bluuebunny/crossref_metadata_2025_split huggingface dataset:
Geographical aspects of peptic ulcer surgery
Authors: Tovey Frank I. 
Published: May 2005

AbstractThe geographic distribution of duodenal ulcer and its characteristics in rural areas of high incidence in developing countries are reviewed. The choice of surgical procedures is discussed in light of the bulky diet and nutritional problems of these countries. A vagotomy procedure is advised for duodenal ulcer and a Billroth I gastrectomy for gastric ulcers of the body of the stomach.
Surgery of hemophiliacs—20 years' experience
Authors: Nilsson Inga Marie , Hedner Ulla , Ahlberg åke , Larsson S. Anders , Bergentz Sven ‐Erik 
Published: May 2005

AbstractSeventy‐seven hemophilic patients of type A or type B were subjected to a total of 108 major surgical procedures mainly in the field of general surgery, orthopedic surgery, or neurosurgery. The principles for the substitution therapy in the different types of procedures and different types of hemophilic diseases are described, as well as the indications for surgery and the surgical technique. The importance of prolonged substitution therapy postoperatively to avoid late hematoma, particularly in patients with severe hemophilia undergoing major surgery, is stressed. With this type of management there has been no increased intraoperative hemorrhage, and very few cases of late hematoma formation. By combining the substitution therapy with immunosuppression, it has been possible to operate also on patients with inhibitors against factor VIII or IX. The rate of complications, particularly the incidence of hepatitis, has been low with the type of substitution given in this series of patients. It is concluded that major surgery can be carried out even in severe hemophilia without significantly increased risk. The handling of the substitution therapy, and the surgical judgment and technique, offers however, special problems, necessitating centralization of elective cases.
Isolation of viable human pancreatic islets
Authors: Ferguson John , Allsopp Roger H. , Taylor Ross M. R. , Johnston Ivan D. A. 
Published: May 2005

AbstractThis article reports a method for the isolation of viable pancreatic islets from the human pancreas. Isolated islets were obtained from human pancreata of cadavers, patients undergoing surgical operations, and fetuses, using a freehand microdissection procedure. Viability was assessed by light microscopy of sections stained with aldehyde fuchsin and by measuring the insulin output of islets in response to a glucose stimulus in vitro using a perifusion system. Ten pieces of cadaver pancreas were studied. Islets were isolated from 6 specimens and in 5 of these were shown to respond to a glucose stimulus in vitro. Histologically the islets showed minimal damage with slight degranulation of the beta cells. Five pieces of pancreas removed at operation were studied as well. Islets were isolated in all cases, but only 2 showed a response to a glucose stimulus. Pancreata from a 26‐week and 34‐week human fetus were also studied. It was not possible to microdissect islets from either case, but small pieces of pancreas from the 26‐week fetus were shown to respond to a glucose stimulus by producing a significant increase in insulin output.
Transsphenoidal microsurgery for selective removal of functional pituitary microadenomas
Authors: Nielson Karl D. , Watts Clark , Clark Kemp 
Published: May 2005

AbstractThe transsphenoidal approach to the pituitary gland is emerging as the safest and most efficacious procedure for the management of pituitary tumors. With the aid of the microscope large tumors producing visual symptoms can be removed and microadenomata producing only signs and symptoms of endocrinopathies can be safely and adequately approached. The procedure is described in this report. The results of its use in 29 patients with selected illustrative case reports are described.
Bronchobiliary fistula due to echinococcosis of the liver
Authors: Tierris Emmanuel J. , Avgeropoulos Kostas , Kourtis Kostas , Papaevangelou Evangelos J. 
Published: May 2005

AbstractIn Greece, which has the second highest incidence of echinococcosis in the world, there has been an overall decrease in the frequency of this disease and its complications during the past 15 years. Between 1920 and 1960, approximately 46 patients per year were operated on for echinococcosis at the Hellenic Red Cross Hospital, and 1.8% of 1037 hepatic hydatid cysts had ruptured into the bronchi. From 1960 to 1975, the number of patients requiring operation decreased to approximately 25 per year, and the incidence of rupture into the bronchi declined to 1% of 288 liver cysts. The reduction has resulted from improvements in preventive medicine and surgical care and a decrease in the frequency of infected cysts.Bronchobiliary fistula is a serious complication of hydatid cyst of the liver and it must be treated surgically. A right thoracotomy or thoracoabdominal approach offers the possibility of dealing simultaneously with the hepatic cyst and the pulmonary lesions. The choice of operation depends on the findings and ranges from simple drainage of the hepatic cavity with division of the bronchobiliary communication, to resection of the lung (usually lobectomy) when a chronically infected pulmonary cavity is present. If a hydatid cyst of the liver ruptures simultaneously into the lung and the extrahepatic biliary tree with resultant obstruction of the common bile duct, unblocking of the common duct by evacuation of cysts and debris through a laparotomy takes priority over any other surgical action. Of 3 patients with bronchobiliary fistulas treated during the past 15 years, 2 were cured by simple drainage through a transabdominal approach.
Survival of patients with duodenal fistulas from necrotizing pancreatitis
Authors: Storm F. Kristian , Wilson Samuel E. 
Published: May 2005

AbstractAcute necrotizing pancreatitis associated with occult duodenal necrosis and perforation developed in 3 patients 2 to 4 weeks after initially successful treatment of hemorrhagic pancreatitis. Exploration was required for fever, abdominal mass, or X‐ray findings of an intra‐abdominal abscess. At operation all pancreatic and retroperitoneal abscesses were drained with sump tubes, and the duodenal fistula was closed. An intraluminal tube, placed via a gastrostomy, was used for decompression of the duodenum. Postoperative management included total parenteral nutrition, antibiotics specific for aerobic and anaerobic flora, and frequent X‐rays to locate new intra‐abdominal abscesses. One to 4 reoperations were necessary because of continuing pancreatic necrosis and abscess formation in each patient. Necrotizing pancreatitis with unrelenting retroperitoneal sepsis and fistula formation results in serious morbidity, hospital stays of several months, and is now the major cause of death in patients with pancreatitis. Survival of all 3 patients resulted from drainage of evolving retroperitoneal abscesses and improvement in our technique for management of large duodenal fistulas.
Prevention of pulmonary embolism by inferior vena cava filters: Results in 62 cases
Authors: Schlosser Volker , Spillner G. , Kaiser W. 
Published: May 2005

AbstractThe most effective methods of preventing recurrent pulmonary embolism involve interruption of the pathway of emboli through the inferior vena cava. Of the several procedures that interrupt vena caval blood flow, percutaneous implantation of a screen filter is associated with the lowest risk and appears to be as effective as any of the other procedures in preventing recurrent emboli. This article describes the experience with 62 cases of screen filter implantation performed between 1971 and 1975. Pulmonary embolism recurred in 1.6% of the patients, and 10% of the patients developed swelling of the lower extremities that did not exist preoperatively. Inferior vena cava phlebography performed 6 to 24 months postoperatively in 25 patients showed a patent inferior vena cava in 9 patients, partial occlusion of the vena cava in 8 patients, and complete occlusion of the vena cava with extensive collateral veins in 8 patients.
Pathology of gastric cancer
Authors: Wanke M. , Schwan H. 
Published: May 2005

AbstractThis paper reviews the gross morphology, histologic classification, location, and modes of spread of gastric cancer. On the basis of gross appearance, we have classified gastric carcinoma into 4 types: (a) superficial spreading (6% of cases), (b) polypoid (11% of cases), (c) ulcerated (45% of cases), and (d) diffuse infiltrating (38% of cases). Our histologic classification includes 4 categories: (a) adenocarcinoma (70% of cases), (b) round cell carcinoma, (c) mucinous carcinoma, and (d) rare forms of carcinoma (squamous, adenoacanthoma, carcinosarcoma, collision tumor, ductogenic carcinoma). These main histologie categories are subdivided according to the degree of differentiation of each tumor. From 81 to 86% of gastric cancers arise in the pyloric region. Multifocal origin of stomach cancers occurs in about 10% of cases. The prognosis of gastric cancer depends on the extent of spread at the time of treatment. Intramural propagation beyond the grossly apparent margins is common, and extension into the duodenum and esophagus from lesions in the pylorus and cardia regularly occurs. Approximately 50% of gastric cancers infiltrate neighboring organs. Metastases to regional lymph nodes, particularly in the lesser curvature drainage area, occur in over half of the cases. Blood‐borne spread, to the liver and beyond, and peritoneal seeding are common.
Early cancer of the stomach
Authors: Murakami Tadashige 
Published: May 2005

AbstractDefinition, macroscopic and histologic classification, diagnosis, surgical treatment, and prognosis of early gastric cancer are described. The definition and macroscopic classification were agreed upon by endoscopists, pathologists, radiologists, and surgeons at the meeting of the Japanese Gastroenterological Endoscopy Society in 1962. Early gastric cancer was grossly classified into 3 major types, based solely on surface characteristics in order to make the classification usable for radiologists and endoscopists. Since most early gastric cancers are asymptomatic, mass survey examinations are of value. Patients with a suspicious lesion or symptoms should undergo a thorough diagnostic workup that includes x‐ray studies, endoscopy, and biopsy for histologic examination. The aim of surgery is complete eradication of cancer cells. Since peritoneal dissemination and liver metastases are rare, surgery is directed at removing regional lymph nodes with possible metastases and not leaving any cancer cells at the gastric suture line. Although the incidence of metastases to regional lymph nodes is reported to be about 5% and of lymphatic permeation to be about 12%, 5‐year survival rates ranging from 89 to 95% have been achieved.
The role of lymphadenectomy in curative surgery for gastric cancer
Authors: Soga Jun , Kobayashi Kiyoo , Saito Juichi , Fujimaki Masao , Muto Terukazu 
Published: May 2005

AbstractA total of 530 cases of gastric cancer treated by curative surgery was analyzed with regard to lymph node metastases and survival rate. During this period, curative resections made up 75.9% of all resections (530/698) for gastric cancer, and the 5‐year survival rate was 50.6% (268/530). A total of 15,739 regional lymph nodes (an average of 30 per specimen) removed at surgery were examined histologically for metastases, and 16.0% were found to be positive. Of 339 patients with advanced, transmural cancers, 74.9% had lymph node métastases; those with negative nodes had a 5‐year survival rate of 63.5%, while those with positive nodes had a 5‐year survival rate of 29.9%. The 5‐year survivors with positive nodes made up 58.5% of all 5‐year survivors. The almost complete removal of at least the primary and secondary lymph node groups draining a gastric neoplasm is an essential part of the curative surgical treatment of gastric cancer. For lesions in the upper and middle portions of the stomach that invade the serosa of the posterior wall, total gastrectomy with a caudal hemipancreatectomy and splenectomy should be aggressively performed, so as to accomplish complete en bloc removal of the lymph nodes in these regions.
Indications and contraindications for surgery in gastric carcinoma
Authors: ReMine William H. 
Published: May 2005

AbstractOperation for gastric carcinoma should be undertaken in the presence of known or probable carcinoma of the stomach, in the absence of clear contraindications. These contraindications include serious disease elsewhere (such as cardiac insufficiency, advanced pulmonary disease, and pronounced renal failure), definite objective evidence of distant metastases, and evidence of local extension beyond the point of resectability. To deny a patient the potential benefits of exploratory laparotomy is to eliminate the chance of cure. After thorough exploration of the abdomen, curative resection of gastric cancer involves radical subtotal gastrectomy for lesions restricted to the distal 2/3 of the stomach, and total gastrectomy with splenectomy for lesions in the upper 1/3. When there is local extension of the cancer, resection of adjacent organs should be performed if it appears that the growth can be completely removed. When curative resection is not possible, palliative resection or gastroenterostomy is often indicated to relieve symptoms.
Treatment of gastric cancer with combined surgery and intraoperative radiotherapy
Authors: Tobe Takayoshi , Hikasa Yorinori , Matsuda Susumu , Kaneko Iwao , Mori Kenjiro , Abe Mitsuyuki 
Published: May 2005

AbstractIn order to increase the cure rate of stomach cancer, we have used intraoperative radiotherapy in which resectable lesions are removed surgically and the remaining cancer nests sterilized with a single massive dose of irradiation during laparotomy. In cooperation with surgeons, radiologists, and anesthesiologists, effective doses of irradiation of 3,000–4,000 rads were administered in 85 patients with advanced cancer. After resection of the stomach and removal of regional lymph nodes, and before gastrojejunostomy, the region of the celiac axis was irradiated in order to destroy regional microscopic metastasis that could not be removed surgically. The survival rates were 0 of 8 patients with nonresectable lesions, 3 of 15 with absolutely noncurable resectable tumors, 6 of 11 with relatively noncurable resectable cancers, and 48 of 51 with absolutely or relatively curable resectable lesions. In the latter group, insufficient time has elapsed to calculate the 5‐year survival rate. No serious complications occurred except for an increase of serum amylase. These results, as well as experimental radiotherapy of the dog pancreas, are discussed.
Palliative operations for incurable gastric cancer
Authors: ReMine William H. 
Published: May 2005

AbstractThe experiences of 206 patients who underwent palliative operations for advanced gastric carcinoma have been reviewed to evaluate the effect of treatment. Gastroenterostomy for obstruction alleviates vomiting for most patients, but significant palliation followed operation in only 1/3 of cases. The procedure was accomplished with an acceptable mortality rate, and the average period of postoperative hospitalization was 13 days. The results of palliative partial gastrectomy for patients having obstructive symptoms preoperatively were only slightly better than those following gastroenterostomy. Approximately 1/3 of the patients lived in relative comfort for more than a year. The poor progress of 6 patients who received total gastrectomy supports the opinion that total gastrectomy is not a satisfactory palliative operation. Palliative esophagogastrectomy for patients with dysphagia gave results similar to, or possibly better than, palliative resections for distal lesions. Although the results following the use of prostheses for inoperable malignant stricturing of the esophagogastric junction were disappointing, the procedure had significant advantages when compared with the marked limitations and disadvantages of jejunostomy and the transient relief afforded by transesophageal dilatation. Review of the records of patients who had had a feeding jejunostomy confirmed the general opinion that this procedure seldom is indicated in the management of advanced gastric carcinoma.
Clinical experience with a new method of gastric replacement following total gastrectomy
Authors: Kieninger G. , Koslowski L. , Durst J. , Kummer D. , Wolf K. ‐J. 
Published: May 2005

AbstractSince 1972 we have used a new type of gastric replacement following total gastrectomy that was developed experimentally in our laboratory. The reconstruction is done by end‐to‐end interposition between the esophagus and duodenum of a proximal 25 cm isoperistaltic jejunal segment and a distal 10 cm antiperistaltic (reversed) jejunal segment. The reversed segment acts as a substitute for the pylorus, causing delayed and intermittent emptying of the above proximal isoperistaltic segment. To date we have performed this operation in 31 patients, with only 1 postoperative death and nonfatal anastomotic leakage at the esophagojejunal junction in 4 patients. The longest postoperative observation period has been more than 4 years. The function of the gastric substitute has been found to be very satisfactory by cineradiography, endoscopy, and fat absorption tests. Based on our encouraging experimental and clinical experience, it is concluded that this new method of gastric replacement has many advantages over other methods. The quality of life of patients treated in this way has been better, since digestion and absorption have been improved and many of the typical postgastrectomy sequelae have been reduced or eliminated. This type of reconstruction is now being used routinely in our clinic in curative resections for gastric cancer.
The development of endocrinopathies in the prospective screening of two families with multiple endocrine adenopathy, type I
Authors: Friesen Stanley R. 
Published: May 2005

AbstractThe majority of the members of 2 families afflicted with genetic manifestations of the multiple endocrine adenopathy (MEA) type I syndrome have been prospectively studied. The slow and insidious onset of endocrinopathies in these high‐risk relatives was preceded by chemical and humoral abnormalities which could be surgically treated early in the course of the endocrinopathy. The predominant pathologic process in those patients diagnosed prospectively was that of hyperplasia with some benign adenomatous developments; malignancy was not observed except in those studied retrospectively. Screening protocols for the detection of multiple endocrinopathies in the symptomatic patient with one endocrinopathy, as well as in asymptomatic family relatives, appear to yield endocrinopathies at an earlier stage of development. Antral G cell hyperplasia was observed on endoscopic mucosal biopsy to be associated with the development of clinical endocrinopathies; it is not known yet whether this is of predictive value. The pathogenesis of multiple APUD cell abnormalities, though not known, apparently involves an embryologic programming of cells from the neuroectoderm, as well as a genetic pleiotropic factor and environmental influences.
Precise antrectomy
Authors: Jensen Hans ‐Eric , Badskjaer Jørn , Andersen Bent Nyboe , Johansen Aage 
Published: May 2005

AbstractA follow‐up study of 108 patients 2–8 years after precise antrectomy for gastric ulcer showed no ulcer recurrences. The frequency of complications was similar to that following conventional resections. Biopsies taken at gastroscopy at the time of follow‐up showed permanent removal of all functioning antral mucosa; no gastrin‐producing cells could be recovered from any part of the gastric remnant. There was a close relationship between gastric acid secretion and the incidence and spreading of chronic atrophic gastritis in both resected specimens and biopsies. Following precise antrectomy alone, acid secretion was reduced considerably 3 months postoperatively, and the reduction was unchanged at the time of follow‐up. In patients with a high preoperative insulin‐stimulated acid secretion, precise antrectomy plus vagotomy reduced acid secretion significantly more than precise antrectomy alone. Besides producing a decrease in acid secretion, the advantage of precise antrectomy appears to be that the target area for recurrent gastric ulcer is permanently removed.
Correction of common bile duct stricture by onlay patch of duodenum
Authors: Senning Åke 
Published: May 2005

AbstractA simple method to correct iatrogenic common bile duct strictures is presented. The stenotic bile duct is incised longitudinally and a large T‐tube inserted, the ends extending proximal and distal to the incision. The rim of the incision is sutured to the posterior duodenal wall, and this is used as a serosal patch for roofing. The T‐tube is removed after 3–6 months. Use of this technique in 2 patients was successful.
Surgical treatment of hypopharyngeal and cervical esophageal cancer
Authors: Silver Carl E. 
Published: May 2005

AbstractNumerous methods have been employed for esophageal replacement after total pharyngolaryngectomy‐esophagectomy. These have included the use of skin, as well as free transplantation or transposition of various abdominal viscera. The history and technical aspects of the procedures that have been used on the author's service are reviewed and results of 32 reconstructive operations are presented. Lower mortality and morbidity rates were obtained and palliation more consistently achieved with visceral transposition procedures than when the esophagus was reconstructed with skin. The 3‐year cure rate of patients undergoing resection for cancer was 21%. Gastric transposition after extrathoracic total esophagectomy is the preferred procedure for suitable patients with post‐cricoid and cervical esophageal carcinoma. Skin flaps are preferred for high hypopharyngeal tumors and in the poorest risk patients. Reversed gastric tube esophagoplasty and esophagocoloplasty are best employed for secondary rather than primary reconstruction.
Pharyngogastric anastomosis following pharyngolaryngoesophagectomy. Analysis of 157 cases
Authors: Lam K. H. , Wong J. , Lim S. T. K. , Ong G. B. 
Published: May 2005

AbstractDuring the last 14 years, pharyngogastric anastomosis following pharyngolaryngoesophagectomy was performed in 157 patients, among whom 67 had carcinoma of the hypopharynx, 7 had carcinoma of the cervical esophagus, and 83 had carcinoma of the larynx involving the hypopharynx. The operative procedure was that described previously by Ong in 1960, and modified in 1971. The overall hospital mortality was 31%, which in the last 2 years of the study had fallen to 18%. It was found that the mortality was higher in patients with poor cardiopulmonary status and in patients whose tumors had extended into the vallecula, thus requiring resection of the posterior third of the tongue. Previous failed radiotherapy increased the risk of leakage of the anastomosis. The immediate results of the operation can be improved if the surgeon ensures that a healthy stomach is prepared, a secure anastomosis is performed, and the vulnerable blood vessels are protected. Postoperative function in terms of swallowing ability was good, but rehabilitation of speech was poor. The 5‐year survival rate was 17.8%. The longest surviving patient is still alive 10 years after the original operation. The most common cause of long‐term failure was the development of metastatic disease. Improvement in survival results may require the use of adjuvant therapy to operative treatment.