bluuebunny/crossref_metadata_2025_split huggingface dataset:
Subcuticular Skin Closure as a Standard Approach to Emergency Appendectomy in Children: Prospective Clinical Trial
Authors: Serour Francis , Efrati Yigal , Klin Baruch , Barr Joseph , Gorenstein Arkadi , Vinograd Itzhak 
Published: August 2002

AbstractWe evaluated the morbidity associated with primary closure by interrupted subcuticular absorbable sutures following emergency appendectomy. In a prospective clinical trial over a 12‐month period, 216 children who underwent emergency appendectomy had skin closure using subcuticular interrupted absorbable polyglactin 4‐0 sutures. Preoperative prophylactic antibiotics consisting of metronidazole alone or in combination with gentamicin were used in patients with suspected phlegmonous appendicitis; a combination of metronidazole, gentamicin, and ampicillin was used when perforation of the appendix was suspected. Postoperatively, in patients with phlegmonous appendicitis metronidazole was given for 24 hours, whereas in those with peritonitis the triple antibiotics were continued for 7 to 10 days. All patients were assessed for complications resulting from the technique of wound closure. No intraabdominal abscesses or serious complications were recorded. The overall incidence of wound infection was 1.8%. Among children with a perforated appendix the rate of superficial wound infection was 5.7%. There was no difference in the rate of wound infection between patients who received metronidazole alone or metronidazole plus gentamicin preoperatively. All the patients and their families were satisfied with the cosmetic results and with the fact that removal of skin sutures was unnecessary. We conclude that the use of prophylactic antibiotics permits standard skin closure by interrupted absorbable subcuticular suture.
Carcinoid Tumors: Development of Our Knowledge
Authors: Creutzfeldt Werner 
Published: August 2002

AbstractHistorically, carcinoids have long been known to be a morphologically distinct class of rare intestinal tumors that behave less aggressively than the more common intestinal adenocarcinomas. It was not until much later that their endocrine nature was recognized. Some authors restrict the term carcinoid to intestinal endocrine tumors, whereas others include a large variety of neuroendocrine tumors. In the WHO classification of 1980, carcinoids were defined as tumors of the diffuse neuroendocrine system that are either benign or neoplasms with a more favored prognosis than carcinomas. They are characterized by a typical growth pattern, silver affinity, and positive immunohistochemical reaction with neuron‐specific markers; and they can express different peptides and biogenic amines. Neuroendocrine tumors originating from endocrine glands (pituitary, thyroid, adrenals, pancreas) and highly malignant neuroendocrine carcinomas are excluded from the carcinoid group of neoplasms. For the natural history of carcinoid tumors several independent predictive parameters can be defined: size, site of origin, growth pattern, and hormone dependence. The number of neuropeptides and amines expressed by a carcinoid or the amount of biologically active neurohormones secreted are of no prognostic significance regarding malignant behavior. The carcinoid syndrome is a rare clinical entity that occurs with a prevalence of 1.6% for carcinoid tumors and almost only if liver metastases are present. The complex clinical symptoms are only partially explained by the secretion of serotonin and tachykinins.
Biologic Control of Injury and Inflammation: Much More than Too Little or Too Late
Authors: Guirao Xavier , Lowry Stephen F. 
Published: August 2002

AbstractA generalized host inflammatory response is necessary to orchestrate the maintenance or recovery of tissue repair and immune competence following severe injury or infection. When excessive in initial magnitude or duration, however, these otherwise beneficial inflammatory processes may eventuate in deterioration rather than restoration of homeostasis. Although the adverse consequences of excessive inflammatory stimuli may be acutely evident, their influences are more often insidious. A complex cascade of endogenously derived proinflammatory mediators are currently hypothesized to be responsible for both the beneficial and the adverse sequelae of infection and injury. The cytokine proteins tumor necrosis factor and interleukin 1 have been most widely studied as potential targets for antagonist intervention in both experimental models and prospective clinical trials. Preclinical evidence supporting these approaches is briefly discussed herein, as are the results of clinical trials attempting to modulate cytokine influences in the presence of sepsis. The present discussion focuses on potential insights gained from these investigations and the evolving appreciation for the importance of cytokine counterregulatory mechanisms. Examples of potentially complex interactions between inflammatory cytokines and infection‐induced antagonist proteins or counterregulatory hormones are provided. It is hypothesized that a sustained imbalance among these proinflammatory and counterregulatory influences may be a critical determinant of outcome in patients with severe infection.
Low‐Molecular‐Weight Heparin versus Warfarin for Prevention of Recurrent Venous Thromboembolism: A Randomized Trial
Authors: Das S. K. , Cohen A. T. , Edmondson R. A. , Melissari E. , Kakkar V. V. 
Published: August 2002

AbstractA group of 105 consecutive patients with venographically proved major acute deep vein thrombosis (DVT) were randomized in an open prospective study to evaluate the comparative efficacy and safety of a fixed dose of subcutaneous low‐molecular‐weight heparin (LMWH) and warfarin for the prevention of recurrent venous thromboembolism. Four patients developed venographically proved recurrent DVT during the 3 months of treatment: three in the LMWH group and one in the warfarin group. Nonfatal pulmonary embolism occurred in two patients in the LMWH group and in one in the warfarin group. Five of the 55 patients (10%) in the warfarin group and none of the 50 patients in the LMWH developed bleeding complications (two‐tailed Fisher exact test, p = 0.06). A preliminary assessment of the costs indicated that treatment with LMWH was less expensive by £900 per patient than warfarin. In conclusion, the fixed daily dose of LMWH and the adjusted dose of warfarin therapy were of similar efficacy in preventing recurrence of DVT. However, warfarin therapy, despite strict laboratory control, is associated with more frequent side effects and is expensive. Another study with a higher dose of LMWH is recommended.
Laparoscopic Approach to Pheochromocytoma: Hemodynamic Changes and Catecholamine Secretion
Authors: Fernández‐Cruz Laureano , Taurá Pilar , Sáenz Alejandro , Benarroch Guerson , Sabater Luis 
Published: August 2002

AbstractThis study compares the outcome of laparoscopic adrenalectomy (LpA) in 23 patients using CO2 insufflation with the outcome of this procedure in another 8 patients with pheochromocytoma (7 unilateral, 1 bilateral) using helium for pneumoperitoneum. The adrenal lesions in the first group included nonfunctional adenoma (n= 3), aldosterone adenoma (n= 11), Cushing's adenoma (n= 6), and Cushing's disease (n= 3). The latter patients were compared with a third group of 8 patients with pheochromocytoma undergoing conventional transabdominal adrenalectomy (CTA). With both procedures, intraoperative changes in plasma catecholamine levels were studied during pheochromocytoma removal and the changes correlated with intraoperative cardiovascular derangements. LpA was successfully performed in 95% of patients with adrenal lesions and in 100% of patients with pheochromocytoma. There was no significant difference in laparoscopic adrenalectomy for pheochromocytoma compared to that for other adrenal lesions in terms of operative time, blood loss, hospital stay, analgesic requirements, and return to normal activity. The outcome was less favorable in pheochromocytoma patients undergoing CTA. The largest increase of catecholamine levels in pheochromocytoma patients occurred during tumor manipulation with both LpA (17.4‐fold for epinephrine and 8.6‐fold for norepinephrine) and CTA (34.2‐fold for epinephrine and 13.7‐fold for norepinephrine), but cardiovascular instability was associated only with CTA. LpA may become the technique of choice for surgical removal of adrenal lesions and may also become the preferred method for removing pheochromocytoma.
Evaluation of Penetrating Injuries of the Neck: Prospective Study of 223 Patients
Authors: Demetriades D. , Theodorou D. , Cornwell E. , Berne T.V. , Asensio J. , Belzberg H. , Velmahos G. , Weaver F. , Yellin A. 
Published: August 2002

AbstractThe objective of this study was to assess the role of clinical examination, angiography, color flow Doppler imaging, and other diagnostic tests in identifying injuries to the vascular or aerodigestive structures in patients with penetrating injuries to the neck. A prospective study was made of patients with penetrating neck injuries. All patients had a careful physical examination according to a written protocol. Stable patients underwent routine four‐vessel angiography and color flow Doppler imaging. Esophagography and endoscopy were performed for proximity injuries. The sensitivity, specificity, and predictive values of physical examination, color flow Doppler studies, and other diagnostic tests were assessed during the evaluation of vascular and aerodigestive tract structures in the neck. Altogether 223 patients were entered in the study. After physical examination 176 patients underwent angiography and 99 of them underwent color flow Doppler imaging. Angiographic abnormalities were seen in 34 patients for an incidence of 19.3%, but only 14 (8.0%) required treatment. Color flow Doppler imaging was performed on 99 patients with a sensitivity of 91.7%, specificity 100%, positive predictive value (PPV) 100%, and negative predictive value (NPV) 99%. These values were all 100% when only injuries requiring treatment were considered. None of the 160 patients without clinical signs of vascular injury had serious vascular trauma requiring treatment (NPV 100%), although angiography in 127 showed 11 vascular lesions not requiring treatment. “Hard” signs on clinical examination (large expanding hematomas, severe active bleeding, shock not responding to fluids, diminished radial pulse, bruit) reliably predicted major vascular trauma requiring treatment. Among 34 of the 223 total patients (15.2%) admitted with “soft” signs, 8 had angiographically detected injuries, but only one required treatment. An esophagogram was performed on 98 patients because of proximity injuries (49 patients) or suspicious clinical signs (49 patients), and two of them showed esophageal perforations. None of the 167 patients without clinical signs of esophageal trauma had an esophageal injury requiring treatment. It was concluded that physical examination is reliable for identifying those patients with penetrating injuries of the neck who require vascular or esophageal diagnostic studies. Color flow Doppler imaging is a dependable alternative to angiography. An algorithm for the initial assessment of neck injuries is suggested.
Complications and Nonclosure Rates of Fasciotomy for Trauma and Related Risk Factors
Authors: Velmahos G.C. , Theodorou D. , Demetriades D. , Chan L. , Berne T.V. , Asensio J. , Cornwell E.E. , Belzberg H. , Stewart B.M. 
Published: August 2002

AbstractThe objective of this study was to identify risk factors for the development of complications and unsatisfactory skin closure following fasciotomy for trauma. Risk factors included in the study are prolonged time from injury to fasciotomy, type of fasciotomy, site of injury, and kind of underlying injury. The study was a retrospective analysis of 100 consecutive fasciotomies done for trauma over a period of 38 months (December 1991 to January 1995) in a “level I” trauma center at a university‐affiliated county teaching hospital. Ninety‐four patients were eligible for analysis, 29 of whom (31%) developed complications at the fasciotomy site. The risk was increased for lower extremity versus upper extremity (34.3% versus 20.8%), prophylactic versus therapeutic (42.0% versus 24.6%), late (>8 hours) versus early (37% versus 25%), and vascular versus musculoskeletal (38.8% versus 22.2%) trauma cases. The same risk factors negatively influenced the ability to close the skin primarily. The four subgroups defined by vascular/nonvascular injury and upper/lower extremity site had significantly different nonclosure rates (p= 0.043). The rate was highest among the vascular/lower extremity group (60.5%) and lowest among the nonvascular/upper extremity group (15.4%). We concluded that fasciotomies in lower extremities, the presence of underlying vascular injuries, fasciotomies performed prophylactically, and a time between the injury and fasciotomy of more than 8 hours are associated with an increased risk for local complications. The same factors are associated with an increased need for skin grafting the wound.
Evaluation of Enoxaparin Given before and after Operation to Prevent Venous Thromboembolism during Digestive Surgery: Play‐the‐Winner Designed Study
Authors: Bjerkeset Ottar , Larsen Stig , Reiertsen Ola 
Published: August 2002

AbstractA total of 316 patients were included in a play‐the‐winner (PTW) designed study comparing the safety of enoxaprain started preoperatively versus postoperatively as prophylaxis against venous thromboembolism for digestive surgery. In a PTW‐designed study the treatment of any next patient depends on the outcome of the previous patient. If successful, the next patient receives the same treatment, if not, the comparative regimen is given. Excessive bleeding according to specified criteria, severe adverse reactions, clinically detected deep venous thrombosis (DVT), or pulmonary embolism (PE) were criteria for classification as “loser.” The PTW design allocates most patients to the superior treatment. The main variable in PTW studies is the number of consecutive patients receiving the same treatment. In this study 163 patients were allocated to postoperatively started and 153 to preoperatively started prophylaxis with enoxaparin. The frequency of “winners” was found to be 82.8% and 78.4% in the post‐ and preoperatively treated groups, respectively. No significant differences were found between the groups with regard to frequency of
“winners” or the number of consecutive patients before change of treatment. The percentile of survival distribution did not detect superiority of any group. Prophylaxis against postoperative venous thromboembolism for digestive surgery using enoxaparin can safely be started preoperatively.
Laparoscopic Splenectomy for Benign and Malignant Hematologic Diseases: 35 Consecutive Cases
Authors: Decker Georges , Millat Bertrand , Guillon Françoise , Atger Jérôme , Linon Michel 
Published: August 2002

AbstractThe feasibility and safety of laparoscopic splenectomy (LS) has been shown for a variety of diseases with small or moderately enlarged spleens. Immune thrombocytopenic purpura thus has become the typical indication for LS, although few data are available to demonstrate any superiority of the laparoscopic approach over conventional surgery for this indication. We retrospectively analyzed 35 cases of LS for benign (22 patients) or malignant (13 patients) hematologic disorders. LS was attempted irrespective of the volume of the spleen. The overall operative mortality rate was 2.9%, and complications occurred in 23% of all patients. The conversion rate was 9%, and accessory spleens were found in 17% of patients. Although the patients with malignant disease were significantly older, were higher operative risks (ASA score), had much larger spleens, and required longer operative times, more conversions to laparotomy, and more blood transfusions than patients with benign disease, their mortality and complication rates and the duration of their hospital stays were not significantly different from those with benign disease. They also compare favorably with the results of conventional surgery for the same indications. Patient selection, operative technique, and outcome of laparoscopic and conventional splenectomy are discussed with regard to the literature. Although the experience with LS for these indications is still limited, the reported results indicate that LS may be as beneficial for patients with malignant as for those with benign hematologic conditions.
Nutritional Status of Gastric Cancer Patients after Total Gastrectomy
Authors: Bae Jae‐Moon , Park Jong‐Wan , Yang Han‐Kwang , Kim Jin‐Pok 
Published: August 2002

AbstractA number of causes of malnutrition after total gastrectomy have been proposed. The purpose of this study was to assess nutritional status and to determine the cause of malnutrition after total gastrectomy. We studied 20 gastric cancer patients who had undergone total gastrectomy and immmunochemotherapy and 6 normal controls. Nutritional status was assessed by dietary history, anthropometric methods, and serologic measurements. Malabsorption tests included the fecal fat excretion test, d‐xylose absorption test, glucose tolerance test, vitamin B12 absorption test using dual isotopes, bacterial culture of jejunal aspirates, and jejunal biopsy. Weight loss was compared to the preoperative status in all patients (average 15%: 59.0 ± 9.9 vs. 50.2 ± 7.8 kg, preoperatively vs. postoperatively). Average daily calorie intake was 1586.2 kcal, which is lower than the normal intake of Korean adults (1838 kcal). Malnutrition of skeletal and visceral protein was not found. There was, however, severe fat malnutrition and a deficit of body fat. Postoperatively the body mass index was considerably lower than that preoperatively (22.2 ± 0.4 vs. 18.9 ± 0.4 kg/m2; preoperatively vs. postoperatively). With malabsorption tests, the daily excreted amount of fecal fat was 28.6 ± 3.4 g (mean ± SD) in patients and 6.9 ± 0.2 g in controls. There was no significant malabsorption of carbohydrates. In 64.3% (9/14) of patients, vitamin B12 absorption was abnormal; and the serum concentration of vitamin B12, which was significantly related to malabsorption of this vitamin, was lower than normal in 73.7% (14/19). Bacterial overgrowth was not found, and there were no abnormal histologic findings in the jejunal mucosa. These results suggest that poor oral intake and fat malabsorption following total gastrectomy cause malnutrition and that fat malabsorption may be related to relative pancreatic insufficiency.
Acute Cholangitis and Pancreatitis Secondary to Common Duct Stones: Management Update
Authors: Raraty Michael G.T. , Finch Margaret , Neoptolemos John P. 
Published: August 2002

AbstractGallstones are found within the main bile duct (MBD) of 7% to 20% of patients undergoing cholecystectomy. MBD stones are the commonest cause of acute cholangitis and acute pancreatitis. Acute cholangitis is the result of infection superimposed on an obstructed biliary system and carries a high mortality rate if left untreated. The mainstay of treatment is a regimen of broad‐spectrum intravenous antibiotics followed by prompt decompression of the obstructed biliary tree. Decompression is best accomplished by the endoscopic route, although transhepatic approaches may also be employed. Gallstone pancreatitis may be associated with cholangitis but is also common as a separate entity. Initial treatment is supportive, although new agents designed to suppress the systemic inflammatory response are under development and have proved beneficial in clinical trials. Severe cases should be treated with systemic antibiotics and early removal of the obstructing stones by endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy. Prophylactic cholecystectomy is recommended to prevent further episodes of gallstone pancreatitis.
Helium and Carbon Dioxide Pneumoperitoneum in Patients with Pheochromocytoma Undergoing Laparoscopic Adrenalectomy
Authors: Fernández‐Cruz Laureano , Sáenz Alejandro , Taurá Pilar , Sabater Luis , Astudillo Emiliano , Fontanals Jaume 
Published: August 2002

AbstractInsufflation with helium is used to prevent respiratory acidosis, hypercapnia, and cardiovascular instability associated with carbon dioxide (CO2) pneumoperitoneum. The aim of this prospective study was to compare CO2 with helium pneumoperitoneum with special reference to respiratory and hemodynamic changes at different times during the operation. Altogether 22 pheochromocytoma patients undergoing laparoscopic adrenalectomy (LpA) were included using CO2 in 11 patients (CO2LpA) and helium in 11 patients (HeLpA). The insufflation pressure was 12 mmHg. The two groups were comparable with regard to demographic data and preoperative management. CO2 and helium insufflation were associated with similar catecholamine increase. The most striking significant increase compared with the baseline was observed during tumor isolation: The mean plasma epinephrine (EPI) and norepinephrine (NE) levels increased 32.86‐fold and 25.92‐fold, respectively, in the CO2LpA patients and 27.43‐fold and 18.46‐fold, respectively, in the HeLpA patients. HeLpA did not result in significant hypercarbia or acidosis at any measured intraoperative point; this was without any alteration in minute ventilation to maintain these normal PaCO2, excess base (EB), and pH values. Significant increases of mean arterial pressure, pulmonary arterial pressure, pulmonary vascular resistance index, PaCO2, EB, and acidosis were seen in the CO2LpA patients at the time of tumor isolation and tumor removal compared with those in HeLpA patients. No patient required conversion to open surgery. There were no significant differences between CO2LpA and HeLpA regarding mean operative time (117.50 ± 93.68 vs. 106.87 ± 16.60 minutes), mean blood loss (168.54 ± 78.63 vs. 142.02 ± 109.26 ml), hospital stay (4 days), the need for analgesics, or mean time required to return to normal activity (12 days). There was one wound infection in the HeLpA group and one wound hematoma and one case of atelectasis in the CO2LpA group. Helium may be the agent of choice for abdominal insufflation in patients undergoing LpA for pheochromocytoma, eliminating the adverse hemodynamic and respiratory changes associated with CO2 insufflation.