bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical and Radiologic Treatment of Primary Budd‐Chiari Syndrome
Authors: Pisani‐Ceretti Andrea , Intra Mattia , Prestipino Francesco , Ballarini Carlo , Cordovana Andrea , Santambrogio Roberto , Spina Gian Paolo 
Published: August 2002

AbstractBudd‐Chiari syndrome (BCS) is an uncommon form of portal hypertension caused by obstruction of the hepatic venous outflow. From 1969 to 1997 we treated 19 patients (7 men, 12 women; mean age 37.6 years) affected by primary BCS. In most of the cases no etiologic factors were identified; in the remaining cases the etiology was associated with polycythemia vera, use of oral contraceptives, presence of endoluminal membranes, and repeated episodes of sepsis. Three patients with membranous occlusion of the major hepatic veins were treated by percutaneous placement of a self‐expanding metallic stent inserted via a transjugular or transhepatic approach. The remaining 16 patients underwent a side‐to‐side portacaval shunt, which required interposition of a graft in five cases. In two patients with a significant caval obstruction, a metallic vascular stent was placed in the narrowed tract of the inferior vena cava, before shunting, by means of a transfemoral venous approach. One patient died within the first 30 postoperative days. The 18 survivors were followed for a mean of 66.7 months. The 5‐year survival was 83%. Primary BCS requires different therapies depending on the stage of the disease. The fulminant or chronic forms with irreversible hepatic damage require definitive treatment, such as orthotopic liver transplantation. For the acute or subacute forms, characterized by reversible hepatic injury, a portasystemic shunt represents the most effective treatment. The patients at poor hepatic risk can be treated by interventional radiology. In both cases preliminary caval stenting is necessary if the syndrome is complicated by significant obstruction of the inferior vena cava.
Laparoscopic Cholecystectomy for Cholelithiasis during Infancy and Childhood: Cost Analysis and Review of Current Indications
Authors: Jawad Akram J. , Kurban K. , El‐Bakry Abdulkarim , Al‐Rabeeah Abdullah , Seraj Mohammed , Ammar Adel 
Published: August 2002

AbstractEleven consecutive laparoscopic cholecystectomies (LCs) were performed between January 1994 and June 1996 compared with seven open cholecystectomies (OCs) performed previously at King Khalid University Hospital. The comparison included surgical, clinical, and economic factors, together with a review of the literature. In the laparoscopic group the main indication for cholecystectomy was symptomatic gallstones. Other indications include mucocele of the gallbladder and chronic cholecystitis. A total of eight children in both group had sickle cell disease. The first two LCs were performed in the presence of an experienced laparoscopic surgeon. There is a learning curve to pass through with LC. The operating time for LC ranged between 65 and 135 minutes (mean ± SD 89.81 ± 21.89 minutes). There was no major morbidity or mortality. The average postoperative parenteral analgesia required for LC (50.45 ± 24.57 mg) was significantly less than for OC (135.14 ± 62.02 mg), and the mean length of hospitalization for LC was significantly shorter than that for OC (1.68 ± 0.46 vs. 6.07 ± 0.30) days. Although the average operative cost per LC (2522 SR) was significantly more expensive than for OC (350 SR), the ultimate cost of LC was significantly less than for OC (5790.00 ± 787 vs. 12,343 ± 139 SR) because the total period of hospitalization was much shorter. In conclusion, LC is safe, effective, and less expensive than OC and therefore is the approach of choice for cholecystectomy in children.
Selective Gut Decontamination in Intensive Care and Surgical Practice: Where Are We?
Authors: Ramsay Graham , van Saene Rick H.K.F. 
Published: August 2002

AbstractSelective decontamination of the digestive tract (SDD) has been widely studied in the intensive care setting. Despite the publication of more than 50 controlled trials, it remains a controversial subject, with widely disparate views on the role of SDD. This article reviews the use of SDD primarily by examining the areas of controversy. The published data seem to show clear evidence that SDD can reduce acquired infection during intensive care. Most individual studies have shown no effect on mortality, but meta‐analyses suggest a 10% overall reduction in mortality. Despite the large number of publications to date, there remain several aspects worthy of further study.
Intraoperative Assessment of Intestinal Viability by Laser Doppler Flowmetry for Surgery of Ruptured Abdominal Aortic Aneurysms
Authors: Redaelli Claudio A. , Schilling Martin K. , Carrel Thierry P. 
Published: August 2002

AbstractIschemic colitis is a well known complication following surgery of ruptured abdominal aortic aneurysms, occurring in up to 60% of these patients. It is caused by failure to restore adequate blood flow to the watershed areas of the sigmoid colon. The purpose of this prospective study was to investigate erythrocyte flux to defined areas of the colon immediately after repair of ruptured abdominal aortic aneurysms using laser Doppler flowmetry (LDF) and to determine the critical level of erythrocyte flux below which revascularization of the colon is indicated. A group of 22 patients with a ruptured infrarenal aortic aneurysm in whom the inferior mesenteric artery was ligated at surgery were studied prospectively. Multiple LDF measurements of bowel blood flow (four per bowel segment) were performed on 103 intestinal segments intraoperatively using a Periflux 4001 Master with a PF 415:1 probe. In addition, histologic findings of ischemically injured intestine biopsied at routine postoperative endoscopy or postmortem examination were compared with the LDF records. There was a 41% incidence (9/22 patients) of postoperative colonic ischemia with a significant decrease in colonic erythrocyte flux below 50 perfusion units (PU) intraoperatively in all nine patients (100%). Four patients had transmural colon necrosis, and two patients died, for an overall mortality of 27%. Five patients were identified as having mild or moderate intestinal ischemia and were treated conservatively. Another 14 patients had no clinical or endoscopic signs of ischemic colitis. Erythrocyte flux in those colonic segments were > 50 PU. An intraoperative LDF recording of < 50 PU achieved a sensitivity of 100% (32/32 colon segments) and a positive prediction value of 100% in patients who developed ischemic colitis after surgery for ruptured abdominal aortic aneurysms. The results of this study demonstrate that LDF is a sensitive guide to and feasible method for evaluating critical colonic blood flow during repair of ruptured abdominal aortic aneurysm. The critical level of microvascular perfusion of the colon wall was found to be around 50 PU, below which revascularization of the colon should be considered to reduce the risk of subsequent ischemic colitis.
Palliative Operation for Cancer of the Head of the Pancreas: Significance of Pancreaticoduodenectomy and Intraoperative Radiation Therapy for Survival and Quality of Life
Authors: Ouchi Kiyoaki , Sugawara Tohoru , Ono Hidemaro , Fujiya Tsuneaki , Kamiyama Yasuhiko , Kakugawa Yoichiro , Mikuni Junichi , Yamanami Hideaki 
Published: August 2002

AbstractThe benefits of a palliative operation and intraoperative radiation therapy (IORT) for survival and quality of life (QOL) of patients with cancer of the head of the pancreas are not clear. Survival and hospital‐free survival (HFS), which are considered to be objective indicators of QOL, were studied in 13 patients who underwent palliative pancreaticoduodenectomy (PD) and 32 patients who underwent surgical bypass. Although there was no significant difference in the survival of patients who underwent PD or bypass (median survivals of 9 months and 7 months, respectively), HFS for 3 months or longer was achieved in 84.6% of the patients who underwent PD, which was significantly higher than that of the 53.1% in patients who underwent surgical bypass (p < 0.05). Among TNM stage III patients, a significant difference in survival was observed between surgical bypass associated with IORT and bypass alone (p < 0.05); the median survival time of the IORT group was 10 months, whereas that of the control group was 5 months. In addition, HFS of 3 months or longer was achieved in 83.3% of patients who underwent bypass with IORT but in only 25.0% of the patients who underwent surgery alone (p < 0.01). The addition of IORT to palliative PD neither prolonged survival nor improved HFS. These results show the beneficial effect of palliative PD on QOL, and the efficacy of IORT for survival and QOL was proved in cases with stage III pancreatic cancer who underwent surgical bypass. For patients subjected to palliative PD, however, IORT is not thought to be beneficial for either survival or QOL.
Effect of Pneumoperitoneum Induced by Carbon Dioxide and Air on Tumor Load in a Rat Model
Authors: Lundberg Owe , Kristoffersson Anders 
Published: August 2002

AbstractLaparoscopic surgery for malignant disease is highly controversial mainly due to the large number of abdominal wall metastases being reported. Previous experimental studies have particularly studied CO2 pneumoperitoneum and its effect on tumor development. The purpose of this study was to compare CO2‐ and air‐induced pneumoperitoneum with regard to intraperitoneal tumor growth. Altogether 39 rats were injected intraperitoneally with 105 colonic tumor cells and randomly allocated into three groups: 13 rats had a pneumoperitoneum created with CO2, 13 with air, and 13 served as controls. Tumor development was determined semiquantitatively by a peritoneal cancer index scale after 12 days. CO2 and air pneumoperitoneum equally increased intraperitoneal tumor growth compared to controls. Pneumoperitoneum induced by CO2 and air seems to increase tumor load, but the mechanisms are not established. This finding supports the hypothesis that insufflation not only by causing tumor cell movements but in fact pneumoperitoneum per se and the used gas are involved in the development of abdominal wall metastases after laparoscopic surgery.
2‐Methoxyisobutylisonitrile Probe during Parathyroid Surgery: Tool or Gadget?
Authors: Bonjer H. Jaap , Bruining Hajo A. , Pols Huib A.P. , de Herder Wouter W. , Proye Charles A.G. , Carnaille Bruno M.L. , Mohammedamin Robert S.A. , Steyerberg Ewout W. , Breeman Wout A.P. , Krenning Erik P. 
Published: August 2002

AbstractThe success of parathyroid surgery is determined by the identification and removal of all parathyroid tumors. Parathyroid tumors accumulate and retain 2‐methoxyisobutylisonitrile (MIBI) labeled with technetium‐99m. Intravenous injection of this radiopharmacon prior to parathyroid surgery allows identification of parathyroid tumors with a hand‐held gamma detector. To assess the value of this technique, a case–control study was performed with 62 patient having nuclear‐guided parathyroidectomy and 60 patients having conventional parathyroid explorations. The sensitivity rates of the MIBI probe in single and multiple gland disease were 84.6% and 63.0%, respectively. Rates of success, temporary and permanent hypoparathyroidism, and injury of the recurrent laryngeal nerve were similar in patients who underwent probe‐guided surgery and those who had conventional surgery. In conclusion, although the MIBI probe appears to be a valuable tool in parathyroid surgery, its use has not improved the outcome of such surgery at our institution.
Laparoscopic versus Open Posterior Adrenalectomy: Comparison of Acute‐phase Response and Wound Healing in the Cushingoid Porcine Model
Authors: Kollmorgen Christine F. , Thompson Geoffrey B. , Grant Clive S. , van Heerden Jon A. , Byrne John , Davies Edward T. , Donohue John H. , Ilstrup Duane M. , Young William F. 
Published: August 2002

AbstractThis prospective randomized study examined the acute‐phase response and wound healing, comparing laparoscopic (LA) and open posterior (PA) adrenalectomy in a cushingoid porcine model. Repository corticotropin gel was given to 40 pigs for 21 days. Biochemical and tissue parameters of Cushing syndrome were confirmed. The pigs were randomized to undergo LA or PA. In addition to operating time and morbidity, the acute‐phase response was compared by measuring the postoperative white blood cell count, fasting glucose, C‐reactive protein, and nitrogen balance. Wound healing was assessed by (1) scored (1–4) gross appearance at 48 hours and 1 and 2 weeks; (2) histologic examination; and (3) tensile strength. There was no difference in operating time (mean ± SD) (36 ± 9 minutes open vs. 37 ± 7 minutes laparoscopic), perioperative mortality, degree of leukocytosis, fasting glucose, or C‐reactive protein (p > 0.05). Nitrogen balance, wound scores, and tensile strength at 24 hours and 1 week were more favorable in the LA group than in the PA group (p < 0.05). In the cushingoid porcine model, laparoscopic adrenalectomy was less catabolic and was associated with fewer wound complications than the open posterior adrenalectomy. These findings provide support for continued pursuit of laparoscopic methods for adrenalectomy in the clinical setting.
Vitamin D Receptor Gene Polymorphism and Parathyroid Calcium Sensor Protein (CAS/gp330) Expression in Primary Hyperparathyroidism
Authors: Carling Tobias , Ridefelt Peter , Hellman Per , Juhlin Claes , Lundgren Ewa , Åkerström Göran , Rastad Jonas 
Published: August 2002

AbstractCalcitriol, via its receptor (VDR), inhibits parathyroid hormone (PTH) secretion and cell proliferation. Physically linked polymorphic VDR alleles denoted b,a, and T, comprise a novel risk factor for postmenopausal primary hyperparathyroidism (pHPT) by their presumed coupling to reduced VDR expression. This study examines VDR gene polymorphisms, parathyroid calcium‐regulated cytoplasmic calcium concentrations ([Ca2+]i) and parathyroid expression of a calcium sensor protein (CAS/gp330). Genomic DNA was obtained from 66 postmenopausal women with pHPT and 66 age‐matched female controls. Polymorphic VDR alleles were detected after polymerase chain reaction (PCR) and restriction digestion. Cryosections of pathologic parathyroid glands from 41 of the patients were immunostained with a monoclonal anti‐CAS/gp330 antibody. Homozygosity for the VDR alleles b, a, and T was overrepresented in pHPT (p < 0.01–0.05) but did not couple to ED50 for calcium‐regulated [Ca2+]i. The enlarged parathyroid glands possessed heterogeneous down‐regulation of CAS/gp330. This down‐regulation was the least conspicuous in the BBgenotype, and these few patients generally had larger parathyroid lesions (p < 0.05). The VDR haplotype baTis a risk factor for pHPT possibly by hampering the regulatory actions of calcitriol. In contrast the BAt haplotype seems to be underrepresented in pHPT and to couple to larger parathyroid lesions as well as less deranged CAS/gp330 expression and parathyroid cell function. HPT in these individuals may relate to genetic events principally altering the regulation of cell proliferation, rather than calcium sensing of the parathyroid cells.
Intraperitoneal Normal Saline Infusion for Postoperative Pain after Laparoscopic Cholecystectomy
Authors: Tsimoyiannis Evangelos C. , Siakas Philipos , Tassis Andreas , Lekkas Epameinondas T. , Tzourou Helen , Kambili Maria 
Published: August 2002

AbstractAfter laparoscopic surgery carbon dioxide remains within the peritoneal cavity for a few days, commonly causing pain. This prospective randomized study was performed to determine the efficacy of intraperitoneal infusion of normal saline on postoperative pain after laparoscopic cholecystectomy. Altogether 300 patients were randomly assigned to one of five groups of 60 patients each. Group A: control group, no peritoneal infusion, no subhepatic drain. Group B: no peritoneal infusion but a subhepatic closed drain was left for 24 hours. Group C: normal saline 25 to 30 ml/kg body weight at a temperature of 37°C was infused under the right hemidiaphragm and left in the peritoneal cavity. Group D: normal saline in a room temperature was infused under the right hemidiaphragm and suctioned after the pneumoperitoneum was deflated. Group E: normal saline was infused and suctioned as in group D, but a subhepatic closed drain was left for 24 hours. Postoperatively, analgesic medication usage, nausea, vomiting, and pain scores were determined at 2, 6, 12, 24, 48, and 72 hours (during hospitalization and at home). Postoperative pain was reduced significantly (p < 0.001) in the patients of groups C, D, and E versus controls, whereas no difference was observed between groups A and B. Among groups C, D, and E, group E (p < 0.01) had the best results followed by group D and then group C. Intraperitoneal normal saline offered a detectable benefit to patients undergoing laparoscopic cholecystectomy. The beneficial effect was better when the fluid was suctioned after deflation of the pneumoperitoneum and even better when a subhepatic closed drain continued fluid suction during the first postoperative hours.
Excising the Reexcision: Stereotactic Core‐Needle Biopsy Decreases Need for Reexcision of Breast Cancer
Authors: Kaufman Cary S. , Delbecq Ronald , Jacobson Leslie 
Published: August 2002

AbstractThere is debate regarding use of the stereotactic core‐needle biopsy (SCNB) for highly suspicious mammographic lesions. This study compares a serial group of mammography‐detected breast cancer patients treated before and after the use of SCNB. We studied 113 consecutive nonpalpable breast cancers between 1994 and 1996. Altogether 47 patients were diagnosed by wire‐localized breast biopsy (wire group) and the next 66 consecutive breast cancer patients by SCNB (stereo group). Negative margins were found more often in the stereo group than in the wire group (77% vs. 38%, p < 0.001). Reexcision was required more frequently in the wire group than in the stereo group (68% vs. 21%,p < 0.001), and one‐staged surgical procedures were done more often in the stereo group than the wire group (79% vs. 21%,p < 0.001). The volume of the initial wide excision was much larger in the stereo group than in the wire group (p= 0.002). Those in the wire group required 50% more operations per patient (1.8 vs. 1.2) than the stereo group. A significant cost savings can be estimated in the stereo group compared with the wire group. The use of SCNB was associated with breast excisions of larger volume, negative margins, and decreased need for reexcision. Simultaneous adjunct procedures resulted in one‐stage operations, improving cost savings. The use of SCNB for nonpalpable breast cancer benefits the patient, the surgeon, and the payor. It should be undertaken prior to the first surgical procedure.
Arterial Reconstruction: Justified for Patients with Intermittent Claudication?
Authors: Fujioka Kentaro , Esato Kensuke , Zempo Nobuya , Katoh Tomoe , Fujimura Yoshihiko , Yoshimura Koichi 
Published: August 2002

AbstractThe objective of this study was to evaluate the effects of arterial reconstruction in patients with intermittent claudication. A total of 243 patients (305 limbs) underwent lower extremity vascular reconstruction at our institution from 1979 to 1995. They were assessed by physical examination, pulse volume recordings, segmental pressure, Duplex ultrasonography, and intravenous subtraction arteriography to evaluate the effects of arterial reconstruction. Surviving patients (220 limbs) were enrolled for evaluation of outcome during the follow‐up period. There were 59 deaths during the follow‐up period. The cumulative life‐table 5‐year patency rates were 90% ± 3%, 73% ± 6%, and 74% ± 10% for aortoiliac, infrainguinal, and aortofemorodistal arterial reconstructions, respectively. Among 129 repairs in the aortoiliac region, Fontaine stages I, II, and III were found in 109 limbs (84.5%), 17 limbs (13.2%), and 2 limbs (1.5%), respectively. There was one (0.7%) minor amputation. There was Fontaine stage I in 50 limbs (76.9%), Fontaine stage II in 14 limbs (21.5%), and Fontaine stage III in 1 limb (1.5%) for repairs in the infrainguinal region. Among the 26 aortofemorodistal repairs, there was Fontaine stage I in 21 limbs (81%) and Fontaine stage II in 5 limbs (19%). There was a statistically significantly higher incidence of Fontaine stage I than Fontaine stage II or III in aortofemoral, infrainguinal, and aortofemorodistal arterial reconstructions (p < 0.0001). Arterial reconstruction for patients at Fontaine stage II offered benefits and improved quality of life at follow‐up. Arterial reconstruction for patients at Fontaine stage II offers benefits and improved quality of life at follow‐up. It was concluded that the significant improvement in quality of life after arterial reconstruction warrants continued use of the procedure in patients with intermittent claudication.
Genetic and Biochemical Screening for Endocrine Disease
Authors: Goretzki P.E. , Höppner W. , Dotzenrath C. , Clark O.H. , Simon D. , Cupisti K. , Schulte H. , Röher H.D. 
Published: August 2002

AbstractThe development of biochemical and genetic screening tests for inherited endocrine diseases has dramatically changed our approach to surgical patients with endocrine tumors. Among more than 1800 patients with endocrine tumors and a possible inherited disease operated on between 1986 and 1997, there were 6.1% to 7.3% who were found to have a familial disease associated with familial medullary thyroid cancer, (MTC), multiple endocrine neoplasia type IIa (MEN‐IIa), MEN‐IIb, or MEN‐I. Genetic testing for the
RET proto‐oncogene is therefore recommended for all patients with MTC, and testing for the MEN‐I gene is recommended in patients with suspected MEN‐I and in specific clinical subgroups with an increased probability of endocrine tumor heredity. Early treatment based on early diagnosis by genetic testing appears to improve survival and to decrease morbidity in these patients.
Effects of Laparoscopic and Conventional (Open) Cholecystectomy on Human Leukocyte Antigen‐DR Expression in Peripheral Blood Monocytes: Correlations with Immunologic Status RID="" ID="" This International Society of Surgery (ISS)/Soci&eacute;t&eacute; Internationale de Chirurgie (SIC) article was presented at the 37th World Congress of Surgery International Surgical Week (ISW97), Acapulco, Mexico, August 24&ndash;30, 1997.
Authors: Carlei Francesco , Schietroma Mario , Cianca Giovanni , Risetti Alberto , Mattucci Sandro , Ngome Enang Gerard , Simi Mario 
Published: August 2002

AbstractIt is well known that surgery significantly decreases immune responses. Laparoscopic cholecystectomy
(LC) is a “miniinvasive” surgical procedure; and on the basis of this consideration we have investigated if and how the immune response is modified in patients after laparoscopic cholecystectomy compared to patients who underwent open cholecystectomy. Immune activity
[neutrophils, total lymphocytes count, lymphocytes subpopulations, human leukocyte antigen‐DR (HLA‐DR)] was evaluated in 53 patients 1 day before surgery and respectively, 1, 3, and 6 days after surgery; 26 patients underwent “open” cholecystectomy and 27 LC. A day after surgery, patients with open cholecystectomy showed a significant increase (p < 0.05) in plasma neutrophils, while they were almost unchanged in LC patients. Monocyte antigen HLA‐DR was reduced in patients with “open” cholecystectomy. We recorded two cases (7.6%) of respiratory tract infection in the “open” group. In conclusion, LC strongly reduces postoperative (p.o.) pain and hospitalization, and it promotes earlier recovery and return to normal activity, avoiding p.o. immunosuppression, mostly due to conservation of HLA‐DR activity, with less p.o. morbidity compared to that seen with open surgery.RID="" ID="" <E5>Correspondence to:</E5> F. Carlei, M.D.