bluuebunny/crossref_metadata_2025_split huggingface dataset:
Systemic antibacterial mechanisms in trauma
Authors: MacLean Lloyd D. 
Published: May 2005

AbstractHost defense mechanisms are cell‐ mediated, humoral and phagocytic. Acquired derangements of one or many of the immune antibacterial defenses are common after injury. These defects include (a) a failure of T‐ cell response (DTH) to antigen stimulation manifested by negative skin test reactions to common antigens (anergy); (b) a failure of humoral response, or B‐ cell depression after appropriate antigen stimulation; and (c) development of serum inhibitors of phagocyte chemotaxis.Anergy reflects an immunodeficiency state more profound than impaired T‐ cell function alone and, if left uncorrected, is associated with a markedly increased incidence of sepsis and associated mortality. Therapeutic implications of these findings for now and the future are summarized.
Selective mesenteric vein catheterization and plasma serotonin determination in patients with carcinoid tumors
Authors: Nobin Anders , Axelsson Sture , Falck Bengt , Ingemansson Stig , Lunderquist Anders , Mårtensson Hans , Reichardt Wolfgang 
Published: May 2005

AbstractSelective abdominal vein catheterization with blood sampling for serotonin determination was evaluated regarding its use in the diagnosis, location, and characterization of carcinoids. Serotonin was determined in a platelet‐poor plasma fraction (PPP) by an enzymatic procedure.In 5 normal subjects the concentration of serotonin in PPP in the celiac artery, the hepatic vein, and different intestinal and pancreatic veins ranged from 1.2 to 5.4 ng/ ml. In 10 patients with carcinoid tumors, the concentration of serotonin in tumor‐draining veins was clearly elevated and ranged from 10 ng/ml to 88 ng/ml PPP. 5‐HIAA urine levels were false‐negative in 4 cases, liver scintiscan was false‐negative in 3 cases, and the angiograms were not conclusive in 2 cases.The technique with plasma serotonin determination in combination with selective catheterization is a useful complement to other investigative techniques in the diagnosis, location, and follow‐up of patients with carcinoid tumors.
Abdominoperineal excision of the rectum: A prospective study based on a standardized method
Authors: Liavåg Ivar , Roland Magne 
Published: May 2005

AbstractA prospective and consecutive series of 72 patients with rectal carcinoma was subjected to excision of the rectum. The operations were performed according to a standardized program based on previous studies and established surgical principles:Two days on a liquid diet, laxative, and enemas.Irrigation of the pelvic cavity with 5 liters of saline solution after removal of the specimen.Leaving the pelvic peritoneum unsutured.Obliteration of the presacral cavity with living omentum, uterus, or small intestine.Suprapubic, closed suction drainage.Primary closure of abdominal and perineal wounds without drainage.Antibiotic prophylaxis against aerobic as well as anaerobic bacteria.Parenteral nutrition from the first postoperative day and until the bowel acts properly.Two patients died postoperatively (3%), and 93% achieved primary healing of the perineal wound.
Abnormal sex‐steroid milieu in young adults with hepatocellular carcinoma
Authors: Malt Ronald A. , Galdabini James J. , Jeppsson Bengt W. 
Published: May 2005

AbstractFive of 7 patients in the age group 20–30 years treated for hepatic cell carcinoma during the past 15 years had an endogenous or exogenous disturbance of gonadal function. The 2 men were taking methyltestosterone. Two of 5 women had taken long courses of oral contraceptives; a third had Stein‐Leventhal syndrome; one woman was infertile for 18 months. Fibrolamellar‐variant carcinomas were present in 4 women and a trabecular‐variant carcinoma in one. Stopping methyltestosterone or oral contraceptives and performing a major hepatectomy apparently cured 3 patients. Although the data are consistent with a role for sex steroids in some cases of hepatic carcinogenesis, a casecontrol study would be necessary to eliminate chance concurrence of fibrolamellar‐variant cancer in the age group most likely to be taking oral contraceptives or to be concerned about infertility.
Localization of the antral‐corpus boundary in proximal gastric vagotomy: An experimental comparative study
Authors: Ramos Carlos Martinez , Pelayo Adela , de Vega Damaso S. , Jerez L. , Cazenave E. , Pardo Pilar , Nuñez J. R. , Tamames S. 
Published: May 2005

AbstractA comparative, experimental study has been done in which 3 methods were utilized to determine the macroscopic antral corpus boundary in proximal gastric vagotomy: anatomical references (A.R.), pHmetry, and Congo red (C.R.). Acute experiments were done on 10 dogs in which, after stimulation of the gastric secretion with 6 pg/kg of pentagastrin intravenously, the macroscopic antral‐corpus boundary was determined at the level of the lesser curvature of the stomach using the 3 methods. At the same time a series of specimens of gastric mucosa was obtained along the whole of the lesser curvature, to determine the relation between these macroscopic results and the microscopic limit.The results indicate that the A.R. gave an average error of 0.20±0.47 cm in relation to the microscopic limit, which was not significant (p>0.30). The average error produced by pHmetry was 1.45±0.36 cm, and that obtained with C.R. was 2.25±0.72 cm, which were both statistically significant (p<0.001). If these results are contrasted 2 by 2, it is found that the error with A.R. is significantly less than with pHmetry and with C.R. (p< 0.001). Likewise, the error with pHmetry is significantly less than with C.R. (p<0.05).We conclude that the determination of the macroscopic antral‐corpus boundary in proximal gastric vagotomy should preferably be done using anatomical references, since this procedure is the most precise in relation to the microscopic line and is also the easiest to perform.
Villous adenoma of the stomach
Authors: Herrington J. Lynwood , Powell Stephen , Granda Antonio 
Published: May 2005

AbstractVillous adenomas are common neoplasms in the rectum and distal colon. They occur less frequently in the remainder of the gastrointestinal tract but irrespective of location are associated with a high malignant potential. The stomach is an unusual site of involvement and only approximately 100 cases have been recorded. Gastric villous lesions may be multiple and may coexist with an independent gastric carcinoma or be associated with neoplasms elsewhere in the gastrointestinal tract.Gastric villous tumors demonstrate carcinomatous changes in from 25 to 72% of cases, and complete surgical removal is mandatory for cure. Since preoperative endoscopic frozen section examinations and frozen section studies at operation are unreliable in detecting carcinomatous changes, the surgeon may be faced with a difficult decision in choosing the proper operative procedure. Lesions located in the proximal stomach pose a more difficult problem in surgical judgment than do distally located lesions, particularly when multiple frozen section studies fail to reveal malignant features and yet the possibility of carcinoma exists. Such a case is described and the operative approach is outlined.
Pulmonary edema: Current concepts of pathophysiology, clinical significance, and methods of measurement
Authors: Demling Robert H. 
Published: May 2005

AbstractBy definition, pulmonary edema is simply excess fluid in the lung. The distribution of the fluid dictates the clinical significance of the edema. As far as a mechanism of edema formation, microvascular hydrostatic pressure remains the predominant Starling force. The lung interstitium is a major factor in determining both the amount of edema formed as well as the distribution. Increased permeability edema, with a more peripheral distribution of fluid as seen in the adult respiratory distress syndrome, may well be the result of interstitial matrix and basement membrane changes rather than simply more holes in the endothelial membrane. The significance of the edema, again, depends on its distribution, with perihilar interstitial fluid being much less significant than alveolar flooding. The relevance of the measurement of lung water, therefore, is dependent as much on where the water resides as on the absolute amount. The clinical applicability of methods that do not give information on distribution, therefore, is dependent on the clinician's understanding of the differences in distribution with various disease states and, therefore, the importance of the water in producing the pulmonary abnormalities.
The hypermetabolism organ failure complex
Authors: Cerra Frank B. 
Published: May 2005

AbstractMultisystem organ failure remains the predominant cause of death in the surgical intensive care unit. What used to be thought of as isolated organ failure, such as adult respiratory distress syndrome, is now seen as part of the systemic response to injury and of a systemic injury and repair process. Sepsis has become the systemic inflammatory response to invading microorganisms; the same response is now recognized after severe perfusion deficits and in the presence of continuing sources of dead and injured tissue. Once present, the organ failure syndrome continues to have a high mortality rate. From a treatment perspective, it is being recognized that there is probably no “magic bullet”; that regimens will probably be time‐dependent and “multiple‐drug”; and that the best treatment is prevention. Malnutrition, as a distinct entity from the changes in body composition that occur as a result of disease process, has become a recognized co‐factor in patients with persistent hypermetabolism. In addition, the metabolic processes of hypermetabolism have become increasingly well defined and understood. The result of these 2 processes has been the development of metabolic support principles that are distinct from those of nutritional support and are designed to prevent the end‐organ changes of malnutrition, prevent the development of substrate‐limited metabolism, to support organ structure and function, and to arrest the metabolic processes. The current state of the art has been to learn to do no harm, an outcome reasonably achieved. In addition, several beneficial results have been recognized, including new substrate techniques to better support total body protein synthesis, hepatic protein synthesis, and energy production. Techniques to better support organ structure and function are currently being tested. No techniques are currently available to control proteolysis and the redistribution of skeletal muscle nitrogen. A great deal of research is necessary in this field which is still in its infancy.
Corticosteroids, nonsteroidal anti‐inflammatory drugs, and naloxone in the sepsis syndrome
Authors: Long William M. , Sprung Charles L. 
Published: May 2005

AbstractCorticosteroids have proven to be effective as adjunctive treatment in sepsis and severe typhoid fever when used early and in high doses. If corticosteroids are given in high doses (30 mg/kg), they should be administered in 1–2 doses, and not to exceed 4 total doses within 24 hours. The efficacy of the drug may be diminished in more severe sepsis, but use of corticosteroids in severe sepsis may delay death. If the benefit of corticosteroid use in late sepsis is only to prolong impending death, then steroid administration is probably futile; however, the alternative view is that corticosteroid use may constitute one step in a series leading to shock reversal and recovery. Risks and benefits of corticosteroid use should be tailored to the individual patient with consideration given to the nature and extent of the underlying disease. Although the pathophysiology of the sepsis syndrome remains elusive, new therapeutic regimens may evolve using nonsteroidal anti‐inflammatory drugs and neuropeptide antagonists. As with corticosteroids, their application before or early after the onset of shock appears more beneficial; however, the patient population that will benefit most from treatment with these drugs remains, for the most part, unidentified, and more clinical trials are needed.
Prevention of postoperative wound infection after appendectomy by local application of tinidazole: A double‐blind study
Authors: Eklund Anders ‐Erik , Tunevall T. Göran 
Published: May 2005

AbstractThe effect of local application of tinidazole on wound infection rates has been studied in 510 patients undergoing acute appendectomy. Patients with perforation of the appendix were not included in the study. After suture of the peritoneum, the exposed tissues were washed with 200 ml of tinidazole solution 2 mg/ml or, in control cases, with the same amount of saline solution. The study was prospective, controlled, and double‐blind. The total number of postoperative wound infections was 3.5% (18 patients). Among 116 patients with gangrenous appendicitis, a significant reduction of postoperative wound infections was observed in the group given tinidazole prophylaxis (p=0.02). The infection rates observed were 2.0% in the treatment group and 13.8% in the control group. The costs for prophylactic tinidazole to avoid 1 infection was estimated at 568 Swedish kronor (SEK) ($73, U.S.) while every infection gives rise to an extra cost of 10,100 SEK ($1,295, U.S.). Local application of tinidazole in cases of gangrenous appendicitis thus proved to be highly cost‐effective.
Cancer of the thyroid in youth
Authors: Buckwalter Joseph A. , Gurll Nelson J. , Thomas Colin G. 
Published: May 2005

AbstractThis is a review of 68 patients 20 years of age and younger with well‐differentiated carcinoma of the thyroid seen at the University of North Carolina Memorial Hospital and University of Iowa Hospital since 1935. These patients are included in the Thyroid Carcinoma Registry that provides continuing follow‐up of all patients with carcinoma of the thyroid at these 2 hospitals. The historical, clinical, laboratory, and surgical pathological findings in these 68 patients, their treatment, and survival are reported. Comparisons are made with findings in the 486 patients 21 years of age or older with well‐differentiated carcinoma of the thyroid seen during the same time. The most striking finding of this clinical investigation is that only 1 of the 68 patients, followed up for as long as 30 years, has died as a result of the well‐differentiated thyroid carcinoma. There was a history of irradiation to the head or neck, 28% of patients younger than 15 years of age, 15% of those 15 to 20 years of age, and 6% of patients older than 21 years. The results of this study reaffirm the conclusion that the treatment of well‐differentiated carcinoma of the thyroid in young patients as in older patients is empirical. Our experience suggests that the surgical approach should be determined by the biologic aggressiveness of the disease. Lobectomy, including isthmusectomy, is performed for well‐circumscribed lesions less than 2 cm in diameter in the absence of lymph node metastases. Near total thyroidectomy is advised in the presence of unilateral disease and ipsilateral lymph node metastases. Total thyroidectomy is performed for multifocal disease, when required to remove gross neoplasm, with bilateral lymph node metastases, and with follicular carcinoma in the presence of metastatic disease. Thyroid hormone therapy is used prophylactically. Radioiodine is advised for inoperable, residual, or recurrent disease.
TSH suppression in the management of thyroid nodules and thyroid cancer
Authors: Clark Orlo H. 
Published: May 2005

AbstractClinical and experimental data concerning TSH suppression, by giving exogenous thyroid hormone, in patients with goiter and in patients with thyroid cancer show a beneficial effect. In the goiter patients, TSH suppressive therapy seems most effective in young patients with diffuse or newly discovered goiters, in hypothyroid patients, and in patients with chronic lymphocytic thyroiditis or compensatory thyroid hypertrophy after partial thyroidectomy. With TSH suppressive therapy about 2/3 of thyroid nodules become smaller, but only about 5% to 10% disappear. In patients with differentiated thyroid cancer (papillary, mixed papillary‐follicular, and follicular), tumor recurrence, tumor progression, and long‐term survival all seem to be influenced favorably by TSH suppressive therapy. Experimental investigations demonstrate that both benign thyroid adenomas and differentiated thyroid carcinomas have TSH receptors situated on the plasma membranes. These TSH receptors appear to be coupled to the activation of adenylate cyclase in a one‐to‐one relationship. Experimental and clinical studies strongly support the use of thyroid hormone both for the treatment of patients after thyroidectomy for thyroid cancer and as prophylaxis to prevent the development of thyroid cancer in high‐risk irradiated patients. The dose of thyroxine recommended for adequate TSH suppression is the lowest dose of thyroxine that will completely block the TSH response to TRH (usually 0.2 to 0.25 mg).
Results of surgical treatment of early gastric cancer in 113 patients
Authors: Gentsch Hans H. , Groitl Heiner , Giedl Josef 
Published: May 2005

AbstractFrom 1961 to 1978, 113 patients with early gastric cancer were treated surgically at Erlangen University. The lesions were located in the lower 1/3 of the stomach in 47% of the patients, in the corpus and fundus in 46%, and in the gastric stump after resection in 7%. Surgical techniques included subtotal distal resection, proximal resection, total gastrectomy, local excision and polypectomy, and their use depended on the circumstances. The tumors were classified as intestinal type carcinoma in 71% of patients and diffuse type carcinoma in 29%. The 5‐year survival rates calculated by the actuarial method were 74% (observed) and 87% (age corrected). Tumors in the lower 1/3 of the stomach had a better prognosis than tumors of other regions. Tumors limited to the mucosa had a higher 5‐year survival rate than those with invasion of the submucosa. In Europe, as in Japan, early gastric cancer has a much better prognosis than all other forms of gastric cancer.
Amylase creatinine clearance ratio following biliary tract surgery
Authors: Tonelli Francesco , Senati Emidio , Indinnimeo Marileda 
Published: May 2005

AbstractAn increase in the amylase creatinine clearance ratio (ACCR) is considered to be a more specific diagnostic test of acute pancreatitis than elevation of the serum or urine amylase activity. Simultaneous serum and urine samples for the determination of amylase and creatinine were obtained preoperatively and at various intervals postoperatively in 75 patients undergoing surgery. No increase in ACCR was observed in a control group of 5 patients who underwent extra‐abdominal surgery. ACCR increased significantly following cholecystectomy (40 patients) and sphincterotomy (10 patients), but did not increase in patients in whom cholecystectomy was performed without operative cholangiography and in those who underwent cholecystectomy and prophylactic treatment with Trasylol. Use of a different technique in performing sphincterotomy, probing the papilla and the duct of Wirsung transduodenally, did not lead to a significant difference in the postoperative ACCR increase. The increase in postoperative ACCR was significantly higher in patients who underwent cholecystectomy with sphincterotomy than in those who underwent cholecystectomy alone. Serum amylase levels exceeded the normal range only in a few patients. These results suggest that sphincterotomy and operative cholangiography performed without control of infusion pressure cause an increase in ACCR with values similar to those found in acute pancreatitis. However, damage to the pancreas must be mild since none of the patients developed clinical features of acute pancreatitis.
Idiopathic perforation of the sigmoid colon in Japan
Authors: Kasahara Yoh , Matsumoto Hiroki , Umemura Hiroya , Shirafa Sei , Kuyama Takeshi 
Published: May 2005

AbstractThis is a report of a case of idiopathic perforation of the sigmoid colon, a rare condition, and a review of 65 cases collected from the Japanese literature including our own. The ratio of males to females was 42∶23, the ages ranged from 16 to 87 years, and 68% of the patients were in the sixth decade or older. The perforation sites were in the middle of the sigmoid colon in 43 cases, of which 79% were at the antimesenteric border, and in the rectosigmoid region in 2 cases. Several pathogenetic factors are considered to be responsible for this perforation, among which constipation and raised intra‐abdominal or intraluminal pressure may be most important. In the cases associated with constipation, differential diagnosis must be made by histologic examination. Free air under the diaphragm was noted on x‐ray in 46% of patients and leukopenia under 4000/mm3in 35% of the cases. Only 2 patients with confined perforation were diagnosed preoperatively by barium enema x‐rays. The overall mortality rate was 35%. Exteriorization or resection of the perforated site resulted in the best prognosis among the various operative procedures. There were 5 instances of colocutaneous fistula in 13 patients who underwent simple closure of the perforation.
The problem of classifying obesity
Authors: Scuro Ludovico A. , Bosello Ottavio 
Published: May 2005

AbstractThe numerous attempts to classify obesity demonstrate the difficulty of grouping the obesity syndrome into a single schema. The criteria can be subdivided into 3 groups: the first based on etiology and pathogenesis; the second based on clinical observation, anthropomorphic measurements and adipose tissue histology; and the third based on psychological and nutritional behavior, and environmental elements. The etiological classification subdividing obesity into genetic, hypothalamic, nutritional, physical inactivity, and endocrine groups is important because it best approximates the clinical reality of obesity.Recently acquired knowledge about adipose tissue cellularity and its metabolism has become important for clinical classification of the different types of obesity. Now we can divide obesity into hypertrophic (the weight of the adipocite increases), hyperplastic (only the number of adipose cells increases), and combined (number and weight of adipocite increase). Pure hyperplastic obesity is rarely found, while combined obesity is more frequent; the hypertrophic form is associated with obesity arising in adult life.Considerable information is gained from the study of anomalous nutritional behavior. The excess of food intake has psychologically disparate motivations that are caused by emotional reaction to anxiety‐provoking events or to a developing modification of personality. The first is reactive obesity, the second developmental obesity. However, among the obese there are individuals who have no specific psychological problems and are prompted to hyperfeed by environmental factors. In this case, the term “environmental obesity” is used. As regards a proper therapeutic approach, these distinctions are very important.
Psychological evaluation of extremely obese patients before and after surgical treatment
Authors: Husemann B. , Erzigkeit H. 
Published: May 2005

AbstractThe psychological and psychosomatic status of extremely obese patients were analyzed before and after surgical weight reduction (jejunoileostomy or gastric bypass) by means of questionnaire and interview. Somatic discomfort, disturbances of vegetative functions, and depressive mood can be considered the results of obesity. They improve with weight reduction. However, normal values are not achieved after either jejunoileostomy or gastric bypass. For this reason, weight reduction alone cannot be considered the optimal treatment for obese patients. Additional supportive medical and psychological measures are necessary.