bluuebunny/crossref_metadata_2025_split huggingface dataset:
Repair of complete atrioventricular canal in infancy
Authors: Castaneda Aldo R. , Mayer John E. , Jonas Richard A. 
Published: May 2005

AbstractResults of operative repair of complete atrioventricular canal defects (CAVCD) are improving due to: general advances in pre‐, intra‐, and postoperative care; a better understanding of the relevant pathological factors, principally of the left atrioventricular (A‐V) valve; a clearer definition of the path of the specialized conduction tissue; and the recognition of associated defects such as single left ventricular papillary muscles, ventricular hypoplasia, with or without malalignment of the common A‐V valve, coexistent ventricular septal defects, and double orifice left A‐V valves. Forty‐eight patients underwent repair from July 1980 through July 1984. Three patients died early and 2 late after the operation. One patient with an additional posterior ventricular septal defect (VSD) remained in complete heart block. Three patients required reoperation for residual left A‐V valve regurgitation and 1 for a residual VSD. In 20 recatheterized patients, mitral regurgitation was moderate in 4 and severe in 2. Pulmonary artery pressure (pulmonary/systemic arterial systolic pressure ratio) remained unchanged in only 1 patient with significant A‐V valve regurgitation. To avoid the development of pulmonary vascular obstructive disease, and based also on the trend of decreasing operative mortality and morbidity rates, primary repair of CAVCD is recommended within the first year of life.
Gastrointestinal myoelectric activity following abdominal operations in the opossum
Authors: Coelho Julio C. U. , Gouma Dirk J. , Moody Frank G. , Li Young F. 
Published: May 2005

AbstractGastrointestinal myoelectric activity of the opossum, both in fasting and fed states, was studied after abdominal operations. Five different procedures were performed: a 5‐min, a 1‐hour, and a 3‐hour laparotomy with intestinal handling, enteroenterostomy, and gastrojejunostomy. Electromyographic recordings from the stomach, duodenum, jejunum, ileum, and sphincter of Oddi were obtained from unanesthetized animals. A normal fasting pattern after abdominal operations was observed from immediately after surgery to the fifth postoperative day and depended on the type and duration of the surgical procedure. A fed pattern did not occur in the experiments in which food was instilled before the appearance of the myoelectric migrating complex. A normal fed pattern was observed after the myoelectric migrating complex appearance in all but 2 experiments, one of which occurred in an animal with an intra‐abdominal abscess.
Prophylactic regimens in colorectal surgery: Comparisons between metronidazole used alone or with ampicillin for one or three days
Authors: Roland Magne , Bergan Tom , Bjerkeset Tormod , Erichsen Hans , Hoel Roar , Johansen Svein , Liavåg Ivar , Reinertsen Sverre , Rosseland Arne , Teigan Tor , Thorsen Glen , Wiig Johan 
Published: May 2005

AbstractThe purpose of this study was to compare as anti‐infectious prophylaxis in elective colorectal cancer surgery the effect of metronidazole alone and in combination with ampicillin, and the effect of a duration of 1 or 3 days of prophylaxis. The prophylactic regimens designated regimens A‐D given in randomized order were metronidazole 500 mg used alone or with 2.0 g ampicillin administered every 8 hours as separate but simultaneous infusions. All patients studied received preoperative mechanical evacuation of bowel contents. Eight surgical departments participated in the study. Two hundred thirty‐three patients were studied. The distribution of sex, age, and type of operation was similar among the groups of patients receiving each regimen, except that there were more cases of sigmoidectomy, low anterior resection, or rectal amputation in the group receiving regimen D. The duration of the operations was comparable, even for each type of operation considered separately. Samples for bacteriological examination were obtained by abscess punctures when relevant. The pus was taken and transported to the laboratory under anaerobic conditions. Moderate or severe infections were observed in 6 (10.3%) of 58 patients on regimen A, in 2 (3.5%) of 58 patients on regimen B, in 4 (7.0%) of 57 receiving regimen C, and in 2 (3.3%) of 60 given regimen D. The highest incidence of postoperative infections was observed in rectal amputation. The bacteria causing postoperative infections were similar in the regimens A and C receiving only metronidazole for 1 and 3 days, respectively and in regimens B and D in which ampicillin was added. Only one anaerobe, aClostridium perfringens, was recovered from regimen C; twenty‐two strains of anaerobic bacteria were recovered from regimen A. The number of aerobic bacteria was 25 in regimen A and 16 in regimen C. The yield of bacteria was much more sparse when metronidazole was combined with ampicillin. Eleven isolates (2 anaerobes) were recovered from regimen B, only one isolate was recovered from patients on regimen D, an indole positiveProteus. In conclusion, th'is study indicates that a combination of metronidazole and ampicillin is particularly useful in rectal surgery. Metronidazole alone may suffice in colonic surgery, but a combination with an agent against aerobes is recommended in rectal surgery. The difference between 1‐day prophylaxis and 3‐day prophylaxis was insignificant for metronidazole plus ampicillin; a single day of this prophylactic regimen would appear advisable.
Cushing's syndrome and pheochromocytoma caused by an adrenal tumor, also containing met‐enkephalin and somatostatin: A case report
Authors: Bruining Hajo A. , Ong Eveline G. L. , Gershuny Anthony R. , Lamberts Steven W. J. 
Published: May 2005

AbstractThe simultaneous occurrence of hypercorticolism and increased plasma catecholemia due to pheochromocytoma does not fit into the concept of the known combinations of multiple endocrine adenomatosis. In this paper we communicate the very rare picture of a adrenocorticotropic (ACTH)‐producing pheochromocytoma, giving rise to both clinical entities simultaneously. It is hypothesized that the severity of the clinical picture of this patient was caused by hypercorticolism, which affects the metabolism of catecholamines resulting in a relatively increased production of dopamine.
Nutritional assessment and severity of illness classification systems: A critical review on their clinical relevance
Authors: Dionigi Renzo , Cremaschi Riccarda Erica , Jemos Vassili , Dominioni Lorenzo , Monico Roberto 
Published: May 2005

AbstractSeveral studies have attempted to define nutritional parameters that can be used to select undernourished hospitalized patients and identify those who present higher risk of postoperative septic complications. Nevertheless, the majority of these studies do not take into consideration the severity of infectious episodes. Systems for scoring the severity of illness are of critical importance in hospital practice and clinical research. In fact, they could be used for the following purposes: (a) a more correct stratification of patients in clinical studies; (b) monitoring the evolution of the infectious complication; (c) prediction of survival; (d) optimization of the criteria for admission to and discharge from intensive care units; and (e) evaluation of quality, quantity, and costs of nutritional therapy in critically ill patients. In this article, the authors present a critical review on the clinical relevance of the methods of nutritional assessment more commonly used in clinical practice; and, moreover they discuss the more recently proposed systems for scoring the severity of illness.
Protein‐sparing therapy in the postoperative period
Authors: Keller Ulrich , Clerc Didier , Kränzlin Marius , Heberer M. 
Published: May 2005

AbstractSurgical trauma leads to increased nitrogen loss which may result from increased protein breakdown, diminished protein synthesis, or both. Increased protein breakdown is predominant after surgical trauma, whereas protein synthesis has been reported to be either unchanged or increased. Attempts to improve nitrogen balance should be directed toward both mechanisms; protein breakdown is diminished by avoiding tissue damage, and by prevention of sepsis which results in release of catabolic peptides, e.g., of interleukin 1. Protein breakdown may also be diminished by avoidance of stress hormones, particularly of cortisol, and by providing energy substrates, i.e., glucose, long‐ or medium‐chain fatty acids. Protein synthesis is enhanced by providing nutrition, including supply of energy and amino acids. Data obtained in human volunteers demonstrated that transient elevation of plasma cortisol to stress levels resulted in sustained elevation of plasma amino acids, indicating increased proteolysis. Four hours after plasma cortisol elevation, glucose “clamp” studies indicated insulin resistance of peripheral and hepatic glucose metabolism. In contrast, insulin action on plasma amino acids was unimpaired suggesting that hyperinsulinemia was capable of reverting the cortisol‐induced protein breakdown. The effect of postoperative amino acid therapy was studied in 60 patients after major surgery who received either amino acids or carbohydrates, or both by peripheral venous administration. Postoperative nitrogen balance during 6 days was not significantly improved when amino acids were administered in spite of different plasma concentrations of glucose, insulin, and ketone bodies during the various nutrition regimens. Thus, measures to diminish protein breakdown and to increase protein synthesis should be integrated into the management of the postoperative patient, in order to diminish nitrogen loss and thus to decrease postoperative morbidity.
Parenteral nutrition by peripheral vein, portal vein or central venous catheter?
Authors: Bodoky Andras 
Published: May 2005

AbstractDifferent venous accesses used for parenteral nutrition are described. The most important complications and possibilities for prevention are discussed according to both literature and personal experience. As a result, peripheral venous access is recommended for short‐term parenteral nutrition (up to 8 days), whereas central venous access should be used to deliver high caloric loads during extended periods of time. Portal venous access does not appear to have a place in parenteral nutrition to date.
Indications and effects of preoperative parenteral nutrition
Authors: Müller J. M. , Keller H. W. , Brenner U. , Walter M. , Holzmüller W. 
Published: May 2005

AbstractMalnutrition can be an important risk factor, especially in patients undergoing major gastrointestinal surgery. With 7–10 days of adequate preoperative parenteral nutrition, we are able to improve the nutritional status of most patients. Concentrations of several parameters of the protein compartment and immunocompetence increase significantly. The effect of preoperative parenteral nutrition on postoperative outcome has been tested in only a few properly designed comparative trials. The results were not unanimous. If the postoperative complication rate was high, preoperative parenteral nutrition significantly reduced it. Improvement in surgical technique limited the value of preoperative parenteral nutrition. However, as long as the postoperative complication rate is not zero, preoperative parenteral nutrition is indicated, especially in patients with cancer of the upper gastrointestinal tract, when a major operation is planned.
Alternative methods of nutrition in the postoperative phase
Authors: Heberer Michael , Harder Felix 
Published: May 2005

AbstractEnteral nutrition as the natural alternative to parenteral feeding offers a wide range of choices with respect to access to the intestinal tract, type of substrate, and mode of application. For most enteral feeding problems in general surgery, nasogastric tubes and the catheter jejunostomy can be regarded as well standardized, cost‐effective, safe and simple solutions. Enteral feeding should be preferred when nutritional support is required for extended periods of time, whereas parenteral nutrition is preferred when nutritional or metabolic imbalances need to be compensated within short periods of time or when enteral nutrition is contraindicated.
Choledochal cyst: Complications of anomalous connection between the choledochus and pancreatic duct and carcinoma of the biliary tract
Authors: Nagata Eiichi , Sakai Katsuji , Kinoshita Hiroaki , Hirohashi Kazuhiro 
Published: May 2005

AbstractWe have done a retrospective study of the clinical features, complications, surgical treatment, histological findings, and outcome of 27 adults with choledochal cyst (congenital biliary dilatation) whom we have encountered in the past 11 years. In 24 (88.9%) of them, an anomalous connection between the choledochus and the pancreatic duct was found by direct cholangiography, or during operation or autopsy; three also had carcinoma of the biliary tract. In congenital biliary dilatation, this anomalous connection seems to be a major factor in causing cholangitis and carcinoma of the biliary tract. For this reason, congenital biliary dilatation must be treated surgically. This involves resection of the dilated bile duct and the gallbladder to remove the place where bile stasis had been present, and reconstruction of the biliary tract to stop reflux of pancreatic juice in the bile duct.
Effect of parathyroid surgery on cartilage calcification
Authors: Van Geertruyden Jean , Kinnaert Paul , Frederic Nany , Fuss Michel , Corvilain Jacques 
Published: May 2005

AbstractThe incidence of chondrocalcinosis in 4 locations (knees, wrists, lumbar discs, and symphysis pubis) has been compared on x‐rays made before and after parathyroid surgery in patients operated on for primary and secondary hyperparathyroidism. Before parathyroid surgery, the overall incidence of chondrocalcinosis in primary and secondary hyperparathyroidism is comparable. However, the distribution by age, the number of joints affected, and the locations are different. Parathyroid surgery changes neither the incidence nor the severity of chondrocalcinosis, in patients with primary or secondary hyperparathyroidism.
The current status of biliary tract surgery: An international study of 1072 consecutive patients
Authors: DenBesten Lawrence , Berci George 
Published: May 2005

AbstractAn international study to determine the practice patterns and outcome of operations for stone‐related biliary tract disorders was commissioned by the International Biliary Association in 1981. Twenty‐one institutions generated 69,700 data bits from 1,072 consecutive patients over an 18‐month period. These data were analyzed for approach to diagnosis, conduct of operation, and outcome. Of the 1,072 operations (412 United States, 660 international), 986 (92%) were primary and 86 (8%) were secondary or repeat procedures. Although elective cholecystectomy was preceded by 2 or more diagnostic tests in 25% of patients, institutional patterns ranged from a single test in 60% of patients to 94% of patients having more than 3 preoperative diagnostic tests. Elective cholecystectomy included operative cholangiography in 83% of patients and choledochotomies in 17% (182 of 1,072). The incidence of negative duct exploration and retained stones was 18.5% and 4.5%, respectively. Choledochoscopy was done before duct exploration in 25% (30.4%‐U.S.A.; 19.5%‐international) and prior to T‐tube insertion in 38% (29%‐U.S.A.; 43%‐international). Repeat operations for choledocholithiasis included a drainage procedure in 72% of American and 46% of European patients. Complications after primary procedures were 17% in the United States (12.4% biliary, 4.4% nonbiliary) and 35% (25% biliary, 9.1% nonbiliary) in the international series. Complications after secondary procedures were 48% (40% biliary, 8% nonbiliary). The mortality rate for all patients was 1.6% for primary procedures (0.6% for cholecystectomy alone) and 2.3% for secondary procedures. These data indicate that: (a) duplication of diagnostic procedures is frequent and characteristic of certain institutions; (b) cholangiography decreases the incidence of negative choledochotomy, and choledochoscopy reduces the incidence of retained stones; and (c) diagnosis, operative management, and outcome vary greatly among institutions.
Total gastrectomy: Is the early postoperative morbidity and mortality influenced by the choice of surgical procedure?
Authors: Hassler H. , Bochud R. , Nöthiger F. , Stafford A. 
Published: May 2005

AbstractFrom 1973 to 1982, seventy‐two total gastrectomies were performed. The Siewert‐Peiper gastric replacement procedure was used in 48 cases, while the Rou‐xen‐Y method was performed in 24 cases. Retrospective analysis showed no significant statistical difference between the 2 methods with regard to postoperative morbidity and mortality. There was an overall mortality rate of 11% and a morbidity rate of 45% (10% anastomosis breakdown, 27% pulmonary complications, 1% bowel obstruction, 7% other complications). As the Roux‐en‐Y anastomosis is technically easier to perform compared to the Siewert‐Peiper gastric replacement and as the functional results from the literature are similar, we will, in the future, favor using the Roux‐en‐Y method in our department.
Gastrointestinal perforations in renal transplant recipients immunosuppressed with cyclosporin
Authors: Rigotti Paolo , Van Buren Charles T. , Payne William D. , Peters Charles , Kahan Barry D. 
Published: May 2005

AbstractGastrointestinal perforations frequently represent a lethal complication of immunosuppression. Of 325 renal transplant recipients treated with cyclosporin (CsA), 4 patients (1.2%) developed gastrointestinal perforation: 1 from gastric ulcer and 3 from colonic diverticula. All patients underwent operative treatment and all survived without complications. Three patients maintained a well‐functioning allograft. In comparison to azathioprine, CsA does not seem to greatly affect the immune response to bacterial infections, thus representing a considerable advantage in the management of serious gastrointestinal complications.
Rapid progressive dissemination of hemangiosarcoma of the spleen following spontaneous rupture
Authors: Simansky David A. , Schiby Ginette , Dreznik Zeev , Jacob Erwin T. 
Published: May 2005

AbstractHemangiosarcoma of the spleen is a rare entity with only 58 reported cases. It is a highly malignant tumor and, in 80% of the cases, metastases are already present at the time of diagnosis. Thirty percent of the patients present with spontaneous rupture of the spleen. This event is catastrophic and results in rapid dissemination of the disease, deterioration, and death. An additional case of hemangiosarcoma of the spleen presenting as spontaneous rupture is described. Despite repeated laparotomies, the histopathological diagnosis was made at a late stage of the disease.
Inotropic agents in the treatment of cardiogenic shock
Authors: Mueller Hiltrud S. 
Published: May 2005

AbstractThe pharmacological therapy of cardiogenic shock is determined by the underlying pathophysiology. In pump failure, secondary to severe obstructive coronary artery disease with a large compartment of ischemic myocardium at risk, coronary reserve is severely impaired. Any attempt to improve cardiac performance must consider the delicate balance between oxygen supply and requirement. Coronary blood flow is dependent on coronary perfusion pressure. Agents increasing arterial blood pressure improve coronary perfusion, but do not increase cardiac output and, thus, interfere with perfusion of vital organs. Inotropic agents, improving cardiac performance, may increase myocardial oxygen requirements in excess of availability; improvement of peripheral perfusion occurs at cost of a deteriorating pump. Contrarily, in pump failure due to primary myocardial impairment, as myocardiopathy or depression of ventricular function by extracorporal circulation, impairment of energy utilization by the myocardium, of contractility, and of neuro‐humoral responses are primary factors. Measures to improve cardiac performance are less limited by considerations of increasing myocardial oxygen requirements. Dobutamine, a relatively selective beta1, agonist, and dopamine, a nonselective beta, alpha, and dopaminergic agonist, are the most frequently applied vasoactive agents in the treatment of cardiogenic shock. Their effects are highly dose dependent. Both catecholamines improve cardiac performance and peripheral perfusion. The major differences between the two drugs are related to the effect on heart rate, cardiac filling pressure, and systemic vascular resistance. At clinically tolerated doses, dobutamine is a more potent inotropic agent than dopamine. The decrease in vascular resistance, unloading the left ventricle, is beneficial for the failing heart. Heart rate remains essentially unchanged. In contrast, dopamine increases arterial pressure, left ventricular filling pressure and, at higher doses, heart rate. If blood pressure cannot be maintained by dobutamine, dopamine is preferable. Moreover, the combination of both vasoactive agents has been proven beneficial, supplemented by I‐norepinephrine, if necessary. An aggressive approach to unstable angina and complicated myocardial infarction, identification of the patient at high risk for sudden cardiac events, introduction of myocardial preservations during surgery, and improved techniques have contributed to the decreased frequency of cardiogenic shock.
Experience with the pierce‐Donachy ventricular assist device in postcardiotomy patients with cardiogenic shock
Authors: Pennington D. Glenn , Samuels Larry D. , Williams George , Palmer Diane , Swartz Marc T. , Codd John E. , Merjavy John P. , Lagunoff David , Joist J. Heinrich 
Published: May 2005

AbstractIn order to assess the current status of ventricular assist device (VAD) support of patients with postcardiotomy ventricular failure, we evaluated the data from 17 patients treated over a 2‐year period with a Pierce‐Donachy paracorporeal pneumatic sac‐type VAD using atrial cannulation and asynchronous pumping. All patients had severe ventricular failure refractory to intra‐aortic balloon (IAB) and drug therapy. The effects of the VAD on left ventricular function were evaluated by nuclear ventriculography and hemodynamic measurements during brief pump on/pump off periods. Eight patients received only left VAD's, 5 received right VAD's and IAB, and 4 received 2 VAD's. All patients were weaned from cardiopulmonary bypass with VAD flows ranging from 1.55 to 2.78 L/min per m2.Eight patients died of bleeding, biventricular failure, or multiple organ failure without improvement in cardiac function. However, 9 patients (53%) had improved cardiac function, 8 were weaned from the VAD, and 7 (41%) were discharged. Five of the last 6 patients survived. Two patients with isolated left ventricular failure survived with left VAD alone. However, of 15 patients with biventricular failure, 5 of 9 receiving biventricular assistance were weaned, while only 1 of 6 receiving left VAD alone was weaned. Although activation of the left VAD decreased left ventricular ejection fraction, left atrial pressure, and left ventricular volume, it concomitantly increased left ventricular afterload. The Pierce‐Donachy VAD provided salvage of patients with severe ventricular failure after cardiac operations. The majority of patients had biventricular failure, which was best treated with biventricular mechanical support. Although the VAD reduced left ventricular preload, ejection fraction decreased as afterload increased, suggesting that asynchronous left atrial pumping does not unload the left ventricle.