bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pregnancy: A Contraindication?
Authors: Holthausen Ulla H. , Mettler Liselotte , Troidl Hans 
Published: August 2002

AbstractAccording to David L. Sackett evidence‐based medicine is the conscientious, explicit, and judicious use of current best evidence when making decisions about the care of individual patients. It means integrating individual clinical expertise with the best available external evidence from systematic research. On the basis of this idea in medicine the following communication summarizes and evaluates current statements and literature on laparoscopic surgery during pregnancy. The topic is an example for excellent individual clinical performance on one hand, as gynecologists have perform laparoscopic procedures during pregnancy for decades. On the other hand, pregnancy is considered to be a contraindication for laparoscopic surgery by clinicians, because no excellent external evidence from systematic research is available. To find an answer to the question of whether pregnancy is a contraindication for laparoscopic surgery we performed a literature search and gained information by conducting interviews with several experts in gynecology and endoscopic operations. We concluded that there are almost no “scientific” data about endoscopic surgery during pregnancy, but gynecologists representing the “real world” seem to have no fear of the procedure for their patients. Between the two extremes, performing laparoscopic operations during pregnancy might be advantageous for maximal patient‐friendly surgery, but considering pregnancy as a contraindication for the laparoscopic approach might be the safer treatment. The reader may decide that the subject on endoscopic surgery in pregnancy is still open.
Development of Clinical Practice Guidelines: Surgical Perspective
Authors: Brouwers Melissa C. , Browman George P. 
Published: August 2002

Abstract.Clinical practice guidelines (CPGs) are systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances. The implications of this definition are that: the methodologic perspective and operations for systematic development must be specified, a strategy is needed to account for the patient's perspective in the CPG development process and the clinical decision, and a mechanism is required to determine how appropriateness ought to be conceptualized and defined. Addressing these issues, we review models of CPG development, outline challenges to evidence‐based approaches to CPG development, address unique factors relevant to the development of guidelines for the surgical community, introduce an Ontario practice guidelines strategy that uses complementary methods of CPG development, and summarize the feedback provided by the surgical community regarding the practice guidelines produced in Ontario's cancer system.
Effects of Early Eschar Excision En Masse at One Operation for Prevention and Treatment of Organ Dysfunction in Severely Burned Patients
Authors: Huang Yuesheng , Yang Zongcheng , Chen Faming , Crowther Roger S. , Li Ao 
Published: August 2002

Abstract.We sought to determine whether early eschar excision en masse (EEE) at one operation would be effective in the prevention and treatment of postburn organ dysfunction (OD) and multiple organ dysfunction syndrome (MODS). A total of 60 patients, with total body surface burned area over 35% and a third degree burn area over 20% were studied and divided into two groups, the EEE group (35 cases) and the group treated with repeated escharectomies by stages (repeated escharectomy group, 25 cases). Other than the different operations undertaken, the patients in both groups received identical conventional treatment. Before, during, and after operation the hemodynamic and blood gas indices, plasma levels of endotoxin and tumor necrosis factor (TNF), and the injurious effects of burn patients' sera on endothelial cells in vitro were determined in patients of the EEE group. The incidence of OD and MODS was decreased significantly (11.4%) in patients of the EEE group, and the cure rate increased greatly (85.7%). The cardiac output dropped to 77.8% of its preoperative level at the end of escharectomy but began to rise at 2 hours and returned to its baseline levels at 24 hours after operation. Plasma levels of endotoxin and TNF and levels of lactic dehydrogenase and 6‐keto‐prostaglandin F1|ga in the endothelial cell culture media were all reduced profoundly. The cultured endothelial cells maintained their original morphology. The findings substantiate the hypothesis that eschar excision en masse at one operation is feasible and effective in preventing and treating early postburn OD and MODS, mainly by alleviating systemic inflammatory response syndrome and endothelial cell injury.
Long‐term Results of Total Adrenalectomy for Cushing's Disease
Authors: Nagesser Suresh K. , van Seters Arnoud P. , Kievit Job , Hermans Jo , Krans H. Michiel J. , van de Velde Cornelis J.H. 
Published: August 2002

AbstractThe objective of this study was to present the long‐term results of total adrenalectomy for Cushing's disease. Forty‐four patients undergoing total adrenalectomy for Cushing's disease between 1953 and 1989 at Leiden University Medical Center, The Netherlands, were studied retrospectively. Remission was achieved in 42 patients (95%), with a mean duration of 19 years. Adrenal remnants were observed in 12 patients (27%), and were without clinical consequence in the majority of patients, but caused early recurrent disease in 2 patients. Nine patients (20%) experienced Addisonian crises up to 30 years following treatment. Nelson's syndrome developed in 10 patients (23%) 7–24 years following total adrenalectomy. Prior pituitary irradiation was a protective factor against Nelson's syndrome as it delayed its onset (p= 0.025). On the other hand, subnormal dose or noncontinuous glucocorticoid replacement therapy was associated with increased risk of development of Nelson's syndrome (p= 0.047). The incidence of Nelson's syndrome increased with prolonged follow‐up, and female patients seemed to be at increased risk. Quality‐of‐life assessment showed less favorable scores on mental health and health perception scales, for which no explanation can be found except the long‐lasting metabolic effects of Cushing's disease, even when successfully treated. In conclusion, total adrenalectomy remains the final treatment for Cushing's disease. The presence of adrenal remnants which can cause recurrent disease and the development of Nelson's syndrome during prolonged follow‐up enhance the need for continued regular follow‐up. Pituitary irradiation prior to total adrenalectomy delays the onset of Nelson's syndrome.
Changes in Intestinal Transit Time after Proctocolectomy Assessed by the Lactulose Breath Test
Authors: Bruewer Matthias , Stern Josef , Herrmann Silke , Senninger Norbert , Herfarth Christian 
Published: August 2002

AbstractAfter proctocolectomy with ileal pouch‐anal anastomosis (IPAA) patients have increased stool frequency and intermittently use antidiarrheal medication. In addition to other factors, gastrointestinal transit time (MTT) could influence stool frequency. The aim of this study was to investigate how MTT changes after IPAA and to study whether MTT has an influence on daily stool frequency. In a prospective trial MTT was investigated with the lactulose breath test in 12 patients undergoing surgery for chronic ulcerative colitis (CUC) or familial adenomatous polyposis coli (FAPC) at different stages: before proctocolectomy, after IPAA with loop ileostomy, and 3 months and 1 year after ileostomy closure. MTT was also measured in 12 patients with IPAA, 12 patients with subtotal colectomy and ileorectal anastomosis (IRA), and 8 patients with conventional proctocolectomy and Brooke ileostomy (CPC) several years after surgery. Twelve healthy volunteers served as controls. Before IPAA, MTT was prolonged in CUC versus FAPC and controls. After restoration of gut continuity MTT was markedly accelerated. After 1 year MTT was slowed again, though values before proctocolectomy and those in controls were not reached. Several years after surgery MTT was significantly prolonged in IPAA and IRA versus controls. In CPC, MTT could not be determined by lactulose breath test. Stool frequency showed an inverse correlation to MTT in IPAA. In conclusion, this study shows that orocecal and oropouch transit are accelerated in the early postoperative period after (procto)colectomy but prolonged in the long‐term course. Adaptation of the small bowel takes longer than 1 year. Impairment of stool frequency may be partly due to this adaptation.
Ultrasound of the Breast
Authors: Kossoff Marjorie Britt 
Published: August 2002

AbstractBreast ultrasound (US) has developed into an essential imaging modality for evaluation and management of the patient with breast symptoms or mammographic abnormalities. US is usually an adjunct to mammography and the clinical examination but in the young patient presenting with symptoms sonography may be the initial or sole imaging procedure. A screening role has not been established, but there may be a subset of high‐risk patients for whom US will prove useful as a screening adjunct. Proper selection of equipment, careful attention to the technical aspects of scanning, and awareness of artifacts are necessary to avoid misinterpretation and to demonstrate subtle changes in breast architecture which indicate a malignancy. Thorough knowledge of the range of normal appearances of the breast and the alterations produced by breast disease are essential requisites for accurate evaluation and lesion characterization. Two of the most important clinical advances in breast US have been the development of criteria that allow improved benign/malignant differentiation of solid breast lesions and the use of US to guide interventional procedures. Other developments such as Doppler and contrast agents remain investigational.
Ultrasound of the Spleen
Authors: Andrews Matthew W. 
Published: August 2002

AbstractUltrasound (US) is a very useful means of noninvasively examining the spleen. Imaging is generally achieved via an intercostal approach using gray scale US supplemented by color flow to assess vasculature. Normal spleen appears uniform with vessels radiating and converging at the hilum. US readily identifies accessory spleens, a common congenital variation. Splenomegaly can be identified by US, however, it is not useful in differentiating the many causes of an enlarged spleen. Focal splenic masses are identified as cystic or solid by US, and features such as calcification, wall thickening, internal debris, and gas may be demonstrated in cystic type masses. Granulomatous calcification may be seen with US and cavernous hemangiomata typically have a characteristic US appearance. US can demonstrate typical features of splenic infarction. Splenic injury can be detected with US, however, whether US is the most appropriate first line investigation for suspected splenic injury is yet to be determined. It is a very useful follow‐up modality for monitoring splenic injuries detected by either US or computed tomography which are treated conservatively.
Review of Venous Vascular Ultrasound
Authors: Phillips Gareth W.L. 
Published: August 2002

AbstractDuplex ultrasound (US) has become the new gold standard in the assessment of acute deep vein thrombosis. In view of the large number of cases with persistent changes, all cases should be reassessed at 6 months to document the extent of residual disease. The role of duplex US in chronic venous disease is less well established but it is evolving as the single most useful examination and is likely to supplant other noninvasive methods in the near future.
Metabolic Management of Severe Acute Pancreatitis
Authors: Windsor John A. , Hammodat Hisham 
Published: August 2002

Abstract.The metabolic management of severe acute pancreatitis involves early identification of patients with severe pancreatitis, aggressive fluid resuscitation, organ support, and careful monitoring in an intensive care environment. Recent evidence has helped to define the roles of enteral feeding, prophylactic antibiotics, endoscopic retrograde cholangiopancreatography, computed tomography, and fine‐needle aspiration for bacteriology. The most difficult decision in the management of these patients is whether surgery is required and which of the complementary approaches to necrosectomy and drainage is appropriate. Key metabolic events in the acinar cell, pancreas, and intestines are now being unraveled, as is the basis for the systemic manifestations and organ dysfunction associated with pancreatitis. This gives hope for the development of more specific metabolic interventions, which will likely target the maintenance of intestinal integrity and function, preservation of pancreatic microcirculation, and balanced modulation of the inflammatory response.
Ureteral Obstruction After Ureteroneocystostomy in Dogs Assessed by Technetium Tc 99m Diethylenetriamine Pentaacetic Acid (DTPA) Scintigraphy
Authors: Barthez Paul Y. , Smeak Daniel D. , Wisner Erik R. , Dibartola Stephen P. , Chew Dennis J. 
Published: August 2002

Objective—To use technetium Tc 99m diethylenetriamine pentaacetic acid (99mTc‐DTPA) renal scintigraphy to monitor ureteral obstruction after ureteroneocystostomy in a canine model of partial ureteral obstruction.Study Design—Experimental study.Animals—Eight normal adult dogs.Methods—Partial ureteral obstruction was created in 8 dogs by incomplete ligation of the terminal right ureter. Two weeks later, ureteroneocystostomy was performed in 7 dogs with unilateral partial ureteral obstruction and in 1 dog that had developed bilateral partial ureteral obstruction.99mTc‐DTPA scintigraphy was performed intermittently for 2 weeks after ureteroneocystostomy. Renal transit time of each kidney, as assessed by the time to maximal uptake (time of peak), and glomerular filtration rate, as assessed by percentage of kidney uptake of the radiopharmaceutical between 1 and 3 minutes, were estimated. Comparison between affected and nonaffected kidneys was performed with the Wilcoxon rank sum test.Results—Unilateral partial ureteral obstruction was induced successfully in 7 dogs. In 1 dog, bilateral partial obstruction was induced inadvertently. After ureteroneocystostomy, percentage of kidney uptake of99mTc‐DTPA was low in 4 affected kidneys. The uptake returned to within normal limits in 2 of the kidneys during the observation period. The time activity curve had a more rounded appearance or was increasing continuously for all affected kidneys. A significant increase in renal transit time was observed 2 and 4 days after ureteroneocystostomy. Transit time progressively returned to normal by 4 to 11 days for all affected kidneys except 1.Conclusion—Ureteroneocystostomy resulted in persistent partial ureteral obstruction for 4 to 11 days as determined by99mTc‐DTPA scintigraphy.Clinical Relevance—99mTc‐DTPA scintigraphy may be a useful procedure for monitoring renal function and ureteral obstruction after ureteroneocystostomy. Persistent partial ureteral obstruction may be seen 1 to 2 weeks after ureteral reimplantation in dogs with previously existing dilated ureters.
An In Vitro Comparison of Cordopexy, Cordopexy and Laryngoplasty, and Laryngoplasty for Treatment of Equine Laryngeal Hemiplegia
Authors: Jansson Nicolai , Ducharme Norm G. , Hackett Richard P. , Mohammed Hussni O. 
Published: August 2002

Objective—To examine the effect of cordopexy, laryngoplasty, and cordopexy combined with a modified laryngoplasty on airway mechanics.Study Design—Experimental airway mechanics were determined by subjecting equine cadaveric larynges to airflows similar to inspiratory airflow of exercising horses.Animals or Sample Population—Twenty equine larynges.Methods—Using cadaveric larynges, we developed and tested a new technique of arytenoid cartilage abduction. All larynges had the right arytenoid cartilage abducted to mimic the degree of arytenoid abduction that occurs at maximal exertion in live horses. Three surgical techniques were used to stabilize the left arytenoid cartilage of treated larynges; the left arytenoid cartilage was not stabilized in control larynges. Technique 1: Cordopexy—a suture was placed between the vocal ligament and the lamina of the thyroid cartilage. Technique 2: Standard laryngoplasty—a suture was placed between the muscular process of the arytenoid cartilage and the caudomedial aspect of the cricoid cartilage. Technique 3: Cordopexy plus modified laryngoplasty—the cordopexy suture was placed with a second suture between the horizontal ridge rostral to the muscular process of the left arytenoid cartilage and the lamina of the thyroid cartilage. Translaryngeal impedances (TI) were determined for each surgical technique by subjecting the larynges to increasing airflows and measuring the translaryngeal pressure differences. The arytenoid right to left angle quotient (RLQ) and the glottic cross‐sectional area (CSA) were also measured.Results—At maximal airflow, the adjusted means for the arytenoid RLQ and the TI for the cordopexy plus modified laryngoplasty (1.48 ± 0.04, 0.69 ± 0.05 cm H2O/L/s) and the standard laryngoplasty (1.39 ± 0.04, 0.78 cm H2O/L/s,) were different (P< .05) from values obtained after cordopexy alone (2.74 ± 0.37, 1.76 ± 0.48 cm H2O/L/s) or in control larynges (3.66 ± 0.54, 4.16 ± 0.96 cm H2O/L/s). Overall, a cordopexy plus modified laryngoplasty (9.69 cm2), a standard laryngoplasty (9.34 cm2), and a cordopexy alone (9 cm2) resulted in an increased glottic CSA greater than that for control larynges (6.94 cm2;P= .0001).Conclusions—Cordopexy alone did not improve airflow in a left laryngeal hemiplegic model. Cordopexy plus modified laryngoplasty was as efficacious as the standard laryngoplasty in alleviating the effects of left laryngeal hemiplegia on TI, glottic CSA, and arytenoid RLQ.Clinical Relevance—Fixation of the vocal cord (cordopexy) in addition to a laryngoplasty procedure may prove useful in the surgical treatment of equine laryngeal hemiplegia.
The Effect of Implanting Gentamicin‐Impregnated Polymethylmethacrylate Beads in the Tarsocrural Joint of the Horse
Authors: Farnsworth Kelly D. , White Nathaniel A. , Robertson John 
Published: August 2002

Objective—To determine the effect of intra‐articular gentamicin‐impregnated polymethylmethacrylate (PMMA) beads inserted in the equine tarsocrural joint on the synovial fluid, synovial lining, and cartilage, and to determine the peak and sustainable gentamicin concentrations in synovial fluid and plasma.Study Design—Pharmacokinetic, cytologic, and histologic study of the effect of gentamicin‐impregnated PMMA on normal equine tarsocrural joints.Animals—Five healthy adult horses.Methods—Gentamicin‐impregnated PMMA bead strands (3 strands each of 40 beads, with each strand containing 100 mg gentamicin) were surgically inserted into one radiographically normal tarsocrural joint in 5 horses. Each horse had both joints flushed with 1 L of lactated Ringer's solution before bead administration. Synovial fluid total protein concentration, white blood cell (WBC) count, gentamicin concentration, synovial histology, cartilage integrity, and cartilage glycosaminoglycan (GAG) concentrations were determined.Results—Gentamicin concentration (mean ± SEM peak concentration, 27.9 ± 2.27 μg/mL) occurred in the first 24 hours and remained above 2 μg/mL for 9 days. Gentamicin concentrations in control joints and the plasma remained below detectable levels. The synovial fluid WBC count for treated joints was increased compared with control joints for 72 hours, but was similar at day 6. The synovial protein concentration in gentamicin‐treated joints remained increased for 21 days. Synovium in treated joints had diffuse synovitis, whereas control joints had less fibrovascular proliferation. Superficial cartilage erosion was present in all treated joints. There was no difference in the GAG content of treated and control joint cartilage.Conclusions—Short‐term implantation of gentamicin (300 mg)‐impregnated PMMA beads can provide therapeutic levels of gentamicin (>2 μg/mL) in the normal tarsocrural joint for 9 days; however, gentamicin‐impregnated PMMA beads induce synovitis and superficial cartilage erosion.Clinical Relevance—Temporary intra‐articular administration of antibiotic‐impregnated PMMA may be an effective way to treat septic joints that require constant high concentrations of antibiotics.
Podotrochlear Bursa Endoscopy in the Horse: A Cadaver Study
Authors: Cruz Antonio M. , Pharr John W. , Bailey Jeremy V. , Barber Spencer M. , Fretz Peter B. 
Published: August 2002

Objectives—To evaluate podotrochlear bursa (navicular bursa) endoscopy as a diagnostic technique in horses and to correlate observations to radiographic and pathologic findings.Study Design—Descriptive study.Sample Population—Seventeen equine cadaver forelimbs.Methods—Five standard radiographic views of the navicular region and a bursographic study with lateromedial and caudal tangential radiographic views were taken of each forelimb. Radiographic scoring of the navicular bone (0, excellent; 1, good; 2, fair; 3, poor) was performed using a previously reported technique. Endoscopic examination was performed using a 30° wide‐angle forward oblique–viewing, 4‐mm outside diameter (OD), arthroscope. Four examiners using recorded videotapes made independent evaluations of bursal endoscopy. The specimens were then dissected and examined to verify radiographic and endoscopic findings.Results—The distribution of radiographic scores (RS) were 0 (5 limbs), 1 (7), 2 (2), and 3 (3). Abnormal endoscopic findings (fibrillation of the deep digital flexor tendon, a defect in the navicular bone fibrocartilage, and synovial hyperplasia) were identified in 3 limbs (2 with an RS of 1, and 1 with an RS of 3). The endoscopic observations made in the two RS 1 bursae were not confirmed on gross examination, whereas they were in the RS 3 specimen, which also had the only abnormal bursogram. Evaluation of the bursa on the side ipsilateral to the arthroscope portal was difficult. Complications of the technique included inadvertent penetration of the distal interphalangeal joint and the digital sheath, and superficial scoring of the navicular bone fibrocartilage.Conclusions—Podotrochlear bursa endoscopy is feasible and may be a useful technique in identifying early abnormalities associated with podotrochleosis.Clinical Relevance—In horses with podotrochleosis, endoscopic examination of the podotrochlear bursa may improve identification of pathologic changes within the bursa.