bluuebunny/crossref_metadata_2025_split huggingface dataset:
Role of liver transplantation in the treatment of unresectable liver cancer
Authors: Pichlmayr Rudolf , Weimann Arved , Oldhafer Karl J. , Schlitt Hans J. , Klempnauer Jürgen , Bornscheuer Albrecht , Chavan Ajay , Schmoll Ekkehard , Lang Hauke , Tusch Günter , Ringe Burckhardt 
Published: December 2004

AbstractResection remains the treatment of choice in liver cancer. In order to avoid liver transplantation in conventionally unresectable tumors ex‐situ (“bench” procedure), in‐situ and ante‐situm resection technique should be prefered whenever feasible. Despite the deficiency of donor organs, a single center experience with 198 patients reveals that liver transplantation continues its role as a therapeutic option for selected patients. At present “favorable” indications for transplantation are International Union against Cancer (UICC)‐stage II hepatocellular carcinoma as well as the subtype fibrolamellar carcinoma, uncommon tumors such as epitheloid hemangioendothelioma, hepatoblastoma, and liver metastases from neuroendocrine tumors. Due to unsatisfying results, intrahepatic bile duct‐, stage III and IV hepatocellular carcinoma, hemangiosarcoma, and liver metastases from nonendocrine primaries should be excluded from liver transplantation alone. For these advanced tumors, especially in cases of extrahepatic involvement, a combination of liver transplantation and multivisceral resection has been proven feasible. However, a significant improvement in patient survival may only be expected by currently investigated multimodality treatment protocols which will require further randomized studies.
Cavernous hemangiomas of the liver: Are there any indications for resection
Authors: Farges Olivier , Daradkeh Salam , Bismuth Henri 
Published: December 2004

AbstractA total of 163 patients with cavernous hemangiomas of the liver were managed at Paul Brousse Hospital between 1970 and 1992. The tumor was smaller than 4 cm in 54 patients and larger than 10 cm in 38 patients. The diagnostic sensitivities of the imaging procedures were as follows: ultrasonography 61%; angio‐computed tomography scanning 77%; angiography 85%; magnetic resonance imaging 92%. The tumor was diagnosed during the evaluation of abdominal pain in 87 patients. Forty‐seven patients had associated disorders that proved to be responsible for the symptoms. Fourteen patients with incapacitating symptoms underwent specific treatment of their tumor: resection (n=8), embolization (n=5), or hepatic artery ligation (n=1). Seven of these patients are still symptomatic, indicating that the hemangioma was in fact not responsible for their symptoms. Twenty‐five patients were given oral analgesic medications; in 21 the symptoms diminished or became infrequent. Unresected hemangiomas did not significantly increase in size, nor have they become complicated or symptomatic. These results indicate that resection of liver hemangiomas is rarely required, and such treatment should be carefully balanced against the risk inherent in liver surgery.
Surgical treatment of hepatocellular carcinomas in noncirrhotic liver: Experience with 68 liver resections
Authors: Bismuth Henri , Chiche Laurence , Castaing Denis 
Published: December 2004

AbstractHepatocellular carcinoma (HCC), although generally associated with cirrhosis, can also develop in a noncirrhotic liver. To study HCCs in noncirrhotic liver, their surgical management and prognosis, 68 patients with partial hepatectomy for this disease were analyzed. The liver, in all cases, appeared normal macroscopically at laparotomy, but in 13 cases (19%) it presented some slight histologic modifications, such as steatosis or portal fibrosis. Five patients had a fibrolamellar carcinoma. The mean diameter of the tumors was 8.8 cm. Sixteen patients (23.5%) were treated preoperatively by embolization or chemoembolization. Surgical procedures consisted in a major hepatectomy (three segments or more) in 72% of the cases. Operative mortality and morbidity were, respectively, 2.9% and 19.0%. The 1‐, 3‐, 5‐, and 10‐year survivals and the survivals without recurrence were 74%, 52%, 40%, and 26% and 69%, 43%, 33%, and 19%, respectively. Recurrence, which was in most cases intrahepatic, occurred in 39 of the 66 survivors (59%) and was treated by rehepatectomy in 12 cases, providing long survivals. These data justify extensive, aggressive surgery for HCCs in noncirrhotic liver and show the need for long‐term follow‐up to defect late recurrence, as surgery for recurrent disease prolongs survival.
Treatment of unresectable primary liver cancer: With reference to cytoreduction and sequential resection
Authors: Tang Zhao‐You , Yu Ye‐Qin , Zhou Xin‐Da , Ma Zeng‐Chen , Yang Bing‐Hui , Lin Zhi‐Ying , Lu Ji‐Zhen , Liu Kang‐Da , Fan Zeng , Zeng Zhao‐Chong 
Published: December 2004

AbstractUnquestionably, progress has been made in the early detection and early treatment of primary liver cancers (PLCs), although most remain unresectable, mainly because the cancer is advanced and coexists with liver cirrhosis, particularly in Oriental patients. Thanks to the progress of regional cancer therapy, a multidisciplinary approach, and changing concepts about surgical oncology, it has been proved that some unresectable but not far advanced PLCs are potentially convertible to being resectable, particularly those cancers confined to the right lobe of a cirrhotic liver. A retrospective analysis of 571 unresectable PLCs revealed the following: (1) There was an increase in 5‐year survivals in the series, from 0% during the 1960s (n=61), to 4.8% during the 1970s (n=163), to 21.2% during the 1980s (n=347). It might be a result of the increase in double‐ or triple‐modality treatments in these series (from 9.8%, to 19.6%, to 70.3%, respectively) and in the sequential resection rate after cytoreduction (from 0%, to 2.5%, to 14.7%). (2) The combination of hepatic artery ligation, hepatic artery cannulation and infusion, and intrahepatic arterial radioimmunotherapy has resulted in better shrinkage of the tumor, a higher sequential resection rate, and a higher 5‐year survival (28.2%). (3) Of the 55 patients who had initially unresectable PLCs and yielded “cytoreduction and sequential resection”, the 5‐year survival was 58.5%. It is concluded that cytoreduction and sequential resection might be an important approach to improving the prognosis of patients with unresectable PLCs.
Liver transplantation for hepatocellular carcinoma
Authors: Selby Rick , Kadry Zakiyah , Cari Brian , Tzakis Andreas , Madariaga Juan R. , Iwatsuki Shunzaburo 
Published: December 2004

AbstractTotal hepatectomy plus liver transplantation was performed on 105 patients considered unsuitable for liver resection. Postoperative 5‐year actuarial survivals correlated with the pathologic stage of the tumor: stage I 75%, stage II 68%, stage III 52,1%, and stage IVA 11%. The overall 5‐year survival for all patients was 36%. Nodal disease, bilobar tumor, and macroscopic venous invasion were significant poor‐prognosis features. In addition, 12 patients with pT4N1M0 lesions (also stage IVA) had hepatectomy plus more extensive en bloc regional resection (Whipple procedure or cluster resection) plus transplantation in an effort to prevent local recurrence. Only 2 of these 12 patients (16.7%) are alive and free of disease after 2 years. Seven patients (58%) have died from tumor recurrence usually originating from distant metastases an average of 10.6 months after transplantation. Successful transplantation for hepatoma depends on screening programs to identify early stage disease. Successful outcome of transplantation for late stage disease, which includes most of the patients in our series, awaits the development of neoadjuvant therapy to control distant microscopic metastases, which are almost certainly present though not apparent at the time of transplantation.
Resection of colorectal liver metastases
Authors: Scheele Johannes , Stang Richard , Altendorf‐Hofmann Annelore , Paul Martin 
Published: December 2004

AbstractFrom 1960 to 1992 a total of 1718 patients with liver metastases from colorectal carcinoma were recorded. Of these patients, 469 (27.3%) underwent hepatic resection, which was performed with curative intent in 434 patients (25.3%). Operative mortality in this group was 4.4%, being 1.8% (2 of 114) during the last 3 years. Significant morbidity was observed in 16% of patients with a decrease to 5% (6 of 112) for the last 3 years. A 99.8% follow‐up until November 1, 1993 was achieved. Excluding operative mortality, there are 350 patients with “potentially curative” resection and 65 corresponding patients with minimal macroscopic (n=19) or microscopic (n=46) residual disease. The latter group demonstrated a poor prognosis, with median and maximum survival times of 14.4 and 56.0 months, respectively. Among the 350 patients having potentially curative resection, the actuarial 5‐, 10‐, and 20‐year survivals were 39.3%, 23.6%, and 17.7%, respectively. Tumor‐free survival was 33.6% at 5 years. In the univariate analysis, the following factors were associated with decreased crude survival: presence and extent of mesenteric lymph node involvement (p=0.0001); grade III/IV primary tumor (p=0.013); synchronous diagnosis of metastases (p=0.014); satellite metastases (p=0.00001); metastasis diameter of>5 cm (p=0.003); preoperative carcinoembryonic antigen (CEA) elevation (p=0.03); limited resection margins (p=0.009); extrahepatic disease (p=0.009); and nonanatomic procedures (p=0.008). With respect to disease‐free survival, extrahepatic disease (p=0.09) failed to achieve statistical significance, whereas patients with primary tumors in the colon did significantly better than those with rectal cancer (p=0.04). The presence of five or more independent metastases adversely affected resectability (p<0.05). However, once a radical excision of all detectable disease was achieved, no significant predictive value of an increasing number of metastases (1–3 versus≥4) on either overall (p=0.40) or disease‐free (p=0.64) survival was found. Using Cox's multivariate regression analysis, the presence of satellite metastases, primary tumor grade, the time of metastasis diagnosis diameter of the largest metastasis, anatomic versus nnanatomic approach, year of resection, and mesenteric lymph node involvement each independently affected both crude and tumor‐free survival.
Surgical treatment of cholangiocellular carcinoma
Authors: Pichlmayl Rudolf , Lamesch Peter , Weimann Arved , Tusch Günter , Ringe Burkhardt 
Published: December 2004

AbstractIntrahepatic cholangiocellular carcinoma (CCC) is known to be associated with severe symptoms and a particularly poor prognosis. Nonsurgical methods have failed to change this situation up to now. Surgical therapy, so far, is the only chance for effective treatment, but it has had limited success. The relative infrequency of this tumor does not allow extensive statistics and limits our present knowledge. In this contribution the outcome of 50 patients who underwent liver resection or liver transplantation in our institution is reported. Their courses have been reevaluated according to pathohistologic classification and TNM tumor staging. The median survival rates were 12.8 months in the group of patients after liver resection (n=32) and 5.0 months after liver transplantation (n=18). Liver transplantation, however, was performed only in patients with unresectable tumors. The longest survival after transplantation was 25 months; after resection four patients survived more than 5 years. In the resection group and the transplantation group survival rates correlated with tumor size and tumor stages according to TNM, although the differences were not statistically significant. Liver resection thus has its place in resectable situations. Liver transplantation for unresectable lesions of this tumor type—always deemed critically in the past—seems not to be indicated with our present stage of knowledge, unless adjuvant protocols appear promising and are tested.
Temporary abdominal wall closure in trauma patients: Indications, technique, and results
Authors: Howdieshell Thomas R. , Yeh Karen A. , Hawkins Michael L. , Cué Jorge I. 
Published: December 2004

AbstractFrom 1988 to 1992 more than 5300 patients were admitted to a level I trauma center, with 36 of these patients requiring Silastic abdominal closure. Patients ages ranged from 13 to 75 years with a mean Injury Severity Score (ISS) of 30 (range 13–50). Nineteen patients (53%) suffered penetrating injuries, and 17 (47%) were victims of blunt trauma. Silastic closure was performed at admission laparotomy in 15 patients (42%) due to inability to close the fascia primarily. Twenty‐one patients (58%) underwent Silastic closure at reexploration for inability to close primarily (12 patients), elevated intraabdominal pressure with deteriorating renal function (6 patients), and wound sepsis with fascial necrosis (3 patients). Twenty‐six patients (72%) survived and 10 patients (28%) expired. The causes of death were multiple organ failure (9 patients) and exsanguination (1 patient). Of the 26 survivors, 8 patients (31%) underwent fascial closure at initial hospitalization, and 18 patients (69%) required split‐thickness skin grafting to visceral granulation tissue. Of theses 18 patients, 13 (72%) have already undergone ventral herniorrhaphy at subsequent admission. No patient developed a complication attributable to the technique.
Molecular biology of breast carcinoma
Authors: El‐Ashry Dorraya , Lippman Marc E. 
Published: December 2004

AbstractDuring the last several years basic research has resulted in the identification of many of the factors involved in signal transduction pathways, leading us to a greater understanding of the mechanisms of growth control in breast cancer cells. Many of these factors are the products of proto‐oncogenes or suppressor genes. This review describes the role of some of these factors in breast cancer development, progression, and metastasis and discusses implications for future directions.
Evaluation and management of high risk and premalignant lesions of the breast
Authors: Page David L. , Jensen Roy A. 
Published: December 2004

AbstractSpecific, combined histologic and cytologic patterns of atypical epithelial hyperplasia (AH) in the breast indicate a medically relevant risk of breast cancer development in 5% to 10% of women with otherwise benign biopsies. This risk is four to five times that of similar women without such lesions, that is, women of the same age and at risk for the same period of time. These relative risks are not stable and fall 10 to 15 years after detection, more closely approximating the risks of women of comparable age. Proliferative disease without atypia, no matter how extensive or complex, predicts only a slight elevation of risk, which approaches double that of the reference population. There is a strong interaction of AH with family history of breast cancer in at least a first degree relative. This risk doubles the risk of AH alone and is approximately 20% at 10 to 15 years after biopsy, particularly for women in their forties and early fifties. These considerations are of less clinical importance in women over age 60. Low replacement doses of conjugated estrogen after the menopause do not further elevate risk beyond that identified by histologic patterns. Noncomedo ductal carcinoma in situ may be considered a true precursor lesions; however, it differs significantly in many ways from the more advanced lesion recognized as the comedo type of ductal carcinoma in situ. Small examples of noncomedo ductal carcinoma in situ can eventuate in invasive carcinoma after 6 to 10 years. They may be treated by wide local excision without radiation, with no recurrence up to 8 to 10 years in all likelihood. Ductal carcinoma in situ lesions can be extensive within the breast, and this conservative posture should be reserved for smaller lesions.
Patient selection criteria for conservation surgery versus mastectomy: Memorial hospital breast service experience
Authors: Moore Michael P. , Kinne David W. 
Published: December 2004

AbstractBreast cancer remains the most common noncutaneous malignancy of women. Although the incidence of the disease continues to rise, most women now present with early (stage I or II) disease. Breast conservation has been demonstrated to be equal in efficacy to mastectomy in such patients in six modern‐day randomized trials. The utilization of breast conservation has been slow throughout the United States. At Memorial Hospital the utilization of breast conservation almost equals that of modified mastectomy in the treatment of 950+annual primary operable cancers. Excellent local‐regional control can be obtained with a defined surgical approach to the primary tumor and axillary nodes, radiotherapy to the breast with a boost to the primary site, and finally patient selection.
Conservation approaches for the management of stage I/II carcinoma of the breast: Milan Cancer Institute Trials
Authors: Veronesi Umberto , Luini Alberto , Galimberti Viviana , Zurrida Stefano 
Published: December 2004

AbstractThe most recent analysis of the results of three major trials on breast conservation carried out at the Milan Cancer Institute between 1973 and 1988 showed that breast conservation consisting of a wide breast resection (quadrantectomy) plus radiotherapy is a safe procedure, and that there are no differences in long‐term survival (up to 19 years) compared with women who have undergone Halsted's mastectomy. The studies also showed that reducing the extent of surgery from quadrantectomy to lumpectomy increases the risk of local recurrence by nearly three times, as does withdrawing radiotherapy. However, in women older than 55 years, quadrantectomy alone (without radiotherapy) may yield good results. Among the risk factors for local recurrence, a young age and the presence of an extensive intraductal component are the most significant.
Management of locally advanced breast cancer
Authors: Borgen Patrick Ivan 
Published: December 2004

AbstractThe management of locally advanced breast cancer with single modality therapy has been associated with a high rate of systemic failure. A multimodality treatment strategy that includes induction cytotoxic chemotherapy, surgery, radiation therapy, and, possibly, hormonal ablation therapy is the current preferred management approach. As our knowledge and understanding of the mechanisms involved in mitogenic signal transduction improve, it is likely that less toxic, more effications agents will emerge.
Effects of highly selective vagotomy and additional procedures on gastric emptying in patients with obstructing duodenal ulcer
Authors: Wang Chia‐Siu , Tzen Kai‐Yuan , Chen Pang‐Chi , Chen Miin‐Fu 
Published: December 2004

AbstractA solid gastric emptying study was conducted on 46 patients more than 1 year after highly selective vagotomy (HSV) and additional procedures for obstructing duodenal ulcer and on 21 patients after HSV alone for uncomplicated duodenal ulcer. The additional procedures included dilatation (n=14; HSV+D group), Holle pyloroplasty (n=14; HSV+P group), and Jaboulay gastroduodenostomy (n=18; HSV+GD group). The test meal consisted of two eggs labeled with99mTc sulfur colloid, two slices of white bread toast, and 300 ml of organge juice (total 322 kcal). Gastric emptying curves and emptying parameters (t1/2, half emptying time; lag phase, TLAG; emptying rate, k; and β value) were compared with those of 17 healthy volunteers, the normal control group. The patients after HSV alone had an almost normal gastric emptying. The HSV+D group showed a significant delay from minute 45 to the end of the emptying curve, corresponding to a longer t1/2(p=0.02), and a slower emptying rate (p=0.029). The HSV+P group approached a nearly normal emptying curve, corresponding to an insignificant difference in emptying parameters. The HSV+GD group had significantly faster emptying from minute 15 to the end of the emptying curve, corresponding to a faster t1/2(p=0.0005), a shorter lag phase (p=0.027), and a faster emptying rate (p=0.021). Recurrent ulcerations were noted in one patient (4.8%) of the HSV alone group, five (35.7%) of the HSV+D group, one (7.1%) of the HSV+P group, and one (5.6%) of the HSV+GD group. This study indicates that HSV plus dilatation is not an adequate operation because of the high incidence of delayed gastric emptying and recurrence. Drainage is necessary for prevention of post‐operative delayed gastric emptying after HSV treatment for an obstructing duodenal ulcer. To achieve nearly normal gastric emptying, Holle pyloroplasty is the first choice for drainage. Because of a rare dumping syndrome in our patients, Jaboulay gastroduodenostomy is another choice, if the stenosis cannot be managed easily by Holle pyloroplasty.
Doppler analysis of hepatic blood flow predicts liver dysfunction after major hepatectomy
Authors: Kin Yukoh , Nimura Yuji , Hayakawa Naokazu , Kamiya Junichi , Kondo Satoshi , Nagino Masato , Miyachi Masahiko , Kanai Michio 
Published: December 2004

AbstractIn 17 consecutive patients who underwent major hepatic resection, 9 of whom with combined resection of the gastrointestinal tract or the pancreatic head (or both), postoperative hepatic blood flow was investigated. In this study, the patients were classified into two groups according to their postoperative serum total bilirubin level: Group A comprised 7 patients with the level higher than 7 mg/dl for more than 1 week postoperatively, and group B comprised 10 patients who did not meet this criterion. For 2 weeks after surgery, the portal blood flow velocity, the hepatic artery resistive index (RI) calculated from the changes in Doppler frequency shifts, and the hepatic venous blood flow velocity were measured intermittently using color Doppler ultrasonography. Liver volume was assessed by computed tomography to provide the restoration. Significant differences in portal blood flow velocity and hepatic artery RI were noted between the two groups from the third postoperative day. In group A the portal blood flow velocity decreased below the preoperative value, and the hepatic artery RI increased above 0.75. In contrast, group B showed high portal blood flow velocity and low hepatic artery RI. In both groups the RI correlated significantly with the total bilirubin level (r=0.74; p<0.0001), and the growth rate of the remnant liver was proportional to the mean postoperative portal blood flow velocity (r=0.70; p=0.016). We concluded that measurement of the portal blood flow velocity and hepatic artery RI can be useful for predicting postoperative liver dysfunction and liver regeneration after major hepatic resection.