bluuebunny/crossref_metadata_2025_split huggingface dataset:
Multiple neuroectodermal abnormalities in pheochromocytoma patients
Authors: Jansson Svante , Tisell Lars ‐Erik , Hansson Göran , Stenström Gunnar 
Published: May 2005

AbstractA series of 80 consecutive pheochromocytoma patients operated on from 1956 to 1985 were investigated for other neuroectodermal abnormalities. Such abnormalities were found in 23 (29%) patients. Medullary thyroid carcinoma was the most common associated neuroectodermal abnormality followed by von Recklinghausen's neurofibromatosis. Other abnormalities were intracranial tumors, midgut carcinoid, and parathyroid hyperplasia. All 6 patients with multiple pheochromocytomas had other neuroectodermal abnormalities. In the total series, the 14 patients with hereditary disease had multiple neuroectodermal abnormalities (MNA). Hypertension occurred significantly less often in MNA patients (p<0.05). All the MNA patients had benign adrenal pheochromocytoma. In 7 of 9 normotensive patients, pheochromocytoma was suspected because of the presence of other neuroectodermal abnormalities. None of these 9 patients had any cardio‐ or cerebrovascular complications, but these occurred in 22% of the hypertensive patients. No patient in the series died from pheochromocytoma, but 4 of 5 deceased MNA patients died as a result of their associated neuroectodermal disease. During the last decade, 40% of the pheochromocytoma patients had MNA diagnosed compared to 20% during the previous period. An increased observation for other neuroectodermal abnormalities in pheochromocytoma patients and for pheochromocytoma in patients with neuroectodermal abnormalities should lead to earlier diagnosis and a better prognosis for the patients concerned.
The pathophysiology of enterocutaneous fistulas
Authors: Fischer Josef E. 
Published: May 2005

AbstractThe patient with an enterocutaneous fistula represents a high‐risk situation with overall mortality rates of up to 20%, depending on the series. Treatment of these patients to a successful outcome requires attention to detail and, if necessary, meticulous operative technique.For convenience, care of these patients is divided into 5 phases:
Stabilization. Resuscitation with crystalloid colloid and/or blood. Drainage of only obvious abscesses. Beginning of local wound care. Initiation of nutritional support.
Investigation. Radiographic investigation of local fistula area, principally by sinography and, if necessary, other contrast studies. Purpose of these studies is to determine likelihood of spontaneous closure with nutritional support.
Decision. Is operation indicated and, if so, when? A decision must be made as to the necessity for operative closure in situations in which the fistula appears anatomically favorable but shows no signs of closure.
Definitive therapy—either spontaneous closure or operation. If the latter, careful preparation is required. Resection and end‐to‐end anastomosis gives the best results.
Healing phase. Nutritional support should not be discontinued too soon for fear of breakdown of newly laiddown protein.
With experience and proper management, relatively high success rates can be achieved.
Alimentary tract fistula: Stomatherapy techniques of management
Authors: Devlin H. Brendan , Elcoat Catherine 
Published: May 2005

AbstractSkin care of enterocutaneous fistulas is demanding but rewarding work, and there is considerable benefit if these cases are referred to centers in which the interests and skills are already developed. Management must include nutritional support, skin care, and morale improvement. The details of the principles of skin care are outlined in this report. The variety of materials utilized in stoma care and indications and instructions for their utilization are discussed.
Operative strategy in the treatment of enterocutaneous fistulas
Authors: Hill Graham L. 
Published: May 2005

AbstractAn overall plan for the management of patients with enterocutaneous fistulas is presented. It comprises 4 sequential but frequently overlapping stages which include control of the fistula output, drainage of sepsis, intravenous nutrition, and excision of the fistula if there is no spontaneous closure.When the fistula persists, radiological investigations usually reveal the cause, and definitive surgery is required. This is conducted 6–8 weeks after all signs of sepsis have gone and the patient has been restored to nutritional health. For fistulas of the distal duodenum, jejunum, and ileum, the surgical procedure is a radical one involving complete dissection of the entire small intestine, resection of the segment of bowel involved, and primary anastomosis. Occasionally, especially when there has been abdominal irradiation, it is not possible to excise the diseased bowel, and bypass is preferred. Fistulas of the second part of the duodenum are treated by the serosal patch technique in which the jejunal wall is sutured directly to the opening of the fistula.Surgery is also often required early in the course of treatment when abscesses are drained and proximal diversion (with or without excision of the involved segment of bowel) may be required to control the fistula output. Definitive surgery at this stage frequently results in recurrence of the fistula and carries a high mortality rate.
Postoperative liver insufficiency: Prevention and management
Authors: Bismuth H. , Houssin D. , Mazmanian G. 
Published: May 2005

AbstractPostoperative hepatic insufficiency is a rare cause of liver failure. Consequences of this usually predictable complication can be limited by appropriate preventive measures and careful postoperative management. This report reviews the current experimental and clinical literature with regard to postoperative hepatic insufficiency.
Acute pancreatitis after cardiac transplantation
Authors: Adiseshiah M. , Wells F. C. , Cory‐Pearce R. , Wallwork J. , English T. A. H. 
Published: May 2005

AbstractThree cases of acute pancreatitis, which occurred in the early postoperative period after heart transplantation, are reported. This represents an incidence of 10% of a total of 30 cases. The disease was relatively mild and the serum amylase not grossly elevated. The diagnostic importance of laparotomy is stressed.
Effect of trauma on malaria infection
Authors: Aina A. Olufemi 
Published: May 2005

AbstractSpecific malaria antibody concentrations in the sera of Nigerian patients were estimated before and after elective surgery by the microplate version of the enzyme‐linked immunoabsorbent assay (ELISA). Parasitized erythrocytes per 100 leukocytes in Leishman‐stained tail blood smears were also counted on the pre‐ and early post‐trauma days in traumatized and non‐traumatized (control) laboratory mice previously inoculated withPlasmodium berghei malaria parasites.On the 1st, 2nd, and 3rd postoperative days, specific malaria antibody levels in the sera of Nigerian patients were significantly depressed (p<0.02;p<0.01;p<0.001, respectively) while parasitemia was significantly elevated in laboratory mice with fractured femur (p<0.02;p<0.01;p<0.05, respectively).Increased susceptibility to malaria after severe injury is suggested.
The radiocephalic fistula as vascular access for chemotherapy
Authors: Wobbes Theo , Slooff Maarten J. H. , Lichtendahl Dagna H. E. , Vriesendorp Robert , Mulder Nanno H. 
Published: May 2005

AbstractIn 110 patients 127 radiocephalic arteriovenous fistulas were performed as vascular access for chemotherapy. If patients did not receive cytostatic agents prior to the operation or were treated for less than 4 weeks, the success rate of the operation was 75%. If chemotherapy was administered for longer than 4 weeks, it was possible to construct a functioning fistula in only 28% of patients. The radiocephalic arteriovenous fistula is considered to be a convenient access for chemotherapy provided the operation is performed before the start of the treatment.
Preoperative transhepatic biliary decompression in pancreatic and periampullary cancer
Authors: Ellison E. Christopher , Van Aman Michael E. , Carey Larry C. 
Published: May 2005

AbstractPancreatic resection for pancreatic and periampullary cancer between 1969 and 1975 at The Ohio State University Hospitals had an associated operative mortality rate of 30% and a morbidity rate of 80%. Transhepatic biliary decompression (THD) has been accepted as a method of preoperative risk reduction in the deeply jaundiced patient and an alternative to surgical biliary decompression. The use of preoperative THD in pancreatic and periampullary cancer was examined. Of 44 patients with bilirubin greater than 10 mg/100 ml, 17 had radical resection (THD=7, no THD=10), and 27 had palliative operation (THD=17, no THD=10). Preoperative serum bilirubin in the THD group was 7.3±1.0 compared to 16.3 ±1.5 in the no THD group (p< 0.05). Operative morbidity rate was: radical surgery: THD (40%), no THD (70%); palliative surgery: THD (18%), no THD (20%). Operative mortality rate was: radical surgery: THD (28%), no THD (60%); palliative surgery: THD (6%), no THD (0%). Catheter‐related complications were minimal. Preoperative THD tends to reduce the risk of curative resection for pancreatic and periampullary cancer, but does not alter the outcome of palliative surgery. Long‐term THD may be an alternative if palliative surgical biliary decompression either fails or is not technically possible in the patient with unresectable cancer.
Cancer of the pancreas: Palliative operation, Whipple procedure, or total pancreatectomy
Authors: Longmire William P. 
Published: May 2005

AbstractCurrent reviews of the treatment of cancer of the pancreas, most of which evaluate cases treated in the past one or two decades, continue to present discouraging results. The advantages and disadvantages of performing a resection must be carefully evaluated for each patient. The dilemma of resection should be discussed with the patient before operation and when capable he or she should influence the decisions the surgeon anticipates facing during the operation. Pancreatoduodenectomy is the treatment of choice for carefully selected cases of carcinoma of the head of the pancreas and other periampullary carcinomas. Total pancreatectomy has not, at this point, been shown to provide sufficient advantages to warrant routine adoption as the treatment of choice when resection is to be performed.
Surgical treatment of pancreatic cancer
Authors: Kümmerle F. , Rückert K. 
Published: May 2005

AbstractFrom 1964 to 1982, there were 782 patients treated for carcinoma of the pancreas. In 174 patients pancreaticoduodenal resection was possible (22%). Until 1977 we performed Whipple procedures, while from 1978 to 1982 total pancreatectomy was preferred. Comparing the results of both methods, we did not find any advantages of total pancreatectomy. Operative mortality did not decrease, survival time did not extend, and the higher resection rates (up to 26%) for more advanced tumor stages were accompanied by greater morbidity. With respect to the patients with inoperable cancer of the pancreas, we found over the last 5 years that the rate of those not undergoing surgery has climbed from 8% to 25%, while the rate of exploratory laparotomies was reduced from 28% to 5%. With the advent of preoperative percutaneous transhepatic cholangio‐drainage (PTCD), the mortality rate of our palliative procedures dropped to 12%. Biliodigestive anastomosis of choice is the hepaticojejunostomy.
Pancreatoduodenectomy with preservation of the pylorus
Authors: Braasch John W. , Gongliang Jin , Rossi Ricardo L. 
Published: May 2005

AbstractWe report 45 consecutive pylorus‐preserving pancreatic resections performed from September, 1979, to August, 1983, for chronic pancreatitis or a variety of periampullary malignancies without an operative death. Of these, 36 patients had pancreatoduodenectomy with pancreatic anastomosis. The most common cause of postoperative morbidity was delay in gastric emptying, which extended beyond 10 days in 13 patients. Twenty‐eight patients could be evaluated for digestive function. Of these, 2 had mild dumping symptoms, and 14 required pancreatic exocrine supplements. A marginal ulcer developed in only 1 patient and was successfully treated by histamine H2‐receptor blockers. Food capacity was normal in 23 of 28 patients and 50–90% of normal in 5. A mean body weight of 93% of pre‐illness weight and 106% of preoperative weight had been regained. Ten of 11 patients with adenocarcinoma of the pancreas were dead of disease (median survival, 12 months), but 19 of 20 other patients with other periampullary malignancies were alive and free of disease up to 42 months postoperatively. Pylorus‐preserving pancreatectomy is the operation of choice for most lesions requiring removal of the periampullary area.
Intraoperative radiation therapy for patients with pancreatic carcinoma
Authors: Shipley William U. , Tepper Joel E. , Warshaw Andrew L. , Orlow Erica L. 
Published: May 2005

AbstractThe results of treatment with intraoperative and external beam radiation for patients with carcinoma of the pancreas are presented. Among patients treated with125I implants for localized unresectable disease, local control rates ranged from 67% to 93% and median survival ranged from 7 to 12 months. In a series using intraoperative electron beam boosts, a 59% local control rate with a median survival of 16 months was achieved. Good palliation rates were achieved, although a high proportion of fatal complications occurred in one125I series. Less promising results were seen in patients receiving intraoperative radiation following resections, with a local control rate of 50% and a median survival of 7 months in a series of 10 patients.
Malignant islet‐cell tumors of the pancreas
Authors: Thompson Norman W. , Eckhauser Frederic E. 
Published: May 2005

AbstractAlthough malignant islet‐cell tumors are uncommon, they are an important group of pancreatic neoplasms because appropriate treatment can often result in effective palliation even though cure is infrequent. In general, these tumors are relatively slow growing so that a combination of surgical and chemotherapeutic measures may prove very beneficial. In some patients with tumors hypersecreting insulin, gastrin, glucagon, or vasoactive intestinal polypeptide (VIP), the hormonal effects of the neoplasm can be life‐threatening. Surgical treatment must, therefore, consider both the functional and malignant characteristics of the individual tumor. In many patients with functional tumors, surgical debulking of the primary tumor may be indicated even when a curative resection cannot be accomplished. Some malignancies may be cured by an appropriate pancreatic resection even when peripancreatic lymph nodes are already involved. Although a Whipple procedure is not indicated when hepatic metastases are present, this procedure may cure tumors localized to the pancreatic head and/or peripancreatic lymph nodes. Because hepatic metastases are usually multiple and involve both lobes, liver resections, other than wedge excisions of peripherally located functional metastases, are not indicated. Malignant nonfunctioning islet‐cell tumors are probably best treated with systemic or regional chemotherapy when metastatic. Surgical resections or bypass procedures may be infrequently useful in those cases in which the primary tumor causes either duodenal or bile duct obstruction. The most effective methods used to control hepatic metastases are systemic and hepatic arterial chemotherapy. An alternative is selective hepatic artery embolization. Recently, an implantable hepatic arterial infusion pump has been used with encouraging results in this group of patients. The chemotherapeutic agents that have been most effective in the treatment of hepatic metastases include streptozotocin, DTIC, and fluorouracil.
The future in treatment of pancreatic cancer
Authors: Dietzen Charles D. , Cohn Isidore 
Published: May 2005

AbstractThe mortality rate for pancreatic cancer continues to rise. Despite advances in surgery, radiotherapy, and chemotherapy, the survival rate remains dismal. Future treatment will depend on further epidemiologic, diagnostic, and pathologic studies, as well as controlled clinical trials. Application of new areas of oncologic research to pancreatic cancer is a worthwhile endeavor. Promotion, publication, and dissemination of such research on pancreatic cancer are the goals of the National Pancreatic Cancer Project.
Radiothallium scintigraphy in solitary nonfunctioning thyroid nodules
Authors: Höschl R. , Murray I. P. C. , McLean R. G. , Choy D. , Indyk J. S. 
Published: May 2005

AbstractThe role of radiothallium201Tl chloride scintigraphy was evaluated in 117 patients with solitary thyroid nodules, demonstrated as nonfunctioning with99mTc pertechnetate, and in which histologic diagnosis was obtained. The nodules were malignant in 25 patients and benign in 92. In an attempt to improve the initial diagnostic discrimination between malignant and benign lesions, the degree of accumulation of201Tl by the nodule was assessed semiquantiatively. The uptake was graded by comparing the accumulation by the nodule with that in the paranodular tissue (PN) (1‐absent; 2‐minimal uptake but lower than in PN; 3‐uptake equal to PN; 4‐mildly preferential uptake in comparison with PN; 5‐markedly increased uptake). None of the patients with grade 1 or grade 2 uptake had malignant disease. Of 25 patients with histologically confirmed cysts, 21 had uptake of grade 1 and 4 of grade 2. Benign adenomas (67 patients) were associated with all grades, 45% having grade 3 uptake. Uptake of201Tl in malignant lesions was in all instances at least equal to paranodular tissue or higher (grades 3–5). The incidence of malignancy was 17% in grade 3, 15% in grade 4, and 67% in grade 5 uptake. It is considered that thallium scintigraphy is not by itself a definitive investigation for thyroid cancer but, since the predictive value of malignancy with strict decision threshold (grades 1–4 considered normal and grade 5 abnormal) is 67%, and predictive value of a negative test is 90%, the procedure does have a useful role in investigation of nonfunctioning solitary thyroid nodules either by heightening the suspicion of malignancy or by indicating a very low probability of malignant change.
The use of PMMA beads in recurrent high anal fistula: A preliminary report
Authors: Kupferberg Arie , Zer Michael , Rabinson Souzane 
Published: May 2005

AbstractFive patients with recurrent high anorectal fistula, in which traditional methods had failed to give complete recovery, were successfully treated by a new technique consisting of partial excision of the fistula, insertion of PMMA beads (Septopal®) and primary closure of the wound, followed by gradual removal of the beads, beginning 7 days after operation and extending over at least 3 weeks (partly on an ambulatory basis). In all these patients, there was eventual complete healing of the problematic fistula. This safe, easily performed method is recommended as being a useful means for combating infection, making possible complete healing, and preventing future recurrence in similar challenging cases.
Repair of ventricular septal defects
Authors: Doty Donald B. , Lamberth Wade C. 
Published: May 2005

AbstractPrimary closure of large ventricular septal defects was performed in 57 patients ranging in age from 1 to 24 months during an 11‐year period. Weight of patients ranged from 2.5 to 12.2 kg (mean, 6.6±0.9 kg). Shunt flow was large with mean Qp/Qs, 3.5±0.5. It was possible to close the defect by the transatrial approach in 86% of patients using a prosthetic patch attached to the ventricular septum by continuous polypropylene suture (89%). Early mortality of 5% and late mortality of 2% and excellent functional results in 93% suggest that this approach is appropriate.
Obstructions to left ventricular outflow
Authors: Weldon Clarence S. 
Published: May 2005

AbstractModern techniques of cardiopulmonary bypass combined with methods for myocardial protection make the conventional operations of prosthetic patch aortoplasty, aortic valvotomy, and transvalvular resection of subaortic membranes dependable and accurate procedures which can provide the obliteration or successful reduction of systolic gradients with rare mortality or morbidity. Sonography provides a technique for the diagnosis of critical aortic stenosis in the newborn, permitting expeditious surgical intervention, while prostaglandin therapy provides a technique for the restoration of systemic blood flow and the reversal of acidemia in preparation for surgical intervention. Hypothermic techniques provide protection of ischemic myocardium which is thought to be a principal cause for earlier failures in the management of critical aortic stenosis. An appreciation that critical aortic stenosis need not be cured but only relieved for infant survival has led to the application of dilatation techniques using mechanical dilators and angioplasty balloon catheters. Successful repair of such complex malformations as atrioventricular septal defect, aortic arch interruptions, and the coarctation syndrome in the neonate has uncovered a variety of new fibrous, muscular, and fibromuscular left ventricular outflow tract obstructions which appear to be acquired and progressive and not solely congenitally determined. Sonography provides a technique for the detection and the serial assessments of these lesions. Radical operative approaches have been devised for enlarging, reconstructing, exposing, and replacing the left ventricular outflow tract. These operations, which have thus far found their principal use for the relief of complex and combined left ventricular outflow tract obstructions in older children and for reoperations on the left ventricular outflow tract, will achieve a fuller potential when the procedures are miniaturized and adapted to the use in surgery of the neonate and young infants.
Valve replacement in children
Authors: Elliott Martin J. , de Leval Marc 
Published: May 2005

AbstractWith increasing experience in the surgical management of children with congenital heart disease has come an increasing use of prosthetic valves. They have been employed in a wide variety of conditions ranging from simple congenital stenosis or incompetence to an essential part of repair of more complex disorders. As in adult cardiac surgery, there has been considerable debate over the exact prostheses that should be used in individual circumstances. As we point out in this article, experience has varied both geographically and with time. Our own experience at Great Ormond Street, for example, has been of initial satisfaction with results of mechanical valves followed by enthusiasm for, sequentially, the Hancock and the Ionescu prostheses. Now we have turned full circle and predominantly use mechanical valves, primarily owing to the extraordinary incidence of premature, degenerative calcification of bioprosthetic valves in children. The exact rates of degeneration of these valves are variable; thus it is difficult to relate prosthesis survival to the growth rate of the child. The experience with homograft valve replacements is encouraging, since they do not seem to degenerate so rapidly. Valve replacement in children carries a high risk. The younger the child, the higher the risk, with mitral valve replacement being the most dangerous procedure of all. We conclude that valve replacement in children is a procedure that should not be taken lightly and for which, at present, mechanical valves offer the best prognosis, despite the small risk of anticoagulation.