bluuebunny/crossref_metadata_2025_split huggingface dataset:
Influence of Enteral Nutrition‐induced Splanchnic Hyperemia on the Septic Origin of Splanchnic Ischemia
Authors: Kazamias Pantelis , Kotzampassi Katerina , Koufogiannis Dimitris , Eleftheriadis Efthimios 
Published: August 2002

AbstractThe purpose of this experimental study was to investigate whether enteral nutrition‐induced postprandial intestinal hyperemia has a beneficial effect on the splanchnic ischemia due to sepsis. Fourteen dogs, after exposure to Escherichia coli endotoxin via portal vein administration were grouped according to whether they were fed enterally via a jejunostomy or given a placebo. Systemic hemodynamics; portal vein, hepatic, and superior mesenteric artery blood flow; hepatic and intestinal microcirculation; hepatic tissue PO2; intestinal pHi; and hepatic energy charge were assessed before, during, and after endotoxin infusion as well as during and after enteral or placebo feeding. All splanchnic hemodynamic parameters revealed a statistically significant decline (p= 0.001) during the endotoxin shock period relative to the baseline. After enteral feeding all parameters exhibited a statistically significant increase (p= 0.001) relative to the placebo group. The results of this study led us to suggest that enteral nutrition reverses the lipopolysaccharide infusion‐induced splanchnic ischemia.
Diagnostic Value of Positron Emission Tomography for Detecting Breast Cancer
Authors: Noh Dong‐Young , Yun Ik‐Jin , Kim Jee‐Soo , Kang Han‐Sung , Lee Dong‐Soo , Chung June‐Key , Lee Myung Chul , Youn Yeo‐Kyu , Oh Seung Keun , Choe Kuk Jin 
Published: August 2002

AbstractPositron emission tomography (PET) is an imaging method that employs radionuclide and tomography techniques. PET has high sensitivity for detecting breast cancer, both the primary tumor and axillary node metastasis. From June 1995 to November 1996 a total of 27 patients underwent breast operations based on PET results at Seoul National University Hospital. Whole‐body PET images were obtained beginning 60 minutes after injection of 370 MBq (10 mCi) 18F‐fluorodeoxyglucose. Regional scans were also obtained with transmission images. We compared the PET results with those from the physical examination and mammography. All cases were histologically confirmed. The diagnostic accuracy of PET was excellent for the primary tumor mass (97%) compared with that of the physical examination (78%) and mammography (67%). For axillary lymph node metastasis, PET had outstanding detection accuracy (96%) compared with the physical examination and mammography (74% and 60%, respectively). Whole‐body PET scans made it possible to see all of the metastatic lesions at a glance in cases of metastatic or recurrent breast cancer. There was a probable correlation between the standard uptake value (SUV) and the number of axillary lymph node metastases, but in this study statistical significance was not proved because of the small number of cases. PET also could detect breast cancer in paraffin‐augmented breasts. We concluded that PET is a highly sensitive, accurate diagnostic tool for breast cancer and that SUV, after more studies, could be used as an important prognostic factor.
Critical Assessment of the Head and Neck Clinical Skills of General Surgery Residents
Authors: Sloan David A. , Donnelly Michael B. , Schwartz Richard W. , Vásconez Henry C. , Plymale Margaret , Kenady Daniel E. 
Published: August 2002

AbstractHead and neck surgery is an important part of general surgery. There is, however, little information about the quality of residents’ clinical skills in this important field. In an Objective Structured Clinical Examination (OSCE), residents encounter multiple patients with various clinical problems and are rated by faculty members using objective criteria. This study was undertaken to assess the head and neck surgery skills of a group of general surgical residents. Fifty‐one general surgery residents examined the same nine patients with head and neck disease. Faculty members graded each clinical interaction according to preset objective criteria. Both actual (e.g., thyroid nodule, oral cancer follow‐up examination) and simulated (e.g., dysphagia) patients were used in the OSCE. The reliability of the examination was assessed by coefficient α. The construct validity was determined by a two‐way analysis of variance with one repeated measure. The reliability was 0.75 for the clinical examination. Performance varied by level of training: Residents performed at a higher level than interns (p< 0.0001), but overall scores were poor (mean score 55%). Important deficits in skills were identified at all levels of training. It is concluded that more attention should be focused on specific outcome assessments of surgical training programs and on strategies for upgrading the clinical skills of surgical residents.
Abdominal Sonography Screening of Clinically Diagnosed or Suspected Appendicitis before Surgery
Authors: Chen Shyr‐Chyr , Chen Kai‐Mo , Wang Shih‐Ming , Chang King‐Jen 
Published: August 2002

AbstractWe conducted a prospective study to evaluate the value of abdominal sonography in the diagnosis of acute appendicitis and determine the need for abdominal sonography before operation. Altogether 191 patients with clinically diagnosed or suspected appendicitis underwent an abdominal sonography examination performed by a staff surgeon before operation. The sonographic findings are classified into three categories: appendicitis, other diseases, or normal screening. A total of 158 patients (82.7%) with positive findings of appendicitis proceeded to surgery; 18 patients (9.4%) were found to have other diseases, and they were treated for their conditions; and 15 patients (7.9%) with normal screening were discharged from the hospital and were reevaluated 2 weeks later. Only one patient had a false‐negative finding. Of the 158 patients undergoing operation, 143 (90.5%) were proved to have appendicitis by the pathologic reports. A total of 32 negative appendectomies (16.8%) were prevented after sonographic examination. Abdominal sonography for detecting acute appendicitis had a sensitivity of 99.3%, a specificity of 68.1%, an accuracy of 91.6%, a positive predictive value of 90.5%, and a negative predictive value of 97.0%. The value of meticulous history‐taking, physical examination, and laboratory tests cannot be overemphasized. Our experience suggests that patients with clinically diagnosed or suspected acute appendicitis should routinely undergo abdominal sonography examination, performed by an experienced surgeon, to further decrease the negative appendectomy rates.
Fibrin Glue Sandwich Prevents Pancreatic Fistula following Distal Pancreatectomy
Authors: Ohwada Susumu , Ogawa Tetsushi , Tanahashi Yoshifumi , Nakamura Seiji , Takeyoshi Izumi , Ohya Toshihiro , Ikeya Toshiroh , Kawashima Kenji , Kawashima Yoshiyuki , Morishita Yasuo 
Published: August 2002

AbstractPancreatic fistula is a major form of morbidity following pancreatic resection. We conducted a nonrandomized clinical trial comparing the sealing and sandwich techniques of spraying fibrin glue to prevent pancreatic fistula following distal pancreatectomy. The pancreas was transected with a scalpel to identify and suture the main pancreatic duct and its small branches. In the sealing group, fibrin glue was sprayed over the closed pancreatic stump and sutures. Alternatively, in the sandwich group fibrin glue was sprayed so as to cover and join the cut surface of the pancreatic remnant, which was then held closed with sutures. Altogether 111 patients were included in the study (90 with gastric cancer, 10 with esophageal cancer, and 11 with pancreatic cancer). Patients were nonrandomly assigned to the sandwich or the sealing group. Morbidity was 21.8% for the patients in the sandwich group versus 33.9% in the sealing group. Pancreatic fistulas occurred in 9.0% of the sandwich group versus 26.8% of the sealing group. The incidence of fistula was thus significantly lower in the sandwich group. The incidence of fistula was also significantly lower in the sandwich group for gastric malignancy patients undergoing extended radical lymphadenectomy down to the paraaortic lymph nodes combined with left adrenalectomy. Of the patients with gastric malignancy, pancreatic fistulas occurred in 9.3% of the sandwich group versus 25.5% of the sealing group. The fibrin glue sandwich technique is simple and reliable and should be valuable for complementing other prophylactic methods of preventing pancreatic fistula.
Prospective Surgical Outcome Study of Relief of Symptoms following Surgery in Patients with Primary Hyperparathyroidism
Authors: Pasieka Janice L. , Parsons Louise L. 
Published: August 2002

AbstractMany of the symptoms experienced by patients with primary hyperparathyroidism (HPT) develop insidiously and have often been misinterpreted as normal aging. The purpose of this study was to quantify HPT patients’ preoperative symptoms prospectively and study the impact of successful surgical intervention on these symptoms. Altogether 63 consecutive patients with primary HPT and 54 comparison patients with nontoxic thyroid disease were prospectively enrolled in the study. An outcome questionnaire documenting symptoms with a visual analog scale (VAS) was used. The questionnaire was filled out preoperatively and at 7 to 10 days and 3 and 12 months postoperatively. At 1 year the questionnaire also included a general health assessment and quality of life index. Demographic data and follow‐up blood work was obtained. Descriptive statistics, parametric comparisons (t‐tests, ANOVA), and nonparametric comparisons (Mann‐Whitney U‐test) were calculated. The HPT group demonstrated a significant decrease in reported symptoms between the preoperatively assessment and 7 to 10 days after operation (p < 0.001). There were no further statistically significant decreases in the HPT group's symptoms at 3 and 12 months, but there was a trend for these symptoms to decrease over time. HPT patients perceived a 60% increase in their general health at 1 year; the comparison group perceived no increase. There was no significant change in the symptoms reported by the comparison group between each of the study intervals. Surgical intervention on HPT patients significantly reduces preoperative symptoms, and this reduction is most marked within the first 10 days after surgery.
Clinicopathologic and Immunohistochemical Studies of Papillary Thyroid Microcarcinoma Presenting with Cervical Lymphadenopathy
Authors: Sugitani Iwao , Yanagisawa Akio , Shimizu Akira , Kato Mitsuyasu , Fujimoto Yoshihide 
Published: August 2002

AbstractAlthough most papillary thyroid microcarcinomas (PMCs) are of little clinical significance, patients with PMCs occasionally have an unfavorable outcome, especially when they present with bulky nodal metastasis or distant metastasis. We have attempted to identify “high‐risk” PMCs by evaluating clinical, pathologic, and immunohistochemical prognostic factors. Among 190 patients with a PMC, 156 without clinically apparent nodal metastasis had a benign course. The remaining 34 patients, who presented with cervical lymphadenopathy of at least 1 cm, were studied. Three of the four patients who developed distant metastasis died of the disease, and the other died of local recurrence. All patients who developed distant metastasis or died of the disease had both nodal metastasis of at least 3 cm and a nonencapsulated type of primary lesion. All patients who developed distant metastasis showed both extracapsular extension of the metastatic lesions in lymph nodes and positive staining for transforming growth factor‐β3 (TGFβ3) (a potent growth inhibitor) in the primary lesion. The Ki‐67 (an indicator of cell proliferation) labeling indices in the primary and metastatic nodal lesions of patients who died of cancer were significantly higher than those of the others with nonfatal disease. None of the patients showed P53 (nuclear tumor‐suppressor phosphoprotein) overexpression. In conclusion, patients with PMC who have both 3 cm or larger lymphadenopathy and a nonencapsulated type of primary lesion may be regarded as high‐risk patients. Immunohistologic positivity for Ki‐67 and TGFβ3 in cancer cells is a potential indicator of aggressively malignant PMC.
Biliopancreatic Diversion
Authors: Scopinaro Nicola , Adami Gian Franco , Marinari Giuseppe M. , Gianetta Ezio , Traverso Enrico , Friedman Daniele , Camerini Giovanni , Baschieri Giorgio , Simonelli Alessandro 
Published: August 2002

AbstractBiliopancreatic diversion (BPD) has made reacceptable the malabsorptive approach to the surgical treatment of obesity. The procedure, in a series of 2241 patients operated on during a 21‐year period, caused a mean permanent reduction of about 75% of the initial excess weight. The indefinite weight maintenance appears to be due to the existence of a threshold absorption capacity for fat and starch, and thus energy, and the weight loss is partly due to increased resting energy expenditure. Beneficial effects other than those consequent to weight loss or reduced nutrient absorption included permanent normalization of serum glucose and cholesterol without any medication and on totally free diet in 100% of cases, both phenomena being due to a specific action of the operation. Operative mortality was less than 0.5%. Specific late complications included anemia, less than 5% with adequate iron or folate supplementation (or both); stomal ulcer, reduced to 3.2% by oral H2‐blocker prophylaxis; bone demineralization, increasing up to the fourth year and tending to decrease thereafter, with need of calcium and vitamin D supplementation; neurologic complications, totally avoidable by prompt vitamin B administration to patients at risk; protein malnutrition, which was reduced to a minimum of 3% with 1.3% recurrence, in exchange with a smaller weight loss, by adapting the volume of the gastric remnant and the length of the alimentary limb to the patient's individual characteristics. It is concluded that the correct use of BPD, based on the knowledge of its mechanisms of action, can make the procedure an effective, safe one in all hands.
Socioeconomic Aspects
Authors: Rutkow Ira M. 
Published: August 2002

AbstractMost surgeons conceptualize “surgical advance” as the introduction of a new operative technique or the presentation of a technologic breakthrough. However, the true landmark innovations of the past decade, with regard to effecting surgical health care delivery, have been the impact of economics and sociology in determining the profession's future. In the past, the surgeon's primary interests revolved around the art and science of surgery, and socioeconomic issues were deemed of secondary importance. Consequently, few of the investigations into “surgical socioeconomics” were conducted by surgeons, and the surgical establishment was more than mildly apathetic toward such social science research. All of this has changed, and it is now evident that there is an overwhelming need for surgeons to incorporate an understanding of sociologic and economic conditions into their clinical thinking. Basic tenets of surgical socioeconomics are presented, and their impact on various clinical situations is discussed.
Surgical Stress Response: Does Endoscopic Surgery Confer an Advantage?
Authors: Kehlet Henrik 
Published: August 2002

Abstract“Open” surgical procedures are followed by profound changes in endocrine metabolic function and various host defense mechanisms, impaired pulmonary function, and hypoxemia. These physiologic changes are supposed to be involved in the pathogenesis of postoperative morbidity. Endoscopic surgery, mostly studied during laparoscopy, when compared with similar open operations, has no important effects on classic endocrine metabolic responses but may slightly reduce inflammatory responses and various immune functions, although the data are not consistent. In contrast, most data show improvement of postoperative pulmonary function and less hypoxemia with endoscopic operation. The slight modification of surgical stress responses by endoscopic surgery is in contrast to the common, though not universal, demonstration of less pain, shorter hospital stay, and less morbidity after endoscopic surgery. In conclusion, endoscopic surgery has so far not been demonstrated to have important modifying effects on classic endocrine metabolic responses and only a slight inhibitory effect on various inflammatory responses, but with improved pulmonary function and less hypoxemia. More data are needed from major operations where differences are more likely to be found. The clinical consequences of these findings in relation to allover surgical outcome remain to be defined, but effective pain treatment, stress reduction by other techniques, and provision of an active rehabilitation program with early mobilization and oral feeding may be more important than the choice between an endoscopic technique versus “open” operation per se to improve outcome.
Endoscopic Surgery: What Has Passed the Test?
Authors: Köhler L. 
Published: August 2002

AbstractThe use of endoscopic surgery has increased in gastrointestinal surgery since the introduction of laparoscopic cholecystectomy. It was the aim of this study to investigate the impact of endoscopic procedures in 1998. Laparoscopic cholecystectomy, fundoplication, repair of perforated peptic ulcer, gastric banding procedure, sigmoid resection for diverticulitis, and ileal pouch–anal anastomosis were investigated using techniques of technology assessment. Feasibility, efficacy, and effectiveness were used to evaluate the different types of operation. The statements were graded by three categories of evidence. Laparoscopic cholecystectomy and fundoplication have passed the test. Laparoscopic repair of perforated duodenal ulcer, gastric banding for morbid obesity, and sigmoid resection for diverticulitis are feasible and efficient but not effective today. Laparoscopy‐assisted ileal pouch–anal anastomosis has been shown to be feasible but is not yet efficient and effective.
Pancreatic Biopsy: Why? When? How?
Authors: Ihse Ingemar , Axelson Jan , Dawiskiba Sigmund , Hansson Lars 
Published: August 2002

Abstract.For final diagnosis of pancreatic cancer histologic or cytologic confirmation is needed. Tissue or cell material can be achieved by percutaneous puncture as part of the preoperative workup. During operation core‐needle, incisional, and wedge biopsies or fine‐needle aspiration cytology (FNAC) can be chosen. Sensitivity and diagnostic accuracy are high for both histologic and cytologic examinations, and false‐positive results are exceptional, giving a specificity of 100% in most published series. The complication rate is low, also for knife biopsies in recent reports, provided biopsy of seemingly normal tissue is avoided. Percutaneous puncture is currently restricted to patients found to have advanced disease and who are not candidates for laparotomy. Microscopic confirmation is required in all patients in whom chemotherapy, radiotherapy, or both are planned. However, for attempted radical surgery per se, biopsy is not mandatory if the clinical suspicion of cancer is high and the surgical team has documented low postoperative mortality and morbidity rates.
Outcomes Research: What to Measure
Authors: Wright James G. 
Published: August 2002

Abstract.Surgeons assess the outcomes of treatment to determine if treatment is effective. The most commonly used types of outcomes have been measures of disease process (or impairment measures) because surgery is often directed toward ameliorating abnormalities of structure or function. Patient‐based outcomes, such as measures of health or health‐related quality of life, are necessary, however, to determine if patients have been made better by treatment. Disease‐specific measures of health focus specifically on those aspects of the disease of most concern to patients, whereas generic measures of health and health‐related quality‐of‐life measures have a much broader focus. Patient satisfaction is an additional increasingly used outcome measure. Satisfaction may be directed toward the processes of care or the outcomes of care. Satisfaction with the outcomes of care is an important secondary outcome provided the aims of treatment have been achieved and the health of patients has been improved. In conclusion, different outcomes of treatment provide different and complementary information and all have a role to play in deciding if surgical treatments are effective.
Pylorus‐preserving Total Pancreatectomy for Pancreatic Cancer
Authors: Sugiyama Masanori , Atomi Yutaka 
Published: August 2002

AbstractStandard total pancreatectomy (TP) combined with gastric resection often results in uncontrollable diabetes and malnutrition. Pylorus‐preserving total pancreatectomy (PPTP) and standard TP for pancreatic cancer were compared in terms of operative outcomes, nutritional recovery, and long‐term survival. Twenty‐four patients with pancreatic ductal adenocarcinoma (n= 14) or intraductal papillary mucinous carcinoma (N = 10) underwent PPTP (n= 10) or standard TP (n= 14). There were no significant differences in age, gender, or tumor type or stage between the PPTP and standard TP groups. Early (within 30 days of surgery) morbidity and mortality rates were 20% and 0% for PPTP and 29% and 7% for standard TP, respectively. Delayed gastric emptying occurred in 2 patients in each group. The incidence of late complications, including uncontrollable diabetes, diarrhea, and malnutrition, tended to be lower after PPTP (30%) than after standard TP (69%). Serum albumin and body weight at 6 months after surgery were significantly higher in the PPTP than in the standard TP group. Regardless of the tumor type, long‐term survival did not differ significantly between patients receiving PPTP and those with standard TP. PPTP for pancreatic cancer improves nutritional recovery, without compromising long‐term survival, compared with standard TP.
Therapeutic Splenectomy in Immune Thrombocytopenic Purpura
Authors: Wani Nazir A. , Parray Fazal Q. 
Published: August 2002

AbstractThe effects of splenectomy in 41 patients managed from 1982 to 1995 at Sher‐i‐Kashmir Institute of Medical Sciences, Srinagar (Jammu and Kashmir), India, were studied. Immune thrombocytopenic purpura (ITP) was the main indication for therapeutic splenectomy among all the hematologic disorders. The mean age was 30 years (range 7–64), and the male to female ratio was 1.05:1. The mean platelet count in the preoperative period was 31,751/mm3 (range 4000–85,000). All patients presented with thrombocytopenia, i.e., platelet count of <100,000/mm3. In addition, 5 patients presented with anemia, i.e., Hb <10 g%. Among the patients with thrombocytopenia, 30 patients presented with counts <50,000/mm3 and 11 patients presented with counts between 50,000–100,000/mm3. None of the patients presented with leukopenia. The morbidity observed was 15% and mortality was 2%. The response to splenectomy was complete for thrombocytopenia in 3 patients and partial in 5 patients; 4 patients failed to show any response. In anemic patients, 4 patients showed complete response and 1 patient showed no response. The prognosis was excellent in patients with platelet count >50,000/mm3, age <50 years, no concomitant disease, and disease of shorter duration.