bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lower esophageal sphincter and the gastroesophageal antireflux mechanism
Authors: Laitinen Seppo T. , Larmi Teuvo K. I. 
Published: May 2005

AbstractVarious factors involved in the structure and functional control of the gastroesophageal antireflux mechanism were investigated experimentally in dogs and in a clinical series, with special attention to manometric examination of the lower esophageal sphincter (LES). The prevention of the compressive action of extrinsic paraesophageal structures did not lead to changes either in LES pressure or in LES response to increases in abdominal pressure. The mechanism intrinsic to the gastroesophageal junction, the LES, seems to be primarily responsible for the maintenance of gastroesophageal competence. Also, the LES response to increased ultra‐abdominal pressure appears to be a property of the LES itself. Vagotomy performed at different levels did not produce a change in LES pressure, whereas LES response was significantly attenuated after each type of vagotomy. The vagus nerves apparently have no important role in the maintenance of LES pressure, whereas LES response seems to be mediated by a vagal reflex. Intragastric bile instillation caused a significant rise in LES pressure, but chronic intragastric bile contamination did not lead to changes in gastroesophageal competence. This suggests that intragastric bile contamination does not have a deleterious effect on LES competence and does not seem to predispose to gastroesophageal reflux. Of the drugs generally used in premedication for or induction of anesthesia, atropine decreased LES pressure significantly. Metoclopramide, in turn, produced a significant rise in LES pressure and, when administered before atropine, was capable of preventing the depressant effect of atropine on LES pressure. Thus, routine use of metoclopramide in premedication for or induction of anesthesia to prevent the depressant effect of atropine on LES pressure and the possible consequent gastroesophageal reflux, pulmonary aspiration, and postoperative pulmonary complications should be considered. The mean LES pressure after surgery for reflux esophagitis was significantly greater in patients with an objectively good operative result than in those with an objectively poor result. However, some overlapping occurred in LES pressure values between these two groups. The correlation between LES manometry and other examination methods in the evaluation of the operative result of reflux esophagitis seems to be rather good.
Hemangiopericytoma: A clinicopathologic and ultrastructure study
Authors: Bose Bireswar 
Published: May 2005

AbstractHemangiopericytoma is a rare mesenchymal tumor arising from special cells known as “pericytes,” present on the outer walls of the capillaries. This neoplasm, first described by Stout in 1942, can occur in any part of the body but the majority are confined to the trunk and lower limbs. It can affect both sexes equally and all age groups, but occurs principally in adults in the 4th decade of life. Occasionally, the spectrum of variations in its histologic features lead to misinterpretation; such errors can be avoided by the use of electron microscopy. Approximately 50% are malignant and certain criteria are used to differentiate the benign from its malignant counterpart.This paper is based on a study of 6 patients seen in a special referral center during a 10‐year period; in 2 patients electron microscopic studies were undertaken to confirm the diagnosis. Four patients (66%) died within 5 years, and the remaining 2 are alive without recurrence at 6 years and 32 months, respectively. The literature on hemangiopericytoma is briefly reviewed from a surgeon's viewpoint, with special reference to the place of preoperative tumor embolization and recent advances made in the field of adjuvant radiotherapy and chemotherapy.
Medical management of ulcerative colitis and indications for colectomy
Authors: Truelove Sidney C. 
Published: May 2005

AbstractContemporary medical management of ulcerative colitis is surveyed. The most valuable drugs are corticosteroids, which may be administered orally, by injection, or topically (as enemas); and sulphasalazine (Azulfidine®) for oral or topical use. Other agents such as immunosuppressive drugs and disodium cromoglycate may also have a small role in management. In addition, in very ill patients, intravenous fluid and electrolyte replacement, blood transfusion, or parenteral nutrition may be required.Suitable regimens of medical treatment for mild, moderate, and severe attacks of colitis are outlined as well as the indications for surgery. The best choice of medication for maintenance therapy is also considered.The risk of malignant change in long‐standing colitis is discussed with particular reference to the method of containing this risk during continued conservative management by regular proctoscopic and colonoscopic biopsies to detect the premalignant condition of severe epithelial dysplasia.
Complications and function of the continent ileostomy at the Cleveland clinic
Authors: Fazio Victor W. , Church James M. 
Published: May 2005

AbstractWe have reviewed the results of continent ileostomy management in 168 patients treated from 1977 to 1985: 83 men and 85 women ranging from 16 to 69 years of age (median, 35 yr). One hundred fifty patients were diagnosed as having ulcerative colitis originally (14 later manifested Crohn's disease), 7 had familial polyposis coli, 1 Crohn's disease, and 10 continent urostomies. Twenty‐four patients were referred with pouches made elsewhere. A total of 252 operations were undertaken to construct or reconstruct the ileostomies, with a postoperative mortality rate of 0.04% (1 case). Postoperative complications following pouch construction or revision included bowel obstruction (5.2%), hemorrhage (2.8%), and sepsis (4.8%), while valve necrosis occurred in 4 patients and there were 5 fistulas. Twenty‐nine percent of patients developed pouchitis, all treated medically. Valve extrusion occurred in 17% of cases, late fistulas in 7.1%, valve prolapse in 3%, and peristomal sepsis in 11%. Reoperation rates were 42.5% in the first 3 years of the series, 38.5% in the next 5 years, and 6.5% in the last year. The use of Marlex® mesh in pouch construction was effective in stabilizing the valve, but led to a prohibitively high incidence of late complications and was abandoned in 1984. Ten pouches have been excised (8 of 15 done for Crohn's disease) and a total of 6 patients have died. Of the 152 patients alive with a pouch, 91% were continent. Results are encouraging and support the use of the continent ileostomy in patients unsuited for ileoanal pouch procedures.
Total colectomy and ileorectal anastomosis for ulcerative colitis
Authors: Mann C. V. 
Published: May 2005

AbstractThe pros and cons of total colectomy and ileorectal anastomosis for ulcerative colitis are discussed based on the author's experience and on the collective results with this operation at St. Mark's Hospital, London, over a 20‐year period. Its chief merits are that it is easy to perform, carries a low operative mortality and morbidity, and, when it works well, usually affords excellent anorectal function. It has 2 main disadvantages: in a proportion of cases it proves unable to control the disease because of continuous or recurrent activity of the residual proctitis, and occasionally a carcinoma may develop in the rectal stump. But patients who have failed with it can easily be salvaged, as a rule, by proceeding to a proctectomy and ileoanal anastomosis (or ileostomy). As for the risk of cancer arising in the rectum, fortunately, this can now be largely contained by regular follow‐up attendances, at which rectal biopsies are taken to look for evidence of the premalignant change of severe epithelial dysplasia, a precaution that is absolutely essential after this operation.Important points in the technique of ileorectal anastomosis are emphasized, and the suitability of the operation for colitis in various clinical settings is examined.
Proctocolectomy and ileoanal anastomosis
Authors: Beart Robert W. 
Published: May 2005

AbstractAn account is given of the evolution of proctocolectomy with construction of a pelvic ileal pouch and an ileoanal anastomosis, which has probably become the most popular elective operation at the present time for ulcerative colitis. The technique favored by the author for this procedure is described and the results obtained in 422 cases at the Mayo Clinic are analyzed, with 188 of them analyzed in detail. Outstanding issues regarding technical methods and outcome are discussed.
Proctocolectomy and ileoanal anastomosis with J‐shaped or S‐shaped ileal pouch
Authors: Cohen Zane , McLeod Robin S. 
Published: May 2005

AbstractThis article reports an experience of 150 ileoanal anastomoses with pelvic ileal pouches performed between January, 1982 and March, 1986. The pouches were J‐shaped in 70 patients, and S‐shaped in 80 (with an exit conduit not longer than 2.5 cm). In most of the former group, a long cuff of rectal muscle coat (10 cm from the pectinate line) was preserved, while only a short cuff (2 cm from the pectinate line) was retained in some of the former group and all of the latter group, a modification which had considerable technical advantages and seemed to carry no detriment to subsequent function.An attempt was made to assess the influence of these variations in operative technique on the quality of the functional result by a special study of 82 patients: 39 with a J pouch and long rectal cuff, 2 with an S pouch and long rectal cuff, 28 with a J pouch and short cuff, and 13 with an S pouch and short cuff. At an initial survey, the patients with J pouches reported more urgency and frequency of defecation and more frequent disturbances at night than did those with S pouches. Almost all these differences disappeared 8 months later. At this stage, 94% of the patients were very pleased with the outcome of their surgery and glad to have avoided an ileostomy, but, even so, most of them continued to have some bowel complaints.
Emergency surgery for ulcerative colitis
Authors: Hawley P. R. 
Published: May 2005

AbstractIn this article, the role of emergency surgery for severe acute phases of ulcerative colitis is examined. Consideration is given to the diagnosis of the urgent condition, the assessment of the severity of the attack, and the timing of the decision to abandon intensive medical treatment for operation. The form that this emergency intervention should take is then discussed, the author's preference being an ileostomy and subtotal colectomy, and described, in detail, is the operative technique employed in these acute cases. The results obtained from this and other emergency procedures at St. Mark's Hospital, London, and elsewhere are analyzed.
Medical management: Its accomplishments in Crohn's disease and indications for surgery
Authors: Allan R. N. 
Published: May 2005

AbstractWhile the etiology of Crohn's disease remains unknown, the optimal treatment of patients with this complaint must include integrated medical and surgical management.Crohn's disease is, in practice, not a single disorder but comprises a wide variety of disorders masquerading under the one name, so that each patient requires careful individual evaluation, including a review of previous resections and a clear definition of the site and extent of macroscopic disease. Any anemia and fluid or electrolyte depletion must be detected and rectified. Local complications such as stricture, abscess, or enterocutaneous fistula must be identified, and secondary complications such as renal stones, gallstones, or peptic ulcer considered. Symptomatic relief of diarrhea with codeine phosphate, Lomotil®, or loperamide may be appropriate. In symptomatic patients with nonobstructing Crohn's disease, “specific therapy” using sulphasalazine, metronidazole, corticosteroids, or immunosuppressive therapy may play a useful shortterm role. In a few patients, dietary manipulation and enteral or parenteral feeding may be of value. Several controlled trials have shown that “specific” medical treatment is not of any benefit either for patients with quiescent disease or for asymptomatic patients after resection of their lesions.Crohn's disease complicated by the occurrence of a stricture, an intraabdominal abscess, or an enterocutaneous fistula lies essentially within the province of the surgeon.Many patients with Crohn's colitis respond initially to specific medical treatment, but relapses are common, so that resection is appropriate in those patients with chronic ill health; there is a negligible mortality in experienced hands. The risk of recurrent disease should not delay surgical treatment, which can restore the chronically ill patient to good health, often for a considerable time. Furthermore, recurrent disease is commonly localized to the site of previous resection; if symptoms persist, a further resection can be undertaken with minimal morbidity.
Surgical treatment of Crohn's disease of the small bowel or ileocecum
Authors: Hultén Leif 
Published: May 2005

AbstractStandard surgical treatment for most cases of Crohn's disease of the small bowel or ileocecal region consists of resection, which, however, suffers 3 major disadvantages: (a) It often causes a fair amount of operative morbidity and mortality, especially when performed in the presence of septic complications. To reduce these immediate hazards, a strong case can certainly be made for an earlier resort to surgery before the onset of such complications; (b) It is followed by a high incidence of recurrence of the disease, amounting to about 50% by 10 years. Claims that the risk of recurrence can be reduced by using a more radical type of resection have not been substantiated. Fortunately, recurrences can usually be excised with no increased likelihood of further recurrence, and, by a combination of resection and reresection as required, many patients can be afforded prolonged periods of symptomatic relief; (c) Normal intestinal absorption is impaired, especially after major or repeated resections of the small bowel. The consequences are diarrhea and possible hematological and nutritional disturbances and a predisposition to the formation of biliary and urinary calculi. But, even a loss of up to 50% of the entire small intestine is often compatible with a reasonably good state of general health, particularly if most of the colon has been preserved. Fortunately, such extensive intestinal losses are rare, even after 2 or 3 resections.For short stenosing Crohn's lesions of the small bowel, the alternative operation of stricturoplasty has recently become available. Although the initial results have been encouraging, more prolonged study is required for a valid appraisal.
Surgical treatment of Crohn's disease affecting mainly or entirely the large bowel
Authors: Goligher J. C. 
Published: May 2005

AbstractThe measures available for the elective or emergency surgical treatment of Crohn's disease confined mainly or entirely to the large intestine are surveyed in the light of the author's personal experience in the management of 250 cases, followed up since operation for a mean period of 5 years (range, 7–25 yr).
Management of perianal Crohn's disease
Authors: Allan Arthur , Keighley Michael R. B. 
Published: May 2005

AbstractMost patients with perianal Crohn's disease are asymptomatic and perianal disease may resolve given adequate medical treatment for the underlying intestinal lesion. This will consist principally of sulphasalazine and prednisolone, both of which are known to be effective in the treatment of Crohn's disease. Should the local perianal disease become more severe, a trial of oral metronidazole may be worthwhile. The development of an ischiorectal or perianal abscess is an indication for the simplest surgical drainage procedure, and rectal strictures resulting from the healing of perianal fissures may be gently dilated. Further progression of disease may be treated by diversion of the fecal stream, but this will stand a greater chance of success in patients without florid rectal Crohn's disease. Fecal diversion is also indicated as a preliminary to the repair of rectovaginal fistulas. Patients with florid perianal Crohn's disease and severe anorectal disease will probably come to proctocolectomy, but initial defunctioning of the colon will make the operative procedure easier, may facilitate perineal healing, and some patients may actually avoid proctectomy with its high risk of a persistent perineal sinus.
Management of conventional ileostomies
Authors: Pemberton John H. 
Published: May 2005

AbstractWith few exceptions, proctocolectomy is the treatment of choice for patients with chronic ulcerative colitis. The method by which patients are offered control of bowel function postoperatively, however, is more controversial. Traditionally, proctocolectomy is accompanied by a conventional Brooke ileostomy and control of enteric effluent provided by an external appliance. Today, several alternatives are available, such as Kock's continent ileostomy and the ileoanal anastomosis. The results of both are generally good. The functional outcome of these procedures is, however, not always uniform and not all patients are candidates for such alternatives. Conventional ileostomy, therefore, remains the standard surgical approach; Brooke ileostomy is the one procedure which is applicable to any patient regardless of age, body habitus, type of disease, or other medical problems. It is the aim of this article to summarize important principles of surgical technique and of stomal care, to detail the functional results and physiologic consequences of standard ileostomy, and to document the impact of ileostomy on quality of life. Finally, the current and future role of ileostomy in the era of surgical alternatives will be discussed.
Estimation of serum complement and its role in management of trauma
Authors: Kapur M. M. , Gidh M. 
Published: May 2005

AbstractSerum samples of traumatized (16) and operated (31) patients were analyzed to determine C3 levels and activation. It was found that in the immediate postinjury and postoperative periods, serum C3 activation occurred with a fall in C3 levels. The degree of serum C3 depletion was directly related to the severity of injury, as assessed by the injury severity score (ISS), and to the extent of surgical procedure performed, as assessed by the total duration of surgery and total blood loss. The mean ISS of patients with activated complement was 20.3, in comparison with the ISS of those in whom complement was not activated (mean ISS, 6.6;p<0.01). The mean serum C3 level of patients with ISS≥12 was 80.3 mg% in comparison with the mean C3 level (110.2 mg%) of those with ISS<12(p <0.01).Serial assay for serum C3 levels at 24‐hour intervals in uncomplicated cases revealed a gradual return of the levels to near normal values over a period of several days. Failure to return to normal levels at the expected time invariably indicated complications and, in all such patients, an occult septic focus was either discovered or it revealed itself during the subsequent period of observation. Resolution of septic complication by therapeutic intervention led to a prompt return of the levels to normal. One patient ultimately succumbed to sepsis and had persistently low C3 levels until death.Serial serum C3 estimation is recommended here as a simple, effective, and inexpensive parameter for feedback information in the management of traumatized and operated patients.
Recurrence rate after highly selective vagotomy
Authors: Busman Dick C. , Volovics Alexander , Munting Jaap D. K. 
Published: May 2005

AbstractSeveral ways of analyzing recurrence figures are presented in order to demonstrate the difficult interpretation of recurrence rate with highly selective vagotomy (HSV) in 262 patients operated on for duodenal ulcer with an almost complete follow‐up. Actuarial recurrence risks and cumulative recurrence hazards are calculated and compared with several studies on the same subject.We conclude that: (a) There is no such entity as a fixed or definitive recurrence percentage (usually indicated in clinical reports as “recurrence rate”) after HSV or other operations for duodenal ulcer; (b) The risk of any patient developing a recurrence at any time after HSV is constant in the immediate future and is as high 6 years after operation as it is after 1 year; and (c) There is no permanent cure after HSV; cure can only be expressed as a certain probability of freedom from recurrence in a similar way to that of oncological or vascular surgery.
Dynamic Visick grading after highly selective vagotomy
Authors: Busman Dick C. , Munting Jaap D. K. 
Published: May 2005

AbstractA continuous way of assessing the results after highly selective vagotomy (HSV) is presented, as applied in 262 patients operated on for duodenal ulcer. Regrading of all patients who showed recurrences at any time is permitted according to their actual condition at each grading moment. The dynamic Visick grading shows the same percentage of success at each assessment in spite of an ever increasing percentage of recurrences— many defined failures appear to be temporary failures—which is accounted for in this type of presentation.The conclusion is that HSV appears to favorably change the natural history of duodenal ulcer disease in 94% of patients at any time of assessment and that 3% of patients in the present series are graded as permanent failures.
Effects of thyroxine on cell proliferation in human multinodular goiter: A study on growth of thyroid tissue transplanted to nude mice
Authors: Smeds Staffan , Peter Hans J. , Gerber Hans , Jörtsö Erik , Lennquist Sten , Studer Hugo 
Published: May 2005

AbstractTo analyze the inhibitory effect of thyroxine (T4) on thyroid growth, freshly obtained biopsies of human nontoxic multinodular goiter tissue from 9 patients were transplanted to nude mice. After the implantation period, thyroid growth was stimulated by either hemithyroidectomy (HT) or by administration of the goitrogen propylthiouracil (PTU), with or without simultaneous administration of T4. During the latter period,3H‐thymidine was continuously administered by osmotic minipumps to label replicating cells. After processing of the tissue for autoradiography, the fraction of labeled cells (LI) was calculated.Following HT, the fraction of labeled cells in nontoxic multinodular goiter tissue was 4.8%. T4 significantly reduced the LI to 1.0%. The goitrogen induced transplant growth, the LI varying between 28% and 61% in the different specimens. Administration of T4 resulted in lower LI in all transplants: in 5 specimens the LI was similar to control transplants. In transplants from 3 goiter specimens, however, significantly higher LI were found.The present results show that administration of T4 significantly inhibits growth of human thyroid tissue. The effect seems, however, to vary in different specimens of nontoxic goiter, indicating a varying degree of autonomous replicating activity.