bluuebunny/crossref_metadata_2025_split huggingface dataset:
Staging and Management of Colorectal Cancer
Authors: Northover John M.A. 
Published: August 2002

AbstractThe management of colorectal cancer becomes ever more complex. Rational decision‐making depends on knowledge of the apparent stage of the disease in the individual patient. Many decisions require input from the patient, who therefore must be party to all relevant information, including any that is predictive of the likely outcome of the disease and the effects of treatment. The process of staging once required only pathologic information gleaned from the surgical specimen. Later clinical information was often added to produce a more practically useful prediction of outcome; necessarily, the staging process, whether pathologic or clinicopathologic, could only be completed postoperatively. Today there is a momentum toward preempting this process through the use of scanning and other modalities, so “staging” information can be used when planning primary treatment, including neoadjuvant therapy and surgery. The ultimate staging system would comprise just two reliably predictive patient categories: those expected to survive and those destined to die. So far no system has approached that “ideal.” Given such a system, therapeutic and research efforts could be concentrated on reversing the outcome for those predicted to die.
Laparoscopic versus Open Surgery for Colorectal Cancer
Authors: Milsom Jeffrey W. , Kim Seon‐Hahn 
Published: August 2002

AbstractThere are three basic roles of laparoscopic surgery for patients with colorectal cancer. First, although infrequently needed prior to therapy, diagnostic or staging laparoscopy may be valuable in certain colorectal cancer patients. Second, the laparoscopic approach may offer several attractive features for the palliative management of patients with incurable colorectal cancer. Finally, although this issue is the most controversial, there are theoretic but unproved advantages of using laparoscopic techniques for curative colorectal cancer therapy. The concerted efforts of surgical oncologists and their colleagues must prove this theory in well constructed trials.
Potentially Multicentric Hepatocellular Carcinoma: Clinicopathologic Characteristics and Postoperative Prognosis
Authors: Yasui Motoshi , Harada Akio , Nonami Toshiaki , Takeuchi Yuuki , Taniguchi Kenji , Nakao Akimasa , Takagi Hiroshi 
Published: August 2002

AbstractWhen multiple hepatic tumors are present, it is sometimes difficult to distinguish between metastatic and multicentric hepatocellular carcinoma (HCC). To identify the important clinicopathologic features of multicentric HCC, we evaluated the clinical characteristics of patients with multicentric HCC and examined the usefulness of surgical treatment in those patients. A total of 99 patients with multiple HCCs were classified into one of the following two groups according to whether their tumors were multicentric or metastatic: Group MO consisted of 18 patients with tumors thought to have developed synchronously from multicentric origins. Group IM consisted of 64 patients with intrahepatic metastases. In this study 18% of the patients with multiple HCCs were thought to have presented with multicentric tumors. This study revealed that synchronous multicentric HCCs often affected multiple segments of the liver and responded relatively well to partial hepatectomy of individual tumor‐affected areas. To appropriately treat potentially multicentric HCC, it is important to understand the histopathologic characteristics of multicentric HCC and diagnose during preoperative and intraoperative ultrasonography, so surgical treatment may be useful.
Xenoantigens and Xenoantibodies: Their Modification
Authors: Cooper David K.C. , Thall Aron D. 
Published: August 2002

AbstractThe hyperacute rejection of pig organs by primates, including humans, results from antibody‐mediated complement activation. Protection from complement injury still leads to delayed rejection, which results from other mechanisms that may also be dependent on the presence of antibody. Anti‐pig antibodies are directed largely, if not entirely, against α‐galactose (αGal) epitopes on pig vascular endothelium. Prevention of antibody–antigen binding is being attempted by methods that (1) alter antigen expression on the donor organ or (2) deplete the potential recipient of anti‐αGal antibody. To date, most progress has been made in depleting antibody by extracorporeal immunoadsorption using immunoaffinity columns of synthetic αGal oligosaccharides. A pig organ transplanted into a recipient baboon depleted of antibody functions for several days—in contrast to minutes to hours in unmodified baboons. The return of antibody, however, results in rejection of the graft. Pharmacologic immunosuppressive agents are relatively ineffective for prolonged suppression of anti‐αGal production. Total‐body irradiation and splenectomy are proving more successful. Studies are continuing with the aim of achieving a state of B cell tolerance toward αGal epitopes.
Cancer Dissemination during Laparoscopic Surgery: Tubes, Gas, and Cells
Authors: Targarona Eduardo M. , Martínez Joaquín , Nadal Alfons , Balagué Carmen , Cardesa Antonio , Pascual Salvador , Trias Manuel 
Published: August 2002

AbstractPort‐site metastasis has been an unexpected finding after laparoscopic surgery in gastrointestinal cancer patients. No clear explanation exists for this phenomenom. The aims of this study were to evaluate the dissemination pattern in an experimental model of hepatocarcinoma in the rat and summarize current knowledge about the risks and the results of experimental studies on cancer dissemination during laparoscopic surgery. NDA‐induced hepatocarcinoma was obtained in Sprague‐Dawley rats. Tumors were manipulated during laparoscopy (group 1, n= 11) or laparotomy (group 2, n= 12). A Medline review of all experimental studies about the risk of cancer dissemination during laparoscopic surgery was undertaken. Both models were associated with implants in parietal wounds [1/11 in group 1 (9%) vs. 1/12 in group 2 (8%), p= NS]. Analysis of the current literature confirms that laparoscopy is associated with abdominal cell mobilization, and cells can be recovered in trocars, filtered exhaust gas, and instruments. Postoperative immunosuppression, the biologic aggressiveness of the tumor, and the gas used for laparoscopy also influence tumoral growth. Port‐site metastases are secondary to multiple factors, including the technical skill of the surgeon, the biologic properties of the tumors, and local environmental aspects. Undoubtedly, laparoscopy can help disseminate aggressive tumors and should be reserved for diagnostic and staging procedures or for treatment of low‐grade malignant tumors. Therapeutic resection, especially of colon cancer, should be restricted to prospective and randomized trials until there are enough hard data to rule out the clinical importance of this potentially severe complication.
Endothelial Cells: Role in Infection and Inflammation
Authors: McGill Sandra N. , Ahmed Najma A. , Christou Nicolas V. 
Published: August 2002

AbstractInfection and resulting sepsis continue to be important causes of morbidity and mortality in surgical patients. Although much has been learned about the pathogens and the leukocyte responses to these pathogens, we are only beginning to understand the role of the host in these pathologies. The endothelium is a dynamic participant in cellular and organ function rather than a static barrier as it was once believed. Emerging evidence implicates the endothelium as a central effector in the inflammatory response. Through the expression of surface proteins and secretion of soluble mediators, the endothelium controls vascular tone and permeability, regulates coagulation and thrombosis, and directs the passage of leukocytes into areas of inflammation. Derangements in these normal functions may contribute significantly to a maladaptive inflammatory response leading to systemic inflammation and multiple organ failure.
Prophylactic Inspiratory Muscle Training in Patients Undergoing Coronary Artery Bypass Graft
Authors: Weiner Paltiel , Zeidan Fawaz , Zamir Doron , Pelled Benny , Waizman Joseph , Beckerman Marinella , Weiner Margalit 
Published: August 2002

AbstractPulmonary complications after cardiac surgery are a leading cause of postoperative morbidity and mortality. Respiratory muscle weakness may contribute to the postoperative pulmonary abnormalities. We hypothesized that: (1) there is a decrease in inspiratory muscle strength (PImax at residual volume) and endurance (Pmpeak/PImax) following coronary artery bypass graft (CABG); (2) this weakness is associated with reduced pulmonary function tests (PFTs), impaired gas exchange, and a higher rate of pulmonary complications; and (3) prophylactic inspiratory muscle training (IMT) can prevent those changes. Eighty‐four candidates for CABG, with ages ranging from 33 to 82 years, were evaluated prior to operation and randomized into two groups: 42 patients underwent IMT using a threshold trainer for 30 min/day for 2 weeks, 1 month before operation (group A); 42 patients served as a control group and underwent sham training (group B). There was a significant decrease in respiratory muscle function, PFTs, and gas exchange in the control group following CABG, whereas these parameters remained similar to those before entering the study in the training group. The differences between the groups were statistically significant. In addition, 11 (26%) patients in the control group but only 2 (5%) in the training group needed postsurgical mechanical ventilation longer than 24 hours. CABGs have a significant deteriorating effect on inspiratory muscle function, PFTs, and arterial blood gases. The decrease in these parameters can be prevented by prophylactic inspiratory muscle training, which may also prevent postsurgical pulmonary complications.
Parathyroidectomy in the Elderly: Do the Benefits Outweigh the Risks?
Authors: Chen Herbert , Parkerson Sara , Udelsman Robert 
Published: August 2002

AbstractAlthough the incidence of hyperparathyroidism (HPT) in the elderly exceeds 1.5%, limited resources and co‐morbidity inhibit referral for parathyroidectomy. To determine the risks and benefits of surgery, we examined the outcomes of elderly patients who underwent exploration for primary HPT. Data from 211 consecutive patients who underwent parathyroidectomy by one surgeon at the Johns Hopkins Hospital between August 1990 and May 1996 were recorded prospectively. Of these patients, 184 had primary HPT. Demographic and outcome data of elderly patients (> 70 years of age) (n= 36) were compared to those from younger patients (< 70 years of age) (n= 148). Preoperative symptoms of mental impairment, bone disease, and fatigue were more common in elderly patients (p < 0.05), and nephrolithiasis was more frequent in younger patients (p < 0.025). Elderly patients presented with more advanced disease, manifested by higher preoperative parathyroid hormone levels (301.9 ± 63.3 vs. 169.2 ± 14.3 pg/ml, p < 0.05). The cure rate (94.4%), morbidity (5.5%), and mortality (0%) in the elderly were indistinguishable from those of their younger cohorts (98%, 1.4%, and 0%, respectively). In conclusion, the more advanced disease seen in the elderly suggests that they are referred for surgery with a higher threshold than younger patients. Although several series of parathyroidectomy in elderly patients have reported high morbidity rates, significant mortality, and long length of stay (LOS), we found that parathyroidectomy in these patients can be performed with high cures, low morbidity, no mortality, short LOS, and high patient satisfaction. These data suggest that the benefits of surgery outweigh its risks and argue for a lower threshold for referral of elderly patients with primary HPT for surgical treatment.
Reoperative Surgery for Organic Hyperinsulinism: Indications and Operative Strategy
Authors: Simon Dietmar , Starke Achim , Goretzki Peter E. , Roeher Hans D. 
Published: August 2002

AbstractOrganic hyperinsulinism has a good chance of cure by operation, although patients with diffuse or multiple disease run a high risk of recurrence or persistence of disease. Surgical management and outcome in these patients are presented and discussed. Between 1986 and April 1997 a total of 62 patients were operated on for organic hyperinsulinism [solitary 48, multiple 3, multiple endocrine neoplasia type I (MEN‐I) 2, diffuse 4, malignant 5]. Persistence or recurrence occurred in 10 patients (16%). Among the six that persisted, four were malignant and two benign. All four of those that recurred were benign. Patients with benign disease presented with multiple tumors (n= 3), MEN‐I syndrome (n= 1), and diffuse/nodular hyperplasia (n= 2). The duration between diagnosis and reintervention ranged from 1 to 10 years. Preoperative diagnosis was able to localize tumors in three patients (computed tomography 1, angiography 2, calcium stimulation 1). Operative procedures were multiple enucleations in two patients with sporadic disease, subtotal resection plus enucleation in the case of MEN‐I syndrome, subtotal resection for diffuse hyperplasia, left resection for adenomatosis, and tumor extirpation after multiple previous operations. Long‐term clinical and biochemical cure was achieved in five of six patients (mean follow‐up 5 years). Octreotide therapy shows good symptomatic control in the patient with operative failure. Reintervention for organic hyperinsulinism is successful (80% cure) and requires preoperative imaging and individual surgical management.
l‐Arginine: Effect on Reperfusion Injury after Heart Transplantation
Authors: Szabó Gábor , Bährle Susanne , Bátkai Sándor , Stumpf Nicole , Dengler Thomas J. , Zimmermann Rainer , Vahl Christian F. , Hagl Siegfried 
Published: August 2002

AbstractGlobal myocardial ischemia and reperfusion injury play a major role in early postoperative myocardial graft dysfunction. The aim of the present study was to investigate the effects of the nitric oxide (NO) precursor l‐arginine on myocardial and endothelial function after hypothermic ischemia and reperfusion in a heterotopic rat heart transplantation model. After 1 hour ischemic preservation, reperfusion was started after application of placebo (control, n= 12) or l‐arginine (l‐Arg 40 mg/kg, n= 12), a substrate of NO synthesis. Myocardial blood flow (MBF) was assessed by the hydrogen clearance method. An implanted balloon was used to obtain pressure–volume relations of the transplanted heart. Left ventricular developed pressure (LVDP), rate of pressure development (dP/dt), end‐diastolic pressure (LVEDP), isovolumic relaxation constant (TE), and MBF were measured after 60 minutes and 24 hours of reperfusion. Endothelium‐dependent vasodilatation in response to acetylcholine (ACh) and endothelium‐independent vasodilatation in response to sodium nitroprusside (SNP) were also determined. After 1 hour the MBF was significantly higher in the l‐Arg group (3.6 ± 0.6 vs. 1.9 ± 0.2 ml/min/g, p < 0.05). The l‐Arg group showed better recovery of systolic function and myocardial relaxation (LVDP 106 ± 6 vs. 70 ± 7 mmHg, p < 0.05; maximal dP/dt 5145 ± 498 vs. 3410 ± 257 mmHg/s, p < 0.05; TE 12.1 ± 0.9 vs. 16.1 ± 1.5 ms, p < 0.05, at an intraventricular volume of 80 μl). LVEDP was similar in the two groups. After 24 hours no difference was found between the groups for basal MBF, LVP, dP/dt, TE, LVEDP, or the response of MBF to SNP. However, ACh led to a significantly higher increase in MBF in the l‐Arg group (52 ± 8% vs. 29 ± 7%,p < 0.05). These results indicate that (1) NO donation improves myocardial and endothelial functional recovery during early reperfusion after heart transplantation; and (2) initial treatment with l‐Arg has a persisting beneficial effect against reperfusion‐induced graft coronary endothelial dysfunction during late reperfusion.
Assessing the Suitability of Gastric Carcinoma for Limited Resection: Endoscopic Prediction of Lymph Node Metastases
Authors: Namieno Tsutomu , Koito Kazumitsu , Higashi Tsunemi , Takahashi Masato , Yamashita Kenichiro , Kondo Yukifumi 
Published: August 2002

AbstractSome early gastric carcinomas are free of lymph node involvement; however, the pathosis of these carcinomas is neither well understood nor reflected in the choice of less extensive treatment. We investigated the relation of nodal involvement to pathologic findings of the resected specimens. We present promising standards for predicting the nodal status of early gastric carcinomas, contributing to the indication for limited surgery. The relation of lymph node metastasis to tumor size, infiltration depth, macroscopic appearance, and histologic type of early gastric carcinomas were investigated in 1470 patients with a single primary early gastric carcinoma. Of these carcinomas, 763 were limited to the mucosa (mucosal carcinoma) and 707 to the submucosa (submucosal carcinoma). The overall incidence of lymph node metastasis was 9.0%:2.1% in mucosal carcinomas and 16.5% in submucosal ones, with a significant (p < 0.001) difference of nodal involvement between the two. The macroscopically elevated or compound‐type carcinomas 10 mm or less in diameter were all node‐negative, whereas some depressed‐type carcinomas were node‐positive. The incidence of undifferentiated carcinomas increased with tumor diameter, irrespective of whether they were mucosal or submucosal carcinomas, and they were significantly more node‐positive than were differentiated carcinomas: p< 0.001 for mucosal carcinomas and p < 0.05 for submucosal ones. The carcinomas satisfying the following criteria are node‐negative and eligible for limited surgery: (1) mucosal carcinoma; (2) elevated lesion <10 mm in diameter; (3) differentiated adenocarcinoma; and (4) no ulcer or ulcer scar. The other carcinomas are potentially node‐positive and standard surgery is recommended.
Pattern of Recurrence after Resection for Intraductal Papillary Mucinous Tumors of the Pancreas
Authors: Sho Masayuki , Nakajima Yoshiyuki , Kanehiro Hiromichi , Hisanaga Michiyoshi , Nishio Kazushi , Nagao Mitsuo , Ikeda Naoya , Kanokogi Hideki , Yamada Takatsugu , Nakano Hiroshige 
Published: August 2002

AbstractThe objective of this study was to clarify the patterns of recurrence and prognosis after resection of intraductal papillary mucinous tumors (IPMTs). Fourteen patients with IPMT were reviewed histologically; intraductal papillary adenocarcinoma was present in 12 cases and intraductal papillary adenoma in 2. Six patients were alive with no evidence of disease. Two patients died from other causes. Six patients had recurrences. The median survival time was 46 months. In the six recurrent cases, the median postoperative disease‐free interval was 38 months. Four patients died of recurrence, and the median survival time after recurrence was 6 months. The major site of recurrence was the remnant pancreas. The other sites were the liver in two cases, peritoneum in two, and local in one. These results suggest the multicentric or metachronous oncogenesis of IPMT. Because of the low frequency of lymph node metastases, an operation to preserve pancreatic function may be recommended, especially for localized tumors such as the branch type. It is important to avoid an incomplete resection using intraoperative pancreatoscopy and ultrasonography. Long‐term follow‐up after surgery is necessary even for a curative resection. We should perform total pancreatectomy for recurrences without distant metastases.
Manometric Findings of the Upper Esophageal Sphincter in Esophageal Achalasia
Authors: Yoneyama Fumihiko , Miyachi Masahiko , Nimura Yuji 
Published: August 2002

AbstractPharyngeal and upper esophageal sphincter (UES) manometry was performed in 15 patients with esophageal achalasia and compared with that in 10 healthy controls. Neither the pharyngeal contraction pressure nor the UES resting pressure were significantly different between the two groups, although the UES residual pressure in patients with achalasia was significantly increased compared with that in controls. Pneumatic dilatation of the lower esophageal sphincter (LES) was performed in these patients. After successful LES dilatation, the increased UES residual pressure in patients with esophageal achalasia decreased significantly. Our results suggest that UES relaxation in patients with esophageal achalasia is incomplete compared with that in healthy adults. This UES abnormality is not a primary defect but a secondary phenomenon.
CO2 Pneumoperitoneum: What We Know and What We Need to Know
Authors: Holthausen Ulla H. , Nagelschmidt Manfred , Troidl Hans 
Published: August 2002

AbstractThe development of the laparoscopic technique in surgery was so overwhelming that scientific evaluation could not keep in step. While investigators were still discussing the effects of the pneumoperitoneum on the healthy organism, laparoscopy was already performed in patients with an acute abdomen due to trauma or disease. Therefore, there is an urgent need of further experimental and clinical studies with relevant endpoints to gain external evidence concerning the benefits of diagnostic or therapeutic laparoscopy for critically ill patients. In experiments with pigs we have shown that even in a healthy organism perfusion and energy metabolism of the small bowel is impaired by a pneumoperitoneum with carbon dioxide. Under the conditions of a systemic inflammatory response syndrome induced by infusion of endotoxin, the negative effects of the pneumoperitoneum were significantly amplified. Furthermore, we found that the increased intracranial pressure as caused by a head injury was further enhanced during a pneumoperitoneum but not by the alternative method of mechanical wall retraction. The current literature dealing with the effects of a pneumoperitoneum in critically ill patients is still controversial. Our data support the results of those authors who hold the opinion that creating a pneumoperitoneum in patients with acute abdominal problems means an additional serious burden that in single cases may lead to a disaster. As evidence is lacking, the current extension of laparoscopy into the field of intensive care medicine is still a human experiment that must be performed with high responsibility, extensive monitoring, and according to the rules of a clinical study.