bluuebunny/crossref_metadata_2025_split huggingface dataset:
A new scoring system for disease intensity in a surgical intensive care unit
Authors: Lehmkuhl Peter , Jeck‐Thole Sabine , Pichlmayr Ina 
Published: May 2005

AbstractThis study of 215 patients in a surgical intensive care unit (ICU) compares the predictive value of a new disease intensity scoring system called the Hanover Intensive System (HIS) with two previously described systems: APACHE (Acute Physiology and Chronic Health Evaluation), and TISS (Therapeutic Intervention Scoring System).HIS was superior in predicting a lethal outcome at an earlier time than the other methods of scoring. Practical use of this system in clinical decision making was made in timing of reoperation, planning nursing time, and caring for patients following liver transplantation.It is concluded that an accurate disease intensity scoring system such as HIS is of practical benefit in decision making in a surgical ICU.
Score‐aided decision making in patients with severe liver damage after hepatic transplantation
Authors: Gubernatis Gundolf , Tusch Günter , Ringe Burckhardt , Bunzendahl Hartwig , Pichlmayr Rudolf 
Published: May 2005

AbstractThis article describes how a system of scoring risk factors contributes to deciding whether a patient showing signs of liver failure soon after hepatic transplantation should be treated expectedly or should undergo immediate retransplantation.Of 78 adult patients receiving a first liver graft, 25 had evidence of severe damage of the graft and were further investigated. Nine had failure due to irreversible initial nonfunction, and 2 of the 9 died before a second graft was available. Seven were retransplanted with 3 long‐term survivors. The other 16 patients showed reversible severe damage and survived without retransplantation.Since retransplantation for irreversible initial nonfunction is successful only in the first postoperative days, there is an urgent need to identify the degree of the observed damage. We devised a scoring system which identified and weighted factors that were predictable in determining irreversibility. Measurements of highest relevance are transaminases, bile volume, the slope of the enzyme GLDH, and the amount of fresh blood and fresh‐frozen plasma required for support on the day of operation and the following day. Logistic regressional analysis produced a numerical score which was applied to a decision tree and produced probabilities and utilities to indicate whether reoperation is advisable.We use this scoring system and believe it assists our decisions in the early posttransplant period.
Ultrasonographic screening for abdominal aortic aneurysm: Analysis of surgical decisions for cost‐effectiveness
Authors: Bengtsson Henrik , Bergqvist David , Jendteg Stefan , Lindgren Bjorn , Persson Ulf 
Published: May 2005

AbstractA mathematic model is created to determine the economic cost per year of anticipated prolongation of life that would result from a program of abdominal ultrasonographic (US) screening for abdominal aortic aneurysm. The protocol involves US screening at age 60,67, and 74 years with additional annual follow‐up US and examination if an aneurysm of less than 40 mm is detected. Larger aneurysms are assumed to be sent for early elective resection. The benefits and risks for a subset of men with symptoms of intermittent claudication (IC) as an additional risk factor of atherosclerosis is calculated for comparison.Many of the factors on which these calculated costs and benefits are based are approximations and inferences. These include operative mortality for elective and emergent cases, charges for each such condition, cost of US, and anticipated survival following successful aneurysmectomy both with and without concomitant IC. Sensitivity analysis is performed to show how variations in the major parameters alter the outcome of the calculated cost per year of anticipated extension of life.
Prospective scenarios: A method of evaluating new decision tools
Authors: Dudley Hugh A. F. , Brown Simon Paterson , Thomson Jeremy N. , Eckersley J. Rupert 
Published: May 2005

AbstractProspective randomized controlled trials are rarely suitable for the evaluation of new decision making techniques. An approach is described in which a cohort of patients is taken down the usual study pathway to the point at which the new technique would be used. Conventional decision rules are then applied and the results recorded. The new technique is then deployed and the cohort reclassified. The logical and statistical justification for this approach is outlined. More rapid (although possibly less pure) analysis of the effect of the new technique is achieved.
Dynamics of bile flow through the human choledochal sphincter following exploration of the common bile duct
Authors: Holdsworth R. J. , Sadek S. A. , Ambikar S. , Cuschieri A. 
Published: May 2005

AbstractThe opening pressure and flow rates through the sphincter of Oddi using the patient's own bile to prime the system were measured daily in 17 patients after cholecystectomy and exploration of the common bile duct. The sequential changes in these parameters were correlated with preoperative serum bilirubin, bile bacteriology, biliary lipid composition, and bile viscosity. The opening pressure fell from an initial value of 17.2±1.9 to 9.1±0.9 cm bile (p<0.01) on the seventh postoperative day, indicating a self‐limiting hold‐up following stone extraction. The low opening pressure after the fifth to sixth day is well below the maximal hepatic secretory pressure and suggests that the bile flow into the duodenum may be continuous after cholecystectomy. The flow rate through the sphincter measured at a fixed pressure head of 30 cm of bile increased from 23.9±3.9 to 40.0±6.1 ml during the same period (p<0.01). Presumably, the latter represents the maximal flow rate of bile through the sphincter of Oddi under physiological conditions. These changes in flow could not be explained by alterations in the bile viscosity during the study period. The increase in flow rate was significant only in the nonjaundiced group and correlated positively with the phospholipid concentration in the bile. There were no significant differences in opening pressure, flow rates, and biliary lipid concentrations between patients with sterile bile and those with positive bile cultures.
Long‐term results of hemostatic gastric suture in the treatment of esophagogastric varices
Authors: Romero‐Torres Raul 
Published: May 2005

AbstractPortal azygos disconnection, using vein ligatures and a circumferential hemostatic suture of the gastric wall at the level of the upper pole, is a simple and a rapid technique that effectively controls bleeding from esophagogastric varices. Its low mortality rate in emergency cases or poor‐risk patients can be of great benefit to patients who have not responded to conservative therapy, including tamponade and vein sclerosis.In this article, we conclude that the long‐term results of this operation demonstrate that it can also be used in elective cases, especially in patients with Child's “C” classification. These patients with advanced cirrhosis have a very low survival rate (no more than 5 years) yet they can benefit from this portal disconnection since this procedure does not alter the portal hemodynamics and, consequently, does not induce chronic encephalopathy.
Surgical intervention following fragmentation of gallstones by extracorporeal shock waves
Authors: Teichmann Reinhard K. , Sauerbruch Tilman , Sackmann Michael , Holl Joseph , Paumgartner Gustav , Heberer Georg 
Published: May 2005

AbstractFive cases of surgical intervention following extracorporeal shock wave lithotripsy (ESWL) of gallbladder and bile duct stones are reported. This represents an incidence of surgical intervention in 1% of patients with gallbladder stones and in 9% of patients with common bile duct stones who underwent ESWL during a two‐and‐a‐half‐year investigation period. There was no mortality. In 2 patients with gallbladder stones and persistent colic after ESWL, elective cholecystectomy was performed. There was no evidence of macroscopic or microscopic damage or bleeding within the wall of the gallbladder. Furthermore, no damage to the liver, common bile duct, duodenum, or stomach was noted. ESWL was applied in 34 patients with common bile duct stones in whom endoscopic sphincterotomy and stone extraction had proved ineffective. Three (9%) of these patients required surgery. In 1 patient, a Dormia basket got stuck and the basket, together with the stone, were removed by choledochotomy. In a second patient, rupture of a juxtapapillary diverticulum occurred 10 days after ESWL and 2 days after endoscopic extraction of stone fragments. At laparotomy, the retroperitoneum was drained. In a third patient with gallbladder and common bile duct stones, acute cholecystitis developed after lithotripsy of common bile duct stones. Cholecystectomy was performed and a t‐tube was inserted in the bile duct. In all patients, the postoperative course was uneventful. In our experience, ESWL is a safe procedure with no mortality and an infrequent need for surgical intervention.
Colorectal carcinomas: Diagnostic implications of their changing frequency and anatomic distribution
Authors: Ghahremani Gary G. , Dowlatshahi Kambiz 
Published: May 2005

AbstractThis retrospective review included 1,694 consecutive cases of colorectal carcinoma diagnosed at the University of Chicago Medical Center during a 25‐year period (1960 through 1984). The number and percentage of tumors occurring within 7 anatomic segments of the large bowel were determined. The statistical data for a recent 5‐year interval were then compared with those of the 2 preceding decades. There was a 10.2% increase in the frequency of cancers originating in the cecum or ascending colon, while rectal and rectosigmoid carcinomas declined by 15.8% during the same study period. These data provide further evidence for a progressive left‐to‐right shift in cancer distribution within the colon during the past quarter century. Currently, the most proximal and distal 20–25 cm segments of the large bowel (cecum or ascending colon versus rectum and rectosigmoid) each harbor approximately 25% of the tumors. Therefore, the classic medical teaching that over 50% of colorectal cancers would be detectable by digital examination and/or proctosigmoidoscopy is no longer accurate. This documented increase in proximal colon cancers and redistribution of lesions within various large bowel segments indicate the growing importance of barium enema and colonoscopy as the optimal techniques for detection of colorectal neoplasms.
Surgical complications of typhoid fever: Enteric perforation
Authors: Santillana Miguel 
Published: May 2005

AbstractTyphoid fever remains a prevalent disease in developing nations as the result of adverse socioeconomic factors. The most frequent complication, and principal cause of mortality, is perforation of the terminal ileum. This report presents our experience with 96 patients surgically treated at Cayetano Heredia University Hospital in Lima, Peru from 1972 to 1986. The clinical characteristics and the diverse surgical procedures utilized in the management of these patients are reviewed.
Surgical complications of ascariasis
Authors: Ochoa Bernardo 
Published: May 2005

AbstractOver the past 25 years (1963–1988), a total of 311 children under 12 years of age were admitted to the Pediatric Surgical Service of the San Vicente de Paúl University Hospital, Medellín, Colombia, with complications resulting from infection withEntamoeba histolyticaorAscaris lumbricoides.In this group, the abdominal complications produced by ascariasis numbered 145, and included intestinal obstruction (n = 107), perforation of the appendix (n = 10), and migration of the parasite to the biliary tree or to the peritoneal cavity (n = 28). Evaluation of the living conditions of a significant subgroup of our patients confirms that intestinal parasitism is an endemic condition prevailing in nations that exhibit deep social and economic imbalance, where large sectors of the population remain deprived of the basic services of education, health, housing, and recreation.Massive infestation in children may give rise to grave complications that demand expert surgical care. Third World surgeons practicing in general hospitals that take care of patients of low economic capacity are usually familiar with the diagnosis and management of this pathology; surgeons who practice in the industrialized nations will only occasionally face such problems. The greater mobility of today's societies and the rather massive migrations that take place in current times have resulted in an increasing incidence of these entities in the hospital populations of the large urban centers of these nations. It is for the surgeons practicing in such centers that the information presented herein may be of greater value.
Results of surgical treatment of hepatic hydatidosis: Current therapeutic modifications
Authors: González E. Moreno , Selas P. Rico , Martínez Bercedo , García I. García , Carazo F. Palma , Pascual M. Hidalgo 
Published: May 2005

AbstractHepatic hydatidosis is an endemic disease that affects vast segments of the populations of various countries in the Mediterranean region, South America, the Pacific, and temperate zone nations that possess large numbers of sheep. Four hundred and ten patients bearing 561 hydatid cysts were treated at 2 major hospitals in Madrid, Spain in the period 1974–1989. In order to establish the modifications in diagnostic and therapeutic management introduced as a result of modernization of our clinical facilities and improved technological standards, they were divided into 2 groups: group A corresponded to the period 1974–1984, and group B, corresponded to the period 1985–1989. Since no effective parasiticide agent is available, hepatic hydatidosis must be treated surgically. Today's better knowledge and advancements in liver surgery have made it possible to extirpate the cyst completely with little risk and improved results; hepatic resection should only be considered in exceptional cases; aspiration, drainage procedures, or partial resections of the cyst yield inferior results. We have had no relapse of the hydatid disease in the liver or in any other abdominal site.
Surgical treatment of hepatocellular carcinoma: Experience with liver resection and transplantation in 198 patients
Authors: Ringe Burckhardt , Pichlmayr Rudolf , Wittekind Christian , Tusch Günter 
Published: May 2005

AbstractSurgical therapy offers the only chance for long‐term cure of patients with hepatocellular carcinoma. The role of partial and total hepatectomy with subsequent liver replacement was analyzed in a consecutive series of 198 patients. It was the aim of this study to compare both treatment modalities on the basis of various clinicopathological prognostic factors including the TNM system of pathological classification. One hundred thirty‐one resections and 61 transplantations were performed for the following histological diagnoses: hepatocellular carcinoma without coexisting liver disease (86) or associated with various hepatic abnormalities (79), fibrolamellar carcinoma (19), and mixed hepatocholangiocellular carcinoma (8). Overall actuarial survival rates at 5 years were 35.8% following resection and 15.2% after transplantation, respectively. For partial hepatectomy, factors significantly associated with improved long‐term outcome were: age 30–50 years, hepatocellular carcinoma without coexisting liver disease, fibrolamellar carcinoma, solitary tumor, unilobar location, absence of vascular invasion, portal vein thrombosis or extrahepatic spread, primary tumor categories pT 2/3, stage groups II/III, and curative operation (R0). Regarding total hepatectomy, the corresponding figures were: pT2, absence of portal vein thrombosis or extrahepatic spread (negative regional lymph nodes, no distant metastases), stage group II, and curative surgery. It could be clearly shown by uni‐ and multivariate analyses that the pTNM classification is of clinical value regarding the assessment of prognostic significance after resection and transplantation. A group of 13 patients had secondary resection (8) or transplantation (6) for intrahepatic tumor recurrence. Whereas in all resected patients cancer recurred again, 5 of 6 transplant recipients are alive and disease‐free at 12–40 months. The results of this study demonstrate that liver resection is the treatment of choice for primary liver cancer while transplantation may be indicated, especially in cases of nonresectable or recurrent lesions. Thus, the therapeutic spectrum for hepatocellular carcinoma should include both partial and total hepatectomy, being integrated into one common concept.
Change of gastric liquid emptying after highly selective vagotomy and pyloric dilatation for patients with obstructing duodenal ulcer
Authors: Wang Chia‐Siu , Tzen Kai‐Yuan , Huang Miau‐Ju , Chen Pang‐Chi , Chen Miin‐Fu 
Published: May 2005

AbstractGastric liquid emptying was studied in duodenal ulcer patients with and without stenosis before highly selective vagotomy (HSV) and 1 week, 3 months, and 1 year after. The test meal consisted of 1 mCi of 99m Technetium‐diethylene penta‐acetic acid (DTPA) in 500 ml of isotonic saline. The patients were divided into 2 groups: group 1 (16 cases) without clinical stenosis, who underwent HSV alone, served as control; group 2 (14 cases) with mild to moderate stenosis, who underwent HSV and transgastric dilatation to 20 mm in diameter.Before HSV, the stenotic group showed a significantly slower liquid emptying than the nonstenotic. Most of the stenotic group could resume a normal diet quickly after operation, but they still had prolonged liquid emptying. At 3 months, the emptying curve of the stenotic patients had approached that of the preoperative controls without a significant difference, while the nonstenotic patients showed an accelerated initial emptying. Although there was a significant improvement with the appearance of accelerated initial emptying at 1 year, the stenotic group still demonstrated slightly slower emptying than the nonstenotic group. A temporary state of preexistent gastric atony due to chronic outlet obstruction may explain the delayed emptying in the early postoperative period; however, minor residual resistance in the fibrotic, scarred tissue was postulated to be persistent despite dilatation, and responsible for the slower emptying of the stenotic than the nonstenotic group at 1 year.
Prognosis in gastric cancer associated with pregnancy
Authors: Ueo Hiroaki , Matsuoka Hideo , Tamura Shigeaki , Sato Koichi , Tsunematsu Yoshihiro , Kato Tetsuo 
Published: May 2005

AbstractGastric cancer concomitant with pregnancy is rare. In order to determine the clinical problems and practical guidelines on this particular subject, 61 Japanese patients were analyzed for clinical features and the results of obstetric and surgical treatment corresponding to the time of detection of the gastric cancer during the gestational period. The data indicated a limitation in diagnostic approaches caused by pregnancy and difficulty in saving both the mother and the fetus. Only 20 (58.8%) of the pregnant women underwent both obstetric treatment for the fetus and surgical treatment for gastric cancer. Fifty‐nine of the gastric cancer cases (96.7%) were advanced and resectability was consistently low (47.5%). The patients who received gastrectomy had a high incidence of hospital death (22.7%) and a poor prognosis—21.1% 3‐year survival. Based on the authors' cases of both early and advanced gastric cancer associated with pregnancy, the importance of early detection by gastroendoscopy is emphasized.
Gastric antral patch esophagoplasty for extensive corrosive stricture of the esophagus
Authors: Hugh Thomas B. , Meagher Alan P. , Li Bei 
Published: May 2005

AbstractA case is reported of a patient with a 9‐cm stricture of the esophagus caused by ingestion of sodium hydroxide, who was treated by gastric antral patch esophagoplasty. In this procedure, a full‐thickness pedicled patch of gastric antrum, based on the left gastroepiploic artery, was used to enlarge the esophageal lumen, thus allowing preservation of esophageal continuity and utilization of a functioning lower esophageal sphincter. The patient ate normally after the operation, and radiological, manometric, and esophageal pH monitoring studies indicated satisfactory esophageal function.Gastric antral patch esophagoplasty avoids the complications associated with esophageal bypass or resection. Previous long‐term results of this procedure in patients with reflux‐induced esophageal stricture have been good, and the technique merits consideration in the treatment of severe corrosive strictures.
Transthoracic needle biopsy
Authors: Weisbrod Gordon L. 
Published: May 2005

AbstractPercutaneous fine‐needle aspiration biopsy is a relatively simple invasive procedure with good patient acceptance, low morbidity, and almost negligible mortality. It provides a diagnosis of pulmonary, hilar, and mediastinal masses quickly and accurately, thus eliminating many laboratory tests, saving hospital days, and thereby saving time and money. Percutaneous One‐needle aspiration biopsy should be performed early in the investigation of many types of intrathoracic lesions.
Staging and management of lung cancer: Sleeve resection
Authors: Deslauriers Jean , Mehran Reza John , Guimont Chantai , Brisson Jacques 
Published: May 2005

AbstractSleeve lobectomy is a lung‐saving procedure usually indicated for central tumors for which the alternative is a pneumonectomy. It preserves normal lung tissue and may enable pulmonary resection to be done in selected patients with inadequate cardiac or pulmonary reserve. One experience extends from January 1972 to December 1991, during which time 142 patients underwent a variety of sleeve resections for bronchogenic neoplasms. The majority of operations were upper‐lobe sleeve resections (N=110) and most procedures were considered complete and potentially curative (87%). There were three postoperative deaths (surgical mortality of 2.5%) and prolonged atelectasis was the most common major complication (N=9). Follow‐up was complete for the 139 survivors (mean follow‐up time of 2,149 days) and overall survival was 46% at 5 years and 33% at 10 years. Five‐ and 10‐year survivals for patients with stage I disease were 63% and 52%, respectively, while only 14% of patients with stage III disease survived 5 years. Local recurrences occurred in 23% of patients but when the resection had been complete, this incidence was 17% (21/124). These results indicate that sleeve resection is an adequate cancer operation for both compromised and uncompromised patients. Operative mortality, survival, and incidence of local recurrence are not different than what is seen after more conventional procedures.