bluuebunny/crossref_metadata_2025_split huggingface dataset:
Laparoscopic antireflux surgery and repair of hiatal hernia
Authors: Cuschieri A. 
Published: May 2005

AbstractLaparoscopic mobilization of the esophagus and esophagogastric (O‐G) junction enables the safe and effective performance of endoscopic antireflux surgery for intractable reflux esophagitis. The two antireflux procedures that we have evaluated in clinical practice at this institution are the ligamentum teres cardiopexy (n=9) and partial posterior fundoplication (n=5). More recently, laparoscopic repair of large symptomatic hiatal hernia (sliding, paraesophageal, and mixed) has also been introduced (n=4). The procedure entails reduction of the hernia, mobilization of the O‐G junction with crural repair by a continuous suture technique employing a special preformed jamming loop knot, followed by total fundoplication, which is fixed proximal to the anterior margin of the diaphragmatic hiatus and distal to the O‐G junction. The early results (maximum follow‐up 18 months) of this experience have been favorable, with minimal morbidity, early hospital discharge, and effective control of reflux symptoms without adverse sequelae. Laparoscopic antireflux surgery is an alternative to long‐term medication in patients with intractable esophagitis, and laparoscopic repair of large hiatal hernias offers significant advantage over the conventional open surgical approach in terms of rapid convalescence.
Laparoscopic urology: Past, present, and future
Authors: Clayman Ralph V. , Kavoussi Louis R. 
Published: May 2005

AbstractLaparoscopy has begun to have a significant impact on the management of urologic problems. Although initially limited to diagnostic pediatric problems, it has more recently been used to resolve myriad adult urologic conditions. Indeed, during the past year laparoscopic urology has moved well beyond the diagnosis of the undescended testicle and has been successfully used for pelvic lymphadenectomy, varicocelectomy, ureterolysis, drainage of a pelvic lymphocele, bladder suspension, and nephrectomy. Future applications of laparoscopy in urology may well include nephroureterectomy, cystectomy, and creation of an ileal conduit.
Advances in gynecologic laparoscopic procedures
Authors: Levine Ronald L. , Reich Harry 
Published: May 2005

AbstractMost gynecologic procedures can be accomplished using laparoscopic surgical techniques. Gynecologic laparoscopic procedures are described that involve the reproductive system, lymph node sampling, bowel and urinary tract repair, and abscess therapy. Laparoscopic surgery enhances the outcome of most current gynecologic procedures.
Aberrant left hepatic artery arising from the left gastric artery and liver function after radical gastrectomy for gastric cancer
Authors: Okano Shinji , Sawai Kiyoshi , Taniguchi Hiroki , Takahashi Toshio 
Published: May 2005

AbstractAn aberrant left hepatic artery, arising from the left gastric artery (LHLG), either as an accessory or replacing the left hepatic artery, is occasionally seen in patients with gastric cancer. Resection of LHLG, as part of the gastrectomy procedure, may cause liver dysfunction. The surgical records of a group of 141 patients who had undergone gastrectomy for gastric cancer following preoperative angiography were reviewed. Twenty‐eight of the patients had an LHLG preoperatively; in 15 the artery was severed during surgery and in the remainder it was preserved. Postoperative liver function was assessed by measuring changes in lactate dehydrogenase, glutamic oxaloacetic transaminase, and glutamic pyruvic transaminase activities. The greatest changes in liver function were observed in patients in whom the LHLG had been severed; the changes in liver function among patients whose LHLGs were preserved were similar to those in patients who had no LHLG. Notably, the wider the area fed by the LHLG, the greater was the change in liver function. The observed liver dysfunctions were transient, however, and normal function resumed within 7 days after operation.
Gastroplasty for obesity: Long‐term weight loss improved by vagotomy
Authors: Kral John G. , Görtz Lars , Hermansson Gert , Wallin Göran S. 
Published: May 2005

AbstractSixty‐nine (13M, 56F), severely obese patients (body mass index 47 kg/m2) have had vertical banded gastroplasty (GP) with 5‐cm polypropylene mesh (n=39) or fascia (n=30) bands since 1981. Of these 69 patients, 30 also had truncal vagotomy (TVG) without drainage. Total office follow‐up rate is 94%. During follow‐up of 1 year or more (mean 60 months), 25 patients with vagotomy plus gastroplasty lost 33±3 kg, corresponding to 51% of excess weight, compared to 21±3 kg (34% Excess weight) in the 34 patients having gastroplasty alone (p<0.01). In patients followed ≥ 5 years (mean 83 months) 10 patients with TVG lost 40±5 kg (61% of excess) compared to 17±4 kg (28% of excess) in 22 patients with GP alone (p<0.001). Frequency and severity of complications were similar in both groups, but there were seven reoperations after GP and three after TVG (p<0.05). Studies of gastric emptying of a solid meal in 14 of the patients with GP and 14 with TVG demonstrated greater weight loss in those with prolonged emptying and gastroesophageal pooling, though the emptying rates of patients with GP and those with TVG showed no statistically significant difference. Our earlier studies, which showed reduced liquid consumption after vagotomy, imply that this mechanism (rather than delayed emptying) explains why vagotomy potentiates weight loss after gastroplasty.
Resting energy expenditure and nitrogen loss after surgery in chronically undernourished patients
Authors: Fernandez Ivo S. , Kurpad Anura V. , Kilpadi Arun B. , Shetty Prakash S. 
Published: May 2005

AbstractChronically undernourished patients (n=10) undergoing elective abdominal surgery were assessed with regard to their energy expenditure and urinary nitrogen loss. These measurements were made for 1 week after the surgery, and stress factors for each parameter were computed. The responses of the chronically undernourished patients were compared to those of relatively well nourished patients (n=10) undergoing comparable surgeries. It was found that the postoperative resting energy expenditure (REE) of the chronically undernourished patients was not significantly elevated when compared to their preoperative values (mean±SEM): 1210.66±88.13, 1354.91±86.61, 1215.09±89.68, and 1188.23±86.61 kcal/day preoperatively and on postoperative days 1, 4, and 8, respectively. On the other hand, the postoperative REE of the controls was significantly elevated (p<0.05) over their baseline values: 1357.18±70.81, 1574.66±100.35, 1502.89±109.44, and 1477.23±83.52; kcal/day, respectively, for the same days. The stress factors for the controls were higher than those for the undernourished (1.16 versus 1.12, 1.11 versus 1.00, and 1.09 versus 0.98 on postoperative days 1, 4, and 8, respectively). The urinary nitrogen excretion in both groups (for the 4 days) was not significantly elevated over baseline (6.23±0.87, 7.72±0.71, 8.36±0.87, and 8.04±1.56 grams/day in the undernourished; and 7.59±1.03, 9.57±1.33, 9.49±1.03, and 8.67±0.76 grams/day in the controls. The stress factors for nitrogen excretion were slightly higher in the undernourished group. The data from this study show that the postoperative REE of chronically undernourished subjects is lower than that of well nourished controls. The nitrogen loss, however, is similar in the two groups.
Preventive effect of nicardipine on hyperplastic changes in venous bypass grafts
Authors: GökÇe özcan , GökÇe Çi¯gdem , Günel Salih , özden Akin , Hüseyinoğlu Kemal , UÇar özcan , Güngen Yücel 
Published: May 2005

AbstractNicardipine is a relatively new calcium channel blocker with important properties that could result in attenuation of the adverse proliferative changes in autogenous vein bypass grafts. In this experimental, randomized, controlled study, the effect of nicardipine on the pathologic findings in aortoaortic bypass grafts was assessed. Forty‐two male rabbits (Orycytolagus cuniculus) were randomized to three groups: group 1 received nicardipine and groups 2 and 3 placebo for 4 weeks, after which an aortoaortic bypass was realized with an autogenous inferior vena cava segment. During the following 4 weeks, groups 1 and 2 received nicardipine, and placebo was continued in group 3. The animals were sacrificed at the end of the study to permit removal and evaluation of the bypass grafts. The mean intimal and medial thickness values for groups 1 and 2 were lower than those for group 3, indicating that nicardipine has a significant preventive effect on the hyperplastic changes in venous bypass grafts compared to placebo. The mean intimal and medial thickness values of group 1 were also lower than those of group 2, and the differences carried statistical relevance, suggesting that the use of nicardipine before grafting could potentiate its protective effect. To provide stimulus for further research, an attempt is made to relate the hyperplasia‐preventing effect of nicardipine to possible mechanisms.
Cholecystectomy and drainage: Ultrasonographic and radioisotopic evaluation
Authors: Kapoor Vinay K. , Ibrarullah Mohammad , Baijal Sanjay S. , Kulshreshtha Akhilesh , Mittal Bhagwant R. , Saxena Rajan , Das Birendra K. , Kaushik Satyendra P. 
Published: May 2005

AbstractEighty patients undergoing cholecystectomy were either assigned deliberately (n=30) or randomized (n=50) to drainage (n=38) or nondrainage (n=42). Subhepatic collections were seen on ultrasonography (US) after 48 to 72 hours in 12 of 35 patients with drainage and 24 of 42 patients without drainage (p<0.05). Only two patients with subhepatic collections were symptomatic, and none required treatment. Postoperative infective complications were seen in 13 of 38 patients with drainage and 4 of 42 without drainage (p<0.01). Five of 12 patients with drainage and with a collection, and none of the 18 patients without drainage and without a collection had postoperative infective complications (p<0.05). Cholecystectomy was then performed in 100 patients without using a drain. BULIDA radioisotope scans revealed a bile leak in only 4 of 34 patients studied. Subhepatic collections were seen on US after 48 to 72 hours in 42 patients. The collection resolved in 22 patients and was smaller in 6 on repeat US. None of the patients with collection was symptomatic, and none required treatment. Postoperative infective complications were seen in 7 of 42 patients with a collection and 5 of 58 patients without a collection (not significant). We conclude that (1) cholecystectomy with drainage is associated with more infective complications than when a drain is not used; (2) cholecystectomy without drainage is safe; and (3) asymptomatic nonbilious subhepatic collections are common after cholecystectomy without drainage but do not require treatment, resolving spontaneously.
Abdominal wall retraction during laparoscopic cholecystectomy
Authors: Araki Keisuke , Namikawa Kazuo , Yamamoto Hirotoshi , Mizutani Junichi , Doiguchi Miyuki , Arai Mitsuhiro , Yamaguchi Tetsuya , Uno Keisuke , Ido Yasunori , Hayashi Naoko , Ogawa Michio 
Published: May 2005

AbstractLaparoscopic cholecystectomy has represented a potentially more morbid procedure than open cholecystectomy. Some of this morbidity has been due to complications associated with pneumoperitoneum. We have developed a technique that employs abdominal wall retraction during laparoscopic cholecystectomy and allows access to the right upper part of the abdomen without maintenance of pneumoperitoneum. Among 151 patients who underwent laparoscopic cholecystectomy using abdominal wall retraction there were no recognized adverse effects. Abdominal wall retraction enables the surgeon to minimize the risk of serious complications associated with pneumoperitoneum during laparoscopic cholecystectomy.
Apparent normobasemia as a negative prognostic sign immediately after hepatectomy
Authors: Wada Yasuo , Mori Keiichiro , Sugano Motoki , Fujii Tsuneo , Shimahara Yasuyuki , Yamaoka Yoshio , Ozawa Kazue 
Published: May 2005

AbstractThe acid‐base balance from the postoperative day (POD) 1 to POD 3 after cirrhotic liver resection was investigated in relation to operative outcome by conducting a retrospective study on the changes in arterial ketone body ratio (AKBR), which reflects the hepatic mitochondrial redox state, and arterial blood gas analysis. Patients were grouped according to their outcome: hospital death (HD) and or good outcome, the latter group acting as controls (CTR). Metabolic alkalosis developed in a significant number of the CTR patients (p<0.01), who had high AKBR values. By contrast, metabolic alkalosis did not develop in the HD group, with significantly lower AKBR (p<0.001), and there was almost normobasemia. There were no significant differences in the need for mechanical respiratory assistance, the amounts of fresh frozen plasma administered, and renal function test results between the two groups on each of 3 postoperative days. These data indicated that the absence of metabolic alkalosis during the early postoperative days reflects disruption of energy metabolism in the remnant liver, and that the apparent normobasemia is a significant indicator of poor prognosis after cirrhotic liver resection.
Is there a place for gastroenterostomy in patients with advanced cancer of the head of the pancreas?
Authors: van der Schelling George P. , van den Bosch Rene P. , Klinkenbij Jean H. G. , Mulder Paul G. H. , Jeekel Johannes 
Published: May 2005

AbstractThere remains doubt about the need for gastroenterostomy in patients with advanced cancer of the pancreatic head, performed either prophylactically or when passage of food becomes impossible. The records of 142 patients admitted for advanced pancreatic cancer to the Erasmus University Hospital over a period of 11 years were reviewed. We concentrated especially on the pre‐ and postoperative intake of food in cases involving gastroenterostomy and the morbidity and mortality associated with abdominal surgery in these patients. Of 129 patients without symptoms of gastric outlet obstruction at the time of diagnosis, 31 underwent prophylactic gastroenterostomy. The procedure did not prevent gastric outlet obstruction in 4 patients. Of the remaining 98 patients, 15 developed gastric outlet obstruction. Cox proportional hazards analysis showed no significant difference in the interval to the occurrence of a symptomatic obstruction between these two groups, taking into account other covariables. Postoperative complications and mortality regarding a gastroenterostomy were high, ranging from 9% to 41% and 11% to 33%, respectively. Our results do not indicate that prophylactic gastroenterostomy may significantly prevent future gastric outlet obstruction; therefore, as it also increases morbidity, it should not be performed. A gastroenterostomy to relieve symptoms should be considered carefully, as the success rate is low and is accompanied by a considerable incidence of morbidity and mortality.
Surgical treatment of portal hypertension: A historical perspective
Authors: Donovan Arthur J. 
Published: May 2005

AbstractPortal hypertension has been treated surgically by diversion of blood from the portal system, by interruption of the flow of blood to esophageal varices, or by direct obliteration of the varices. At the beginning of the twentieth century, portal diversion was achieved by omentopexy and, in a few patients, by the creation of a portacaval shunt. The latter operation was abandoned because of high mortality and morbidity rates, including shunt encephalopathy. In the 1940's, interest was renewed in the portacaval shunt. Improved understanding of hepatic physiology and the establishment of precise criteria for selection of cases for surgery resulted in a low operative mortality rate. The operation was highly successful in the control of hemorrhage from esophageal varices but was associated with an undesirable incidence of impairment of hepatic function. Currently, selective decompression of varices by the distal splenorenal shunt is under evaluation as a method of preventing variceal hemorrhage, while preserving hepatic function. Elimination of the threat of hemorrhage from varices by arterial ligation, sclerotherapy, or direct suture has been practiced for almost a century. The result remains one of temporary control with recurrent hemorrhage in the majority of cases.Ascites was formerly considered the dominant manifestation of portal hypertension. Currently, it is usually well controlled by diuretics. Surgery is reserved for the rare case of intractable ascites, often with hepatorenal syndrome. In such cases, a shunt is established between the peritoneal cavity and the systemic venous system, a procedure first performed early in this century.
Nonsurgical management of emergency hemorrhage from esophageal varices
Authors: Schiff Eugene R. 
Published: May 2005

AbstractThe emergency management of bleeding esophageal varices should be successful in at least 50% of cases. The sequence of medical steps instituted will vary depending on the resources of the center. The prevention of exsanguination is paramount initially and then bleeding must be stopped. Replacement of blood, intravenous vasopressin, and balloon tamponade, carried out in an intensive care unit, remain the mainstay of medical therapy. The increasing availability of endoscopic sclerotherapy with flexible instruments has more recently introduced a more direct means for stopping the hemorrhage as well as preventing recurrences.
Portacaval shunts
Authors: Callow Allan D. 
Published: May 2005

AbstractAlthough portacaval shunt has been amply demonstrated as providing effective therapy for the control of bleeding varices, it produces total diversion of portal flow with a high incidence of hepatic failure which, if not fatal, is frequently associated with encephalopathy. Various modifications of the portacaval shunt, physiologically a central shunt, are associated with the same immediate and delayed negative side effects as the standard end‐to‐side portacaval shunt. Numerous therapeutic modifications intended to lessen the incidence and severity of post‐shunt encephalopathy, such as limitation of protein intake, antibiotics, normalization of plasma amino acids, and modification of the gastrointestinal flora, are largely unsuccessful. Trials of adjuvant procedures such as arterialization of the portal vein and colon exclusion, as well as attempts to reduce the mortality rate of the first variceal hemorrhage by either prophylactic shunt or emergency portacaval shunt, have produced disappointing results in most instances. End‐to‐side portacaval shunt is not the therapeutic final solution. It may be indicated in the patient with intractable or severe ascites, in the presence of massive uncontrolled hemorrhage (an emergency situation), and to a very limited extent, in the presence of a few otherwise uncontrollable metabolic diseases such as hyperlipidemia. Ideally, one would prefer to restrict this operation to those patients who are destined to bleed from varices again.
Mesentericocaval shunt (MCS) with autologous jugular vein
Authors: Stipa Sergio , Ziparo Vincenzo 
Published: May 2005

AbstractWe report our personal experience of 114 patients with portal hypertension treated with mesentericocaval shunt (MCS) and 167 with portocaval anastomosis (PCA). In addition, the 2 procedures were evaluated in a controlled trial of 21 MCS patients and 25 PCA patients. We found no significant difference in the results of the 2 operations in terms of operative mortality rate, incidence of hepatic encephalopathy, and long‐term survival. The surgical procedure of MCS is no easier to perform than PCA; it requires the preparation of the graft, 2 vascular anastomoses, and longer operative time. It seems appropriate to select this operation only with those patients who, for anatomical reasons, cannot undergo PCA.
Fifteen years' experience with left gastric venous caval shunt for esophageal varices
Authors: Inokuchi Kiyoshi , Beppu Kazushige , Koyanagi Nobuhiro , Nagamine Kenji , Hashizume Makoto , Iwanaga Tetsuya , Sugimachi Keizo 
Published: May 2005

AbstractData on 231 patients with esophageal varices and portal hypertension secondary to intrahepatic block who underwent a left gastric venous caval shunt are presented herein. Operative death occurred in 5 (2.2%) and late death in 80 (34.6%), resulting in 146 survivors at a mean follow‐up period of 66 months. Postoperative variceal bleeding occurred in 17 (7.4%). Five‐year survival rate was 69.8% overall, and 62.0% in patients with cirrhosis. Eck's syndrome occurred in none, and a prograde portal flow was preserved in all 43 patients who were examined angiographically or ultrasonically.Left gastric venous caval shunt is a safe and effective surgical treatment which provides less insult to portal hemodynamics for a long postoperative period of time.
Changing trends in the management of combined pancreatoduodenal injuries
Authors: Moore John B. , Moore Ernest E. 
Published: May 2005

AbstractManagement of combined injury to the duodenum and pancreas remains controversial. Our review includes a 5‐year period ending June, 1982, in which 34 patients with combined pancreatoduodenal injuries were treated operatively. Nineteen (56%) sustained penetrating injuries and 15 had blunt trauma. Twelve patients underwent active sump drainage and repair. The remaining 22 required more extensive procedures including pyloric exclusion with or without pancreatic resection in 14, and pancreatodu‐odenectomy in one. The overall mortality rate was 9% with 2 early deaths secondary to associated injuries and 1 late death due to the pancreatoduodenal injury. Complications directly related to the combined injury occurred in 47% of the patients, including a 20% incidence of pancreatic fistulas. Although no single procedure uniformly applies to these complex injuries, we advocate frequent use of active sump drainage, pyloric exclusion, and early nutritional support via needle catheter jejunostomy.
The role of lymph node surgery in gastric cancer
Authors: Mishima Yoshio , Hirayama Renzo 
Published: May 2005

AbstractIn Japan, gastric cancer is the primary cause of death in both males and females. Among early gastric cancers, the elevated lesion is almost always the differentiated type, whereas almost half of the depressed lesions are undifferentiated types. As for advanced gastric cancer, the differentiated type tends to grow expansively as in Borrmann I and II. In contrast, the undifferentiated type is an invasive lesion as in Borrmann III and IV, and preferentially metastasizes to both the peritoneum and regional lymph nodes. Both peritoneal dissemination and lymph node metastasis are more frequently noticed in younger patients than in older patients. The standard operation performed for gastric cancer in Japan is usually gastric resection including complete dissection of group II lymph nodes, which are found along the left gastric and common hepatic arteries, and around the celiac artery. Apart from lymph node metastasis, an important factor influencing the long‐term result of surgery is serosal invasion. In order to improve long‐term results, more aggressive lymph node dissection as well as effective management of the peritoneal invasion should be mandatory. Although there is no therapy superior to that of surgery for gastric cancer, it should be stressed that this malignancy should be treated with an appropriate combination of therapies.