bluuebunny/crossref_metadata_2025_split huggingface dataset:
Technical Difficulties and Complications during Laparoscopic Cholecystectomy: Predictive Use of Preoperative Ultrasonography
Authors: Santambrogio Roberto , Montorsi Marco , Bianchi Paolo , Opocher Enrico , Schubert Luca , Verga Maurizio , Federico Luca , Spina Gianpaolo 
Published: August 2002

AbstractThe aim of this study was to evaluate ultrasound findings as predictors of potential operative difficulties and complications during laparoscopic cholecystectomy (LC). From October 1993 to June 1995 a total of 143 patients with symptomatic cholelithiasis (50 males, 93 females, mean age 49.5 ± 15 years) were evaluated by ultrasound (US) the day before LC. The US examination assessed six parameters: gallbladder (GB) volume, GB wall thickness, GB neck position, GB stone mobility, stone maximum size, and GB adhesions. On the basis of these US findings, a predictive judgment of technical difficulties was expressed by degree: easy, difficult, and very difficult. Altogether 101 patients presented with uncomplicated symptomatic cholelithiasis, and 42 had acute cholecystitis. The operation was predicted to be easy in 38% of cases, difficult in 49%, and very difficult in 13% with a good correlation with the surgeon’s intraoperative judgment (r= 0.66). A significant association was found between stone mobility (r= 0.37), presence of adhesions (r= 0.36), and the difficulty of the procedure. The predictive US evaluation was significantly correlated with some intraoperative technical steps [dissection of Calot’s triangle (r= 0.41), dissection of the gallbladder bed (r= 0.41)], and intraoperative bleeding (r= 0.27). Our results suggest that preoperative US is a useful screening test for patients undergoing LC, and it can help predict technical difficulties. On the other hand, a relevant number of cases still exist wherein the concordance between the preoperative US classification and the surgical findings is unsatisfactory. In this group the surgeon cannot safely rely on the US examination alone.
Protective Effects of Antithrombin III Supplementation on Warm Ischemia and Reperfusion Injury in Rat Liver
Authors: Okano Keiichi , Kokudo Yasutaka , Okajima Kenji , Hossain Mohammad Akram , Ishimura Ken , Yachida Shinichi , Tsubouchi Taijirou , Wakabayashi Hisao , Maeba Takashi , Maeta Hajime 
Published: August 2002

AbstractThe effect of antithrombin III (AT III) supplementation on energy status, microcirculation, cytoprotection, and prostacyclin (PGI2) production during and after a period of warm ischemia of the rat liver was investigated. AT III supplementation (250 units/kg) stimulate prostaglandin I2 (PGI2) production from 1 hour after administration, with maximal production observed at 3 hours. Ischemia was induced by occluding the hepatoduodenal ligament for 30 minutes, and experiments were continued for 60 minutes after reperfusion. The rats received AT III (250 units/kg IC) 30 minutes before induction of liver ischemia (AT III group). In the AT III group, recovery of the β‐ATP/inorganic phosphate ratio measured by 31P nuclear magnetic resonance showed significant improvement (p< 0.01), and the recovery of tissue blood flow markedly improved (p< 0.01) compared to the saline‐treated group (control group). Leakages of aspartame aminotransferase, alanine aminotransferase, and lactate dehydrogenase were mitigated in the AT III group (p< 0.05). Ultrastructural alterations of sinusoidal endothelial cells were markedly reduced in the AT III group. The PGI2level at the end of reperfusion was significantly elevated (p< 0.01) in the AT III group compared to the control group. The results of this study indicated that pretreatment with AT III significantly improved the energy status and microcirculation, as well as histologic damage, after liver ischemia and reperfusion. One of the fundamental effects of AT III might be mediated through the production of prostacyclin.
Role of Splenectomy in Hematologic Disorders
Authors: Schwartz Seymour I. 
Published: August 2002

AbstractThere has been an increase in the indications for splenectomy for hematologic diseases. It is a consequence of expanding the list of disorders and liberalizing the indications for splenectomy for many diseases. Hereditary spherocytosis is the most frequently encountered congenital anemia for which splenectomy is curative. Splenectomy is generally advised for warm antibody acquired hemolytic anemia if conventional medical therapy fails. Idiopathic thrombocytopenic purpura (ITP) remains the most common hematologic disorder for which splenectomy is therapeutic. A variety of thrombocytopenias are improved by splenectomy. The myeloproliferative disorders constitute a spectrum of disease potentially improved by splenectomy, but preoperative management should be modified in this group. Splenectomy in patients with chronic leukemias and lymphomas are often palliative and facilitate chemotherapy. There are no specific requirements preoperatively other than the administration of pneumoccocal andHemophilus influenzaevaccines. Platelets are not administered to patients with ITP. An integral part of the procedure is the search for accessory spleens. The postoperative complication of overwhelming postsplenectomy sepsis must be considered; it occurs more frequently in association with specific basic diseases and can be obviated by appropriate treatment.
Iodide or l‐Thyroxine to Prevent Recurrent Goiter in an Iodine‐Deficient Area: Prospective Sonographic Study
Authors: Feldkamp J. , Seppel T. , Becker A. , Klisch A. , Schlaghecke R. , Goretzki P.E. , Röher H.D. 
Published: August 2002

AbstractIn a randomized study, prevention of goiter recurrence with l‐thyroxine was compared with pure iodide substitution after thyroid surgery for nodular goiter in an iodine‐deficient area. Altogether 107 patients were followed up for 52 weeks after thyroid resection. The thyroid volume was determined sonographically. Free thyroxine, total thyroxine, thyrotropin, thyroglobulin, and antibodies to thyroglobulin and thyroid peroxidase were measured. The thyroid volume decreased slightly over the course of a year in the two therapy groups. There was no significant difference between the two groups. Recurrences were seen with both l‐thyroxine medication and iodide substitution. The thyroglobulin levels fell significantly over the 52‐week follow‐up period in the iodide group. Antibody formation was not observed under iodine substitution. In an area of iodine deficiency, substitution with iodide is just as effective as medicating the patients with l‐thyroxine for preventing recurrences.
Diagnostic Dilemma of Small Incidentally Discovered Adrenal Masses: Role for 131I‐6β‐Iodomethyl‐norcholesterol Scintigraphy
Authors: Kloos Richard T. , Gross Milton D. , Shapiro Brahm , Francis Isaac R. , Korobkin Melvyn , Thompson Norman W. 
Published: August 2002

AbstractIncidentally discovered adrenal masses are detected in 0.35% to 5.00% of patients imaged with computed tomography (CT) for reasons other than suspected adrenal pathology. Most small adrenal masses are benign, although malignant tumors ≤ 3 cm in diameter are well described. In the setting of normal adrenal hormonal secretion, the preferential accumulation of 131I‐6β‐iodomethyl‐norcholesterol (NP59) by adrenocortical tissues allows the distinction of adenomas from other space‐occupying or destructive lesions, with diagnostic images being obtained in 100% of lesions > 2 cm. Although some lesions ≤ 2 cm have yielded nondiagnostic images, the frequency of this phenomenon and thus the utility of NP59 scintigraphy for the evaluation of small adrenal lesions has remained incompletely characterized. Between January 1976 and December 1994 a total of 166 patients with nonhypersecretory unilateral adrenal masses ≤ 3 cm in maximal diameter, discovered incidentally during CT examinations of the abdomen or chest for reasons other than clinically suspected adrenal disease, were studied with NP59 scintigraphy. Nonhypersecretory masses ≤ 1 cm, > 1 to ≤ 2 cm, and > 2 to ≤ 3 cm yielded diagnostic images in 52%, 89%, and 100% of patients, respectively. Lesions other than adenomas, including malignancies, > 1 to ≤ 2 cm and > 2 to ≤ 3 cm were present in 9% and 10% of patients, respectively. These findings emphasize the need to determine the nature of small incidentally discovered adrenal masses whose management may alter patient care and confirm the utility of NP59 scintigraphy to evaluate nonhypersecretory adrenal masses regardless of size.
Clinicopathologic Differences between Long‐Term and Short‐Term Postoperative Survivors with Advanced Gallbladder Carcinoma
Authors: Chijiiwa Kazuo , Yamaguchi Koji , Tanaka Masao 
Published: August 2002

AbstractThe objective of this study was to determine histopathologic factors that influence the failure or success of extended cholecystectomy and more aggressive surgery to attain long‐term survival in patients with advanced carcinoma of the gallbladder. Of 46 patients with carcinoma of the gallbladder who had undergone surgical resection, 36 had advanced carcinoma invading to or beyond the subserosal layer. Among these 36 patients were 10 long‐term survivors (> 5 years) and 11 short‐term survivors who died of recurrence (< 37 months) after extended cholecystectomy or more extensive surgery. Factors were compared between the two groups. Significant factors observed in the long‐term survivors were the depth of invasion limited to the subserosal layer (p< 0.05), hepatic infiltration < 5 mm (p< 0.01), histologic grade of papillary or well differentiated adenocarcinoma (p< 0.01), absent or minimal venous, lymphatic, and perineural invasion (p< 0.01), and lymph node metastasis limited to the hepatoduodenal ligament (p< 0.05). It was concluded that the patients with subserosal invasion have a hope for long‐term survival by extended cholecystectomy or more aggressive surgery when hepatic infiltration and venous, lymphatic, and perineural invasion are absent or minimal, the histologic grade is papillary or well differentiated adenocarcinoma, and lymph node metastasis is limited to the hepatoduodenal ligament.
High‐Resolution Ultrasonography: Highly Sensitive, Specific Technique for Preoperative Localization of Parathyroid Adenoma in the Absence of Multinodular Thyroid Disease
Authors: Gofrit Ofer N. , Lebensart Penchas D. , Pikarsky Alon , Lackstein Dror , Gross David J. , Shiloni Eitan 
Published: August 2002

AbstractThe objective of this prospective study was to evaluate the role of preoperative ultrasonography (US) for parathyroid lesion localization in patients with primary hyperparathyroidism (PHPT) prior to initial surgery. Fifty‐two consecutive patients with PHPT, diagnosed in our institution within a period of 2 years, were referred for preoperative US and subsequently for bilateral surgical neck exploration. The combination of a confirmatory pathologic report and normalization of blood calcium concentration for a period of at least 3 months was considered an operative success. In 50 patients (96.2%) a single parathyroid adenoma was excised, and in one patient (1.9%) hyperplasia of three glands was found at surgery. In the one surgical failure, no parathyroid pathology was identified in the neck; therefore the operative success in this series was 98%. The sensitivity of preoperative US was 83% with a specificity of 100%. In the absence of thyroid multinodular disease (MND), the sensitivity of preoperative US increased to 90%, whereas in patients with MND the sensitivity was only 64%. Our findings support the notion that patients with PHPT should be investigated with US before initial surgery. Bilateral surgical exploration is warranted in patients with MND. In the absence of such thyroid pathology, an US finding positive for adenoma should allow the surgeon to perform unilateral neck exploration only, with consequent reduction of operation time and postoperative complications.
Resection of Liver Metastases of Colorectal Carcinoma
Authors: Nakamura Satoshi , Suzuki Shohachi , Baba Shozo 
Published: August 2002

AbstractHepatic metastasis of colorectal cancer is a life‐threatening prognostic factor. The present review revealed that hepatic resection is the best treatment modality, although the overall survival rate after hepatectomy for metastatic colorectal cancer is still low (20–40%). Various prognostic factors analyzed by many authors are controversial. The number of hepatic metastases and the surgical margin were the most important prognostic factors, as seen in 10 papers previously reported including our data. A clear surgical margin is achievable, but the prognosis of patients with four or more metastatic nodules in the liver remains poor. Repeat hepatectomy is also evaluated and is believed by many surgeons to have acceptable mortality. It improved survival to a certain extent. Analysis of the biologic characteristics of primary and metastatic tumors is extremely important and is urgently indicated.
Stereotactic Breast Biopsy as an Alternative to Excisional Biopsy
Authors: Park Soon‐Tae , Galbo Claudia , Ghosh Bimal C. 
Published: August 2002

AbstractThe current widespread use of modern mammography has increased the detection of suspicious mammographic lesions, which has led to a greater number of diagnostic surgical biopsies. Most of these lesions referred for surgical biopsy have been benign. The reduction in the number of benign surgical biopsies can reduce medical costs and unnecessary invasive breast surgery. Stereotactic large‐core needle biopsies in patients with suspicious mammographic lesions can preselect the breast lesions that need further evaluation with surgical excisional biopsy. Our results with stereotactic large‐core needle biopsies support this alternative approach to the workup of suspicious mammographic lesions.
Peripancreatic Fluid Cytology: Detection of Early Rejection versus Graft Pancreatitis after Canine Pancreatic Transplantation
Authors: Suzuki Yasuyuki , Kuroda Yoshikazu , Tanioka Yasuki , Matsumoto Shin‐ichi , Kim Yongsik , Ku Yonson , Tsukamoto Ryuko , Saitoh Yoichi 
Published: August 2002

AbstractIt is particularly difficult to distinguish between early rejection and graft pancreatitis when early rejection produces an elevated serum amylase level. In this study we determined whether peripancreatic fluid cytology (PFC) can differentiate early acute rejection and graft pancreatitis as an alternative diagnostic tool to graft biopsy that has the potential of pancreatic fistula and hemorrhage. Sixty‐two dogs received either a segmental pancreas allograft (n= 25) or autograft (n= 37) heterotopically in the neck. This study included five groups: allografts without immunosuppression (group A,n= 12), allografts with immunosuppression (group B,n= 13), autografts without immunosuppression (group C, n= 11), autografts with immunosuppression (group D, n= 12), and autografts treated by 45 minutes of pretransplant warm ischemia to induce acute graft pancreatitis (group E, n= 14). A closed suction drainage catheter was placed next to the graft to collect peripancreatic fluid daily after the transplant. PFC was performed using May‐Gruenwald‐Giemsa double‐staining technique and compared to the corresponding histology through the observation period. In analyses of 50 functioning grafts, PFC performed on day 1 showed similar neutrophil accumulations in all groups. In sharp contrast, on days 3 and 6, group A had dramatically increased mononuclear cell concentrations in PFC, whereas groups B, C, and D showed significantly lower concentrations, the percent of mononuclear cells among total leukocytes being 47.3 ± 23.4%, 11.8 ± 4.9%, 4.3 ± 1.8%, and 6.4 ± 2.4% (day 3); and 32.7 ± 9.8%, 10.5 ± 4.8%, 7.2 ± 4.2%, and 8.6 ± 6.4% (day 6) in groups A, B, C, and D, respectively. On the other hand, in group E numerous degenerating neutrophils with a marked to moderate increase in necrotic tissue fragments were observed by PFC on days 3 and 6. In terms of graft histology on days 3 and 6, group A showed interstitial mononuclear cell infiltration indicating an acute rejection process, whereas groups B, C, and D had minimal inflammatory cell infiltration. In group E graft pancreatitis was histologically confirmed on days 3 and 6. These results suggest that PFC after pancreas transplantation could be a safe, simple, useful diagnostic tool for discriminating early graft rejection from graft pancreatitis.
Delayed Xenograft Rejection
Authors: Hancock Wayne W. 
Published: August 2002

AbstractThe triumph of genetic engineering in overcoming hyperacute rejection (HAR) of a discordant organ xenograft is clear, but the promise of clinical application of xenotransplantation remains unfulfilled as further immunologic barriers are defined that lead to rejection of a vascularized xenograft within days of transplantation. This report describes the features of this second set of immunologic responses, collectively termed delayed xenograft rejection (DXR). DXR is a syndrome seen in xenograft recipients in which HAR has been avoided or suppressed by antibody depletion or blockade of complement activation. DXR may result, at least in part, from the persisting activation of those pathways first encountered during the HAR phase. Serial studies over several days after transplant show that, histologically, xenografts undergoing DXR demonstrate varying combinations of (1) progressive infiltration by activated macrophages and natural killer (NK) cells, (2) platelet aggregation and fibrin deposition throughout the microvasculature, and (3) endothelial activation. In various experimental models, DXR is T cell‐independent and can occur in the absence of demonstrable xenoreactive antibodies. Hence DXR is probably best regarded as arising from the activation of innate host defense mechanisms coupled with failure of normal regulatory mechanisms due to manifold molecular incompatibilities. Although DXR‐like features can be seen in concordant models, T cell involvement in the latter is probably requisite. Similarly, in a much muted form, aspects of a DXR‐like process may contribute to numerous inflammatory processes, including allograft rejection. The importance of DXR in xenotransplantation is that its development appears resistant to all but the most dense and toxic forms of immunosuppression, which prolong xenograft survival at the expense of inducing host leukopenia, thrombocytopenia, and coagulopathies. It is likely that until the basis of DXR is more clearly understood there can be no further significant progress toward clinical xenotransplantation. However, as the mechanisms responsible for DXR are dissected and understood, still further genetic engineering of donor pigs, involving the introduction of additional or multiple genes to regulate macrophage and NK cell responses, local coagulation, and endothelial cell activation, may once again prove to be an attractive, practical, powerful therapeutic option.
Laboratory Studies in Cross‐Species Lung Transplantation
Authors: Kamholz Stephan L. , Brewer Robert J. , Grijalva Galo , Burack Joshua , Del Rio Michael J. , Vaynblatt Michael , Lawson Nuria , Squinto Steve , Fodor William L. , Norin Allen J. 
Published: August 2002

AbstractThe lack of sufficient suitable human donor lungs for the many patients requiring pulmonary transplantation as life‐saving therapy for end‐stage lung diseases has generated extensive interest in cross‐species lung transplantation. Ethical concerns and those of animal rights advocates have prompted studies of nonprimate species as potential solid organ donors for humans. This paper provides an overview of some of the laboratory studies of cross‐species pulmonary transplantation performed over the past 20 years and focuses, in particular, on more recent work (from our laboratory and others) in the area of porcine‐to‐primate pulmonary xenotransplantation.
Carnitine Contents in Remnant Liver, Kidney, and Skeletal Muscle after Partial Hepatectomy in Rats: Randomized Trial
Authors: Lai Hong‐Shiee , Chen Yun , Chen Wei‐Jao 
Published: August 2002

AbstractCarnitine, an important carrier of free fatty acid that is transported into mitochondria for beta‐oxidation, was thought to be one of the key factors in the regulation of liver regeneration. If the carnitine content is insufficient in the hepatocyte, it might impair the energy substrate's transport and the energy charge required for cell regeneration. The purpose of this study is to evaluate the changes of carnitine content in remnant liver, kidney, and skeletal muscle simultaneously after partial hepatectomy in rats. Partial hepatectomy with resection of the median and left lateral lobes was performed on male Wistar rats. Rats with a sham operation comprised a control group. This study was an experimental randomized trial. Ten rats from each group were sacrificed before the operation and at 6, 24, 48, and 72 hours after the operation. The carnitine content, as total and free forms, in remnant liver, kidney, and skeletal muscle were quantified by high‐performance liquid chromatography. The carnitine contents in the remnant liver increased significantly at 6, 24, and 48 hours after partial hepatectomy (p < 0.01). The increase of total carnitine content was more obvious than that of the free form. In contrast, the decreasing concentrations of total carnitine and free carnitine in the kidney were significant (p < 0.01). In skeletal muscle the total carnitine content decreased to a small extent, and it was observed only at 6 hours after partial hepatectomy (p < 0.05). It is suggested that remnant liver promoted the generation of carnitine, whereas kidney and skeletal muscle released their stored carnitine at an early stage after partial hepatectomy. As a result, the influx of the carnitine into hepatocytes increased at the regenerative stage. The carnitine content of remnant liver is sufficient during the early posthepatectomy stage.
Tertiary Peritonitis: Clinical Features of a Complex Nosocomial Infection
Authors: Nathens Avery B. , Rotstein Ori D. , Marshall John C. 
Published: August 2002

AbstractThe objective of this study was to define risk factors for and the clinical course of recurrent or tertiary peritonitis. Intensive supportive care of patients with life‐threatening intraabdominal infections has led to the emergence of a new clinical syndrome, tertiary peritonitis, defined as the persistence or recurrence of intraabdominal infection following apparently adequate therapy of primary or secondary peritonitis. We undertook a retrospective study of 59 patients admitted with intraabdominal infection to a surgical intensive care unit (ICU). Tertiary peritonitis developed in 74% (44/59) of patients. Despite comparable premorbid health status, source of peritonitis, and admission APACHE II scores, patients with tertiary peritonitis had a significantly longer ICU stay (21.8 ± 14.9 vs. 8.5 ± 7.9 days), more advanced organ dysfunction reflected in higher organ dysfunction scores (13.3 ± 5.1 vs. 7.7 ± 3.3), and higher ICU mortality (64% vs. 33%) than patients with uncomplicated secondary peritonitis. The most common infecting organisms in patients with tertiary peritonitis were Enterococcus,Candida, Staphylococcus epidermidis, andEnterobacter. Infectious foci were rarely amenable to percutaneous drainage and were found to be poorly localized at laparotomy. Recurrent, or tertiary, peritonitis is a common complication of intraabdominal infection in patients admitted to an ICU. It differs from uncomplicated secondary peritonitis in its microbial flora and lack of response to appropriate surgical and antibiotic therapy. Like nosocomial pneumonia in the critically ill patient, the syndrome appears to be more a reflection than a cause of adverse outcome.