bluuebunny/crossref_metadata_2025_split huggingface dataset:
Bleeding gastroduodenal ulcers: Selection of patients for surgery
Authors: Hunt Phillip S. 
Published: May 2005

AbstractIn a prospective study of bleeding peptic ulcer from 1980 to 1985, endoscopic findings were found to be inferior to shock on admission in the prediction of further bleeding in the hospital. According to management policy, 40 patients (age greater than 50 years on admission) from a total of 376 cases were treated by emergency surgery for shock. Endoscopic methods of treatment were not used during this period of study. In the remaining 336 cases, 83 (25%) bled again in the hospital and 62 patients in this group underwent urgent surgery. Endoscopic findings were classified into 3 groups: active bleeding (including visible vessel), evidence of recent bleeding, and no stigmata of hemorrhage in the upper gastro‐intestinal tract. In patients who bled again in the hospital, there was no significant difference between the number of cases with active bleeding (44%) and those with signs of recent bleeding (30%). Visible vessel was an unusual finding, present in 4% of cases, but was associated with a risk of further bleeding of 38%, an incidence comparable to active bleeding on endoscopy. The incidence of further bleeding was low (7%) without stigmata and comparable to that found in 33 cases with prepyloric ulcer (10%). Shock on admission was associated with a significantly greater incidence of rebleeding in 70% of cases. The combination of shock on admission and active bleeding on endoscopy was no better a predictor of further bleeding than was shock alone. Age was a poor discriminator as the incidence of further bleeding was the same comparing those under and over 50 years. Active bleeding on endoscopy was a less common finding with gastric ulcer than with duodenal ulcer, but was associated with a significantly greater incidence of rebleeding of 58% of cases compared to 42% for duodenal ulcer.
Pyloric stenosis complicating duodenal ulceration
Authors: Ellis Harold 
Published: May 2005

AbstractPyloric stenosis would be better termed gastric outlet obstruction but popular usage favors the former title. The most common cause in adults is a stenosing chronic duodenal ulcer, but differential diagnosis must be made clinically, radiologically, and endoscopically from other causes, particularly carcinoma of the gastric antrum. Metabolic disturbances due to fluid and electrolyte loss are not common but, if present, require correction by intravenous replacement therapy.The condition is becoming less common due to the overall decline in incidence of duodenal ulcer in the Western world and the more effective medical treatment of duodenal ulcer with H2antagonists. It is still common, however, in many parts of the Third World.Treatment is invariably surgical but medical preoperative preparation is required. Vagotomy combined with drainage gives excellent results.
Giant gastric and duodenal ulcers: A population‐based study with a comparison to nongiant ulcers
Authors: Gustavsson Sven , Kelly Keith A. , Hench Victoria S. , Melton L. Joseph 
Published: May 2005

AbstractAmong 454 operations done for peptic ulcer between 1956 and 1985 on residents of Rochester, Minnesota, U.S.A. in whom ulcer size could be determined accurately, 50 operations (11% of the total) were performed for giant ulcers and 404 (89%) for nongiant ulcers. The annual operation rate per 100,000 residents for giant ulcer did not clearly decline during the 30‐year period in contrast to the dramatic fall in operation rates for nongiant ulcers. Nonetheless, the ratio of operation rates for giant ulcer compared to nongiant ulcer changed relatively little. Giant ulcers required emergency operation for massive bleeding more often than nongiant ulcers. Also, giant ulcers presented with unusual and severe complications such as gastrocolic fistula. Survival after surgery for giant ulcer was poorer than survival after an operation for nongiant ulcer. We conclude that giant ulcers are operated on somewhat less often today than in the past, while operations for nongiant ulcers are much less frequent. The giant ulcers that are operated on, however, are more prone to massive bleeding and are associated with poorer postoperative survival than their nongiant counterparts.
The influence of remnant size, antithyroid antibodies, thyroid morphology, and lymphocyte infiltration on thyroid function after subtotal resection for hyperthyroidism
Authors: Jörtsö Erik , Lennquist Sten , Lundström Björn , Norrby Klas , Smeds Staffan 
Published: May 2005

AbstractThe influence of thyroid remnant size, antithyroid antibody titre, thyroid morphology, and lymphocyte infiltration on postoperative thyroid function was studied in 179 patients undergoing subtotal thyroidectomy because of hyperthyroidism. The surgical procedure was strictly standardized and included determination of the thyroid remnant size. The preoperative medication used was beta‐adrenoceptor blocking agents in 101 patients and antithyroid drugs and thyroxine in 78. With remnant size adjusted to 6–10 g (or, in goiters less than 20 g, to 25–30% of initial gland weight), the overall recurrence rate after 2–8 years (mean 5.3±2.0) of follow‐up was 1.7% and the incidence of thyroid hypofunction was 29.6%.In toxic nodular goiter (TNG; n=63), a significant negative correlation was found between TSH and remnant size after 12 months as well as a significantly lower remnant weight in patients developing postoperative hypothyroidism. In toxic diffuse goiter (TDG; n=116), there was no difference in remnant size between euthyroid and hypothyroid patients. For patients with TDG treated preoperatively with beta‐blockers, the incidence of autoantibodies against thyroid cytoplasm was increased in patients who postoperatively developed thyroid dysfunction. Within the group of TDG developing hypofunction, we found increased titre of autoantibodies and “presence of lymphoid tissue” more often in patients treated preoperatively with beta‐blockers compared to thyrostatics. In toxic nodular goiter, the remnant size was considered the parameter most helpful to the surgeon in predicting postoperative thyroid function.
Nuclear DNA patterns and survival in metastasizing ileal carcinoids
Authors: Nobin Anders P. , Erhardt Kerstin , Auer Gert , Falkmer Sture , MÅrtensson Hans 
Published: May 2005

AbstractThe prognostic value of assessing the tumor cell nuclear DNA pattern in metastasizing ileal carcinoids was evaluated in 22 patients. Eleven patients survived for 5 years or more after the diagnosis of the liver metastases, whereas 11 died within 3–4 years. Clinical data as well as histopathological and immunohistochemical tumor characteristics were studied. DNA measurements in single tumor cells were performed on histologic sections with a photographic cytophotometric method.The number of aneuploid tumor cells was almost negligible in all tumor specimens. When the number of nondiploid cells was evaluated, however, a tendency was observed for more frequent nondiploidy in tumor cells from patients surviving less than 3–4 years. Histopathologically and immunohistochemically, there were no clear‐cut differences between the tumors of the 2 patient categories. Consequently, an assessment of the DNA pattern may help in determining the malignant potential of individual ileal carcinoids.
Is major surgery in hemophiliac patients safe?
Authors: Rudowski Witold J. , Scharf Romuald , Ziemski Jan M. 
Published: May 2005

AbstractIn the last 20 years, surgery in patients with hemophilia has been carried out with progressively less mortality and morbidity. Even extensive and major surgical operations can be carried out provided that the underlying coagulopathy is corrected and normal hemostasis restored.We report the results of 196 operations performed in 147 hemophiliacs during the period 1961–1985 in the Department of Surgery, Warsaw Institute of Hematology. Our patients experienced, in this 25‐year period, 23% of hemorrhagic complications in hemophilia A and 12.5% in hemophilia B. In the last 5 years, however, the incidence of hemorrhagic complications was reduced to 5.2% in hemophilia A and 8.3% in hemophilia B. This correlates with the discovery of cryoprecipitate and with the development of concentrates of factor VIII and IX, respectively.In all patients, deficient factor levels were determined before the operation. The replacement therapy was based on the policy of raising the level of factor VIII or IX above 60% of the normal value and maintaining this level above 30% in the postoperative period until final wound healing.Problems discussed in this article include the principles of replacement therapy, its advantages and disadvantages, and the organization and degree of cooperation among surgeon, hematologist, and blood bank staff.
Effect of varying number and volume of transfusions on mortality rate following septic challenge in an animal model
Authors: Waymack J. Paul , Warden Glenn D. , Miskell Phil , Gonce Sara , Alexander J. Wesley 
Published: May 2005

AbstractIt is well established that transfusions given prior to transplantation diminish rejection, and recent reports suggest that transfused patients having surgery for cancer develop metastases more rapidly than do those not receiving transfusions. Recently, we have demonstrated in an animal model that allogeneic blood transfusions increase susceptability to infectious complications. To determine if this effect could be altered by changing either the number or the volume of transfusions, Lewis rats were given varying volumes of blood in both single and multiple dosages. A control group received only saline. These rats were subjected to a 30% total‐body surface area full‐thickness burn which was inoculated withPseudomonas aeruginosa1244 on postburn day one. The animals were then followed for 28 days to determine the mortality rates. Each group of transfused rats had an increased mortality rate compared to the saline group. There were no differences between the various transfusion groups. In conclusion, the increased susceptability to infections seen following transfusions does not appear to be influenced by the volume or the number of transfusions within the limits tested.
Pathologic changes secondary to radiation
Authors: Berthrong Morgan 
Published: May 2005

AbstractIn order to be effective in the treatment of disease, especially neoplastic disease, radiation necessarily needs to be given in large doses. When treating tumors with high radiosensitivity in tissue of relatively low radiosensitivity, few complications of therapy occur. Frequently, however, the differential of sensitivity to radiation between the neoplasm and normal tissues exposed is small and the incidence of radiation injury to normal tissues becomes significant. Nowhere is this more apparent than in treatment of neoplasms during which the alimentary canal is heavily radiated. The following discussion will describe the pathologic changes that occur in the various units of the exposed alimentary tract and in various components of those units during and especially months or years after radiation therapy. The usual rapid and effective regeneration of the rapid‐renewal cell system after injury will be noted. The serious delayed manifestations of injury to the fibrovascular tissues with resulting delayed complications of ulcerations, stenoses, fistula formation, and obstructing adhesions will be emphasized. Brief discussions of several other organ systems injured by radiation will be presented.The development of second neoplasms as a result of radiation will be briefly mentioned and discussed from three standpoints: very low levels, low levels, and high levels of radiation.
Repair of radiation complications in the head and neck
Authors: Larson David L. 
Published: May 2005

AbstractComplications attendant on the use of irradiation in the head and neck occurred in 72 of 128 patients at the M. D. Anderson Hospital. The author outlines a rational approach to the patient with head and neck cancer that can help in preventing undesirable sequelae. Dental status, tumor location, and patient compliance are major factors that bear on incidence of major complications of radiation. Recent advances in reconstructive surgery now permit safe transfer of tissue with its intrinsic blood supply‐not dependent, as in the past, on the local radiated area for its vascularity. When complications of radiation therapy occur, they are usually late and in some instances no treatment is indicated or desired. Clinical examples are used to identify specific areas of concern.
An approach to repair of radiation necrosis of chest wall and mammary gland
Authors: Sando William , Jurkiewicz M. J. 
Published: May 2005

AbstractChest wall reconstruction following radiation no longer need be a protracted sequence of multiple stage tissue transfer with potential necrosis of the flap at each step. Muscle flaps with or without the overlying skin provide very reliable and effective methods of single‐stage repair. For the anterior chest the latissimus dorsi, the rectus abdominis, and pectoralis muscles are the choices with omen turn as an alternative in salvage cases. For the posterior chest, choices are the latissimus dorsi or trapezius.In selected patients, breast reconstruction can be offered. The use of either the rectus abdominis or latissimus dorsi musculocutaneous flap, singly or in tandem, is the current preferred choice.
The radiation‐damaged rectum: Resection with coloanal anastomosis using the endoanal technique
Authors: Cooke Stanley A. R. , Wellsted Michael D. 
Published: May 2005

AbstractFifty‐nine consecutive patients with a radiation‐damaged rectum were treated by subtotal rectal resection, continuity being restored by coloanal sleeve anastomosis using the endoanal suture technique. There were no deaths. Technical success was achievd in 55 patients (93%) with rectovaginal fistula, hemorrhagic proctitis, painful radiation ulcer, rectal stricture, or carcinoma developing in an irradiated rectum. An additional risk factor was present in all 4 technical failures, including a divided irradiated sphincter, previously divided marginal artery, diabetes, and persistent sepsis. Restorative surgery was attempted in all patients, irrespective of the severity of the radiation injury. Postoperative continence depended on anal sphincter function, with an improvement in full continence from 54% to 76% over the first postoperative year. Of the first 28 patients assessed at 1 year after operation, all 19 of those whose initial condition was well above the sphincter mechanism were fully continent, compared to only 2 of 9 with low fistulas extending down to the anal sphincter, which in these patients was histologically shown to be severely damaged by radiation. The functional status was assessed 1 year after surgery in 46 of the total 59 unselected patients treated. Thirty‐five were continent (76%), 7 incompletely continent (15%), and 4 incontinent (9%). Long‐term follow‐up was possible in 35 of the first 37 consecutive patients successfully treated before February, 1980, and followed for a mean of 5.1 years (range 1–8 years 9 months). Four died of recurrent cancer. Twenty‐four (77%) of the surviving 31 patients were fully continent at the time of final assessment, 4 incompletely continent, and 3 (9.7%) reverted to a colostomy because of incontinence or pelvic obstruction.
Resection and pull‐through for rectovaginal fistula
Authors: Cuthbertson Alan M. 
Published: May 2005

AbstractReconstruction of the rectum following irradiation injury may be achieved if the injury is localized. This type of injury may follow intracavity irradiation during which the rectum may have received an unexpectedly high dose. Heavily irradiated tissue heals poorly, and so a method that introduces nonirradiated tissue is necessary for a successful repair. Presacral infection following rectal resection is the other problem which determines the outcome. The pullthrough resection with delayed colorectal anastomosis fulfills these requirements. Four patients were treated by this operation successfully prior to 1975. Since then no further cases suitable for this type of repair have been seen due to modifications to the irradiation technique. The operation had been used in 223 patients with rectal cancer prior to 1975 with a mortality rate of 4.9%. The major cause of death was from failure of blood supply to the exteriorized colon, but with adequate mobilization of the left colon this complication can be avoided. Bowel function following pull‐through resection is slow to return, but after 12 months over 90% of patients have reached an acceptable level. The operation is, therefore, not recommended as a palliative procedure.
Functional results after postirradiation rectal reconstruction
Authors: Bricker Eugene M. , Kraybill William G. , Lopez Marvin J. 
Published: May 2005

AbstractThe functional results obtained in 26 patients operated on for postirradiation rectovaginal fistula, stricture, or combination of fistula and stricture are reported in detail. Emphasis is placed on the degree of continence obtained. The operation consists of use of proximal nonirradiated colon to repair the damaged area without doing a rectal resection. It has been found that nonirradiated colon with a good blood supply can be expected to heal to irradiated colon or rectum and complete resection of the entire irradiated area is not necessary. The results of this operation have been excellent in 11, satisfactory in 8, and poor in 2; the procedure failed in 2 patients. One patient died as a consequence of the operation and 2 patients died of other causes before having closure of a temporary colostomy. It was found that the presence of radiation damage to the small intestine could influence the quality of the end result.
Pelvic complications after interstitial and external beam irradiation of urologic and gynecologic malignancy
Authors: Schellhammer Paul F. , Jordan Gerald H. , El‐Mahdi Anas M. 
Published: May 2005

AbstractPelvic malignancies comprise 19% and 28% of all malignancies in the female and male, respectively. The majority of gynecologic and urologie pelvic malignancies are treated with radiation therapy either alone or in combination with surgery either as definitive or palliative therapy. The pelvic organs, therefore, are at risk for injury by pelvic radiation. We have reviewed our experience and that of the literature with regard to the incidence of injury associated with pelvic irradiation and give recommendations for management. The most frequent and severe complications occur in association with cystectomy performed for carcinoma of the bladder that has failed definitive radiation therapy and in association with radiotherapeutic and surgical treatment of carcinoma of the cervix. We have found an 11% incidence of bowel injury following planned integrated preoperative radiation followed by cystectomy. In our experience, bowel and urinary complications secondary to external beam radiation or125I brachytherapy for definitive treatment of carcinoma of the prostate are very similar. The morbidity of external beam radiation therapy has been reduced using a triple‐course fractionated protocol. Rectal ulceration requiring colostomy has occurred in approximately 3% of patients treated with external beam or interstitial125I therapy. Surgical correction of rectal fistulas using vascularized flaps has been successful after125I injury but has not been possible after external beam injury. Urethral complications associated with definitive external beam radiation therapy for carcinoma of the prostate are most often associated with prior transurethral resection. They can be significantly reduced by withholding initiation of therapy for 4–6 weeks after completion of transurethral resection.
Partial hepatectomy for intrahepatic stones
Authors: Choi Tat K. , Wong John 
Published: May 2005

AbstractFifty partial hepatectomies were performed in 49 patients as the definitive treatment for symptomatic intrahepatic stones. The part of the liver containing the strictured ducts and stones was resected. In 39 patients, it was done as the primary procedure, and in 11, it was done when an initial procedure (including one left hepatic lobectomy) had failed. Partial hepatectomy was the preferred method of management when the patients had 1 or more of the following conditions: stones confined to one segment or one lobe of the liver; destruction of the portion of the liver harboring the stones from repeated episodes of obstruction and infection; and multiple strictures of the ducts in the involved portion of the liver. The operative mortality was 2%. Long‐term follow‐up on 44 patients at a median of 7 years showed that 82% were symptom free, 7% had occasional mild attacks of cholangitis, and 11% had severe cholangitis requiring surgical intervention. At reoperation for severe cholangitis, 2 were found to have sphincteroplasty strictures and 3 had stones and ductal strictures. The low operative mortality rate and the overall good results show that partial hepatectomy can be considered as the primary treatment of choice for selected patients with intrahepatic stones.
Hepatic resection for hepatocellular carcinoma associated with liver cirrhosis
Authors: Kinami Yoshio , Takashima Shigeki , Miyazaki Itsuo 
Published: May 2005

AbstractSixty‐three patients with hepatocellular carcinoma associated with cirrhosis received various kinds of treatment at our clinic during the past 21 years. Of these, 35 patients who underwent hepatic resection were divided into a large tumor group (tumors more than 5 cm in diameter) and a small tumor group (tumors less than 5 cm in diameter), and the operative results of both groups were studied. There was a difference in the average ages between the 2 groups (p <0.05), but there was no difference in the duration of illness or laboratory data. The resectability rate of the liver in 17 patients with small tumors was 89% and was significantly higher than that of 41% in 18 patients with large tumors (p<0.005). The overall operative mortality rate was 14% for both groups. Patients with tumors over 3 cm already exhibited the histological findings seen in advanced cancer. Cumulative 3‐year survival rates of the large and small tumor groups were 0% and 53%, respectively, and there was a significant difference in survival curves between the 2 groups (p<0.005). The above results suggest that hepatic resection for patients with small tumors is effective as a treatment for hepatoma associated with cirrhosis.
Determination of the extent of feasible hepatic resection from hepatic blood flow
Authors: Mimura Hisashi , Takakura Norihisa , Ohno Yasuhiko , Matsuda Tadakazu , Kin Hitoshi , Hamazaki Keisuke , Tsumura Makoto , Toda Satoshi , Hiraki Yoshio 
Published: May 2005

AbstractBlood flow in the residual liver after major hepatectomy is considered an important determinant factor of liver function. Presented here is a method of obtaining the whole and regional hepatic blood flow index from hepatic clearance of198Au‐colloid, which can predict the blood flow index of residual liver before operation and thereby prevent postoperative hepatic failure due to too large a resection. Hepatic resection was followed by a decrease of the hepatic blood flow index (KLAu) almost proportional to the amount of hepatic mass resected. An analysis of data from 34 patients who underwent hepatectomy showed that the preoperatively predicted value of the blood flow index in the unresected liver had a good correlation (r=0.9) with that measured 1 month after hepatectomy. It also correlated well with the risk of death from liver failure among those patients whose KLvalue of residual liver was under the critical level. Since 1981 the early death rate from liver failure after hepatectomy was reduced remarkably by preparing the resection boundary on the basis of the blood flow index of residual liver. With the use of our method in animal experiments, the hepatic blood flow index was found to be uninfluenced by reticuloendothelial system function and was considered to be a reliable indicator of blood flow in hepatic sinusoids.