bluuebunny/crossref_metadata_2025_split huggingface dataset:
Liver injuries
Authors: Kovic M. , Prinicic J. , Pegan V. , Bedencic N. , Gadzijev E. 
Published: May 2005

AbstractIn Yugoslavia, liver injuries are still the most frequent indications for liver surgery. From 1975 through 1979, a total of 75 patients with liver injuries were treated operatively; 69 (92%) were caused by blunt and 6 (8%) by sharp trauma.In minor liver ruptures, we removed the devitalized liver tissue by means of the finger‐fracture technique with ligation of blood and bile vessels. After removing the devitalized area, we left the liver widely open and drained with Penrose drains. In major or deep liver ruptures, we performed resection of the affected liver lobes or segment. We always drained the common bile duct with a T‐tube to obtain postoperative information on either patency or leakage from the biliary tree. This procedure has always been free from complications.We performed a resection in 21 patients (28%); of these 4 had a segmentectomy; 3, an atypical resection; and 14, a formal resection. The ages of the patients ranged from 5 to 71 years. After resection, 3 patients died.Seven patients had trauma restricted to the liver, 16 sustained injury to the liver and spleen, and 52 presented with trauma involving the liver and two or more other organs. Injury was further complicated by liver abscess in 7 patients (9.3%), hemobilia in 9 patients (12%), and bile leakage in 2 patients (2.6%). Eight patients (10.6%) required repeated surgery for bleeding and 3 (4%) developed hepatic coma. Forty‐six patients (61.3%) were free of any complications. Mortality was 24%, 18 of 75 patients treated.
Experience with a new device for colostomized patients: External magnetic ring
Authors: Desaive C. J. , Louis J. C. 
Published: May 2005

AbstractIn this paper we have examined the preliminary results concerning a new covering device for colostomies. This device can only be used for end colostomies, provided that the stoma is flat and its diameter is less than 3 cm. The magnetic ring proved to be light, flexible, discreet, and very effective on odor and noise prevention. The adhesive part can be left in place for several days and permits colostomy washouts or the use of colostomy bags.
Pathophysiology of acute pancreatitis
Authors: Trapnell John E. 
Published: May 2005

AbstractLocal parenchymal damage in acute pancreatitis has been well recognized for many years. This damage leads to a considerable leak of extracellular fluid and so to gross hypovolemia. It also produces the pain that is a major clinical feature of the disease. More recently, the autodigestive process has been recognized to generate, within and around the gland, a “broth” of many components that is vasoactive and tissue destructive and which, in turn, produces systemic changes. These changes affect the whole body and may lead to multiorgan damage. The coagulation mechanism, heart action, peripheral resistance, liver function, as well as the lungs, kidneys, brain, and endocrine homeostatic mechanism are all affected; these patterns and their clinical implications are reviewed. When this multisystem failure occurs in its severest form, the patient may best be described as in a state of “enzymic shock.” This hypothesis is not just of academic interest; it provides a working concept upon which to base a more scientific treatment of acute pancreatitis.
Hemodynamic and metabolic impairment in acute pancreatitis
Authors: Di Carlo Valerio , Nespoli Angelo , Chiesa Roberto , Staudacher Carlo , Cristallo Marco , Bevilacqua Giuseppe , Staudacher Vittorio 
Published: May 2005

AbstractTwenty‐one patients with acute pancreatitis underwent evaluation of cardiovascular function and oxygen consumption; 5 of those who were critically ill had a further study of hormonal metabolism. The evaluation of hemodynamic parameters was made using a computer‐based cardiovascular program developed by Siegel et al. During the initial phase of the disease a reduction in vascular tone (relating cardiac index with total peripheral resistance) represented the basic abnormality seen in all patients, while a depression in ventricular function (relating left ventricular stroke work with central venous pressure) was observed in more than 40% of patients. With the progression of pancreatitis, cardiovascular monitoring identified a time, 5 days after admission, in which a clear deterioration of the hemodynamic parameters occurred. Beyond 5 days, all patients developed a hyperdynamic state with mild to severe deficiency of oxygen extraction. In the most seriously ill patients, oxygen consumption fell and peripheral shunting increased in a similar manner to that observed in septic and cirrhotic patients. At this time a Survival Index permitted recognition of those patients at high risk of rapid deterioration who might benefit from emergency surgical therapy. In 5 patients who developed a hyperdynamic unbalanced state, a marked reduction in oxygen consumption was associated with significantly increased serum levels of insulin, glucagon, aromatic amino acids, octopamine, and phenylethanolamine. While false neurotransmitters may be invoked in explanation of peripheral vascular abnormalities, the cause of impairment in oxygen extraction remains unclear.
Role of surgery in the management of acute pancreatitis
Authors: Hollender L. F. , Meyer C. , Marrie A. , da Suva E. Costa J. , Castellanos J. Garcia 
Published: May 2005

AbstractThree important aspects of the surgical therapy of acute pancreatitis are discussed: the time at which operation appears to be indicated, the procedure to be chosen (in accord with operative findings), and the results. After initial medical treatment, the timing of intervention should be based on clinical and biological information. Classification of acute pancreatitis in 3 degrees of severity may facilitate the decision. When edematous pancreatitis is found, irrigation and drainage are indicated. For distal necrosis, a left or subtotal pancreatectomy should be carried out. Necrotic lesions of the isthmus should be excised locally; if necessary, local isthmus excisions may be combined with left pancreatic resection. Resections of the head of the pancreas have been abandoned because of their high mortality rate; intervention is now limited to local excision of necrotic tissue (necrosectomy), with drainage and irrigation. In all cases, complementary biliary drainage by choledochostomy or at least cholecystostomy, drainage of areas of necrosis, and gastric suction are also mandatory. Forty‐nine patients who were operated upon according to these principles with a mortality rate of 36.7 % are discussed.
Importance of peritoneal irrigation after surgical treatment of hemorrhagic, necrotizing pancreatitis
Authors: Gebhardt Christoph , Gall Franz P. 
Published: May 2005

AbstractThis is a report of 139 patients with hemorrhagic, necrotizing pancreatitis, 135 of whom were operated upon. The poorest results (mortality rate of 64%) were found in patients with total necrosis of the gland, while partial necrosis of the pancreas had a better outcome (33% mortality rate). The most favorable form of therapy was either local excision of necrotic pancreatic tissue (necrosectomy), or left resection of the pancreas, combined with postoperative irrigation and sump drainage of the peritoneal cavity. With this technique, the mortality rate of 72% seen with drainage of the peritoneal cavity alone was reduced to 33%.
Management of complications after operations for acute pancreatitis
Authors: Kümmerle Fritz , Neher Manfred 
Published: May 2005

AbstractAfter early operation in 49 patients and delayed operation in 114 patients, all with acute hemorrhagic‐necrotizing pancreatitis, 65% of patients developed local or general complications. Local complications were abscesses, peritonitis, bleeding, gastrointestinal fistulae or stenoses, and external pancreatic fistulae. Their cause can be traced to the large wound cavity with the tryptic wound surface as well as residual necrosis. The general postoperative complications were shock, acute renal failure, cardiorespiratory insufficiency, gastrointestinal bleeding, ileus, coagulopathy, and sepsis. These may have resulted from the local complications, or may even have been present before operation. If local septic complications do not respond to conservative treatment, they require reoperation. For gastrointestinal fistulae or stenoses, or for pancreatic fistulae, a “wait and see” attitude is recommended. Generalized complications call for aggressive intensive medical care.Despite the frequency of postoperative complications, the total mortality rate in our series was 30% in patients with partial pancreatic necrosis operated on early, and in patients who received delayed operations for acute hemorrhagic‐necrotizing pancreatitis. The 74% mortality rate in early operations of subtotal and total pancreatic necroses was admittedly high. Operative results in those patients who were under our care from the beginning, however, were more encouraging (mortality rate of 50%) and demonstrate that the correct treatment for severe acute hemorrhagic‐necrotizing pancreatitis is surgery.
The natural history of chronic leg ischemia
Authors: McGrath Michael A. , Graham Antony R. , Hill David A. , Lord Reginald S. A. , Tracy G. Douglas 
Published: May 2005

AbstractThe onset of leg ischemia may be sudden or gradual, occurring over a wide age spectrum and as a result of multiple causes. The clinical outcome is extremely variable, and only about 1 patient in 8 will progress to the stage of ischemic gangrene. Many patients have the capacity to show marked clinical improvement, or to maintain a comfortable life with claudication that is not severely disabling.Of over 2,000 patients referred to a vascular unit, only about 30% required operative intervention. Rigorous conservative measures should be given a trial for at least 3 months in all patients except those whose limbs are severely threatened, since that period of time is necessary to judge the capacity for spontaneous improvement, before the patient is subjected to the invasive technique of aortography.A flow chart of management decisions is suggested for patients with intermittent claudication.
Limb ischemia caused by small artery disease
Authors: Porter John M. , Taylor Lloyd M. 
Published: May 2005

AbstractThe pathophysiology and clinical manifestations of limb ischemia due to small artery diseases are reviewed, based on records from over 400 patients who were examined since 1971. Details of prospective clinical, laboratory, and angiographic evaluation and long‐term follow‐up are presented. The predilection of small artery diseases for the upper extremity remains unexplained. Preliminary results with the use of nifedipine for chronic treatment of vasospastic symptoms are reported.
Acute lower limb ischemia: Pathogenesis and management
Authors: Lusby Robert J. , Wylie Edwin J. 
Published: May 2005

AbstractAcute lower limb ischemia continues to be a problem both in diagnosis and management. The high mortality rate appears to be related to the metabolic consequences of ischemia, a function not only of time, but also of severity. The etiology of acute ischemia is reviewed along with the pathophysiological response. The management of the patient centers on diagnosis of cause and estimation of the severity of ischemia. Correction of metabolic disturbances and early restoration of flow is the preferred treatment, although there remains a place for late operative intervention in patients with less severe symptoms. Despite improved diagnostic and operative techniques, the thrombotic and metabolic changes that occur in the small vessels and muscular tissues appear to limit the success rate, with mortality rates remaining around 25%.
Surgery or cimetidine? I. Comparison of two plans of treatment: Operation or repeated cimetidine
Authors: Andersen Daniel , Amdrup Erik , Sørensen Finn Hanberg , Jensen Kurt Birger 
Published: May 2005

AbstractThe aim of this study was to compare the effect of 2 different treatment plans on the definitive treatment in a group of duodenal ulcer patients with symptoms severe enough to indicate surgery after pre‐cimetidine criteria.The patients were randomized to either 8 weeks of cimetidine 1 g per day followed by operation in case of symptomatic recurrence, or to repeated 8‐week courses of cimetidine 1 g a day in case of recurrence. Many patients wanted to change their treatment plan, which was allowed and used as evidence of their value judgments.After 3 years the cumulative operation rate was 74% in the Full dose/Stop cimetidine group and 60% in the Repeated cimetidine group. During the first year the probability of operation was highest in the group with only 1 course of cimetidine, but after this time the patients came to surgery with equal probabilities. Eight percent of the patients had no relapse and, therefore, had not undergone surgery after 3 years.The study suggests that patients with severe ulcer disease usually have to undergo surgery, even after the advent of cimetidine, but surgery is delayed. It makes little difference whether cimetidine is offered once or in several courses. The economic consequences of the 2 schemes are very similar. Intermittent treatment with cimetidine, thus, cannot be expected to have much influence on the indications for surgery in severe duodenal ulcer disease. All patients should have 1 course of cimetidine, but additional courses make no material difference in the end result and usually can be avoided.
Surgery or cimetidine? II. Comparison of two plans of treatment: Operation or cimetidine given as a low maintenance dose
Authors: Andersen Daniel , Amdrup Erik , Sørensen Finn Hanberg , Jensen Kurt Birger 
Published: May 2005

AbstractThe aim of this study was to compare the effect of 2 therapeutic schemes on the final treatment of patients with duodenal ulcer disease severe enough to indicate surgery. One group was randomized to cimetidine 1 g/day for 8 weeks and operation was suggested in case of symptomatic recurrence. The other group was given a prophylactic dose of cimetidine 400 mg at night after the full‐dose course and operation was suggested in case of symptomatic recurrence during the maintenance treatment.The study showed that cimetidine on a long‐term basis substantially reduced the tendency to symptomatic recurrence of duodenal ulcer. The effect on the operation rate, however, was rather modest and was in essence a postponement rather than a prevention. In regard to ability to reduce the number of patients operated on, the result of maintenance therapy was very similar to the result seen in a previous study on intermittent courses of cimetidine.This and our earlier study suggest that operative treatment will still be the choice of the majority of patients with severe duodenal ulcer disease, and that neither intermittent nor continuous cimetidine treatment will radically change this. An important effect of cimetidine is that some patients can be treated without operation because of very long remissions, and that other patients in a high‐risk group can be kept on cimetidine. The value judgment of patients may, however, change with time, because medical treatment will decrease the symptomatic strain on the future ulcer patients as compared to patients remaining from the precimetidine era.
An interim report of a prospective, randomized, controlled study of adjuvant chemotherapy in operable gastric cancer: British stomach cancer group
Authors: Fielding J. W. L. , Fagg S. L. , Jones B. G. , Ellis D. , Hockey M. S. , Minawa A. , Brookes V. S. , Craven J. L. , Mason M. C. , Timothy A. , Waterhouse J. A. H. , Wrigley P. F. M. 
Published: May 2005

AbstractA prospective, randomized, controlled study of adjuvant chemotherapy in operable gastric cancer was commenced in 1976. Four hundred and eleven patients have been randomized into 1 of 3 treatment groups. Group A received a placebo injection of intravenous normal saline (10 ml) at 3‐week intervals. Group B received a 5‐day induction course of 5‐fluorouracil (5‐FU), vincristine, cyclophosphamide, and methotrexate followed by 3‐week intravenous injections of 5‐FU and mitomycin C (MMC). Group C received 3‐week intravenous injections of 5‐FU and MMC. The treatment was to be given for 2 years. Patients were stratified for age, sex, preoperative duration of symptoms, and clinicopathological stage prior to randomization. At this interim analysis, preoperative duration of symptoms and clinicopathological stage were statistically significant prognostic factors (p=<0.05 and <0.001, respectively).At the time of this analysis, there has been no significant improvement in survival in either of the treatment groups compared to the control group. While treatment could begin at any time during the first 3 postoperative months, survival at 1 year was significantly improved (p=0.013) by treatment C in those who started treatment within 1 month of surgery; however, this benefit of treatment was not maintained at 3 years. Of the 279 deaths, 16 (5.7%) have been drug‐related, 11 resulting from renal toxicity associated with this therapeutic regimen.This study has confirmed the poor prognosis of gastric cancer, and the early results demonstrate that there is no place for the use of cytotoxic agents in this disease outside prospective controlled studies.
Determinants of optimal results after ileoanal anastomosis: Anal proximity and motility patterns of the ileal reservoir
Authors: Schraut Wolfgang H. , Rosemurgy Alexander S. , Wang Chen‐Hwu , Block George E. 
Published: May 2005

AbstractEnd results after ileoanal anastomosis with a proximal ileal reservoir range from defecatory frequency to obstruction. To define the physiological (reservoir compliance, motility) and anatomical (reservoir design, anal proximity) determinants of the varying clinical outcome, we placed an S‐shaped (SS‐R) or double‐barreled (DB‐R) reservoir in comtinuity with the anus in dogs, either directly or via 2‐cm or 6‐cm ileal conduits.Because of increased compliance, either reservoir provides for fecal storage, prolongs intestinal transit time, and alleviates the defecatory frequency seen after direct ileoanal anastomosis. Electromyography and manometry revealed that repetitive, simultaneous peristaltic contractions of the 2 and 3 ileal limbs forming the DB‐R and SS‐R, respectively, are required to generate the intraluminal pressure waves necesssary to promote complete reservoir evacuation. Such simultaneous contractions occur less often in the SS‐R than in the DB‐R. Therefore, the SS‐R develops into an inert, obstructing viscus within 6 months, which is not seen with the peristaltically stronger DB‐R. Ileal conduits facilitate reservoir placement; but, when longer than 2 cm, they impede reservoir evacuation and predispose to obstruction.We conclude that, in contrast to the SS‐R, the DB‐R has physiological characteristics (compliance yet contractility) that allow normal bowel habits, but only if it is placed in anatomical proximity to the anus.
Thromboembolic complications from central venous catheters: A comparison of three catheter materials
Authors: Efsing Hans Olof , Lindblad Bengt , Mark Joakim , Wolff Tomas 
Published: May 2005

AbstractIn this comparative study of catheter materials used in central venous catheterization (CVC) into large veins, the overall frequency of CVC‐induced thrombosis was 12%. A 20% incidence of CVC‐induced thrombosis with siliconized polyethylene catheter, 9% with Teflon® catheter, and 6% with heparinized polyethylene catheter was seen. Thrombosis thus was significantly less common with Teflon® and heparinized polyethylene than with siliconized polyethylene (p<0.05). Repeat arm phlebography was performed in 15 patients and revealed no late formation or progression of thrombosis. Pulmonary embolism appeared in 2 patients and was fatal in one of them.
A unifying concept of polymorphonuclear neutrophil function in acute bacterial infection
Authors: Krukowski Z. H. , Smith G. 
Published: May 2005

AbstractAlteration in neutrophil function during bacterial infection has been variously reported as either increased or decreased depending on the parameter measured, the technique used, and the nature of the infection. The chemotaxis, phagocytosis, and intracellular killing of neutrophils from 2 groups of patients were studied in an attempt to clarify the possible changes during bacterial infection. Chemotaxis was measured with the “leading front” modification of the Boyden micropore technique, and phagocytosis and intracellular killing with a simplified scheme for the interpretation of bactericidal activity. Patients with moderate bacterial infection had increased chemotaxis, phagocytosis, and intracellular killing. Patients with severe infection and toxic changes in the neutrophils had decreased chemotaxis, phagocytosis, and intracellular killing. A unifying concept for the explanation of the observed changes in neutrophil function is proposed.
Recurrence after proximal gastric vagotomy for gastric, pyloric, and prepyloric ulcers
Authors: Heberer G. , Teichmann R. K. 
Published: May 2005

AbstractResults after proximal gastric vagotomy (PGV) with ulcer excision for gastric ulcer type I (according to Johnson) show recurrence rates similar to those for duodenal ulcer. In the European Multicenter Trial with 71 patients, symptomatic recurrence was 7.9% at 5 years and the total recurrence (including asymptomatic recurrences) was 17.5%. Recurrent ulcers are mainly gastric ulcers. Treatment of recurrence is, initially, always conservative with antacids or H2‐receptor blockers. From 19 patients with recurrent ulcer after PGV with ulcer excision for gastric ulcer type I reported from 3 prospective trials, 12 were managed conservatively. The operative procedure of choice for recurrence was partial gastric resection with a Billroth I or Billroth II reconstruction. Favorable results for this type of gastric ulcer after PGV may be explained by maintenance of gastric continence for solids, reduction of duodenogastric reflux and of postoperative gastritis. Preoperatively and intraoperatively, malignancy has to be excluded by multiple biopsies and frozen sections. Combined gastric and duodenal ulcers (gastric ulcer type II) may also be treated by PGV in controlled trials so that more data will be available for that rare type of ulcer. Recurrence rates after PGV for pyloric and prepyloric ulcers (gastric ulcer type III) are significantly higher than those for gastric ulcer type I or duodenal ulcers. After 5 years, recurrence rates of 16.4–35% are reported. This may be due to gastric retention, which is a common feature in patients with prepyloric ulcers. In fact, selective gastric vagotomy and drainage or vagotomy and antrectomy give significantly better results. The operation rate for recurrent ulcers after pyloric and prepyloric ulcers following PGV is about 25% because of pyloric stenosis. It is concluded that PGV and ulcer excision seem to be suitable for gastric ulcer type I and probably for type II. Pyloric and prepyloric ulcers should no longer be treated by PGV alone because of high recurrence rates. A drainage procedure should be added. In general, the operation should be performed by experienced surgeons since recurrence rates depend on the number of surgeons involved in clinical trials.