bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long‐term Prognosis for Colon Cancer Related to Consistent Radical Surgery: Multivariate Analysis of Clinical, Surgical, and Pathologic Variables
Authors: Jagoditsch Michael , Lisborg Peter H. , Jatzko Gerhard R. , Wette Viktor , Kropfitsch Gerhard , Denk Helmut , Klimpfinger Martin , Stettner Haro M. 
Published: August 2002

Abstract.Despite the improvement in its prognosis in most Western countries, death from colon cancer is still a major problem. In a prospectively planned observation study, a large patient collective from a single institution in Austria was analyzed in terms of the surgical approach and factors influencing survival. A total of 696 patients with colonic carcinomas were admitted to our surgical department between January 1, 1984 and December 31, 1997. Radical surgery for localized tumors was consistently performed, including wide resection margins and complete removal of the regional lymph drainage zones. Clinical, histopathologic, and therapy‐related factors were examined for their influence on long‐term survival by means of univariate and multivariate analysis. The overall tumor resection rate was 99.3% (691/696); complete tumor removal (R0) was possible for 84.8% (590/696) of all patients. The overall postoperative hospital mortality rate was 3.2% (22/696), and it was 1.3% (7/556) for potentially curative resections. Five‐ and ten‐year tumor‐specific survival rates for stage I to III R0 resections were 83.8% and 78.8%, respectively. Adjuvant chemotherapy reduced tumor recurrence for stage III patients by 52.4%. The depth of tumor infiltration, lymph node status, and adjuvant chemotherapy were found to have an independent influence on survival as identified by the Cox models. In conclusion, a consistent radical surgical approach for potentially curative resected colonic cancer patients had survival rates that surpassed those of most published series without sacrificing low complication rates. In addition, adjuvant chemotherapy for stage III substantially improved survival.
Advances in Perioperative Nutrition: Cancer
Authors: Heslin Martin J. , Brennan Murray F. 
Published: August 2002

AbstractThe role of perioperative nutritional support in the management of cancer patients remains controversial. The benefit of supplemental calories is not the only current issue: in fact, the route of delivery, composition of basic nutrients (carbohydrate, protein, fat), and the role of supplemental additives (arginine, glutamine, omega‐3 fatty acids, nucleotides) in improving immune status and ultimate outcome have been the focus of much discussion. Emerging data suggest that the use of supplemental agents is associated with improvement in immune status in these patients, although there is little clear evidence that this improves outcome. Ongoing studies are aimed at defining the group of patients who would most benefit from nutritional interventions during the perioperative period.
Reuse of Liver Grafts after Early Death of the First Recipient
Authors: González E. Moreno , Gómez R. , Pinto I. Gonzalez , Loinaz C. , Garcia I. , Maffettone V. , Corral M. , Marcello M. , Gonzalez A. , Jimenez C. , Castellon C. 
Published: August 2002

AbstractThree cases are reported of reuse of a transplanted liver graft after early death of the first recipient due to cerebral hemorrhage. The good condition of the donors; the excellent biochemical evolution of the graft in the first recipients; total ABO compatibility and donor‐recipient crossmatch; the absence of positivity to hepatitis B virus (HBV), hepatitis C virus (HCV), and bacteriologic cultures; and early death made reuse possible. The shortage of donors in relation to patients on the waiting list and the poor clinical condition of the second recipients made it necessary to adopt the decision to reuse the graft in an attempt to save their lives. The evolution of the patients and the reused grafts was satisfactory, and there were no complications that could be attributed to the fact that the graft had been transplanted before.
Clinicopathologic Characteristics and Postoperative Outcome in Japanese and Chinese Patients with Thoracic Esophageal Cancer
Authors: Adachi Wataru , Koike Shoichiro , Nimura Yoshinori , Koide Naohiko , Iida Futoshi , Du Xi Qun , Ping Yu Min , He Ming , Chen Long Qi , Zhang Ming Dao , Zhang He Lin 
Published: August 2002

AbstractWe evaluated the clinicopathologic findings and surgical results of 140 patients with thoracic esophageal cancer treated at Shinshu University, Japan (Shinshu group), and compared them with those from 1164 patients treated at Hebei Medical College, China (Hebei group) to determine if the two groups showed any differences. The Shinshu group had significantly higher incidences of elderly patients (>70 years of age), male patients, and tumors located at the lower esophagus (p< 0.01). In the Hebei group, although the depth of tumor invasion was more advanced, the incidence of nodal metastasis was significantly lower (p< 0.01). Operative death and postoperative complications were more frequent in the Shinshu group. Comparison of the postoperative survival curves revealed significantly longer survival of patients with pT2or pT3tumor in the Hebei group (p< 0.01), but there were no significant differences between the two groups when the lesions were classified by pTNM stage. This study demonstrated several differences between the patients in the two areas in regard to the clinicopathologic characteristics of thoracic esophageal cancer. The most important characteristic of the esophageal cancer in the Hebei group appears to be the low incidence of nodal metastasis.
Cecal‐Colic Adult Intussusception as a Cause of Intestinal Obstruction in Central Africa
Authors: VanderKolk Wayne E. , Snyder C.A. , Figg David M. 
Published: August 2002

AbstractDuring a 5‐year experience in Central Africa, the most common cause of 78 adult intestinal obstructions was primary adult cecal‐colic intussusception (n= 43; 55%). The symptom complex of colicky abdominal pain and obstipation was present in 100% of the patients with intussusception. Operative repair in 90% of patients consisted of simple reduction of the intussusceptum. There were no known recurrences. The etiology of adult cecal‐colic intussusception is unknown. Patients typically present with a 3‐ to 4‐day history of abdominal pain, obstipation, and usually a palpable mass. Treatment is surgical reduction. Right colectomy is reserved for intestinal gangrene. We treated 43 cases during a 5‐year period with only one death.
Severity Stratification and Outcome Prediction for Multisystem Organ Failure and Dysfunction
Authors: Zimmerman Jack E. , Knaus William A. , Sun Xiaolu , Wagner Douglas P. 
Published: August 2002

AbstractMultiple organ system failure or dysfunction (MOSF/MODS) remains a major cause of morbidity and mortality in hospitalized adults. Among intensive care unit (ICU) patients the extent of physiologic derangement, the type of associated disease or injury, increasing age, and life‐threatening comorbid conditions are the major determinants of risk for developing MOSF and for survival during the 1980s. Hospital mortality for patients with a single organ system failure (OSF) lasting more than 1 day approached 40%; and for those with two OSFs hospital mortality increased to 60%. These outcomes did not change over the decade. For patients with three or more OSFs persisting after 3 days of OSF, however, data suggest that between 1982 and 1990 the mortality has been reduced from 98% to 84% (p= 0.0003). Because of variations in the types and combinations of OSFs, associated disease, and extent of physiologic derangement, it is difficult to interpret variations in mortality among patients with one or more OSFs defined using categorical criteria. For this and other reasons, outcome prediction based on a comprehensive assessment of patient risk factors is a more sensitive, specific, useful approach to quantifying MODS than a simple count of the number and duration of OSFs. Because repeated assessment of risk factors during subsequent ICU days reflects complications and response to therapy, daily outcome predictions are even more precise than estimates at ICU admission. The ability to more accurately predict survival from MODS/MOSF can improve our ability to test new therapies, evaluate how outcome has changed over time, and assess the efficacy of supportive therapy for individuals.
Screening by Genomic Linkage Studies and Mutation Analysis of Hereditary Adenomatous Polyposis Coli: Usefulness for Clinical Practice
Authors: Karner‐Hanusch Judith , Wolf Brigitte , Zehetmayer Martin , Wrba Friedrich , Roth Erich , Mannhalter Christine 
Published: August 2002

AbstractA heterogeneous group of patients suffering from adenomatous polyposis coli (APC) were evaluated by clinical and genetic investigations for the first time in Austria. The patients belonged to eight unrelated APC families. In six families several family members were affected with APC, and linkage analysis with highly informative markers was used to estimate the risk of single individuals in these families to develop APC. All index patients were also tested for the most frequent mutation in the APC gene (mutation cluster region, exon 15). Clinical investigations included ophthalmologic tests for congenital hypertrophy of retinal pigment epithelium and colonoscopy. According to DNA analysis, 5 of 19 at‐risk individuals had to be considered to be at high risk of having inherited the disease. Four of them underwent proctocolectomy, one patient at risk is under colonoscopic surveillance. The predictive value of indirect genotype analyses reached 83.3%; direct mutation analyses allowed risk estimation in 50% of cases. Ophthalmologic investigation was informative in 75% of the families. Direct and indirect genotyping using a panel of highly polymorphic, closely linked microsatellite markers is a valuable, rapid, reliable method for establishing a presymptomatic diagnosis of APC, especially in families in which more than one affected individual is available for analysis. With regard to the onset of APC and extracolonic manifestations, the variability of APC demands clinical investigations in addition to the molecular tests for all patients and their first‐degree relatives.
Endosonography for Preoperative Staging of Specific Nodal Groups Associated with Esophageal Cancer
Authors: Chandawarkar Rajiv Y. , Kakegawa Teruo , Fujita Hiromasa , Yamana Hideaki , Toh Yuji , Fujitoh Hiroyuki 
Published: August 2002

AbstractThe results of endoscopic ultrasonography (EUS), used preoperatively in 74 endoscopically evaluable patients, were compared with the histopathology after subsequent total esophagectomy with radical lymphadenectomy involving a three‐field dissection of the lower cervical, mediastinal, and abdominal nodes. Patients with obstruction to endoscopy were excluded from this study. Overall accuracy, specificity, and sensitivity were 87%, 90%, and 37%, respectively. EUS has an accuracy of more than 80% for detecting metastatic nodes in the cervical paraesophageal, supraclavicular, right recurrent laryngeal, left paratracheal, upper and lower paraesophageal, infraaortic, infracarinal, and lower posterior mediastinal regions. Its sensitivity is highest for cervical and upper thoracic paraesophageal, infracarinal, left paratracheal, and recurrent laryngeal nodes. Accuracy is maximum for periesophageal nodes and varies inversely with the axial distance of the nodes from the esophageal axis. We recommend that EUS be used routinely for preoperative assessment of the cervical and mediastinal nodal status.
Epidermal Growth Factor Receptor Status in Hyperparathyroidism: Immunocytochemical and In Situ Hybridization Study
Authors: Sadler Gregory P. , Morgan John M. , Jasani Bharat , Douglas‐Jones Anthony , Wheeler Malcolm H. 
Published: August 2002

AbstractThe epidermal growth factor receptor (EGFr) family has been increasingly recognized as an important component in the control of normal cell proliferation and the pathogenesis of cancer. We have studied EGFr expression in 104 cases of hyperparathyroidism by immunocytochemistry (ICC) and by in situ hybridization (ISH). Using two different monoclonal antibodies, ICC for EGFr was performed on 66 cryostat sections and 38 wax‐embedded parathyroid glands. ISH was performed on 49 of these glands using a cocktail of three anti‐sense probes to EGFr mRNA and a nonspecific control probe to human HPV‐18 virus. Breast and prostate tumors were employed as positive controls for both ICC and ISH. Controls demonstrated positive EGFr staining. None of the 104 parathyroid glands showed any ICC positivity. ISH displayed positive staining for EGFr mRNA in five of six carcinomas and eight of nine nonrenal hyperplastic glands. Only 3 of 15 adenomas and 3 of 19 renal hyperplastic glands showed positive staining. This difference was statistically significant between adenoma and carcinoma (p< 0.05) and between adenoma and nonrenal hyperplasia (p< 0.01) (Tukey's multiple comparison test). This study demonstrates that EGFr mRNA is present in parathyroid tumors. Expression in carcinoma and nonrenal hyperplasia is significantly different from adenoma and renal hyperplastic glands. In contrast, ICC failed to demonstrate EGFr protein expression. These findings suggest that either receptor numbers are too low to detect by ICC or there is a failure of mRNA translation. More studies are needed to establish whether the EGFr plays a role in the development of parathyroid cancer or hyperplasia.
Prediction of Bone Mass in Renal Hyperparathyroidism by Newly Developed Bone Metabolic Markers: Evaluation of Serum Levels of Carboxy‐Terminal Pyridinoline Cross‐Linked Telopeptide of Type I Collagen and Carboxy‐Terminal Propeptide of Type I Procollagen
Authors: Katagiri Makoto , Fukunaga Masao , Ohtawa Takahiro , Harada Tanekazu 
Published: August 2002

AbstractSerum levels of the carboxy‐terminal pyridinoline cross‐linked telopeptide of type I collagen (ICTP) and the carboxy‐terminal propeptide of type I procollagen (PICP) were measured in 95 patients with renal hyperparathyroidism who had undergone a total parathyroidectomy and autotransplantation of a small portion of the resected gland. The results were compared with the serum levels of other bone metabolic markers and bone mineral densities in the distal radius (R‐BMD) and lumbar vertebrae (L‐BMD), which were measured by dual energy x‐ray absorptiometry and converted to the percentage of the mean value of sex‐ and age‐matched healthy controls. The preoperative mean values of ICTP and PICP were 142.4 ng/ml and 187.8 ng/ml, respectively. Although the serum levels of PICP levels exceeded the normal range in 42.1% of the patients, those of ICTP exceeded it in all of them. The serum levels of ICTP correlated positively not only with those of tartrate‐resistant acid phosphatase (TRACP), total alkaline phosphatase (ALP), and osteocalcin but also negatively with the values of %R‐BMD and %L‐BMD and seemed to manifest specifically the disturbance of bone metabolism. On the other hand, the serum levels of PICP correlated with those of ALP and TRACP but not with values of %BMDs. After surgery, the serum levels of ICTP decreased gradually, but those of PICP increased immediately up to peak values at 7 days and then decreased gradually after 14 days, reaching the normal range at 3 months. These changes in the bone metabolic markers seemed to reflect the change in bone metabolism that was converting from bone resorption to bone formation. The percent change in the PICP/ICTP ratio at 7 days correlated significantly with the percent change in R‐BMD at 12 months, and it was suggested that postoperative bone gain might be predicted using a combination of postoperative changes in PICP and ICTP.
Incidence of Regional Recurrence Guiding Radicality in Differentiated Thyroid Carcinoma
Authors: Simon Dietmar , Goretzki Peter E. , Witte Jürgen , Röher Hans D. 
Published: August 2002

AbstractTotal thyroidectomy has become the routine procedure for treatment of differentiated thyroid carcinoma. However, the necessity of unilateral or bilateral neck dissection is far less standardized. Our usual procedure has been to perform a routine neck dissection in T4 tumors and in all other tumor stages only in the presence of positive diagnostic or intraoperative findings. The results concerning regional tumor recurrence in cervical lymph nodes subsequent to thyroidectomy are studied and discussed. Between April 1986 and December 1992 a group of 252 patients were operated on for differentiated thyroid carcinoma (DTC) (176 papillary, 76 follicular). Postoperative treatment included radioiodine therapy as a rule in all patients more than stage T1, and follow‐up encompassed thyroglobulin measurements, cervical ultrasonography, and radioiodine scintigraphy. After a mean follow‐up of 6.9 years, 77 (31%) of the patients underwent reoperation because of regional tumor recurrence [46 of 176 (26%) papillary, 31 of 76 (41%) follicular]. In papillary thyroid cancer a significant difference could be demonstrated between patients with thyroidectomy only versus thyroidectomy plus neck dissection in all tumor stages (T2, 13 of 29 (45%) versus 1 of 34 (3%); T3, 10 of 13 (77%) versus 4 of 11 (36%); T4, 6 of 8 (75%) versus 6 of 18 (33%) (p< 0.0001). Similar results could be achieved for follicular thyroid cancer, showing statistical significance with regard to operative procedure (p< 0.009). Our experience demonstrates a positive correlation of regional tumor recurrence with increasing tumor stage for both histologic tumor types. The high rate of regional recurrence justifies a more radical approach, including neck dissection at the initial operation. The impact on survival, however, must be proved by further evaluation.
Resuscitation of Ischemically Damaged Pancreas by the Two‐Layer (University of Wisconsin Solution/Perfluorochemical) Mild Hypothermic Storage Method
Authors: Matsumoto Shinichi , Kuroda Yoshikazu , Fujita Hirofumi , Tanioka Yasuki , Kim Yongsik , Sakai Tetsuya , Hamano Mitsuaki , Suzuki Yasuyuki , Ku Yonson , Saitoh Yoichi 
Published: August 2002

AbstractWe have shown that 24‐hour preservation by a two‐layer [University of Wisconsin solution (UW)/perfluorochemical (PFC)] cold storage method at 4°C allowed tissue ATP synthesis and resuscitated canine pancreases subjected to 90 minutes of warm ischemia. The purpose of this study was to examine whether the two‐layer (UW/PFC) mild hypothermic storage method at 20°C could shorten a preservation period for recovery of ischemically damaged pancreas and clarify changes of tissue adenine nucleotide metabolism and tissue perfusions. After 90 minutes of warm ischemia, canine pancreas grafts were preserved by the two‐layer method and then autotransplanted. Tissue adenine nucleotide levels at the end of preservation and tissue perfusions after reperfusion were measured. Pancreas grafts subjected to 90 minutes of warm ischemia did not survive (0 of 5), without preservation. During a 5‐hour preservation by the two‐layer cold storage method the grafts did not synthesize enough ATP to repair damaged cell, although tissue perfusions were maintained after reperfusion. Consequently, ischemically damaged pancreases were not resuscitated (0 of 3). However, during 5‐hour preservation by the two‐layer mild hypothermic storage method, the grafts supplied enough ATP for processes that repair damaged cells, and tissue perfusions were maintained after reperfusion. As a result, ischemically damaged grafts were resuscitated (5 of 5). We conclude that 5‐hour preservation by the two‐layer mild hypothermic storage method accelerates ATP synthesis, which is essential for repairing damaged cells and protects the vascular microcirculation. This method can resuscitate ischemically damaged pancreas faster and holds promise for pancreas‐kidney transplantation from cardiac arrest donors.
Emergency Surgery in Hematologic Patients
Authors: Gold Michael S. , Dietz Patrick A. , Heneghan Steven J. , MacMillan Roger W. , Moglia Robert M. , Rudnicki Marek 
Published: August 2002

AbstractPatients at risk for clinically significant bleeding and who require urgent or emergent surgical procedures are encountered. Usually local causes are responsible, but a generalized hematologic defect may be uncovered. Quickly and effectively distinguishing the cause may be critical to rapid treatment and survival. A careful history, appropriate use of laboratory tests (e.g., partial thromboplastin time, prothrombin time, and platelet count), and knowledge of possible causes are key to prompt diagnosis and treatment. Bleeding from multiple sites, spontaneous bleeding, or unexpectedly severe bleeding suggests a systemic process. Immunocompromised or suppressed patients or systemically ill patients with chronic hepatic renal, lymphatic, and hematologic disorders are seen with urgent surgical problems. The key is rapid diagnosis and effective systemic and local therapy to counter the problem. The syndrome of diffuse “medical bleeding” frequently confronts the surgeon treating a patient who has received transfusions of more than 1.5 times blood volume. The coagulation defect is almost always associated with hypothermia and acidosis. Treatment consists in control of large‐vessel bleeding by appropriate surgical techniques, blunt packing, and tamponade of diffuse bleeding, rapid rewarming of the patient, and adequate resuscitation for shock. Transfusion of platelets and fresh frozen plasma is empiric initially and subsequently guided by the clinical and laboratory coagulation profiles of the patient.
Late outcome after acute pancreatitis: Functional impairment and gastrointestinal tract complications
Authors: Fernández‐Cruz Laureano , Navarro Salvador , Castells Antoni , Sáenz Alejandro 
Published: August 2002

AbstractFunctional and morphologic changes that take place in the pancreatic gland after an episode of acute pancreatitis have been the subject of discussion among experts in recent years. At the present time there are enough studies to support the fact that for a certain time if not permanently after acute pancreatitis a variable number of patients continue to show morphologic pancreatic changes in the pancreas and exocrine functional impairment. These changes are clearly seen to be related to the severity and alcoholic etiology of the pancreatitis. There are also indications of possible progression from acute alcoholic pancreatitis to chronic pancreatitis, related to severity and recurrence. It is more probable that it is the first instance of pancreatitis in a pancreas that has previously suffered asymptomatic alcohol‐induced impairment. The vascular and gastrointestinal tract complications that make a late appearance after acute pancreatitis, although infrequent, on occasion confronts the patient with a high risk of mortality, especially in cases of perforation and hemorrhage.
Laparoscopic Highly Selective Vagotomy: Technical Considerations and Preliminary Results in 119 Patients with Duodenal Ulcer or Gastroesophageal Reflux Disease
Authors: Awad William , Csendes Attila , Braghetto Italo , Yarmuch Julio , Loehnert T. Rodolfo , Burdiles Patricio , Diaz Juan Carlos , Schutte Hans , Maluenda Fernando 
Published: August 2002

AbstractThe technical considerations and preliminary results of 119 patients submitted to laparoscopic highly selective vagotomy are presented. There were 33 with duodenal ulcers, 31 with duodenal ulcers plus gastroesophageal reflux, and 55 with gastroesophageal reflux. Operating time varied from 120 to 160 minutes. Six complications occurred: four perforations of the gastric fundus and two bleeding episodes. Conversion to open surgery was done in four cases and reoperation in one case. No deaths occurred, and the mean hospital stay was 3 days. The mean follow‐up was 16 months, being 94% of the cases with Visick I or II and 6% with Visick III or IV. This technique is completely feasible by laparoscopic procedure and reproduces exactly what has been done with the laparotomy approach.