bluuebunny/crossref_metadata_2025_split huggingface dataset:
The role of hyperthermic perfusion as a first step in the treatment of soft tissue sarcoma of the extremities
Authors: Di Filippo Franco , Calabrò Anna Maria , Cavallari Andrea , Carlini Sandro , Buttini Giovanni Luca , Moscarelli Francesco , Cavaliere Francesco , Piarulli Loredana , Cavaliere Renato 
Published: May 2005

AbstractEighty‐six patients with locally advanced, high‐grade soft tissue sarcomas of the extremities were studied prospectively in order to determine the efficacy of hyperthermic perfusion (HP) or hyperthermic antiblastic perfusion (HAP) as the first step of a combined multimodality therapy.The immediate response was evaluated in terms of tumor regression, and results confirmed the in vivo sensitivity of human sarcomas to the selective antineoplastic action of heat alone or combined with drugs (melphalan, actinomycin D, and cis‐platinum). HAP has been shown to be simpler and safer than HP, and it is now currently routinely employed.As far as the long‐term cure is concerned, all the patients have been evaluated for functional results, locoregional control, and survival, according to the different treatment schedules.The first clinical trials employed HP or HAP followed by delayed surgery alone. In 11 of 17 evaluable patients treated with HP, and in 17 of 29 treated with HAP, conservative surgery could be performed. A high incidence of locoregional relapse (24%) occurred, with low overall survival rates: 50.1% and 31.7% at 5 and 10 years after HP plus surgery, and 47.9% after HAP plus surgery at both 5 and 10 years.The protocol was, therefore, modified to include continuous intraarterial infusion of Adriamycin® (ADR) (17 patients) or radiotherapy (9 patients) before surgery.The results obtained thus far may be summarized as follows: (a) conservative surgery with functional limb‐salvage was possible in all patients; (b) the percentage of locoregional failure decreased to approximately 12% after HAP + ADR infusion + excision, the 5‐ and 10‐year overall survival rates both being 77.6 %, and the 5‐ and 10‐year disease‐free rates both being 57.8%; (c) no local recurrences occurred in the group treated with HAP + radiotherapy + excision with a 5‐year overall survival rate of 71.5% and a 5‐year disease‐free rate of 50.4%.In conclusion, the combined multimodality approaches employed appear to have improved both functional results and long‐term cure, even though these must be further confirmed on a larger series of patients.
The economics of general thromboembolic prophylaxis
Authors: Bergqvist David , Jendteg Stefan , Lindgren Björn , Mätzsch Thomas , Persson Ulf 
Published: May 2005

AbstractThe clinical and economic effects of each of 3 alternatives—no prophylaxis, general prophylaxis, and selective treatment—have been assessed in conjunction with 3 types of surgery—general surgery, the subset surgery for cholelithiasis, and elective hip surgery. The costs of thromboembolic and hemorrhagic complications have been calculated from the figures for 28 patients hospitalized at the Department of Surgery, Malmö General Hospital, Malmö, Sweden. The anticipated number of thromboembolic complications—and thus even the number of fatal pulmonary embolisms—can be minimized in all 3 types of surgery by means of general prophylaxis. General prophylaxis with low‐dose heparin is, however, accompanied by the greatest incidence of hemorrhagic complications.Health care costs are minimized with general prophylaxis in elective hip and general surgery, while no prophylaxis is the best alternative in surgery for cholelithiasis.From the patient's point of view, general prophylaxis minimizes the duration of thromboembolic disease in general surgery as well as in elective hip surgery. In surgery for cholelithiasis, however, no differences in health loss for the individual are shown between the 2 main alternatives, no prophylaxis and general prophylaxis.Selective treatment means treatment after diagnosis of thrombosis with some screening method. The alternative selective treatment was the least satisfactory of those 3 studied.
The role of surgery in the management of unusual complications of transcatheter arterial embolization for hepatocellular carcinoma
Authors: Jeng Kuo ‐Shyang , Ching Hsen ‐Jia 
Published: May 2005

AbstractTranscatheter arterial embolization (TAE) is accepted to be an effective treatment in both resectable and nonresectable hepatoma, which is very prevalent in Taiwan. Two hundred and twenty‐five embolizations of TAE were performed in 137 patients in a 3‐year period. Postembolization syndrome developed in the majority of patients. We analyzed these patients to study the nature and incidence of unusual complications and the surgical role in their managment. In our series, unusual complications, which were rarely reported in the literature, included 13 cases (5.8%) of gastroduodenal bleeding, 2 cases (0.9%) of duodenal perforation, 9 cases (4.0%) of acute pancreatitis with 1 case of gangrenous change, 24 cases (10.7%) of gallbladder infarction with 1 case of perforation, 4 cases (1.8%) of delayed formation of gallstones, 3 cases (1.3%) of hyperuricemia, and 2 cases (0.9%) of hepatoma rupture. Ischemic necrosis of the organs may be attributed to the inadvertent blockade of the gastroduodenal artery, gastric artery, cystic artery, and important collaterals. Inadequate superselectivity, the size of the tumor, regurgitation of embolus, anatomical variations, injury of vessel intima, or pseudoaneurysm formation resulting from previous embolization attempts made the avoidance of complications difficult with this technique. Most of the unusual complications could be managed by conservative treatment, but urgent operation was indicated in the cases of organ perforation. Elective operation was also needed for the delayed formation of gallstones with prominent symptoms. Awareness of the occurrence of these untoward sequelae makes us more careful in the evaluation and long‐term follow‐up of patients following TAE. Surgical intervention plays a selective but important role in the management of these unusual complications.
The role of mammography in the detection of bilateral primary breast cancer
Authors: Tinnemans J. G. M. , Wobbes T. , Hendriks J. H. C. L. , Holland R. , Van Der Sluis R. F. , De Boer H. H. M. 
Published: May 2005

AbstractThe significance of mammography in the detection of contralateral primary breast cancer was evaluated in 55 patients with bilateral breast disease. Fifteen (65%) of 23 patients in the synchronous group and 16 (50%) of 32 patients in the metachronous group had clinically occult carcinoma in the opposite breast. Excluding the 2 malignancies discovered by prophylactic mastectomy, mammography alone was responsible for the detection of 29 (52.7%) nonpalpable, contralateral breast carcinomas. The whole series of 110 malignant breasts comprised 41 nonpalpable carcinomas, of which 12 were noninvasive [ductal carcinoma in situ (7) and lobular carcinoma in situ (5)] and the remaining 29 were invasive carcinomas, either ductal of various types (25) or lobular (4). With regard to the évaluable axillary nodes, 20 (54.1%) of 37 palpable breast cancers and only 3 (11.5%) of 26 nonpalpable breast carcinomas had positive lymph nodes. The multicentricity rate was particularly high in synchronous tumors (70.6%), and in invasive lobular (73.3%) and noninvasive (75%) carcinomas. The favorable 5‐ and 10‐year survival of patients, both in synchronous and metachronous bilateral primary breast cancer, justify that they be treated with aggressive optimism.
Pre‐ and intraoperative localization of insulinomas: Report of 22 observations
Authors: Gianello P. , Gigot J. F. , Berthet F. , Dardenne A. N. , Lambotte L. , Rahier J. , Otte J. B. , Kestens P. J. 
Published: May 2005

AbstractFrom a retrospective analysis of 22 cases of pancreatic insulinoma operated in our center, we have determined the predictive value of various pre‐ and intraoperative localization procedures. In 18 patients, solitary insulinomas were localized by selective arteriography (SA) in 55.5% of cases, by transhepatic catheterization with pancreatic venous sampling (THVS) in 64% of cases, but by ultrasonography (US) and computed tomography (CT) in only 11% of cases. The combination of SA and THVS allowed the preoperative localization of the tumor in 83% of cases. Intraoperative palpation, ultrasonography, and blood glucose monitoring localized a single tumor in all cases.When the insulinomas were multiple, the various preoperative investigations were not reliable. In the 4 cases of multiple insulinoma, various investigations (SA, US, CT, THVS) localized only 8 (28%) tumors of 28. Intraoperative palpation was also unreliable. Only intraoperative ultrasonography and continuous blood glucose monitoring localizeall multiple tumors (the diameter of the smallest tumor was 4 mm). These 2 intraoperative investigations are now the procedures of choice for the detection of small pancreatic insulinomas.
A statistical evaluation of advancement in gastric cancer surgery with special reference to the significance of lymphadenectomy for cure
Authors: Soga Jun , Ohyama Shinichi , Miyashita Kaoru , Suzuki Tsutomu , Nashimoto Atsushi , Tanaka Otsuo , Sasaki Kohichi , Muto Terukazu 
Published: May 2005

AbstractFor the purpose of evaluating recent improvements in gastric cancer surgery, a comparative analysis was made between our previously reported series of 530 curative resection cases in a 10‐year period from 1961 to 1970 (group A) and the present series of 481 curative resection cases in the following 10‐year period from 1971 to 1980 (group B).During the latter period, curative resections made up 74.7% of all resections (481/644) for gastric cancer, and the 5‐year survival rate was 65.9% (294/446). In group B, a total of 15,512 regional lymph nodes, an average of 32.6 per specimen (30 per specimen in group A and 37.9 per specimen in group C, the last 5 years from 1981 to 1985), were removed at surgery, examined histologically for metastases, and 11.0% were found to be positive. Of 247 patients with advanced, transmural cancers, 80.6% had lymph node metastases. Those with negative nodes showed a 5‐year survival rate of 71.4%, higher than the rate of 63.5% in group A, while those with positive nodes had a 5‐year survival rate of 40.6%, significantly higher (p<0.05) than the 29.9% rate found in group A. The 5‐year survivors with positive nodes in group B made up 72.2% of all 5‐year survivors, this also being significantly higher (p<0.05) than the 58.5% noted in group A. The surgical death rate was 1.0% (5/481) of patients in group B and 1.1% (3/274) in group C.In the present study, the significance of lymphadenectomy in curative gastric cancer surgery was well documented and the results indicated that curative gastric resection with extensive lymphadenectomy can be safely performed without increasing, but perhaps decreasing, surgical mortality.
Laparoscopic cholecystectomy: Experience of a single surgeon
Authors: Soper Nathaniel J. , Dunnegan Deanna L. 
Published: May 2005

AbstractGallbladder removal using laparoscopic techniques has rapidly been adopted by surgeons around the world. Questions have been raised concerning laparoscopic cholecystectomy, including the safety of the operation, its implications for management of common bile duct stones, and the means by which surgeons should be trained. In the present series, 424 patients were referred to a single surgeon for cholecystectomy during a 22‐month period. A traditional open cholecystectomy was performed in 9 patients (2.1%) because of presumed contraindications to laparoscopic cholecystectomy. Laparoscopic cholecystectomy was attempted in the remaining 415 patients (97.9%). On the basis of preoperative investigations, 19 patients (4.6%) underwent endoscopic retrograde cholangiopancreatography. Endoscopic sphincterotomy and stone extraction were performed in the 13 patients (3.1%) demonstrating choledocholithiasis. Laparoscopic cholecystectomy was converted to an open operation in 8 patients (1.9%) owing to dense adhesions, obscure anatomy, or cholangiographic abnormalities. Laparoscopic cholecystectomy was successfully performed in 407 patients (96%) in 95 ± 2 minutes (mean ± SEM). Surgical trainees were involved in all operations and performed 68% of the procedures under supervision. Cystic duct cholangiograms were obtained selectively in 129 patients (30.4%). Intraoperative complications occurred in 3 patients, including 1 patient with a minor injury to the common bile duct (0.2%). There was no perioperative mortality, and major complications occurred in 6 patients (1.4%). Minor complications were seen in 12 others (2.8%), and one patient required reoperation for a trocar injury to the jejunum. Prolonged follow‐up has revealed one case of asymptomatic retained common bile duct stones (0.2%). Laparoscopic cholecystectomy can therefore be performed in more than 95% of patients with no mortality and minimal morbidity. The operation is safely taught to surgical trainees. Choledocholithiasis may be treated by a combination of endoscopic and laparoscopic techniques. Because of these considerations, laparoscopic cholecystectomy has become the preferred therapy for symptomatic cholelithiasis at our institution.
Laparoscopic choledochoscopy and extraction of common bile duct stones
Authors: Phillips Edward H. , Carroll Brendan J. , Pearlstein A. Randolph , Daykhovsky Leon , Fallas Moses J. 
Published: May 2005

AbstractVarious strategies have been proposed for the treatment of common bile duct stones encountered during laparoscopic cholecystectomy (LC). Eighty‐three patients who had choledocholithiasis discovered during or just prior to LC are included in this study. These patients were treated by various modalities including preoperative, intraoperative, and postoperative endoscopic retrograde cholangiopancreatography and sphincterotomy, laparoscopic choledochotomy, transcystic duct‐common bile duct (TCD‐CBD) exploration, and conventional “open” common duct exploration. Sixty‐six patients were successfully treated with TCD‐CBD exploration. They were discharged on average 2.6 days postoperatively and were able to return to normal physical activities within 7 days of discharge. There was minimal morbidity and no mortality. The technique of TCD‐CBD exploration is described in detail. The role of laparoscopic choledochotomy and endoscopic sphincterotomy for management of common duct stones in patients undergoing laparoscopic cholecystectomy appears limited.
Management of groin hernias by laparoscopy
Authors: Ger Ralph , Mishrick Abdallah , Hurwitz Jessica , Romero Carlos , Oddsen Robert 
Published: May 2005

AbstractThe surgical treatment of groin hernias continues to undergo technical modifications. The introduction of minimally invasive surgery had added a possible new dimension, replacing an inguinal approach by laparoscopy. Conceived some 15 years ago, the thesis was subjected to a clinical trial where coincidental abdominal hernial openings were closed at laparotomy. This study was followed by an experimental study at which time the openings were closed laparoscopically. The satisfactory results led to the development of a stapling instrument that could be passed through a cannula at laparoscopy and used to close the abdominal hernial opening. The clinical trial of treating hernias by laparoscopy was originally directed to the management of indirect inguinal hernias, but its use has since been expanded to include treatment of direct, femoral, obturator, incarcerated, recurrent, and bilateral hernias. The laparoscopic anatomy of the inguinal hernia, different from that seen by an inguinal approach, is briefly reviewed. The details of the operative technique are presented, as are the bases of other laparoscopic techniques that have evolved. Thirty‐one hernial orifices have been closed and followed over 18 months. The results appear to be satisfactory in 27 instances. There were early technical failures in 2: One patient developed a recurrence after 5 months, later shown to be due to a sliding hernia; and symptoms of meralgia paresthetica of indeterminate origin appeared in one case. The advantages over the traditional approach are described; the disadvantages of the laparoscopic approach are those of laparoscopy itself and the absence of a long‐term follow‐up.
Laparoscopic colonic procedures
Authors: Franklin Morris E. , Ramos Raul , Rosenthal Daniel , Schuessler William 
Published: May 2005

AbstractWith the advent and general acceptance of laparoscopy as a means of surgically treating intraabdominal disease processes, procedures on organs other than the gallbladder and female genital tract have slowly evolved. After developing basic techniques in an animal model, a clinical series (n=19) of laparoscopic procedures for a variety of colonic lesions was undertaken and is herein presented. It included both malignant and 1 nonmalignant disease processes and has carried an acceptable complication rate and survival. The average age of our patients was 68, and except for two extended postoperative hospitalizations and one death for nonprocedure‐related complications, the patients were generally ready for discharge in less than 96 hours. Our current techniques and indications for laparoscopic colonic surgery are detailed.
Surgical treatment of carcinoma of the hepatic duct confluence: Analysis of 55 resected carcinomas
Authors: Ogura Yoshifumi , Mizumoto Ryuji , Tabata Masami , Matsuda Shinsuke , Kusuda Tsukasa 
Published: May 2005

AbstractWe treated 65 patients with carcinoma of the hepatic duct confluence between 1976 and 1991, 57 (87.7%) of whom were treated surgically; of the 57, 55 (96.5%) underwent resection. Radical resection was performed at a rate of 50.9%. Procedures for these 55 patients included resection of the extrahepatic bile duct plus hepatectomy (n=33; 60.0%), and resection of the duct without hepatectomy (n=22; 40.0%). In addition, the caudate lobe was resected in 28 of these patients, and the portal vein, hepatic artery, or both were resected in 6. The overall operative morbidity was 21.8%; morbidity occurred in 33.3% of patients with hepatectomy, a significantly higher percent than the 4.5% rate in those without hepatectomy (p<0.05). Operative death occurred in only 1.9%. As the depth of cancer invasion in the bile duct wall advanced, the incidence of tumor spread (e.g., lymphatic permeation, venous invasion, perineural invasion, lymph node metastasis) increased significantly. The prevalence of extramural tumor extensions in a transverse direction was higher than that in the longitudinal direction along the bile duct wall; and the distance from the margin of the primary tumor to the site of tumor extensions along the bile duct wall was much longer on the hepatic side than on the duodenal side. Cancer invasion of the caudate lobe was observed in 36.4%, and invasion at the surgical margins was found more frequently in those without hepatectomy than those with hepatectomy. Cumulative 1‐, 3‐, and 5‐year survival rates in patients with hepatectomy were 83.5%, 37.1%, and 23.2%, respectively‐significantly higher than the 44.3%, 18.5%, and 18.5% rates in patients without hepatectomy (p<0.05). Furthermore, cumulative survival rates were higher for hepatectomy patients with resection of the caudate lobe than for those without resection of the caudate lobe. The results indicate that hepatectomy improves prognosis because cancer frequently invades the surgical margins in these tumors, although postoperative morbidity is higher with this procedure. Hence for poor‐risk patients (e.g., the elderly, those with poor hepatic functional reserve), caudate lobectomy with or without hilar hepatectomy may be the procedure of choice.
Extension of surgical indications for hepatocellular carcinoma by portal vein embolization
Authors: Lee Kwang Choon , Kinoshita Hiroaki , Hirohashi Kazuhiro , Kubo Shoji , Iwasa Ryutaro 
Published: May 2005

AbstractWe studied, clinically and experimentally, hypertrophy of the part of the liver not embolized after portal vein embolization (PVE). The subjects of the clinical study were 29 patients with hepatocellular carcinoma (HCC) who underwent embolization of the right first portal branch; 19 patients had cirrhosis, and 10 did not. The volume of the liver was calculated from computed tomograms obtained before PVE and 2 weeks after. In all patients, the volume of the nonembolized (left) lobe increased significantly. For the experimental study, we used male Wistar rats. Normal rats were untreated, and in the other rats cirrhosis was induced with carbon tetrachloride. The portal branch that supplies 70% of the total volume of the liver was embolized. The rats underwent one of four procedures: 70% PVE, 70% portal vein ligation, 70% hepatectomy, or laparotomy only. Rats were killed at different times after surgery, and the livers were removed and weighed. The mitotic index and DNA synthesis were measured in the nonembolized lobe (PVE group), in the lobe not supplied by the ligated branch (ligation group), or in the remaining liver (hepatectomy group). The liver weight, mitotic index, and DNA synthesis were high in the PVE, ligation, and hepatectomy groups for both normal rats and rats with cirrhosis. PVE caused cell proliferation and hypertrophy in the nonembolized part of the liver in the normal rats and even in those with cirrhosis. We concluded that PVE can extend the surgical indications for patients with HCC and underlying cirrhosis.
Total pancreatectomy for ductal adenocarcinoma of the pancreas with special reference to resection of the portal vein and multicentric cancer
Authors: Launois B. , Franci J. , Bardaxoglou E. , Ramee M. P. , Paul J. L. , Malledant Y. , Campion J. P. 
Published: May 2005

AbstractBetween March 1, 1968 and March 1, 1986, 323 patients underwent surgery for cancer of the pancreas or the periampullary region. Extirpative procedures were performed in 91 patients, of whom 51 had ductal carcinoma of the pancreas. Forty‐seven patients had total pancreatectomy, 9 associated with resection of the portal vein and 1 with total gastrectomy. Operative mortality was 15% but fell to zero for the 19 total pancreatectomies performed after 1981. With the introduction of total pancreatectomy, the resectability rate increased from 15% to 32%. Overall mean survival was 14.4 months. Actuarial survival was 42.4% at 1 year, 25.6% at 2 years, 11.9% at 3 years, and 8% at 5 years. Six patients are alive 7, 11, 14, 30, 30, and 73 months, respectively, after operation. Survival was calculated according to the classifications of Hermreck, Tryka and Brooks, and the TNM system. Ductal carcinoma was multifocal in 32% of patients, and 25% had epithelial dysplasia of the pancreatic duct. When portal vein resection was necessary, mean survival was 6.1 months, compared with 18.25 months when it was not performed. We conclude that total pancreatectomy has increased our resectability rate, mainly in patients with tumor spread beyond the usual margins of division for Whipple's procedure. However, the procedure does not appear worthwhile when portal vein resection is necessary or when multicentric cancer or neoplastic emboli are observed in the operative specimen.