bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reconstruction after gastrectomy and quality of life
Authors: Buhl Klaus , Lehnert Thomas , Schlag Peter , Herfarth Christian 
Published: October 2004

AbstractTo evaluate quality of life and functional results following surgery for gastric cancer we studied 104 patients with no evidence of disease at a minimum of 12 months postoperatively. Patients were treated with total gastrectomy and jejunal pouch reconstruction according to Hunt‐Lawrence‐Rodino (n=59) or simple esophagojejunostomy (n=24) and distal subtotal gastrectomy (n=21). No significant differences were found between total gastrectomy with pouch reconstruction and distal gastric resection with respect to dumping or heartburn, whereas patients with total gastrectomy and restoration with esophagojejunostomy suffered from both. The latter group of patients also had reduced nutritional status. Although there is a lack of a proper definition of quality of life, all instruments applied to its measurement indicated improved results for patients with pouch reconstruction and those after distal gastrectomy, but we could not state any significant differences. We conclude that in terms of postoperative functional results as well as quality of life distal gastric resection has no advantage over total gastrectomy with pouch reconstruction; hence a reduction of surgical radicality in an attempt to improve postoperative results is not justified. Pouch reconstruction should be considered the treatment of choice for reconstruction after total gastrectomy.
Intrahepatic absorbable fine mesh packing of hepatic injuries: Preliminary clinical report
Authors: Frame Scott B. , Enderson Blaine L. , Schmidt Ulf , Maull Kimball I. 
Published: October 2004

AbstractA previous report from the authors' institution reported the effectiveness of hepatic packing with absorbable fine mesh (AFMP) for the control of hemorrhage in an animal model with an otherwise lethal hepatic injury. The technique has subsequently been applied to 12 abdominal trauma patients with hemodynamic instability and actively hemorrhaging hepatic injuries. Two patients expired in the operating room owing to uncontrolled hemorrhage from hepatic and associated injuries for a mortality of 16.7%. AFMP was successful in controlling hemorrhage in the remaining 10 patients. Hepatic injuries ranged from grade II to grade V, and all were actively hemorrhaging at the time of exploration. None of the surviving 10 patients experienced early or late recurrent bleeding attributable to the hepatic injuries, and there were no intraabdominal abscesses or late deaths. Liver function studies returned to normal prior to discharge in all surviving patients. Follow‐up included serial computed tomographic scans, which demonstrated fibrosis incorporating the mesh packing. Complete resolution of injury and mesh appears to proceed over approximately a 6‐month period. AFMP is a safe, effective method for controlling hepatic hemorrhage. It is easy to perform in the operating room, offers an excellent matrix for hemostasis, provides tamponade of bleeding sites, and does not require reoperation for removal of packing material, as is necessary with conventional, nonabsorbable packing techniques.
Arterial ketone body ratio as a parameter of hepatic mitochondrial redox state during and after hemorrhagic shock
Authors: Nakatani Toshio , Spolter Leonard , Kobayashi Kunio 
Published: October 2004

AbstractThis study was aimed at clarifying the usefulness of the arterial ketone body ratio (AKBR), which reflects hepatic mitochondrial redox state and closely correlates with hepatic energy production, for understanding the degree of hepatic mitochondrial damage and the extent of the deterioration in hepatic energy metabolism during of shortly after hemorrhagic shock. Changes in the AKBR of 33 trauma victims who were admitted to our institute in hemorrhagic shock with a systolic pressure lower than 70 mmHg were measured until the patient recovered with the restoration of AKBR to the normal range (≥ 1.0) or until the patient died. During hemorrhagic shock the AKBRs were highly decreased, indicating deteriorated hepatic function. With successive fluid resuscitation the AKBR quickly recovered in 15 surviving patients from an initial value of 0.26±0.03 toward normal within hours, indicating that hepatic mitochondria are functioning normally. The AKBR recovered to a normal value of 1.10±0.06 on day 2 (p<0.001). In 18 expired patients, AKBR did not recover to normal range, even though some of the patients recovered from the shock state. On the other hand, AST, ALT, LDH, and prothrombin time on day 2 were not significantly different from the values on admission, and the changes during the interval were not unidirectional even in the surviving patients, providing no information on the current functional state of the liver. Measurement of AKBR during and shortly after hemorrhagic shock provides timely and accurate information about liver function.
Calcium/phosphate/vitamin D homeostasis and bone mass in patients after gastrectomy, vagotomy, and cholecystectomy
Authors: Marcinowska‐Suchowierska Ewa B. , Talalaj Marek J. , kłodarczyk Andrzej W. , Bielecki Krzysztof , Zawadzki Jakub J. , Brzozowski Ryszard 
Published: October 2004

AbstractSixty‐two outpatients were assessed and divided into the following groups: 20 patients who had had partial gastrectomy (PG group), 22 patients who had had truncal vagotomy and pyloroplasty (TV group) or high selective vagotomy (HSV group), and 20 patients who had had cholecystectomy (CH group). The patients' age ranged from 35 to 64 years (mean 45 years), and the average postoperative period was 9 years. None of the patients evidenced clinical or biochemical symptoms of malnutrition or malabsorption or of diseases affecting vitamin D metabolism. The function of the kidneys and the liver was normal. An age‐matched group of volunteers served as a control group. The calcium dietary intake was determined using a standardized questionnaire; and the levels of serum calcium (Cas), phosphate (Ps), alkaline phosphatase (AP), and 25‐hydroxyvitamin D [25(OH)D] and the excretion of Ca in a sample of fasting urine corrected for concurrent creatine excretion (FuCa/cr) were assessed by means of standard laboratory techniques. The bone mineral density (BMD) of the lumbar spine (L2–4) and femoral neck (neck‐L) was determined by means of dual energy x‐ray absorptiometry (DXA). The daily Ca dietary intake was lower than recommended (RDA) in 80% of the patients, with most of them ingesting less than 300 mg daily. The mean values of Ca2, P2, AP, and FuCa/cr did not differ from these in the controls. Significantly reduced 25(OH) D levels were observed in the PG group (7.0 ng/ml) (p<0.001) and CH group (12.5 ng/ml) (p<0.01) compared with the values in the control group (20.0 ng/ml). The serum 25 (OH)D concentration was correlated with the Cas level and postoperative period. The BMD of L2–4 was decreased in all postoperative patients compared to that in the control group (in the PG group the BMD was 80±2%; in the CH group 95±2%; and in the TV or HSV group 94 ±1%) (p<0.05). In both L2–4 and three sites of the femoral neck in was lowest in the PG group (neck 94±1%; Ward's triangle 93±3%; trochanter 95±2%) compared with the CH group (neck 98±1%; Ward's triangle 100±1%; trochanter 98±1%) and with TV or HVS group (100±1%; 100±1%; 98±1%, respectively) (p<0.05). In the postgastrectomy group BMD showed a significant negative correlation with the interval following gastrectomy and Ca excretion in urine but a significant positive correlation with the Ca level and serum 25 (OH)D concentration. The BMD in the CH group showed a positive correlation only with the serum 25(OH)D concentration. Gastrectomy and cholecystectomy without postoperative supplementation of Ca and vitamin D led to insidious disturbances in the calcium‐vitamin D homeostasis and osteopenia. Therefore we suggest that immediate supplementation of calcium and vitamin D be initiated as a routine postoperative procedure, particularly in countries where routine fortification of food with Ca and vitamin D is not carried out.
Prognostic implications of the response of arterial ketone body ratio and insulin secretion to glucose load in major hepatectomy
Authors: Kagawa Ryuzaburo , Mori Keiichiro , Yamamoto Yuzo , Fujii Tsunco , Shimabukuro Takashi , Morimoto Taisuke , Yamaoka Yoshio 
Published: October 2004

AbstractImpaired glucose tolerance is a serious obstacle to major hepatic resection. To assess the predictability of surgical risk in major hepatectomy for patients with chronic liver diseases from the viewpoint of glucose metabolism, we evaluated the insulinogenic index (II) and redox tolerance index (RTI) in 48 patients who underwent major hepatectomy at our university hospital due to hepatocellular carcinoma. Patients with low II and low RTI fell into the high risk group. Based on this finding, the Z score was developed as an index of patient risk for major hepatectomy: Z =3.11×[II]+1.43×[RTI]‐2.27. When the Z score was negative, mortality reached 33.3%, but when it was positive the mortality was only 3.2%. Intraportal insulin supplementation after hepatectomy to patients with a negative Z score could reduce mortality. Preoperative evaluation of surgical risk by Z score seems to be useful for predicting patient prognosis after hepatectomy.
Survival until 6 years after cholecystectomy: Female population of Denmark, 1977–1983
Authors: Andersen Tavs Folmer , Brønnum‐Hansen Henrik , Jørgensen Torben , Roepstorff Christian , Loft Anne , Madsen Mette 
Published: October 2004

AbstractIt has been a prevailing assumption that cholecystectomy patients by and large follow a pattern of survival similar to that of the normal population. This paper presents a population‐based study of the long‐term survival after cholecystectomy in order to reassess this assumption. Based on data available in the Danish National Hospital Register the records of all Danish women who were operated between 1977 and 1981 were examined and studied up to 6 years subsequent to surgery. Cholecystectomy patients who were free of diagnosed cancer and who had no major co‐surgery (n=11,123) were compared to both hysterectomy patients and a sample of the female population. Adjusting for age and other covariates, patients with psychiatric hospital admissions prior to surgery experienced a threefold risk of dying within 6 years after surgery. Patients with prior somatic admissions and patient with acute admissions had a relative risk (RR) of about 1.5. Cholecystectomy patients had a significantly increased mortality when compared to hysterectomy patients, RR=1.3 (1.1–1.6), and to the population sample. Heart diseases and cancer occurred significantly more often as causes of death among cholecystectomy patients when compared to hysterectomy patients, but our data suggest that the occurrence of many other causes of death may be increased among cholecystectomy patients as well. The authors concluded that cholecystectomy patients are subject to relatively higher levels of mortality than previously assumed in parts of the literature. Furthermore, the increase seems to be attributable to a multitude of causes of death. The most likely explanation of the excess mortality among cholecystectomy patients is that gallbladder patients are relatively fragile. Indeed, with this vulnerable group of patients the potential trauma of the surgical intervention itself needs careful consideration.
Optimal dose of garlic to inhibit dimethylhydrazine‐induced colon cancer
Authors: Cheng Jhy‐Young , Meng Ching‐Liang , Tzeng Ching‐Cherng , Lin Jih‐Chang 
Published: October 2004

AbstractThis study was designed to investigate the optimal dose of garlic during long‐term feeding and its preventive and therapeutic effects on colon cancer in rats induced by 1,2‐dimethylhydrazine (DMH). A total of 240 male Sprague‐Dawley rats were grouped and fed with either a basal or a garlic diet of different concentration, and some groups were subcutaneously injected with DMH 20 mg/kg once a week for 20 weeks. The incidence of colon tumor was significantly decreased in the groups fed with 2.5%, 5%, and 10% garlic diets (p<0.001). There was no distinct difference among these concentrations (p>0.05). Therefore the minimal optimal dose of garlic to inhibit colon cancer was 2.5%. The equivalent dose of this concentration in humans is 4.76 g/m2 body surface/day. In a therapeutic study, the tumor‐inducing interval in nude mice subcutaneously injected with colon cancer cells (CC‐M2) was prolonged by a 2.5% garlic diet (p<0.01). Thus smaller tumor volume and longer survival time were found in the garlic group than in the controls (p<0.01). However, the growth rate of tumors was not markedly inhibited by garlic. All rats finally died within 18 weeks. This study suggested that a 2.5% garlic dose may be used mainly as an inhibitor to prevent colon cancers and improve survival time.
Twelve‐year experience with the long intestinal tube
Authors: Rodriguez‐Ruesga Roberto , Meagher Alan P. , Wolff Bruce G. 
Published: October 2004

AbstractA number of surgical methods, including use of the long intestinal tube, have been designed to decrease the incidence of recurrent small bowel obstruction. The aim of the present study was to review the indications, morbidity, and long‐term results of the long intestinal tube at the Mayo Clinic. During the 12‐year period 1981–1992, 47 patients had such tubes placed. The patients formed a complex surgical group: 46 patients had previously undergone at least one laparotomy (median 4, range 1–10); 41 patients had been hospitalized at least once for small bowel obstruction (median 3, range 1–15); and all 41 of these patients had undergone at least one previous laparotomy for obstruction (median 2, range 1–7). Eleven patients had a history of inflammatory bowel disease, and eight had a history of irradiation. In addition to dense adhesions in 46 patients, operative findings included large bowel tumors in six patients, intraperitoneal carcinomatosis in four, intraabdominal abscess in four, and small bowel stricture in three. Twenty patients required either a small bowel or large bowel resection, and three had a stoma fashioned. Only one case of morbidity (tube retraction) was related to tube placement. Among the 36 patients with complete follow‐up, nine patients developed episodes of recurrent adhesional small bowel obstruction after a mean follow‐up of 48 months, although only one required laparotomy. Of the remaining 11 patients it is known that two developed small bowel obstruction, one of whom required laparotomy. Use of the long intestinal tube has generally been reserved for surgically complex cases. In light of the diverse and complicated nature of the patients in this series, the long‐term reoperation rate for adhesional small bowel obstruction appears to be low.
Technical aspects and complications of end‐ileostomies
Authors: Carlsen Erik , Bergan Anstein 
Published: October 2004

AbstractDuring a period of 10 years (1980–1990) we constructed or reconstructed 358 end‐ileostomies: 224 were primary constructions, 96 were reconstructed by laparotomy, and 38 were local reconstruction. Only 2 ileostomies were primarily located on the left side. The mean length was 5 cm. We had 11.6% reoperations after primary stomy and 7.3% and 7.9% reoperations after reconstruction by laparotomy and local approach, respectively. There were 12.9% and 8.7% reoperations after emergency and elective primary operations, respectively. Closing the lateral gutter or number of ileum to the rectus fascia did not influence significantly the number of reoperations. Postoperative discolored stomy did not indicate more dysfunction of the ileostomy. Stenosis of the ileostomy, peristomal fistulas, and peristomal dermatitis were seen in 23 (10.3%), 21 (9.4%), and 18 (8%) of the patients after primary ileostomies, respectively. Patients with Crohn's disease had significantly more of these problems than patients with ulcerative colitis. Only a few patients had retraction of the ilcostomy (2.7%), stomal prolapse (1.8%), or parastomal herniation (1.8%). Women had significantly more parastomal herniation than men; otherwise there were no differences between the sexes.
Aggressive surgery for pancreatic duct cell cancer: Feasibility, validity, limitations
Authors: Takahashi Shin , Ogata Yoshiro , Miyazaki Hiroshi , Maeda Dai , Murai Shinji , Yamataka Koichi , Tsuzuki Toshiharu 
Published: October 2004

AbstractPancreatic duct cell cancer is characterized by a low resectability rate and a low long‐term survival rate. Between September 1974 and December 1992 in our institution, 149 (59%) of the 253 patients with this cancer underwent resection. The operative procedures were pancreatoduodenectomy in 105 patients, total pancreatectomy in 36, and distal pancreatectomy in 8. The tumor was extirpated with extensive dissection of the lymph nodes and excision of the nerve plexus in the retroperitoneum. Of the 149 patients, 79 (53%) underwent combined resection of the pancreas and the portal vein; 16 of the 79 patients also underwent resection of the adjacent arteries. Three patients died within 30 days after surgery, and 17 other patients succumbed within 2 to 7 months. The mortality among patients undergoing pancreatectomy and resection of the portal vein (9.5%) was similar to that of patients with pancreatectomy alone (10%). Curative resection was necessary for long‐term survival. The 5‐year survival rate in 61 patients with the curative resection was 15%. Ten patients lived more than 5 years. Even patients with lymph node metastases and cancer invasion of the portal vein had a prolonged survival. Intraoperative irradiation was carried out in 35 patients to improve the survival rate, but without success. Infusion chemotherapy with 5‐fluorouracil via the portal vein was tried in 25 patients, resulting in a decrease in liver metastasis. We have made some progress in the first step toward improving treatment, although we are far from the goal and it is necessary to conduct additional trials.
Male breast cancer: Austrian experience
Authors: Stierer Michael , Rosen Harald , Weitensfelder Wolfgang , Hausmaninger Hubert , Teleky Bela , Jakesz Raimund , Fruhwirth Hannes , Dünser Martina , Beller Siegfried , Haid Anton , Tüchler Heinz 
Published: October 2004

AbstractData were collected on 169 men treated for breast cancer at 36 surgical departments in Austria between 1970 and 1991. We report here several of their clinical features and assess the importance of established prognostic factors. After a median observation period of 51 months 60 patients (35%) suffered a recurrence. The estimated 5‐year recurrence‐free survival for the entire group was 55%, and the estimated 5‐year overall survival was 62%. Although stage‐adjusted data are comparable to those for female breast cancer, the outcome in this series may be attributed to a relatively high frequency of advanced tumor stages. Tumor size (recurrence‐free survivalp=0.00001; overall survivalp=0.03) and axillary lymph node status (recurrence‐free survivalp=0.0001; overall survivalp=0.0001) proved to have a prognostic impact. Using a multivariate analysis, axillary lymph node status (recurrence‐free survivalp=0.001; overall survivalp=0.01) still had prognostic influence. The various procedures used had no effect on local recurrence.
Hepatitis C virus infection among Japanese general surgical patients
Authors: Yanaga Katsuhiko , Wakiyama Shigeki , Soejima Yuji , Yoshizumi Tomoharu , Nishizaki Takashi , Sugimachi Keizo 
Published: October 2004

AbstractThe incidence of hepatitis C virus (HCV) antibody positivity is unknown. The purpose of this study was to clarify the prevalence of HCV infection among surgical patients and to identify high risk surgical patients. HCV antibody tests were performed in 789 surgical patients between April 1991 and March 1992. Of these patients, 129 (16.3%) tested positive, which was much higher than the positivity of the ordinary Japanese. Hepatobiliary diseases and portal hypertension were associated with a higher positivity than other disease categories (94 of 206, 45.6% versus 35 of 583, 6%; p<0.0001). Patients above 50 years of age had a higher positivity than their younger counterparts (118 of 578, 20.4% versus 11 of 211, 5.3%; p<0.0001). The HCV positivity was as high as 54.1% (119 of 220) among surgical patients with known risk factors for hepatitis, in contrast to only 1.9% (10 of 569) among those without such risk factors. We conclude that surgical patients have a high incidence of HCV infection, for whom medical professionals should pay special attention to avoid disease transmission.
Reconstruction of the food passage after total gastrectomy: Randomized trial
Authors: Fuchs Karl‐Hermann , Thiede Arnulf , Engemann Rainer , Deltz Eberhard , Stremme Ortrud , Hamelmann Horst 
Published: October 2004

AbstractControversial results have been reported regarding the importance of the duodenal food passage after total gastrectomy. There are a number of experimental and clinical studies showing an advantage for the jejunal interposition between esophagus and duodenum. Others favor the Roux‐en‐Y reconstruction, as it is technically less demanding. The purpose of this study was the randomized comparison between two major reconstruction principles after total gastrectomy for gastric cancer (i.e., jejunal interposition with pouch versus Roux‐en‐Y pouch reconstruction). A group of 120 patients with gastric cancer were randomized and operated on during a 5‐year period according to standardized operative protocols, using either a jejunal interposition with pouch (JIP) or the Roux‐en‐Y reconstruction with pouch (RYP). Endpoints of this study were operation time, intra‐and postoperative problems and complications, patients' body weight, functional assessment, and quality of life. Of the 120 patients, 14 had to be withdrawn during the operation because only the Roux‐en‐Y reconstruction was technically possible. Finally, 53 patients with JIP were compared with 53 patients with RYP for the perioperative course. There were no significant differences between the two procedures (RYP and JIP) regarding complications (24.5% and 26.4%, respectively), mortality (3.8% and 1.9%, respectively), and operation time (4.35 hours and 4.40 hours, respectively). For long‐term functional comparison 46 (RYP, n=26; JIP, n=20) patients were without recurrence after 3 years of survival. Comparison of body weight, Visick scoring, and the Spitzer Index also did not reveal any significant difference between the two operation methods. In conclusion, patients with gastric cancer after total gastrectomy do not benefit from reconstructing the duodenal food passage by a jejunal interposition with pouch regarding their postoperative quality of life when compared to the widely used and technically less demanding Roux‐en‐Y reconstruction with pouch. Differences between the two reconstruction principles, documented by sophisticated functional assessment, may well exist, but the have no major clinical importance.