bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical Management of Duodenal Leiomyomas
Authors: Rice David C. , Bakaeen Faisal , Farley David R. , Unni K. Krishnan , van Heerden Jon A. 
Published: October 2003

Abstract.Duodenal leiomyomas are rare neoplasms and when present are usually asymptomatic. There are, however, isolated case reports of such leiomyomas giving rise to complications including gastrointestinal hemorrhage and obstruction. The purpose of this study was to review the surgical experience with duodenal leiomyomas at a large tertiary referral center. A retrospective review was performed of all patients with histologically proven duodenal leiomyomas encountered from 1975 to 1995. Twelve patients with surgically treated duodenal leiomyomas were identified. There were eight men and four women with a mean age of 57 years (range 20–73 years) at diagnosis. Anemia was the presenting sign in 10 patients (83%). The mean hemoglobin level at presentation was 10.8 ± 2.67 g/dl. Other presenting signs included melena (n= 5) and epigastric tenderness (n= 4). No patient had obstructive symptoms. Upper endoscopy visualized the lesion in 9 of 10 patients, but endoscopic biopsy provided an accurate histologic diagnosis in only two of six patients biopsied. All resected specimens underwent frozen section and permanent histopathologic analysis. Local excision was performed in eight patients, as benignancy was anticipated at surgical exploration and frozen section findings. Two patients underwent segmental duodenal resection with primary end‐to‐end anastomosis, and two patients underwent a Whipple procedure. There was no perioperative mortality. Morbidity was minimal. There was no tumor recurrence during a median follow‐up of 8.4 years. Gastrointestinal blood loss is the most common complication of duodenal leiomyomas requiring surgical intervention. Small symptomatic leiomyomas with benign features may be safely treated with local excision.
Fluorodeoxyglucose positron emission tomography for detection of recurrent or metastatic breast cancer
Authors: Kim Tae‐Seon , Moon Woo Kyung , Lee Dong‐Soo , Chung June‐Key , Lee Myung Chul , Youn Yeo‐Kyu , Oh Seung Keun , Choe Kuk Jin , Noh Dong‐Young 
Published: October 2003

AbstractFluorodeoxyglucose‐positron emission tomography (FDG‐PET) is a noninvasive imaging technique capable of identifying primary tumors and metastases with high sensitivity and accuracy. The aim of this study was to evaluate the diagnostic accuracy of whole‐body FDG‐PET imaging for the detection of recurrent or metastatic breast cancer after surgery. Whole‐body FDG‐PET imaging was performed on 27 patients with suspected recurrent breast carcinoma. PET images were evaluated qualitatively for each patient and lesion. FDG‐PET scans showed that there were 61 reference sites of malignant or benign lesions in 27 patients. In a patient‐based analysis, FDG‐PET scans correctly identified 16 of 17 patients with recurrent or metastatic disease and 8 of 10 without recurrence, resulting in a sensitivity, specificity, and accuracy of 94%, 80%, and 89%, respectively. In a lesion‐based analysis, FDG‐PET scans correctly identified 46 of 48 lesion sites with recurrent or metastatic disease and 11 of 13 without recurrence. The overall sensitivity, specificity, and accuracy for all lesion sites were 96%, 85%, and 93%, respectively. FDG‐PET scans revealed unsuspected recurrent or metastatic diseases in 8 of 27 (30%) of patients and 11 of 20 (55%) distant metastatic lesions. In 13 patients treatment was altered by the outcome of the PET scan. We concluded that whole‐body FDG‐PET scan is a useful diagnostic imaging modality for detecting recurrent or metastatic breast carcinoma in patients suspected of having recurrent disease after primary surgery.
Improved Survival with Early Fluid Resuscitation Following Hemorrhagic Shock
Authors: Santibanez‐Gallerani Alberto S. , Barber Annabel E. , Williams Shelley J. , Zhao Yan , Shires G. Tom 
Published: October 2003

Abstract.Recent studies have questioned the benefits of early fluid resuscitation in hemorrhagic shock. The purpose of the current study is to evaluate the effects of early fluid resuscitation (HSE) (15 minutes), delayed fluid resuscitation (HSD) (60 minutes), and no fluid resuscitation (HSU) on cytokine levels, hepatic resting membrane potential (Em), renal function, and mortality. Eighty male Sprague‐Dawley rats (350–450 g) were hemorrhaged 35% of their total blood volume and then received 40, 80, or 100 ml of crystalloid per kilogram as intravenous fluids (IVFs). The implementation of HSE resulted in stabilization of the Em (−29 mV), which was significantly different from that seen with HSD or HSU (−24 and −29 mV, respectively). The timing of resuscitation did not affect the elevation of tumor necrosis factor (TNFα) levels. The interleukin‐6 (IL‐6) levels for the HSE group were 81, 101, and 274 pg/ml for 40, 80, and 100 ml/kg, respectively. In contrast, HSD group IL‐6 levels were 440, 566, and 632 pg/ml for 40, 80, and 100 ml/kg (p < 0.0001). IL‐6 levels for the HSU group was 427 pg/ml, which was significantly different from that of the HSE group (p < 0.05). Urine output was present in 58% of the HSE rats but only 24% in the HSD rats and 0% of the HSU rats. Mortality was 11% for HSE, 58% for HSD, and 50% for HSU rats. Despite the recent studies questioning the benefits of early fluid resuscitation, these data show marked improvement in hepatic stability, the presence of urine output, decreased IL‐6 levels, and significantly lower mortality when IVFs were given early after hemorrhagic shock. Furthermore, excessive fluid resuscitation (100 ml/kg) resulted in an increased inflammatory cytokine level and mortality and may account for the controversy.
Difference in Patterns of Met Expression in Papillary Thyroid Carcinomas and Nonneoplastic Thyroid Tissue
Authors: Fluge Øystein , Haugen Dagny R.F. , Lillehaug Johan R. , Varhaug Jan E. 
Published: October 2003

Abstract.Met protein is a tyrosine kinase receptor for hepatocyte growth factor (HGF). c‐Met has morphogenic, mitogenic, and motogenic properties and is overexpressed in many solid tumors. We studied c‐met mRNA and protein expression in papillary thyroid carcinomas and nonneoplastic thyroid tissue. The c‐met mRNA was detected in all biopsies by reverse transcriptase‐polymerase chain reaction and by hybridization of complex cDNA probes to a c‐met‐specific DNA fragment in a dot blot array. Immunohistochemistry on fresh frozen biopsies showed Met protein localized along the basal cell membrane of normal thyrocytes in 32 of 35 nonneoplastic thyroid tissue specimens, sometimes associated with weak cytoplasmic reactivity but without apical cell membrane staining. In papillary carcinomas an increased Met protein expression was seen, comprising a cytoplasmic (33 of 49) and apical cell membrane (24 of 49) immunoreactivity, whereas only 1 of 49 biopsies showed basal cell membrane staining. A 145‐kDa Met‐specific band was detected by Western immunoblotting on protein extracts from papillary carcinomas. The tight junction protein zona occludens‐1 (ZO‐1), studied by immunohistochemistry, was weakly expressed along the apical cell membrane in 10 nonneoplastic biopsies. In contrast, increased and cytoplasmic/apical membranous ZO‐1 immunostaining was seen in 11 of 15 papillary carcinomas. Nuclear ZO‐1 staining was present in a few papillary carcinomas with partial dedifferentiation. The concomitant overexpression and subcellular redistribution of Met and ZO‐1 proteins indicate a change in cell polarity in papillary carcinomas compared to nonneoplastic thyroid tissue. These observations may reflect an important feature of the tumorigenesis of papillary thyroid carcinomas. No significant association was found between semiquantitative immunohistochemical assessment of Met protein and clinical parameters in papillary carcinoma patients.
Calcium ions as a factor of cell—cell cooperation in hepatocyte cultures
Authors: Brodsky Vsevolod Y. , Zvezdina Natalia D. , Nechaeva Natalia V. , Avdonin Pavel V. , Novikova Tatjana E. , Gvasava Inessa G. , Fateeva Valentina I. , Malchenko Ludmila A. 
Published: October 2003

AbstractUltradian protein synthesis rhythm was used as a marker of cell cooperation in synchronous dense and non‐synchronous sparse hepatocyte cultures. Phenylephrine (2 μM, 2 min), an α 1‐adrenoreceptor agonist, which exerts [Ca2+]cytelevation from intracellular stores, affected protein synthesis rhythm in sparse cultures, i.e. initiated cooperative activity of the cells. The same effect was produced by 2,5‐di(tertiary‐butyl)‐1,4‐benzohydroquinone (10 μM, 2 min), which increases [Ca2+]cytby a non‐receptor pathway. Pretreatment of dense cultures with the intracellular calcium chelator, 1,2‐bis (2‐aminophenoxy) ethane‐N,N,N′,N′‐ tetraacetic acid (acetoxymethyl) ester (BAPTA‐AM) at 10–20 μM for, 30–60 min resulted in loss of the rhythm of protein synthesis, i.e. loss of cooperative activity between the cells. The medium conditioned by control dense cultures initiated rhythm in sparse cultures, whereas the conditioned medium of cultures pretreated with BAPTA‐AM did not. [Ca2+]cytincrease is known to occur with monosialoganglioside GM1 treatment. By ELISA estimation, the GM1 content in 3 h conditioned medium was similar in control dense cultures to that in cultures pretreated with BAPTA‐AM. Bearing in mind data on the Ca2+‐dependence of vesicle formation and shedding, the conditioned medium was separated by 150,000 g centrifugation to supernatant containing monomers and micelles, and a pellet containing vesicular form of gangliosides. Only the latter initiated cooperative activity of the cells of sparse cultures. These cultures were also synchronized by GM1‐containing liposomes at lower concentrations than added free GM1, 0.0003 and 0.06 μM respectively. Thus, GM1 and calcium are both involved in cell—cell synchronization. Activation of gangliosides, including GM1 and elevation of [Ca2+]cyt, is known to lead to changes of protein kinase activity and protein phosphorylation resulting in modulation of oscillations in protein metabolism.
Spontaneous uterine rupture during delivery in a patient who had previously undergone laparoscopic myomectomy
Authors: Jakiel Grzegorz , Sobstyl Małgorzata , Swatowski Dariusz 
Published: October 2003

ABSTRACT Introduction  Following laparoscopic myomectomy, uterine rupture during pregnancy or delivery in the area of the scar is a very rare but dangerous complication. Individual cases of uterine rupture during pregnancy are described in the literature.Setting  University Teaching Hospital.Material  Casereport of uterine rupture after delivery in a patient who had previously undergone laparoscopic myomectomy. In the case presented here, the patient conceived 2 months after an 8‐cm subserous myoma with a pedicle had been laparoscopically removed.Intervention  No symptoms suggesting uterine rupture were observed during the pregnancy. Spontaneous vaginal delivery was under way, but in the third stage of delivery the condition of the patient deteriorated and symptoms of oligaemic shock developed. A laparotomy was performed, which showed the presence of blood in the peritoneal cavity and ruptured uterine muscle in the scarred area about 5 cm.Conclusions  In patients who have previously undergone a laparoscopic myomectomy, there is some risk of uterine muscle rupture at delivery. This is also the case where no suturing of the uterine muscle had been required.
Laparoscopic mesh colposuspension in the treatment of stress and mixed incontinence: clinical and urodynamic outcomes
Authors: Valpas Antti , Kivelä Aarre 
Published: October 2003

ABSTRACTObjective  The purpose of this study was to evaluate the results of laparoscopic mesh colposuspension as a treatment for stress incontinence and mixed incontinence.Subjects  Data on the first 40 patients to undergo the operation at Oulu University Hospital were collected retrospectively.Main outcome measures  The primary end‐points were quality of life (QoL) measured by using standardized questionnaires, and urodynamic findings.Results  The subjective cure rate was 90%. There were six (15%) bladder perforations, which were successfully treated and which left no sequelae. Significant improvement was seen in QoL measurements. No significant changes were noted in urodynamic parameters.Conclusions  The short‐term results of laparoscopic mesh colposuspension were comparable with those of open operations. Laparoscopic colposuspension significantly improved QoL scores among both stress and mixed incontinence patients and simultaneously significantly reduced associated urge symptoms. However, the high incidence of serious complications casts doubt on the acceptability of this technique.
Are women able to void to completion prior to laparoscopy?
Authors: Greenland Hugh , Granne Ingrid 
Published: October 2003

ABSTRACTObjective  To establish the amount of urinary residuals in women who are asked to void immediately prior to laparoscopy.Design  Prospective observational study.Setting  A district general hospital.Subjects  A total of 97 women undergoing elective diagnostic laparoscopy.Outcome measure  The amount of urinary residual measured at catheterization prior to laparoscopy.Results  A total of 97 urinary residuals were measured. The average volume was 28 ml. The median volume was 15 mL. Only two women (2%) had urinary residuals above 100 ml.Conclusions  Under appropriate conditions, the majority of women are able to void to completion prior to laparoscopy.
Hysterectomy: a personal audit of an evolving practice
Authors: East Michael 
Published: October 2003

ABSTRACTObjective  To investigate the author's evolving practice of hysterectomy with respect to the introduction of advanced laparoscopic surgical techniques.Design  A retrospective case study.Setting  The Oxford Clinic, St George's Hospital and Southern Cross Hospital, Christchurch, New Zealand.Subjects  A total of 863 patients who underwent hysterectomy during the period January 1992 to May 2001.Results  Over the study period the proportion of hysterectomies performed by laparoscopic assistance gradually increased to 100%. In addition it was observed that the short‐term complication rate of 3.5% for laparoscopically assisted vaginal hysterectomy (LAVH) was significantly lower than those for vaginal hysterectomy (13.6%, P < 0.0001) and abdominal hysterectomy (11.5%, P = 0.002). The long‐term complication of adhesions requiring adhesiolysis was higher for patients undergoing abdominal hysterectomy, at 6.1% vs. 3.1% for vaginal hysterectomy and 3.7% for LAVH, but these differences were not significant. From 1993 until the introduction of the manipuseal© technique in May 1996, there was no significant difference in operating times across the years (P = 0.32, mean 139.2 min). However the mean time declined in every succeeding year after 1996, from 137.2 min in 1996 to 75.2 in 2001 (P < 0.0001). Inpatient stay was shorter for the LAVH patients than for either vaginal hysterectomy or abdominal hysterectomy patients, especially if a day surgery unit was used.Conclusion  LAVH is associated with less short‐term morbidity and a faster recovery rate than either abdominal hysterectomy or vaginal hysterectomy. If this is wanted, 100% of hysterectomies performed to treat benign pathology can be carried out laparoscopically when the author's method of surgery is employed. It is believed that this is the first publication to demonstrate this possibility.
Umbilical Richter's hernia: unusual early complication of gynaecological laparoscopic surgery
Authors: Edi‐Osagie Edmond 
Published: October 2003

ABSTRACTCase  A 39‐year‐old lady undergoing her fourth laparoscopy developed a 5‐cm Richter's hernia of the small bowel through the umbilical port site. Its diagnosis was difficult and this resulted in delay in treatment.Conclusions  Post‐laparoscopy incisional hernias are uncommon, occurring mostly with ports of 10 mm and above, and at the umbilical site. Their occurrence is not influenced by the surgeon's experience. Predisposing factors include previous laparoscopies, extensive manipulation during surgery, increased intra‐abdominal pressure, obesity, use of sharp cutting‐tip trocars, rapid abdominal deflation at the end of surgery, poor port removal techniques and defective closure of the abdominal fascia. The diagnosis is often delayed because most cases present late, and treatment might be instituted along other lines. Computed tomography scans are helpful in its diagnosis and will facilitate prompt treatment to avoid the grave consequence of bowel gangrene.
Endometriotic ovarian cysts: the case for excisional laparoscopic surgery
Authors: Maouris Panos , Brett Lincoln 
Published: October 2003

ABSTRACTObjective  To review the evidence comparing laparoscopic excision with laparoscopic ablation for endometriotic cysts.Design  Review of the current literature.Background  Endometriotic cysts can be managed laparoscopically by stripping and excising, or by ablation.Main outcome measures  Symptom relief, post‐procedure fertility and cyst recurrence rates.Results  With ablative techniques, there are concerns about thermal damage to the underlying follicles, incomplete destruction of endometriotic tissue, overdiagnosis of endometriosis in cases of functional haemorrhagic cysts and missed diagnosis in cases of malignancy. The limited comparative data available demonstrate that the clinical outcomes in terms of symptom relief, pregnancy rates and cyst recurrence, are significantly better with excision when compared with ablation.Conclusions  There is evidence to suggest that laparoscopic excision is superior to ablation in all the important clinical outcomes. There are also theoretical advantages of excision over ablation, with no demonstrable disadvantages.
Surgically induced hormonal, metabolic and inflammatory changes in laparoscopic hysterectomy: a comparison with abdominal hysterectomy
Authors: Holub Zdenek , Jabor Antonín , Šprongl Ludìk , Kliment Lev , Fischlová Drahomíra , Urbánek Štepán 
Published: October 2003

ABSTRACTObjective  To assess and compare surgically induced hormonal, metabolic and inflammatory changes during laparoscopic and abdominal hysterectomy.Setting  Baby Friendly Hospital, Kladno, Postgraduate Medical Institute, Prague.Design  77 women, with no major medical disorder but requiring hysterectomy for benign diseases, were prospectively assigned to undergo laparoscopic (n = 59) or abdominal hysterectomy (n = 18). Surgical characteristics, hospital stay and complications were analysed. Blood samples for assay of markers of tissue trauma (C‐reactive protein (CRP), interleukin‐6 (IL‐6), creatine kinase, cortisol, white blood cell count (WBC) and cystatin C) were taken preoperatively and on the first and third postoperative day.Results  There were no differences between the two groups with regard to demographic characterics, but the mean uterine weight was 220 g in the laparoscopic hysterectomy group vs. 540 g in the abdominal hysterectomy group, (P < 0.0001). The median (interquartile range) operating time was 80 min (70–90 min) in the laparoscopic group and 105 min (80–120 min) in the abdominal group (P < 0.05). For the laparoscopic hysterectomy and abdominal hysterectomy groups, respectively, the estimated blood loss was 100 ml (95–200 ml) and 300 ml (250–2000 ml) (P < 0.0001), the median length of hospital stay was 4 days (3–4 days) and 8 days (7–10 days) (P < 0.0001), and the decline in the haemoglobin level was 0.9 and 2.45 g dl−1 on the third postoperative day (P < 0.001). Preoperative levels of biochemical markers were low in both groups. The rates of major and moderate complications were found to be low in the groups under comparison. One woman with a ureteral injury was excluded from the laparoscopic group for purposes of statistical analysis. There were significant increases in the serum concentrations of cortisol, CRP, IL‐6, creatine kinase and WBC after surgery in both groups. The laparoscopic group demonstrated a less intense stress response in terms of IL‐6 (P < 0.0001), CRP (P < 0.0001), creatine kinase (P < 0.001), cortisol (P < 0.05) and WBC (P < 0.001). Plasma concentrations of cystatin‐C decreased insignificantly during the first postoperative day.Conclusion  Compared with abdominal hysterectomy in women with pelvic disorders, laparoscopic hysterectomy was associated with a less intense hormonal, metabolic and inflammatory reponse and a more favourable clinical outcome.
Classical intrafascial supracervical hysterectomy (CISH): laparoscopy or laparotomy?
Authors: Al Lakkany Naser S. , Badawy Ahmed M. , El Gohary Alaa , El Gharib Mohamed E. 
Published: October 2003

ABSTRACTObjectives  To compare the short‐term outcomes of Semm's classic intrafacial supracervical hysterectomy (CISH) via laparoscopy and laparotomy.Methods  A prospective study of 43 women undergoing hysterectomy were recruited to have CISH and were allocated to either laparoscopy (18 women) or laparotomy (25 women). The study was performed in Department of Obstetrics & Gynecology, Mansoura University, Egypt.Results  Women in both groups were matched regarding age, parity, body weight and previous abdominal surgery. There were no significant intraoperative complications in both groups operative blood loss was insignificantly more in the laparotomy group and the operative time was significantly longer in the laparoscopic group. Resumption of normal bowel function and oral feeding was significantly more rapid in the laparoscopic group. Hospital stay was significantly shorter and resumption of the normal activity was significantly more rapid in the laparoscopy group.Conclusion  CISH represents a novel and a very smart alternative to the traditional hysterectomy. The issue of route selection is left to the operator's perference.
Transcervical endometrial resection: is it really a simple solution for a major problem?
Authors: Arslan Selcuk , Bettocchi Stephano , Van Herendael Bruno 
Published: October 2003

ABSTRACTObjectives  To determine the long‐term efficacy of transcervical resection of the endometrium (TCRE).Design  Prospective long‐term follow‐up study.Setting  Academic practice tertiary care setting.Patients  116 concecutive women undergoing endometrial resection because of menorrhagia, who wished to retain the uterus.Intervention  Hysteroscopic endometrial resection performed as a day procedure.Main outcome measures  Long‐term assessment was on the basis of menstrual symptoms and patient satisfaction, and a questionnaire was used that included open‐ended and closed questions.Results  116 endometrial resections were carried out. The satisfaction rate varied from 75% to 70% over 5 years. At 1 year, 40% of women were amenorrhoeic. Larger uterine size, young age and adenomyosis were factors associated with negative outcomes. After initial TCRE, 20 women required further surgery, menorrhagia being the most common indication.Conclusion  Although the use of TCRE to treat menorrhagia did not avoid the need for hysterectomy in all women, for those considering hysterectomy, it was an alternative procedure that was conservative, had low morbidity and provided a good chance of avoiding the need for major surgery, especially when performed by an experienced surgeon to treat women over the age of 45.