surrounding normal tissues. With the exception of the bone marrow and the lung in which the morbidity may be minimized by reducing the volume irradiated, other structures require limitations of total doses to minimize adverse effects. In thoracic irradiation, the most sensitive normal structure is the lung, while the heart and esophagus do not frequently have serious late effects. Pelvic irradiation carries a much greater risk of morbidity, primarily to the fixed segments of small bowel and less frequently to the large bowel and bladder. Irradiation of the upper aerodigestive tract may be complicated by necrosis of soft tissues and bone, especially the mandible. Dental management greatly affects the risk of complications. Bones and soft tissues elsewhere in the body are rarely affected except in the growing child. The normal pituitary may be irradiated when tumors near the base of the skull are treated. The production of growth hormone may especially be compromised in children. Acute, subacute, and late effects of irradiation of the brain are well recognized. While transient radiation myelopathy is frequent and not serious, progressive radiation myelopathy is rare but extremely grave. Host factors, other diseases, and technical aspects of radiation therapy affect the risks and severity of adverse effects on normal tissues. Surgical procedures may be important in preventing complications as well as in managing them.