bluuebunny/crossref_metadata_2025_split huggingface dataset:
Current concepts in inguinal hernia in infants and children
Authors: Grosfeld Jay L. 
Published: May 2005

AbstractTrends are changing in the management of infants and children with indirect inguinal hernias. Advances in neonatal intensive care have resulted in the survival of many small premature infants who have a high incidence of inguinal hernia. The rate of incarceration, strangulation, and gonadal infarction in these babies is twice that of the general pediatric age group. Respiratory immaturity, apnea, bradycardia, and associated neonatal conditions require special management at the time of hernia repair, usually performed just before discharge from the neonatal intensive care unit. New information concerning volume loss and depletion of germ cells beginning at 6 months of age in boys with undescended testes has stimulated the performance of orchiopexy when the patient is 1 year of age. More than 90% of boys with cryptorchid testes at the age of 1 year have an associated hernia that requires concomitant repair at the time of orchiopexy. The use of the peritoneal cavity for fluid absorptive purposes in hydrocephalus treated by venticuloperitoneal shunts or of peritoneal dialysis for renal failure and metabolic diseases such as hyperammonemia and lactic acidosis causes increased intraabdominal pressure and results in the appearance of a previously unrecognized hernia. Recognition of these and other conditions associated with a high incidence of hernial occurrence should allow early diagnosis and treatment before the development of complications. Most elective repairs of hernias are safely performed in the outpatient setting; however, some infants and children with concurrent illnesses are best managed in a “morning admissions” program, in which hospital admission occurs postoperatively.
The Canadian repair: Personal observations
Authors: Wantz George E. 
Published: May 2005

AbstractThe Canadian hernioplasty is the modern equivalent of the original Bassini operation. Most of the criticism of the repair is unjustified, even the fact that the repair does not address the femoral canal. The incidence of the femoral type of recurrence that typically occurs in the first year was only 0.14% among the 4,366 primary Canadian hernioplasties performed by one surgeon in the years 1970 to 1987. There were a total of 58 recurrences for a raw recurrence rate of 1.3%. About half of the recurrences were considered to be failures of the hernioplasty, and the remaining ones were attributable to continued deterioration of the patient's tissues. This huge experience of one surgeon demonstrates that recurrence rates, to a great extent, depend on the skills of the surgeon. Recurrence rates decrease as a surgeon's experience with the procedure increases. It also demonstrates the importance of technique and how a minor change in the method of beginning the continuous suture reduced suture tension and eliminated the well‐known pubic tubercle type of recurrence seen after all hernioplasties. The recurrence rate for 639 recurrent and rerecurrent hernias repaired by Canadian hernioplasty was 7.2%. This rate is unsatisfactory, and a preperitoneal repair with a polyester prosthesis is preferred for these difficult problems. A local agent neutralized with sodium bicarbonate is the anesthetic of choice, and simultaneous left and right hernioplasties with the patient going home the same day as the procedure are now commonplace.
New techniques in hernia repair
Authors: Bendavid Robert 
Published: May 2005

AbstractThe surgical treatment of inguinal and femoral hernias has evolved through several stages to reach a modern and successful era. This success was shared by all our predecessors who contributed some knowledge with respect to anatomy, physiology, and surgery. Although most patients are treated with satisfaction by primary herniorrhaphy, difficult recurrences can also be treated successfully. The special features that characterize the modern treatment of difficult hernias are the preperitoneal approach and the availability of reliable prosthetic materials. Some of the techniques currently available are discussed. They are the femoral umbrella, transvérsalis fascial replacement, and the fletching. The results have been encouraging. As surgeons, we are behooved to look, assess, and reconsider in order to improve.
Herniography
Authors: Gullmo Åke 
Published: May 2005

AbstractHerniographic examinations were performed on more than 4,000 patients. The method was found to be of great value in patients with obscure symptoms in the groin or pelvis. Herniography shows not only hernial sacs but also the general condition and tissue strength of the inguinal part of the abdominal wall. The different types of hernias have different signs that, as a rule, allow an exact diagnosis. The pelvic floor and the pouch of Douglas can always be evaluated. Young athletes with severe symptoms in the groin, in most instances, were found to have some type of hernial rupture and often osteochondritis in the pubic symphysis as well. In women, the clinical diagnosis of hernia is often difficult. Herniography was of great value in these patients.
Spigelian hernia
Authors: Spangen Leif 
Published: May 2005

AbstractThe diagnosis of spigelian hernia presents greater difficulties than its treatment. The clinical presentation varies, depending on the contents of the hernial sac and the degree and type of herniation. The pain, which is the most common symptom, varies and there is no typical pain of spigelian hernia. Findings to facilitate diagnosis are palpable hernia and a palpable hernial orifice. Large, easily palpable spigelian hernias are not a diagnostic problem. It is small hernias and hernial orifices that are overlooked because they are masked by the subcutaneous fat and an intact external aponeurosis. In the absence of a palpable orifice or sac, persistent point tenderness in the spigelian aponeurosis with a tensed abdominal wall most strongly suggests the diagnosis. Spigelian hernia can be ruled out in patients without palpable tenderness. Ultrasonic scanning can be recommended for verification of the diagnosis in both palpable and nonpalpable spigelian hernia. The hernial orifice and sac can also be demonstrated by computed tomography, which gives more detailed information on the contents of the sac than does ultrasonic scanning.The treatment of spigelian hernia is surgical, and the risk of recurrence is small. A gridiron incision is excellent for operations for palpable hernias. If the hernia cannot be palpated preoperatively, preperitoneal dissection through a vertical incision is recommended. This gives good exposure, facilitates hernioplasty, and permits preperitoneal exploration and treatment of other abdominal wall hernias. The incision is also suitable for exploratory laparotomy, which should be performed on patients with abnormal ultrasonographic or computed tomographic findings in whom no palpable hernia can be detected preoperatively.
Hyperthermic perfusion with chemotherapy for melanoma of the extremities
Authors: Ghussen Farid , Krüger Ingo , Smalley Richard V. , Groth Wolfgang 
Published: May 2005

AbstractA prospective randomized study was carried out to evaluate the effectiveness of additional regional cytostatic perfusion of the extremities in patients with malignant melanoma. In a control group (n=54), the tumors were widely excised, and regional lymph nodes were dissected. The patients in the perfusion group (n=53) received additional hyperthermic (42°C) perfusion with Melphalan. The disease‐free survival time was chosen as the criterion for evaluation. An intermediate analysis revealed a highly significant difference between the 2 groups (21 recurrences in the control group and 4 recurrences in the perfusion group,p< 0.001). Therefore, the study was discontinued prematurely.In an analysis of the data performed after a median observation time of 5 years and 11 months, 26 recurrences were diagnosed in the control group, whereas 6 recurrences were noted in the perfusion group (p< 0.001). The retrospective breakdown into different risk groups according to tumor thickness also demonstrates a significant difference. For patients with a primary tumor of 1.5—3.0‐mm in thickness, 2 of 25 in the perfusion group and 10 of 25 in the control group have relapsed. For those with a primary tumor of greater than 3.0‐mm in thickness, 4 of 28 in the perfusion group and 16 of 29 in the control group have relapsed. Eleven patients in the control group and 3 patients in the perfusion group have died due to metastatic spread of the melanoma (p<0.01).The results most clearly demonstrate the benefits of additional hyperthermic cytostatic perfusion.
Recurrent pulmonary embolism after inferior vena caval interruption with a greenfield filter
Authors: Richenbacher Wayne E. , Atnip Robert G. , Campbell David B. , Waldhausen John A. 
Published: May 2005

AbstractTwenty‐six patients have undergone inferior vena caval interruption with a Greenfield filter. One patient (3.8%) developed a fatal, recurrent pulmonary embolism. Postmortem examination documented the presence of thrombus within the filter, proximal extension of thrombus beyond the filter apex, and fresh pulmonary emboli. In a combined series of 556 patients, 12 patients (2.2%) developed recurrent pulmonary emboli, 2 (0.36%) of which were fatal. Including case reports, 18 patients have had documented recurrent pulmonary emboli following Greenfield filter insertion. In 4 patients, the recurrent embolism was fatal. Six (60%) of 10 patients had a concomitant malignancy. A work‐up and treatment plan for patients having recurrent pulmonary emboli after the insertion of a Greenfield vena caval filter is proposed.
Restrictive versus liberal blood transfusion policy for hepatectomies in cirrhotic patients
Authors: Makuuchi Masatoshi , Takayama Tadatoshi , Gunvén Peter , Kosuge Tomoo , Yamazaki Susumu , Hasegawa Hiroshi 
Published: May 2005

AbstractTo evaluate the worth of intra‐ and postoperative blood transfusion in cirrhotic patients undergoing resection for hepatocellular carcinoma, we compared 13 patients receiving transfusions and 14 matched contemporary patients who did not receive blood. Preoperative hematological and biochemical parameters, the type and extent of liver resection, and the mean blood loss (862 and 870 ml) were similar in the 2 groups. The total volume of intra‐ and postoperative blood transfused ranged from 400 to 1,800 ml (mean, 1,223 ml) in the patients receiving transfusions. During various postoperative time intervals, the mean values of hematocrit, hemoglobin, serum total bilirubin, and lactic dehydrogenase activity were significantly higher in the patients who were transfused compared to those who were not. Mean serum transaminase activities were similar in the 2 groups at the same times. The mean hematocrit values decreased from 36.8% preoperatively to a postoperative minimum of 27.0% in the transfused group, and from 39.9% to 26.1% in the nontransfused group. Our experience and theoretical reasons have led us to withhold blood transfusion until the hematocrit values fall below 30% during hepatectomy and below 20% in the postoperative period (or unless circulatory instability cannot be corrected otherwise). Fresh frozen plasma is preferred for volume substitution and, if blood has to be given, only up to 60–70% of estimated losses should be replaced by fresh blood.
Operative ultrasound establishes resectability of metastases by major hepatic resection
Authors: Brower S. T. , Dumitrescu O. , Rubinoff S. , McElhinney J. A. , Aufses A. H. 
Published: May 2005

AbstractIn this study, the utility of intraoperative ultrasound in the surgical management of hepatic colorectal metastases requiring hepatic resection has been demonstrated. The intraoperative ultrasound technique has been described as a method to accurately monitor curative resection of large colorectal metastases requiring anatomical procedures such as right hepatic trisegmentectomy, bisegmentectomy, and hepatic lobectomy. Preoperative analysis of the patients reported utilizing either computed tomography, ultrasound, or magnetic resonance imaging demonstrated very well the extent of tumor but could not define a major anatomical resection along normal tissue planes. In the 3 patients demonstrated, intraoperative ultrasound was able to confirm a normal hepatic parenchymal dissection overlying the extensive tumors and enabled completion of the curative resections. Furthermore, we have described the intraoperative ultrasound criteria for assessment of resectability. These included a definition of the proximity of the major portal and hepatic venous structures, exclusion of simultaneous minimal metastatic disease in the remaining parenchyma, and the distinction between marginal resectability and resectability for cure along the proposed parenchymal dissection plane. We conclude that intraoperative ultrasound is important in the surgical management of metastatic colorectal cancer and can provide for a more complete clinical staging and appropriate selection of patients for curative major hepatic resection.
Metabolic basis for the management of patients undergoing major surgery
Authors: Hill Graham L. , Douglas Richard G. , Schroeder David 
Published: May 2005

AbstractAfter reviewing our current knowledge of the metabolic response to major abdominal surgery, we present two new studies in which we have followed the changes in body composition, physiologic function, and psychological function for up to 1 year after major surgery. In the first study, 46 patients had changes in body composition, physiologic function, and psychological function measured perioperatively and again at intervals up to 1 year. There was an average loss of weight of 3000 grams (maximum at 2 weeks), and the tissue composition of this weight loss was composed of 1400 grams fat, 600 grams protein, and 1000 grams water. Normal body composition had returned to normal in most patients by 6 months. In the second study of 84 patients, deficits of skeletal muscle function and fatigue were found to be greatest at postoperative day 7. Most patients were back to preoperative levels of muscle function and fatigue 30 days after surgery, and nearly all had normal values 90 days after surgery. Based on these studies we outline our management program for the metabolic care of patients undergoing major abdominal surgery.
Overview of randomized clinical trials of total parenteral nutrition for malnourished surgical patients
Authors: Buzby Gordon P. 
Published: May 2005

AbstractThe past decade has seen a maturation of the art and science of perioperative nutritional support. We now have sufficient data to make informed and reasonable judgments regarding when we should and should not provide perioperative TPN. These judgments can be considered medically sound and fiscally responsible. The following guidelines are proposed: (1) Postoperative TPN should be considered when oral or enteral feeding is not anticipated within 7 to 10 days in previously well‐nourished patients or within 5 to 7 days in previously malnourished or critically ill patients. (2) Preoperative TPN should be considered in patients who cannot or should not eat or receive enteral feedings if the operation must be delayed for more than 3 to 5 days. (3) Preoperative TPN should be considered in the most severely malnourished surgical candidates if an operative delay is not contraindicated. In patients with only mild to moderate degrees of malnutrition preoperative TPN is not indicated.
Prophylaxis against sepsis in patients undergoing major surgery
Authors: Morris W. T. 
Published: May 2005

AbstractPostoperative infection in general surgical patients is discussed according to operation types. A selection of the huge literature on each group is reviewed, and details from the author's own work and ideas are presented. By discussing these points attempts are made to determine the best regimens for a given set of clinical circumstances. There is a small literature indicating that postoperative chest infection can be prevented by some antibacterial drug regimens, and this question has been addressed; it seems that in the past it has been largely ignored. Some nonantibacterial methods of reducing postoperative infection are also briefly discussed.
Preparation of the intensive care patient for major surgery
Authors: Wolfe Bruce M. , Moore Peter G. 
Published: May 2005

AbstractImproved methods for monitoring and treating critically ill patients have increased the number of surgical candidates with multiorgan system impairment. Whereas such patients may have been considered “too sick to undergo surgery” in the past, many such patients linger in the intensive care unit unless definitive therapy is accomplished. Specific attention to review of the patient's preoperative preparation for surgery on a system‐by‐system basis may improve outcome substantially. The need for possible mechanical ventilation prior to transport to the operating room must receive particular attention. Pneumothorax, if present, must be treated prior to institution of positive‐pressure ventilation so progression to tension pneumothorax can be avoided. Deficits in the circulating blood volume must be identified and corrected preoperatively if possible. A need for enhancement of cardiac output or alteration of vascular tone requires pulmonary arterial catheterization and indicates an increased operative risk. Metabolic abnormalities such as disturbances of acid‐base balance, sodium or potassium concentration, and endocrinopathies are identified and corrected as much as possible prior to operation. Antibiotics are instituted as appropriate. Replacement of the red blood cell mass is dictated primarily by anticipated or actual blood loss. Factors of coagulation are infused on a replacement basis as necessary. Great care must be taken during transport to the operating room, as maintenance of intravascular monitoring devices, therapeutic infusions, and mechanical ventilation must continue during transport. Precautions must be taken to avoid hypothermia during transport and institution of anesthesia. Critical illness mandates specific considerations of the anesthetic agents to be utilized.
Perioperative care of the elderly patient
Authors: Ergina Patrick Lee , Gold Susan L. , Meakins Jonathan L. 
Published: May 2005

AbstractSurgical risk increases with age, primarily from loss of cardiac and pulmonary reserve. Complications are tolerated poorly by the elderly, emphasizing the importance of their prediction and prevention. Surgical risk in this population is significant, but with careful preoperative assessment and perioperative management acceptable morbidity and mortality are possible. This review proposes a general approach to the elderly surgical patient and applies it to the most significant sources of morbidity and mortality: pulmonary and cardiac complications. Risk assessment based on validated tools is utilized, and perioperative management recommendations based on the state of the art are examined. In addition, pulmonary embolism and postoperative confusion are examined separately with the same overall strategy.
Perioperative care of the oncology patient
Authors: Kelly Cathal J. , Daly John M. 
Published: May 2005

AbstractCancer patients are often at high risk for perioperative complications because of preexisting conditions, the magnitude of surgery, and the use of aggressive multimodality treatment. It is essential to identify risk factors preoperatively, correct any deficits, and monitor organ dysfunction. During the perioperative period prophylaxis and surveillance for cardiopulmonary, hematologic, and septic complications should minimize morbidity and mortality. Finally, nutritional support should be given to malnourished patients undergoing extensive operative procedures.
Postoperative pain
Authors: Kehlet Henrik , Dahl Jørgen B. 
Published: May 2005

AbstractTreatment of postoperative pain has not received sufficient attention by the surgical profession. Recent developments concerned with acute pain physiology and improved techniques for postoperative pain relief should result in more satisfactory treatment of postoperative pain. Such pain relief may also modify various aspects of the surgical stress response, and nociceptive blockade by regional anesthetic techniques has been demonstrated to improve various parameters of postoperative outcome. It is therefore stressed that effective control of postoperative pain, combined with a high degree of surgical expertise and use of other perioperative therapeutic interventions including nutrition and mobilization, should be combined to improve overall perioperative care and surgical outcome.
Postoperative fatigue
Authors: Christensen Tom , Kehlet Henrik 
Published: May 2005

AbstractUncomplicated major surgery is followed by a pronounced increased feeling of fatigue extending throughout the first month in about one‐third of patients. Postoperative fatigue correlates with the degree of surgical trauma but is not related to duration of general anesthesia and surgery or to preoperative nutritional status, age, or sex. Fatigue also correlates with postoperative deterioration in nutritional parameters and impaired adaptability of heart rate during exercise. Furthermore, a postoperative decrease in muscle force and endurance is related to postoperative fatigue, whereas psychological factors are of minor importance. These findings suggest postoperative fatigue to be mediated by the endocrine‐metabolic response to surgery, impaired nutritional intake, or immobilization, but the relative role of these factors remains to be established. Until then, therapeutic measures against the development of postoperative fatigue should aim at reducing the surgical stress response, effective treatment of pain to facilitate mobilization, and exercise to increase postoperative nutritional intake.
Predicting postoperative fatigue: Importance of preoperative factors
Authors: Schroeder David , Hill Graham L. 
Published: May 2005

AbstractPostoperative fatigue as defined by a 10‐point scale (1=fit, 10=fatigued) was determined prospectively in 84 patients undergoing major surgery. Results from this scale correlated well with standard psychological assessment of fatigue (Profile of Mood States Questionnaire) (bir=0.767;bip<0.0001). Fatigue values were 3.46±0.19 arbitrary units (mean±SEM) preoperatively; and postoperatively they were 5.61±0.24 at day 7, 5.02±0.24 at day 14, 3.74±0.19 at day 28, and 2.77±0.18 at day 90. Fatigue during the postoperative period was integrated to give a total fatigue score (332±14 arbitrary units, range 90–664), and this score was correlated with preoperative and early postoperative factors. The best predictor of postoperative fatigue was preoperative fatigue (bir=0.545;bip=0.001), with lesser correlations with diagnosis (especially cancer); preoperative weight, particularly total body protein (bir=0.317;bip=0.01); and weight loss (bir=0.29;bip=0.03), grip strength (bir=0.352;bip=0.01), and age (bir=0.267;bip=0.01). Postoperative fatigue was not correlated with preoperative anxiety, depression, or hostility, involuntary muscle function, gender, preoperative stress, or changes in total body protein or fat over the two postoperative weeks. It is concluded that patients who present for surgery already fatigued are the ones who are most likely to suffer from prolonged postoperative fatigue, particularly so if they are elderly, suffer from cancer, or have few extra reserves of body protein.