bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical Triumvirate of Theodor Kocher, Harvey Cushing, and William Halsted
Authors: Modlin Irvin M. 
Published: August 2002

AbstractIt is difficult to evaluate precisely the effects of one individual on an entire discipline such as surgery. Indeed, it is impossible to do so when such a discipline spans so vast a country as the United States of America. Nevertheless, as a mountain peak can be seen from afar, so may one perceive the influence of man of Kocher's stature. His connection with Halsted and especially Cushing provided a direct link between the grandeur of Kocher's achievements and their lineal translation to a generation of evolving American surgeons. Both individuals, by personal example and professional endeavor, transmitted the precepts of Kocher to the nascent surgical fellowship of America. Thus the icon of Swiss surgery, recognized by a Nobel laureate and esteemed by his European colleagues, became a profound influence on American surgery. The triumvirate of Kocher, Cushing, and Halsted may thus be acknowledged as of vital consequence to the establishment of American surgery during the twentieth century.
Roles of Nitric Oxide in Surgical Infection and Sepsis
Authors: Johnson Mark L. , Billiar Timothy R. 
Published: August 2002

AbstractRecent advances in nitric oxide (NO) research have begun to elucidate the roles of NO in sepsis and infection. Although adequate levels of NO production are necessary to preserve perfusion and carry out cytoprotective functions in sepsis, overproduction appears to contribute to hemodynamic instability and tissue damage. These observations have led to the development of strategies to inhibit NO synthesis or scavenge excess NO in patients with septic shock. Local expression of the inducible NO synthase also has antimicrobial functions. The combination of NO with superoxide forms peroxynitrite which participates in bacterial killing in the peritoneal cavity. The capacity of red blood cells and hemoglobin to remove NO most likely accounts for the adjuvant effect of blood in peritonitis.This review will summarize the pathobiology of NO in surgical sepsis and infection.
Management of Hyperparathyroidism in an Endemic Goiter Area
Authors: Klingler P.J. , Strolz S. , Profanter C. , Klingler A. , Kendler D. , Lhotta K. , Bodner E. , Riccabona G. 
Published: August 2002

AbstractIn an endemic goiter area patients with hyperparathyroidism (HPTH) frequently also have thyroid abnormalities. In a retrospective study of 95 patients with HPTH we assessed the diagnostic accuracy of imaging techniques (ultrasonography or radionuclide scanning) for preoperative localization of parathyroid adenomas. Altogether 86% of our patients had goiter, requiring thyroid resections in 37%. For 19 patients the parathyroid exploration was the second or third cervical operation, most of them due to goiter. We found that the overall rate of transient and permanent recurrent nerve paralysis is considerably increased in patients with previous neck surgery (26% vs. 7%). The combination of ultrasonography and radionuclide scanning can lead surgeons to the site of parathyroid lesions responsible for HPTH in 85% of cases, although frequent nodular goiters can produce pitfalls for correct imaging in iodine‐deficient countries. In endemic goiter areas preoperative localization studies can be recommended in patients with primary HPTH—for evaluation of thyroid pathology possibly leading to resection or its accuracy in localizing parathyroid adenomas. These studies also seem justified in patients with previously unsuccessful neck explorations for HPTH.
Laparoscopy for Inflammatory Bowel Disease: Pros and Cons
Authors: Sardinha T. Cristina , Wexner Steven D. 
Published: August 2002

AbstractThe role of laparoscopic surgery in the treatment of colorectal malignancies is still under investigation, although it can offer significant benefits to many patients with inflammatory bowel disease (IBD). The aim of this study was to assess the pros and cons of the laparoscopic management of IBD. Data were obtained from a review of the literature published since 1992, when the first report of laparoscopic surgery for IBD appeared in print. From 1992 to 1997 several series of laparoscopic colorectal surgery for the management of IBD have been reported. A close evaluation of these studies revealed that laparoscopy in patients with terminal ileal Crohn's disease or anal Crohn's disease in need of fecal diversion offers significant advantages compared to laparotomy, including decreased pain, length of hospitalization, and disability. An additional bonus is improved cosmesis and a reduction in symptomatic postoperative adhesions. These many benefits can be achieved without any increase in morbidity or expense. Conversely, the use of this technology for restorative proctocolectomy in patients with mucosal ulcerative colitis is associated with a longer operative time and an increased incidence of both intra‐ and postoperative complications compared to laparotomy. Laparoscopic colorectal surgery can thus be advantageous for treatment of terminal ileal Crohn's disease but cannot be routinely justified for the treatment of mucosal ulcerative colitis.
Prevalence of Thyroid Cancer in Hyperthyroid Patients Treated by Surgery
Authors: Zanella Everardo , Rulli Francesco , Muzi Marco , Sianesi Mario , Danese Daniele , Sciacchitano Salvatore , Pontecorvi Alfredo 
Published: August 2002

AbstractA retrospective study has been carried out to evaluate the prevalence of malignant thyroid tumors in 202 patients submitted to surgery for hyperthyroidism. Thyroid cancer was diagnosed in 12 cases (5.9%); the final histologic examination revealed nine papillary carcinomas, one follicular carcinoma, and two Hürthle cell carcinomas. Concurrence of hyperthyroidism and thyroid cancer was more frequent in patients with single toxic adenomas than in those with toxic diffuse or multinodular goiters. In five cases thyroid malignancy was detected in the context of the hyperthyroid lesion (three toxic adenomas and two diffuse goiters). In eight patients the malignant lesion showed a maximum diameter of less than 1 cm, although in five of these cases unfavorable histologic features, such as minimal capsular invasion or multifocality, were present. All patients presenting with thyroid cancer are currently alive and apparently free of residual disease. It is concluded that hyperthyroid patients, particularly those with single toxic adenomas, should be carefully evaluated to exclude the presence of an associated malignancy and to plan the most appropriate therapeutic options.
Tension‐free Laparoscopic and Open Hernia Repair: Randomized Controlled Trial of Early Results
Authors: Picchio Marcello , Lombardi Assunta , Zolovkins Aleksejs , Mihelsons Maris , La Torre Giuseppe 
Published: August 2002

Abstract.The aim of the study was prospectively to compare the early results and outcome in 105 patients randomly allocated to undergo tension‐free laparoscopic hernia repair (LHR) with transabdominal preperitoneal technique (53 patients) or open hernia repair (OHR) with mesh apposition (52 patients). The mean (SD) operation time was longer in the LHR group than in the OHR group: 49.6 (5.4) versus 33.9 (6.2) minutes; p < 0.001. One laparoscopic case was converted to open repair to deal with a hemorrhage from an aberrant obturatory artery at the level of Cooper's ligament. Groin discomfort or pain was the most common complication after both procedures. The patients requiring none, one, two, or more than two doses of intramuscular diclofenac were, respectively, 40.4%, 40.4%, 15.4%, and 3.8% after LHR and 50.0%, 30.8%, 17.3%, and 1.9% after OHR (p= 0.69; NS). The mean ± SEM (range) postoperative visual analog scale score, ranging from 0 (no pain) to 10 (worst pain imaginable), was 3.1 ± 0.2 (1–7) in the LHR subset and 2.7 ± 0.2 (1–5) in the OHR group (p= 0.14; NS); on the second postoperative day the score was 2.3 ± 0.2 (1–6) and 1.8 ± 0.1 (1–4), respectively (p < 0.03). The time ± SEM (range) of resumption of pain‐free normal activities and work was faster in OHR group: 6.1 ± 0.2 (4–8) weeks versus 6.5 ± 0.1 (4–8) weeks; p < 0.03. Our results showed that tension‐free open hernia repair is superior to LHR in terms of postoperative pain with no important differences in recovery.
Decision Analysis for the Surgeon
Authors: Kucey Daryl S. 
Published: August 2002

Abstract.Surgical practice, by nature, is full of important decision making scenarios. Surgeons have begun to utilize the decision sciences as a methodology of approaching clinically relevant surgical problems. This article provides a brief overview of some of the important concepts of the decision sciences as they apply to practicing surgeons. Concepts discussed include the basic principles behind decision trees, valuing outcomes, and Markov modeling as well as the pros and cons of the decision analytic approach. Decision analysis is a valuable aid in determining answers to clinical scenarios, and understanding the principles behind this methodology is an important addition to the armamentarium of all practicing surgeons.
Recipient Factors as Determinants of Mortality after Adult Liver Transplantation
Authors: Palma Fermin , Jimenez Carlos , Moreno Enrique , Loinaz Carmelo , Garcia Ignacio , Palomo Juan Carlos , Hernandez Diego , Gonzalez‐Chamorro Antonio 
Published: August 2002

Abstract.The factors that can influence the outcome of orthotopic liver transplantation (OLT) are numerous. The purpose of this study was to determine the effects of recipient preoperative factors on patient mortality. Between April 1986 and April 1998 a total of 600 OLTs were performed in our institution. We retrospectively reviewed our first 203 consecutive primary adult OLTs with at least 4 years of follow‐up. A case‐control comparison was performed between survivors and nonsurvivors, and differences in recipient variables were studied for their correlation with patient mortality. A logistic regression analysis was also performed. Mortality was significantly increased among those with fulminant hepatic failure (FHF) (66.6%, p= 0.003), primary cancer (63.1%, p= 0.018), females (46.1%, p= 0.043), encephalopathy grade IV (72.7%, p= 0.012), recipients under respiratory support (69.2%, p= 0.031), and ABO‐incompatible transplants (80%, p= 0.05). FHF, primary cancer, and female gender were the only variables that had a significant association with mortality in the logistic regression analysis. A higher incidence of prolonged respiratory support, bacterial and fungal infections, pneumonia, and chronic rejection contributed to the lower outcome observed in females. These results stress the need for continuous evaluation of the selection criteria of candidates for OLT suffering from primary cancer and FHF. The impact of recipient gender on mortality warrants further analysis but suggests that in the future more attention must be paid to the influence of this factor on the final outcome of OLT.
Tauroursodeoxycholate and Cholestyramine Enhance Biliary Carcinogenesis in Hamsters
Authors: Ikematsu Yoshito , Tomioka Tsutomu , Kitajima Tomoo , Inoue Keiji , Tajima Yoshitsugu , Kanematsu Takashi 
Published: August 2002

AbstractThe aim of this study was to examine whether tauroursodeoxycholate (TUDC) and cholestyramine resin (CR) enhance biliary carcinogenesis in the hamster model. A cholecystoduodenostomy with dissection of the extrahepatic bile duct on the distal end of the common duct was performed on Syrian hamsters. The hamsters were then divided randomly into 3 groups: control group, TUDC‐treated group, and CR‐treated group. All animals received N‐nitrosobis(2‐oxopropyl)amine (BOP) to initiate pancreaticobiliary cancer. The experiment was terminated at week 16 and the number of neoplastic lesions was counted microscopically. In the TUDC group, the intrahepatic biliary carcinogenesis was more accelerated than that observed in the control group, but no promoting effect was seen in the pancreas, gallbladder, or extrahepatic bile duct. In the CR group, both the intrahepatic biliary and the gallbladder carcinogenesis were inhibited compared with that observed in the control group and the TUDC group. TUDC enhanced the intrahepatic bile duct carcinogenesis, whereas CR inhibited both the intrahepatic bile duct and the gallbladder carcinoma. Bile acids were suggested to promote biliary carcinoma in the hamster model.
Fate of the Rectum and Ileal Recurrence Rates after Total Colectomy for Crohn's Disease
Authors: Yamamoto Takayuki , Keighley Michael R.B. 
Published: August 2002

AbstractThe aim of this study was to examine the fate of the rectum and ileal recurrence rates after total colectomy for Crohn's disease. One hundred thirty patients who underwent total colectomy between 1970 and 1997 were reviewed; 65 patients underwent end ileostomy with an oversewn rectal stump (TC+I) and 65 had ileorectal anastomosis (IRA). Patients treated by TC+I had significantly more rectal involvement (93%) than those having IRA (43%) (p < 0.0001). The incidence of ileal disease at the time of colectomy was similar (TC+I 34% versus IRA 32%; p = 0.99). Rectal recurrence requiring proctectomy was significantly more common after TC+I (51%) than after IRA (26%) (p= 0.01), whereas ileal recurrence requiring resection was significantly more common after IRA (45%) than after TC+I (18%) (p= 0.002). Using Kaplan‐Meier methods, the 10‐year cumulative probability of proctectomy was significantly higher after TC+I than IRA (58% versus 22%; p= 0.0001), whereas the 10‐year cumulative probability of ileal resection was significantly higher after IRA than TC+I (37% versus 18%; p= 0.03). In conclusion, the proctectomy rate is higher after colectomy and ileostomy probably due to a higher incidence of preoperative rectal involvement. By contrast, the ileal recurrence rate is higher after colectomy and IRA.
Efficacy of Endoscopic Pure Ethanol Injection Method for Gastrointestinal Ulcer Bleeding
Authors: Asaki Shigeru 
Published: August 2002

AbstractWe reviewed endoscopic hemostatic effects of the pure ethanol injection (PEI) method for reducting emergency operations and deaths due to gastroduodenal ulcer bleeding. During 17 years beginning in June 1979 in Tohoku University Hospital, 331 patients underwent endoscopic hemostasis by the PEI method. Initial hemostasis was successfully obtained in all cases. Rebleeding occurred in about 4% of the patients, and rehemostasis was obtained successfully in all of them. Complete hemostasis was obtained in 330 of 331 patients (99.7%) using the PEI method; there were no deaths. Only one patient required emergency operation after hemostasis because of repeated neogenetic bleeding complicated with a perforation and another because of an unidentifiable neogenetic ulcer bleeding located just above the Vater papilla. None required other endoscopic hemostasis or interventional radiology. Moreover, after introduction of “second‐look” endoscopy, the rebleeding rate decreased to about 1% with PEI hemostasis. Based on these excellent hemostatic effects of the PEI method, we believe that a comparative study with other hemostatic methods is not needed.
Postoperative Hepatic Catabolic Stress Response in Patients with Cirrhosis and Chronic Hepatitis
Authors: Lausten Susanne B. , El‐Sefi Talaat , Marwan Ibrahim , Ibrahim Tarek M. , Jensen Lone S. , Grøfte Thorbjørn , Andreasen Frederik , Vilstrup Hendrik , Raouf Ahmed A. , Helmy Amr , Jensen Steen L. 
Published: August 2002

AbstractOpen (OC) or laparoscopic (LC) cholecystectomy is considered a relative contraindication in patients with liver cirrhosis. The effect of LC and OC on the hepatic catabolic stress response was studied in patients with postnecrotic liver cirrhosis and chronic hepatitis to define the most suitable procedure from a metabolic point of view. Altogether 14 patients with cirrhosis and 14 with chronic hepatitis were randomized to LC or OC (n= 7 in each group). The increase in the functional hepatic nitrogen clearance (FHNC) was quantified. Changes in glucose, insulin, glucagon, cortisol, epinephrine, norepinephrine, and prostaglandin E2 (PGE2) were observed. There was no difference in FHNC between LC and OC in any of the patients. Among cirrhotic patients OC caused a 132% increase in FHNC (p < 0.05) and among the hepatitis patients a 69% increase (p < 0.05). In contrast, there was no significant increase following LC in any of the patients. OC increased fasting glucose and insulin in the hepatitis patients (p < 0.01 and p < 0.001, respectively) and in the cirrhosis group (p < 0.01 and p < 0.05, respectively). Alanine stimulation increased glucose in hepatitis patients after OC (p < 0.05) and after LC (p < 0.01). Stimulated glucagon increased after OC in the hepatitis group (p < 0.05). During stimulation cortisol was higher following LC in hepatitis patients (p < 0.01) and cirrhotic patients (p < 0.05). Fasting PGE2 was down‐regulated after LC in hepatitis patients (p < 0.05) and cirrhotic patients (p < 0.01) and after OC in the hepatitis group (p < 0.001). FHNC is similar after LC and OC. Thus from a metabolic point of view, LC has no advantage over OC.
Initiators and Propagators of the Metabolic Response to Injury
Authors: Hill Andrew G. 
Published: August 2002

Abstract.Injury produces tissue hypoperfusion and subsequent reperfusion, afferent neural activity, and immune and vascular endothelial activation. These, in turn, set up a cascade of events coordinated by the central nervous system and at the level of individual tissues such as the liver, gut, and skeletal muscle. They are mediated by a complex array of neutrophil and macrophage products. The changes result in hypermetabolism, lypolysis, lysis of skeletal muscle and visceral protein, and expanded extracellular fluid with consequent organ failure.
Overview of Modern Management of Patients with Critical Injury and Severe Sepsis
Authors: Streat Stephen J. , Plank Lindsay D. , Hill Graham L. 
Published: August 2002

Abstract.Over the last 10 years there have been substantial changes in the issues confronting intensivists and surgeons caring for critically ill patients. A substantial increase in the number of elderly patients with surgical illness and complex co‐morbidity has accompanied the increase in the proportion of elderly in populations in the developed world. This phenomenon has been seen particularly with sepsis. Incidence rates for blunt trauma have declined overall, but the problems of the elderly trauma patient have become more evident. Major elective surgery remains a common indication for short‐term intensive care in many countries, but the need for cost‐containment has led to increased use of high‐dependency care for many such patients. Expectations of both society and clinicians have increased, and this has been reflected in the increased demand for complex procedures (e.g., liver transplantation, cerebral artery aneurysm clipping, aortic aneurysm repair) in patients previously considered at too high risk. Along with these expectations have come pressures on clinicians to reduce costs at the same time as improving clinical outcomes. Despite many advances in the care of critically ill patients with injury or sepsis, mortality, morbidity, and cost remain high; and nutritional support is frequently required. The duration and extent of the metabolic changes seen in response to critical surgical illness and intensive care treatments have become better characterized. Although some of the changes in body water and fat are modifiable, loss of large amounts of (functional) protein has been resistant to various strategies so far studied.
Factors affecting female‐biased sex ratio in a trap‐nesting wasp, Trypoxylon malaisei
Authors: Oku S. , Nishida Takayoshi 
Published: August 2002

AbstractWe examined the female‐biased sex ratio of a trap‐nesting wasp Trypoxylon malaisei considering the following factors: (1) local mate competition (LMC), (2) resource quality, (3) partial bivoltinism, and (4) presence of constrained females. The sex ratio (expressed as male ratio) at emergence was strongly female biased, i.e., 0.30 and 0.19, in terms of the number and investment, respectively. To evaluate the primary sex ratio, we analyzed the data from nests where all the offspring successfully emerged, excluding nests composed of single‐sex offspring. The primary sex ratio was also female biased, at 0.33 and 0.21, in terms of the number and investment, respectively. LMC was highly responsible for the female‐biased sex ratio because both the nonrandom oviposition sequence [females at inner cells and male(s) at outer cells] and earlier emergence of males allowed sib‐matings to occur. In contrast, the other three factors little affected the female‐biased sex ratio: the sex ratio was fairly constant when resource quality (nest size) varied, partial bivoltinism was extremely rare or absent, and constrained females were absent or did not reproduce at all.
Pressure Overload Induces Heterologous Expression of the Atrial Natriuretic Factor (ANF) Gene
Authors: Dosch J. C. , Szwerc M. F. , Lin J. C. , Magovern J. A. , Edwards J. G. 
Published: August 2002

AbstractSeveral investigations have demonstrated the regional heterogeneity of myocardial phenotype, and hypertrophy may also induce regionally disparate changes. We have utilized the direct DNA injection technique to study regional variations in overload‐induced ANF expression. Pressure overload was induced by stenosis of the ascending aorta in canines. ANF promoter reporters were injected into the left ventricle; in different regions including the base, the midwall region, and the apex. Injections were made at different depths to include the epicardial and endocardial layers. The animals were sacrificed 7 days following surgery and the left ventricle harvested for tissue analysis. Under normotensive conditions, ANF reporter expression was similar throughout the heart. PO increased ANF expression and the increases were greater in the endocardium than in the epicaridium. PO also significantly increased expression in the midwall and base regions, but not in the apex. It is unknown from these experiments, whether the greater increases in midwall expression are a function of greater wall stress, metabolic demand, or phenotypic differences in the midwall myocytes. These findings do indicate that regional differences in overload‐induced changes in gene expression are evident and may be functionally important in determining myocardial response to increased functional demand.
Factor structure of the Expagg and Revised Expagg: Failure to replicate using confirmatory factor analysis
Authors: Forrest Sarah , Shevlin Mark , Eatough Virginia , Gregson Mick , Davies Mark N.O. 
Published: August 2002

AbstractThis paper reports tests of the factor structure of the original and Revised Expagg scales using a confirmatory factor analytic approach. Current evidence regarding the dimensionality of the Expagg scale [Campbell A et al. 1992. Aggr Behav 18:95–108] proposes that the scale measures a single bipolar instrumental‐expressive social representation of aggression factor. In contrast, evidence on the Revised Expagg scale [Archer J and Haigh AM. 1997. Brit J Soc Psychol 36:83–105] suggests two unidimensional factors of instrumental and expressive aggressive beliefs. Furthermore, Campbell et al. [1999. Aggr Behav 25:435–444] claim that there is equal evidence for the Revised Expagg being either one‐ or two‐dimensional. They also suggest a short modified version of the Revised Expagg. Current evidence, however, is based on traditional and flawed exploratory factor analytic methods of scale assessment. This paper addresses the limitations of the previous psychometric assessment of these measures by implementing confirmatory factor analytic methods in the assessment of construct validity. It thereby evaluates the previous claims regarding the factor structure of these measures. The results suggest that none of the a priori specifications of the Expagg and Revised Expagg adequately explain the sample data. The results are discussed in terms of the significance of demonstrating sufficient construct validity of measurement instruments in psychological research.Aggr. Behav. 28:11–20, 2002. © 2002 Wiley‐Liss, Inc.