bluuebunny/crossref_metadata_2025_split huggingface dataset:
Multiple Organ Failure: Is It Disappearing?
Authors: Levine Jeffrey H. , Durham Rodney M. , Moran John , Baue Arthur 
Published: August 2002

AbstractThe incidence of multiple organ failure (MOF) during the last decade has been reported variously as 2% to 25%, depending on the patient population examined. The mortality rate from this devastating complication ranges from 40% to 80%. Although the incidence has not changed during the last decade, it does not mean that there has been no progress. Tertiary centers are now seeing trauma and nontrauma patients who have more significant underlying disease and injuries. Likewise, a higher percentage of our trauma patients are now referred from outside institutions where there may not be the facilities to administer the complex, rapid resuscitation these patients require. Prevention of MOF remains its best treatment. Rapid, adequate volume resuscitation, adequate nutrition, appropriate antibiotic usage, and aggressive pulmonary management are important for preventing the downward physiologic spiral that leads to MOF and death. Once MOF has occurred, it is not clear that these same measures are as effective in altering outcome.
Difference between Carcinoma of the Lower Esophagus and the Cardia
Authors: Tachimori Yuji , Kato Hoichi , Watanabe Hiroshi , Sasako Mitsuru , Kinoshita Taira , Maruyama Keiichi 
Published: August 2002

AbstractWe analyzed the records of patients with carcinoma of the lower esophagus and cardia. Mediastinal node involvement was found in 43% of the patients with squamous cell carcinoma of the lower esophagus, and the 5‐year survival after mediastinal dissection for patients with mediastinal node involvement was 27%. Mediastinal node involvement was found in 19% of the patients with adenocarcinoma of the cardia involving the esophagus, and no patients with mediastinal node involvement survived more than 2 years. When the patients had mediastinal node involvement, survival curves were significantly different. There were large differences between these tumors in terms of the extent of lymph node involvement and the survival of patients with mediastinal lymph node involvement. It is incorrect to consider the behavior of these tumors identical and to treat the conditions similarly.
Role and Operative Risk of Bilateral Adrenalectomy in Hypercortisolism
Authors: Chapuis Yves , Pitre Jol , Conti Filomena , Abboud Bassam , Pras‐Jude Nicole , Luton Jean‐Pierre 
Published: August 2002

AbstractTranssphenoidal pituitary surgery has radically modified the management of pituitary‐dependent hypercortisolism (Cushing's disease). Bilateral adrenalectomy may, however, represent the ultimate treatment in some cases of hypercortisolism. In the present study we report our experience of bilateral adrenalectomy in 82 patients operated on during the last 15 years. The causes of hypercortisolism were Cushing's disease (n= 78), ectopic ACTH syndrome (n= 3), and primary adrenocortical nodular dysplasia (Carney‐Meador syndrome) (n= 1). Before operation 37% of the patients had severe symptoms of hypercortisolism. A bilateral posterior approach was undertaken in 58 patients, whereas 18 patients had an anterior transabdominal approach and 6 patients a laparoscopic approach. There were two operative deaths (2.4%). Postoperative complications occurred mostly in cases of advanced disease and were observed in 14 patients (17%), among whom 4 had severe complications. At long‐term follow‐up, one recurrence of hypercortisolism and 12 Nelson syndromes (15%) were observed. In conclusion, bilateral adrenalectomy carries an acceptable operative risk, and we recommend bilateral adrenalectomy rather than long‐term suppressive therapy in patients requiring prompt and definitive control of their hypercortisolism or after pituitary surgery failure.
Localization of Endocrine Pancreatic Islets
Authors: Fiedor Piotr S. , Oluwole Soji F. , Hardy Mark A. 
Published: August 2002

AbstractTransplantation of whole pancreas or pancreatic islets remains a promising approach to treatment of diabetes mellitus. Because at present there is no efficient method for in vivo early diagnosis of pancreatic islet rejection or for disorders of pancreatic endocrine function, we examined if dithizone (DTZ) and a synthetic iodo‐derivative of DTZ (I‐DTZ) can be used as a potential radioactive marker for monitoring viable transplanted pancreatic islets. Human pancreatic islets harvested from multiorgan donors were tested ex vivo after intraductal injection of DTZ solution for islet staining. Lewis rats were used in the in vivo experiments for localizing pancreatic islets in situ after intravenous injection of various concentrations of DTZ or I‐DTZ. Fresh rat islets were transplanted into streptozotocin‐induced diabetic recipients, either underneath the kidney capsule or intraperitoneally. Intravenous DTZ or I‐DTZ was then used for macroscopic and microscopic identification of viable transplanted islets. These studies indicate that DTZ and I‐DTZ solutions specifically stain pancreatic islets in vivo after intravenous injection without damage to their endocrine function as assessed by plasma insulin and glucose levels. Human islets stain red in in vitro studies similar to the DTZ (I‐DTZ) effect in rats. We conclude that DTZ and I‐DTZ are effective in the in vivo and in vitro identification of pancreatic islets and may have potential clinical application in the detection of pancreatic islet tumors (insulinomas) and in the diagnosis of rejection of pancreatic organ allografts or islets.
Management of Acute Steroid‐Resistant Rejection after Liver Transplantation
Authors: Platz Klaus‐Peter , Mueller Andrea R. , Zytowski Michael , Lemmens Peter , Lobeck Hartmut , Neuhaus Peter 
Published: August 2002

AbstractPrior to the FK506 era, OKT3 was primarily used for treatment of steroid‐resistant rejection. Initially FK506 has been used as a last treatment of refractory acute or chronic rejection. We provide strong evidence that the use of FK506 is more successful if rescue therapy is performed early instead of using it as the last resort. Between September 1988 and March 1995 a total of 600 liver transplantations were performed in 550 patients. Of these 550 patients, 426 received primarily cyclosporine A (CsA)‐based immunosuppression. Of the 426 CsA patients, 70 (16.4%) required either FK506 (51.4%), or OKT3 rescue therapy (27.1%), or a combination of the two drugs (21.5%). The latter group of patients received first OKT3 and then FK506 rescue when OKT3 therapy failed. Treatment was initiated simultaneously (within 1 week) in 11 patients, and 4 patients received FK506 rescue later during the course of rejection. The highest success rates (88.9%) were observed in patients given FK506 rescue therapy. Retransplantation was necessary more often in patients receiving OKT3 than in those with FK506 rescue therapy (15.8% versus 5.5%, respectively). Retransplantation and death due to chronic rejection increased with the need for additional FK506 rescue therapy after OKT3 failure. This increase was most pronounced in patients receiving FK506 during the late course of rejection, reaching a failure rate of 75.0% (50.0% of deaths were due to chronic rejection). The lowest incidence of cytomegalovirus infection and of infectious, neurologic, and renal complications was observed in the FK506 rescue group. We conclude that early FK506 rescue therapy may be the treatment of choice for acute steroid‐resistant rejection.
Effects of Platelet‐Activating Factor Antagonist E5880 on Intrahepatic and Systemic Metabolic Responses to Transient Hepatic Inflow Occlusion and Reperfusion in the Rabbit
Authors: Nakatani Toshio , Sakamoto Yoshimasa , Ando Hirofumi , Kobayashi Kunio 
Published: August 2002

AbstractWe investigated the effects of pretreatment with a potent platelet‐activating factor (PAF) receptor antagonist (E5880) on the changes in hepatic and systemic metabolism induced by transient hepatic ischemia and reperfusion. Sixty‐five rabbits were assigned to four groups that either did or did not undergo a period of hepatic ischemia and reperfusion with or without pretreatment. E5880 was administered intraportally 1 minute prior to inflow occlusion. Twenty minutes of warm ischemia was followed by 30 minutes of reperfusion. Blood gas analyses and measurements of levels of arterial pyruvate, lactate, and ketone bodies, arterial and portal ammonia and endotoxin, and intrahepatic adenine nucleotide, pyruvate, and lactate were performed. Results were analyzed by either ANOVA or chi‐square analysis. Hepatic tissue ATP and energy charge levels were significantly increased and the AMP level was significantly decreased after 30 minutes of reperfusion in the pretreatment group compared to those without pretreatment. At the same time, parameters reflecting hepatic mitochondrial function, such as the arterial ketone body ratio and arterial ammonia level, improved, although they were not statistically significant. No difference was observed for parameters reflecting systemic changes, such as arterial blood gas values and pyruvate and lactate levels. PAF is thought to mediate metabolic changes after hepatic ischemia and reperfusion. PAF released in the liver may exert local effects, which appear to be attenuated by pretreatment with E5880. Systemic metabolic changes seen after hepatic ischemia and reperfusion may be mediated by factors other than PAF.
What Is New in the Prophylaxis and Treatment of Venous Thromboembolism?
Authors: Bergentz Sven‐Erik 
Published: August 2002

AbstractDeep venous thrombosis continues to be a frequent complication of surgery and trauma. The topic is controversial with regard to diagnosis, indication for prophylaxis, and suitable methods for prophylaxis and therapy. We review some of the highlights of the extensive literature in this field during the last few years. Particular emphasis is given to new trends in diagnostic methods, newly discovered genetic factors for thrombophilia, and the use of heparins for prophylaxis and therapy of thromboembolic disease.
Changes in gallbladder surgery: Comparative study 4 years before and 4 years after laparoscopic cholecystectomy
Authors: Cervantes Jorge , Rojas Guillermo , Anton Jorge 
Published: August 2002

AbstractOperative procedures on the gallbladder and biliary ducts have undergone a profound transformation since the introduction of laparoscopic techniques in general surgery. As the benefits of minimally invasive procedures become universally known, patients are seeking surgery at an earlier stage, resulting in an increased number of cases for elective surgery and a considerable reduction in emergency operations, morbidity, need for intraoperative cholangiography (IOC), fewer common bile duct (CBD) explorations, shortened hospital stay, and reduced overall costs. The early criteria for IOC and the need for CBC explorations must be reevaluated in view of the observed changes and appropriate modifications made. Looking at the present trends, it seems that the routine use of IOC is not justified in the average patient who presents for laparoscopic cholecystectomy with no history of jaundice or pancreatitis, normal liver function tests, and a normal‐size CBD on ultrasonography. Under those conditions, the chance of leaving an unsuspected stone in the CBD is less than 1%; and if it happens the stone can be easily retrieved by endoscopic sphincterotomy as an outpatient procedure.
Prognostic markers for colorectal cancer: Expression of P53 and BCL2
Authors: Pereira Hermínia , Silva Salete , Julião Rui , Garcia Palla , Perpétua Fátima 
Published: August 2002

AbstractP53 is a tumor suppressor gene that has been implicated in the pathogenesis of a wide range of tumor types including colorectal cancers. bcl2 is a proto‐oncogene that inhibits apoptosis. Immunostaining for P53 and BLC2 protein product was performed in a retrospective series of 80 colorectal carcinomas with a minimum follow‐up of 5 years. The aim of the study was to evaluate the prognostic significance of P53 and BCL2 protein expression and their correlation with clinicopathologic variables such as pathologic disease stage (Dukes system), histologic grade, and vascular invasion. The patients were 41 to 76 years of age, and the follow‐up ranged between 5 and 10 years. Among the 80 cases, 30 were Dukes stage A and 50 stage B. We found vascular invasion in 21.2%. P53 and BCL2 expression was detected, respectively, in 30.0% and 8.8%. We concluded that the P53 and BCL2 expression detected by immunohisto‐chemistry in routinely processed, paraffin‐embedded tissues: (1) has no prognostic significance; and (2) was not correlated with pathologic disease stage, histologic grade, or vascular invasion. Nevertheless, the number of patients in our study was small, and we believe that investigation of a larger series of patients is indicated.
Endoscopic Diagnosis and Treatment of Early Colorectal Cancer
Authors: Kudo Shin‐ei , Kashida Hiroshi , Nakajima Takashi , Tamura Satoru , Nakajo Kazuo 
Published: August 2002

AbstractColorectal adenomas and early cancers are grossly classified into three groups: protruded, flush or slightly elevated (so‐called flat adenomas), and depressed. Protruded lesions and flat adenomas are not invasive until they are rather large, whereas depressed lesions can invade the submucosa even when very small. It is not difficult to detect protruded and flat adenomas, but depressed carcinomas are often overlooked. Keys to the detection of depressed carcinomas are a slight color change, bleeding spots, interruptions of the capillary network pattern, slight deformation of the colonic wall, shape change of the lesion with insufflation and deflation of air, and interruption of the innominate grooves by the lesion. Spraying of indigo carmine dye helps to clarify the lesions. Pit pattern analysis with magnifying colonoscopy is useful for diagnosis of early colorectal cancer. Pit pattern analysis and histologic examination suggest that depressed carcinomas probably have arisen de novo, without going through an adenomatous step. Some adenomas appear at first to have a depression, but such cancer‐mimicking adenomas with pseudodepression must be distinguished from depressed carcinomas because they are quite different in nature. Protruded and flat adenomas can usually be removed with polypectomy or hot biopsy techniques. Depressed carcinomas are treated with an endoscopic mucosal resection (EMR) technique; but when they massively invade the submucosa, surgical resection is indicated. Some neoplastic lesions, which we call laterally spreading tumors, extensively and circumferentially spread along the colonic wall, although they are short in height. They tend to have a rather benign nature despite their large size; therefore EMR or a piecemeal EMR method is indicated.
Long‐Term Prognosis of Patients with Surgical Wound Infections
Authors: Poulsen Kjeld B. , Gottschau Adam 
Published: August 2002

AbstractThis study examined if surgical wound infections (SWI) result in a severe prognosis regarding general health and increase the consumption of social resources. A group of 1301 patients were interviewed by self‐administered questionnaires during 1993–1994, while operated during hospitalization in seven Danish hospitals. These patients were followed up at least once by similar questionnaires at a median time of 5.5 and 10.0 months postoperatively. The consequences of surgically diagnosed SWI were analyzed in a hospital cohort of 58 infected patients and 648 controls. Postdischarge infections were analyzed in a patient cohort of 263 cases and 767 controls. Changes in health was measured by the General Health Questionnaire, Activities of Daily Living index, and self‐assessed health. Consumption of resources were estimated by reliance on assistance from family and friends, use of home services, and contacts to doctors. It was found that the long‐term prognosis of general health was unaffected by SWIs. However significantly increased social dependence was found for patients with SWIs compared to uninfected patients. Almost one‐fourth of the operations were complicated by an SWI. Most of the infections were recognized only after discharge and were thought to be of minor importance, which may explain why no chronic impairment of the health was found for patients with an SWI. A bias toward no‐effect may have been introduced if patients with severe SWIs abstained from participation. The societal cost of care for patients with minor infections seems to be large. The causal relation between outcome and SWI needs to be further investigated.
Genetic Engineering as an Approach to Xenotransplantation
Authors: Bach Fritz H. 
Published: August 2002

AbstractA discordant organ xenograft, such as a heart or kidney transplanted from pig to human, is rejected within 1 to 2 hours by a process called hyperacute rejection (HAR) caused in large or full measure by preexisting host xenoreactive natural antibodies (XNAs) and complement. HAR can be averted by blocking either complement or XNAs; but the xenograft is then rejected at 3 to 4 days by a process called delayed xenograft rejection (DXR), which can occur without the presence of T cells. DXR involves type II endothelial cell (EC) activation (the phase of activation that includes up‐regulation of proinflammatory genes in the EC), infiltration into the graft of host monocytes and natural killer cells (both of which appear to be activated), and a complex cytokine picture. We discuss in this paper various approaches that might help prevent DXR, after which we assume that one would still have to deal with a xenograft counterpart of the T cell‐mediated allograft rejection response. The approach to avoiding DXR focuses largely on genetic engineering of the ECs in the graft.
Tolerance Induction for Xenotransplantation
Authors: Sykes Megan , Zhao Yong , Yang Yong‐Guang 
Published: August 2002

AbstractThe transplantation of donor hematopoietic tissue prior to organ xenografting has the potential to induce lasting T cell tolerance and, possibly, tolerance of natural antibody‐producing B cells. However, the development of specific and nontoxic methods of overcoming the immunologic and physiologic barriers to xenogeneic marrow engraftment is a major challenge that must be met before this goal can be achieved. A greater understanding of the species specificity of molecular interactions important for hematopoiesis and cell homing is a first step toward transcending these physiologic barriers. Perhaps most promising is the potential associated with the use of nonprimate xenogeneic donors genetically engineered to make donor tissues more readily capable of surviving and, in the case of hematopoietic cells, competing with host tissues for survival in a human environment.
Genetically Modified Animal Organs for Human Transplantation
Authors: Squinto Stephen P. 
Published: August 2002

AbstractThe major barrier to successful discordant xenogeneic organ transplantation is the phenomenon of hyperacute rejection (HAR). Hyperacute rejection results from the deposition of high‐titer preformed antibodies that activate serum complement on the luminal surface of the vascular endothelium, leading to vessel occlusion and graft failure within minutes to hours. Here we describe our strategy to overcome HAR in the pig‐to‐primate transplant setting, which includes the genetic incorporation into transgenic organs and high level expression of both a novel human bifunctional complement inhibitor and a human blood group enzyme. The expression of the human blood group enzyme is designed to reduce significantly the natural antibody reactivity to the discordant pig tissue, whereas expression of the complement inhibitor results in inhibition of complement‐mediated cell activation and lysis. High‐level cell surface expression of the complement inhibitor and high‐level expression of the human blood group enzyme in vascular endothelium effectively eliminate both the antibody and complement components of the massive inflammatory response to the xenogeneic tissue. Elimination of HAR will establish inroads into understanding the cellular immune response toward the discordant tissue. It is conceivable that standard immunosuppressive regimens routinely practiced with allotransplantation can also be effective drug therapies for xenotransplantation. Therefore it is critical to develop a system that tests these possibilities in order to solve an ever‐growing need for donor organs.
Physiologic Effects of Cisapride on Gastric Emptying after Pylorus‐Preserving Gastrectomy for Early Gastric Cancer
Authors: Tomita Ryouichi , Takizawa Hidehiro , Tanjoh Katsuhisa 
Published: August 2002

AbstractPylorus‐preserving gastrectomy (PPG) has been considered reasonable reduction surgery. However, even patients in whom more than 1 year passed after surgery frequently have a feeling of gastric fullness after meals and long‐term retention of foods in the residual stomach. To treat this syndrome, cisapride has been administered. We studied the emptying time of a semisolid diet (radioisotope method using 99mTc‐tin colloid‐labeled rice gruel) and the emptying time of a fluid diet (acetaminophen method with orange juice) before and after oral administration of cisapride (15 mg/day for 1 month) in 14 patients (10 men, 4 women; 32–70 years old, average 60.6 years) who underwent PPG (Billroth I procedure, D2 lymph node dissection, curability A) for treatment of early gastric cancer. Ten healthy volunteers without gastrointestinal symptoms and digestive diseases (7 men, 3 women; 28–61 years old, average 49.8 years) were enrolled as controls. The results showed obviously delayed emptying time of the semisolid diet before administration of cisapride in patients with PPG compared with that of the control group, whereas the emptying curves for the fluid diet showed an almost normal pattern. One month after the start of cisapride administration the emptying time of the semisolid diet was improved, and the emptying curves were close to the patterns in the control group. Emptying of the fluid diet was slightly accelerated compared with that before administration of cisapride, and the emptying curves showed almost the same pattern as in the control group. A postgastrectomy symptom, “gastric fullness,” after PPG was alleviated by cisapride. These results showed that cisapride improved delayed emptying of a semisolid diet after PPG and prevented the feeling of gastric fullness after meals due to retention in the residual stomach.