bluuebunny/crossref_metadata_2025_split huggingface dataset:
Primary aldosteronism: Are we diagnosing and operating on too few patients?
Authors: Gordon Richard D. , Stowasser Michael , Rutherford John C. 
Published: October 2003

AbstractMany cases of potentially curable primary aldosteronism are currently likely to be diagnosed as essential hypertension unless screening tests based on suppression of renin are carried out in all hypertensive patients. More than half of the patients with primary aldosteronism detected in this way have normal circulating potassium levels, so measurement of potassium is not enough to exclude primary aldosteronism. When primary aldosteronism is diagnosed, fewer than one‐third of patients are suitable for surgery as initial treatment, but this still represents a significant percentage of hypertensive patients. After excluding glucocorticoid‐suppressible primary aldosteronism, adrenal venous sampling is essential to detect unilateral production of aldosterone and diagnose angiotensin‐responsive aldosterone‐producing adenoma. One cannot rely on the computed tomography scan. If all hypertensive patients are screened for primary aldosteronism and the workup is continued methodically in those with a positive screening test, patients with unilateral overproduction of aldosterone who potentially can be cured surgically are not denied the possibility of cure.
Genetic background of adrenocortical tumor development
Authors: Kjellman Magnus , Larsson Catharina , Bäckdahl Martin 
Published: October 2003

AbstractThe increasing occurrence of incidentally discovered benign adrenocortical tumors has become a clinical dilemma because of the difficulties in differentiating them from their malignant counterpart. Adrenocortical tumors are associated with familial cancer syndromes such as the Beckwith‐Wiedemann syndrome, the Li‐Fraumeni syndrome, the Carney complex, multiple endocrine neoplasia type 1, congenital adrenal hyperplasia, and the McCune‐Albright syndrome. Genetic events are known to take place on the chromosomal and gene level in sporadic adrenocortical tumors.
Secretin and pancreatic islet biood flow in anesthetized rats: Increased insulin secretion with no augmentation of blood perfusion
Authors: Carlsson Per‐Ola , Jansson Leif 
Published: October 2003

AbstractSecretin is a stimulator of both endocrine and exocrine secretions of the pancreas, and we aimed to evaluate its effects on splanchnic blood flow in rats with a microsphere technique. Anesthetized rats were infused with secretin (0.5 or 2.0 µg/kg body weight/hr) for 10 minutes. Some animals were normoglycemic, whereas other received a glucose injection 3 minutes before blood flow measurements. Secretin did not affect serum insulin concentrations in normoglycemic animals but consistently led to higher insulin concentrations in the hyperglycémie rats. Total pancreatic blood flow was increased by the highest secretin dose in normoglycemic animals, whereas no effects were seen in the hyperglycémie rats. Administration of glucose caused a pronounced increase in islet and fractional islet blood flow in saline‐infused animals. Secretin affected neither islet nor fractional blood flow in normoglycemic or hyperglycémie rats. Glucose administration increased duodenal blood flow in animals infused with saline and both duodenal and colonie blood flow in rats given the lowest dose of secretin. No effects on either colonie or duodenal blood perfusion were seen in animals infused with the highest dose of secretin. Secretin mainly affects blood flow to the whole pancreas and not that of the islets. Furthermore, glucose‐induced insulin release can be achieved without a simultaneous increase in islet blood flow; that is these two events may be dissociated from one another.
Early imaging of integration response to polypropylene mesh in abdominal Wall by environmental scanning electron microscopy: Comparison of two placement techniques and correlation with tensiometric studies
Authors: Ferrando José M. , Vidal José , Armengol Manuel , Huguet Pedro , Gil Javier , Manero José M. , Planell José A. , Segarra Alfonso , Schwartz Simón , Arbos María A. 
Published: October 2003

AbstractThe repair of incisional hernias has taken advantage of the strength provided by prosthetic mesh grafts, but the best position for inserting the materials has not been conclusively established. Environmental scanning electron microscopy (ESEM) provides imaging of bio‐logic samples with minimal manipulation. We used ESEM for early imaging of the integration response to polypropylene meshes placed in two anatomic positions in the abdominal wall and correlated results with tensiometric studies. Two macroporous polypropylene prostheses were implanted in a rat model—one on the abdominal aponeurotic layer and one on the peritoneal surface—without creating a wall defect. Studies were performed over implantation intervals of 7, 15, and 30 days in strips obtained from the polypropylene fiber‐receptor repair tissue interface. Microscopic appearance, tensile strength, percent elongation, and stiffness were evaluated. Meshes implanted on the abdominal aponeurotic layer showed better early tissue incorporation (higher collagen deposition, capillary density, cell accumulation) and increased tensile strength, reflecting tighter anchorage to the abdominal wall. The percent elongation increased from day 7 to day 30 after implantation, mainly in the deep stratum. The ESEM images correlated well with biomechanical results, indicating the potential of this technique as a powerful, effective tool for use in wound‐healing studies.
Clinical analysis and literature review of massive Duodenal diverticular bleeding
Authors: Yin Wen‐Yao , Chen Hwa‐Tzong , Huang Shih‐Ming , Lin Hsien‐Hong , Chang Tzu‐Ming 
Published: October 2003

AbstractA duodenal diverticulum (DD) appears in 2.5% of upper gastrointestinal (UGI) examinations and up to 22% of endoscopie retrograde cholangiopancreaticographies (ERCP) and autopsies. Most of these patients are asymptomatic, but the lesion is occasionally associated with bleeding, inflammation, perforation, obstruction of the duodenum or biliary‐pancreatic duct (or both), fistula formation in the bile duct, and bezoar formation inside the diverticulum. A total of 816 patients have undergone ERCP examination at our institution since January 1987, and 100 (12.25%) of them have DD. Seven (7%) patients presented with bloody or tarry stools from massive UGI bleeding followed by shock. Only two could be diagnosed by UGI endoscopy preoperatively. The lesions were demonstrated in angiographie studies in another four cases. However, only one was correctly interpreted and one required reoperation after a correct repeat endoscopie finding. The lesions in the other two patients were identified by thorough exploration during laparotomy. The remaining case was diagnosed by intraoperative endoscopy via pyloroduodenotomy. Six underwent surgical intervention, and one was successfully treated by expectant treatment. Three (50%) had leakage from the duodenotomy but recovered uneventfully with conservative treatment. In conclusion, we believe that DD bleeding is more frequent than usually thought. A high index of suspicion should be raised in cases of UGI bleeding when more obvious and common causes have been excluded by routine endoscopy. Aggressive but careful endoscopie examination combined with accurate angiography can help us diagnose most of the cases preoperatively. Diverticulectomy is an effective surgical procedure, though it is associated with a considerable leakage rate. The morbidity is minimal if we can identify the lesion earlier and evacuate the lesion without delay.
Laparoscopic management of bile duct and bowel injury during laparoscopic cholecystectomy
Authors: Kwon A.‐Hon , Inui Hiroyuki , Kamiyama Yasuo 
Published: October 2003

AbstractAccidentai injuries to the bile duct and bowel are significant risks of laparoscopic surgery and sometimes require conversion to open surgery. Although some of the injuries related to laparoscopic cholecystectomy can be managed by endoscopic techniques, laparoscopic surgery is not yet sufficiently perfected. We investigated the efficacy of laparoscopic management combined with endoscopic tube or stent insertion in cases of bile duct and bowel injuries during laparoscopic cholecystectomy. Laparoscopic cholecystectomy was attempted on 1,190 consecutive patients between April 1992 and June 1999. The first 70 patients underwent only preoperative intravenous infusion cholangiography (IVC), and the remaining 1,120 patients were subjected to both preoperative IVC and intraoperative cholangiography. We experienced 16 cases of bile duct injury (1.4%). Five patients with circumferential injuries of the bile duct were converted to open surgery for biliary reconstruction. The other 11 patients with partial laceration injuries of the bile duct and biliary leakage from the cystic duct underwent a laparoscopic simple closure technique. In 10 of these patients, an endoscopic tube or stent was inserted on the day after surgery to facilitate biliary decompression and drainage. Bowel injuries occurred in seven patients (0.6%). Three intestinal injuries were due to careless technique, and two duodenal injuries and two intestinal injuries were related to dense adhesions. All of these injuries were successfully repaired using laparoscopic techniques, auto‐suturing devices, or extracorporeal suturing via the umbilical incision. No postoperative complications were identified. We concluded that the biliary injury site could be closed with a laparoscopic technique so long as the biliary injury was not circumferential. Bowel injuries also could be repaired laparoscopically.
Hyperamylasemia and subclinical pancreatitis after cardiac surgery
Authors: Ihaya Akio , Muraoka Ryusuke , Chiba Yukio , Kimura Tetsuya , Uesaka Takahiko , Morioka Koichi , Matsuyama Katsuhiko , Tsuda Takeshi , Nara Masafumi , Niwa Hiroyuki 
Published: October 2003

AbstractHyperamylasemia after cardiac surgery is common but typically causes no clinical concern because it consists mainly of the salivary isoenzyme. In this study we evaluated the incidence, source, and time course of postoperative hyperamylasemia with special attention to the possibility of subclinical pancreatitis. In 88 patients prospectively tested for serum amylase and lipase concentrations, elastase 1 activity, and amylase isoenzyme characteristics, 57 (64%) showed hyperamylasemia during the early postoperative period. In most cases early hyperamylasemia was not of pancreatic origin, but two patients were diagnosed with subclinical pancreatitis. Among the last 23 patients, 5 of 10 patients with early hyperamylasemia exceeding 1000 IU/L showed late hyperamylasemia on the seventh postoperative day, when it represented mainly the pancreatic isoenzyme. Lipase concentrations and elastase 1 activities were elevated in these cases. Late hyperamylasemia following cardiac surgery may be of pancreatic origin and indicative of subclinical pancreatitis, even if early hyperamylasemia was of salivary origin.
Histologic factors affecting prognosis following hepatectomy for intrahepatic cholangiocarcinoma
Authors: Uenishi Takahiro , Hirohashi Kazuhiro , Kubo Shoji , Yamamoto Takatsugu , Hamba Hiroyuki , Tanaka Hiromu , Kinoshita Hiroaki 
Published: October 2003

AbstractLong‐term survival following hepatectomy for intrahepatic cholangiocarcinoma has been poor, and specific factors influencing survival are unclear. In a retrospective study we sought to determine prognostic factors related to survival in these patients. In 28 patients who underwent hepatic resection for intrahepatic cholangiocarcinoma, we investigated the relations of several histologic factors to patient survival by univariate and multivariate analyses. No deaths occurred during the first 30 days. Median and mean survival times following hepatectomy were 409 and 935 days, respectively. The respective survival rates at 1, 3, and 5 years were 57%, 27%, and 27%. Resection margin status, intrahepatic metastasis, lymph node involvement, and lymphatic invasion were significant predictors of outcome. In a multivariate analysis using the Cox proportional hazards model, only lymphatic invasion independently predicted survival. Curative resection with clear margins was found to prolong survival after surgery. Hepatectomy for intrahepatic cholangiocarcinoma without lymphatic invasion offers hope for long‐term survival.
Transanal endoscopic microsurgical excision of rectal tumors: Indications and results
Authors: Demartines Nicolas , von Flüe Marcus O. , Harder Felix H. 
Published: October 2003

AbstractTransanal endoscopic microsurgery (TEM) allows local excision of rectal tumors located 4 to 18 cm above the anal verge. The technique is not yet generally established because of the necessary special instrumentation and tools, the unusual technical aspects of the approach, and the stringent patient selection criteria. The aim of this prospective, descriptive study was to analyze the currently accepted indications for TEM and to evaluate the use of this procedure for treating rectal cancer. Over a 4‐year period 50 patients aged 31 to 86 years (mean 64 years) underwent TEM for treatment of rectal tumors located 12 cm above the anal verge (range 4–18 cm). The local complication rate was 4%. Altogether, 76% of lesions were benign, and 24% were T1 and T2 tumors. Of 12 cancer cases, 4 required reoperation by total mesorectal resection; the other 8 are currently under follow‐up management. Over the follow‐up period of 30.6 months (range 11–54 months) the recurrence rate of T1 tumors was 8.3%. TEM is a minimally invasive surgical technique that may benefit a small, specific population of patients with rectal tumors. Compared with conventional transanal resection, TEM provides superior exposure of tumors higher up in the rectum (i.e., up to 18 cm from the anal verge). The greater precision of resection combined with low morbidity (10%, relative to that of anterior resection) and short duration of hospitalization (5.5 days) make this technique a reliable and in some cases more effective surgical approach than laparotomy and low anterior resection.
Colonic J‐pouch function at six months versus straight coloanal anastomosis at two years: Randomized controlled trial
Authors: Ho Yik‐Hong , Seow‐Choen Francis , Tan Margaret 
Published: October 2003

AbstractThe colonic J‐pouch (pouch group) functions better than the straight coloanal anastomosis (straight group) immediately after ultra‐low anterior resection, but there are few studies with long‐term follow‐up. This randomized controlled study compared functional outcome, anal manometry, and rectal barostat assessment of these two groups over a 2‐year period. Forty‐two consecutive patients were recruited, of which 19 of the straight group [17 men with a mean age of 62.1 ± 2.3 (SEM) year] and 16 of the pouch group (11 men with a mean age of 61.3 ± 3.2 year) completed the study. Four died from metastases and two emigrated; there was no surgical morbidity or local recurrence. At 6 months the Pouch patients had significantly less frequent stools (32.9 ± 2.8 vs. 49 ± 1.4/week; p<0.05) and less soiling at passing flatus (38% vs. 73.7%; p<0.05). At 2 years both groups had improved with no longer any differences in stool frequency (7.3 ± 0.4 vs. 8 ± 0.2/week) and soiling at passing flatus (38% vs. 53%). Defecation problems remained minimal in both groups. Anal squeeze pressures were significantly impaired in both groups up to 2 years (p<0.05). The rectal maximum tolerable volume and compliance were not different between groups. Rectal sensory testing on the barostat phasic program showed impairment at 6 months and recovery at 2 years, suggesting that postoperative recovery of residual afferent sympathetic nerves may play a role in functional recovery. In conclusion, stool frequency and incontinence were less in the Pouch patients at 6 months; but after adaptation at 2 years the straight group patients yielded similar results. Nonetheless, this functional advantage can be given to patients with minimal added effort or complications by using the colonic J‐pouch.
Evaluation of risk of splenosis during laparoscopic splenectomy in rat model
Authors: Espert Joan Josep , Targarona Eduard M. , Bombuy Ernest , Setoain Josep , Visa Josep , Trias Manuel 
Published: October 2003

AbstractLaparoscopic splenectomy (LS) is an alternative to open surgery. However, there is a theoretic risk of splenosis and abdominal cavity dissemination of splenic cells if the splenic capsule is broken, as seen by experimental evidence of tumoral cell mobilization by the pneumoperitoneum. We evaluated the features of splenosis after splenectomy operated via an open approach or under laparoscopic control in an experimental model in the rat. A total of 65 Sprague‐Dawley rats were distributed in seven groups that included the open approach, CO2 pneumoperitoneum LS, or wall lift LS with or without a splenic graft. Splenic function was evaluated 90 day later through (1) scintigraphy with Tc‐labeled heat‐damaged erythrocytes; (2) determination of circulating “pitted” cells; and (3) analysis of the distribution of splenic pulp in the peritoneal cavity. Scintigraphy did not show viable residual tissue in any group after splenectomy; splenic activity in the splenic fossa was observed in 40% of the animals with grafts. Splenectomy increased the “pit” cell count, but it was reduced to normal values with a splenic graft. Necropsy showed normal splenic tissue in the splenic fossa in 100% of animals with a graft. Abdominal implants were observed significantly more frequently after CO2 LS than after the open surgery or a wall lift LS (80% vs. 20% vs. 30%; p<0.05). In addition, trocar site implants were observed with CO2 LS (n=3) or wall lift LS (n=2), whereas there were no implants in the wound in the open group. We conclude that in an experimental rat model the pneumoperitoneum may facilitate abdominal splenosis after LS if the splenic capsule is ruptured or if splenic tissue spills compared with surgery without gas (open or laparoscopic).
Surgical management of pectus carinatom: 30 years’ experience
Authors: Fonkalsrud Eric W. , Beanes Steven 
Published: October 2003

AbstractPectus carinatum is an uncommon malformation that is often more symptomatic than the appearance suggests, and one that physicians often do not refer for surgical correction. Hospital records of 90 patients who underwent repair of pectus carinatum deformities between 1970 and 2000 were reviewed. During the same period another 445 patients underwent repair of excavatum deformities. Minimal deformity was observed before the age of 10 years for 81 of 90 patients; only 7 of the 90 underwent repair before age 11 years. AH patients were symptomatic; 84 had exertional dyspnea and exercise limitation, 52 had frequent respiratory infections, 24 had asthma, and 38 had chest discomfort. The mean pectus severity score (width of chest divided by the distance between the sternum and spine) was 1.73 (the normal chest is 2.56). The type of repair varied with the type of deformity, consisting of subperiosteal resection of the deformed cartilages, transverse osteotomy of the anterior sternum with insertion of a cartilage wedge, and support with a steel strut for 4 to 6 months in 76 of 90. There were no deaths within 1 year after the repair. Complications included hypertrophic scar (n=13), wound seroma (n=5), pleural effusion (n=3), and pneumothorax (n=2). The mean blood loss was 78 ml, and the mean hospital stay was 2.6 days. With a mean follow‐up of 12.8 years, all patients experienced alleviation of respiratory symptoms and chest discomfort and diminished exercise limitation; 88 of 90 patients experienced a very good to excellent long‐term result. One patient required reoperation. Pectus carinatum often causes more severe respiratory symptoms and exercise limitation than is generally recognized. Repair in 90 patients with carinatum deformities has resulted in marked clinical improvement in all patients, with low morbidity and short hospitalization.
Silent Cerebral Infarction: Risk Factor for Stroke Complicating Carotid Endarterectomy
Authors: Fürst Heinrich , Hartl Wolfgang H. , Haberl Roman , Berger Hermann , Meimarakis Georgios , Lauterjung Lutz , Schildberg Friedrich W. , Warlow Charles P. 
Published: October 2003

Abstract“Silent” cerebral infarction is found in 20% to 30% of patients with significant internal carotid artery (ICA) disease. Our purpose was to determine whether such “silent” cerebral infarction in the operated carotid territory represents a risk factor for stroke during and immediately after carotid endarterectomy. Over 5 years we followed a cohort of 663 patients with symptomatic and asymptomatic ICA stenosis who were consecutively scheduled for surgery. The stenosis was more than 70% in patients with transient ischemic attacks and more than 95% in asymptomatic stenosis patients. All patients underwent preoperative computed tomography to determine the frequency, extent, and location of any “silent” cerebral infarction. Patients were grouped by the absence or presence of infarction in the operated carotid territory. Among the entire cohort, 20 patients had a major perioperative stroke (3.0%). All deaths were stroke‐related. No intracranial bleeding occurred. Major stroke occurred in four (0.8%) patients without appropriate “silent” cerebral infarction, compared with 16 (8.8%) with an appropriate “silent” cerebral infarct (p < 0.001). After adjustment for confounding co‐variables (e.g., gender, presence of preoperative symptoms, and age), “silent” cerebral infarction was found to be the only independent predictor of perioperative major stroke for symptomatic and asymptomatic stenosis (overall adjusted relative risk 11.5, 95% confidence interval 3.8–34.9, p < 0.0001). Patients with “silent” cerebral infarction seem to be at increased risk of perioperative stroke. Consequently, preoperative cerebral imaging is important for risk classification.
Hypertonic Saline in Hydatid Disease
Authors: Kayaalp Cuneyt , Balkan Mujdat , Aydin Cenk , Ozgurtas Taner , Tanyuksel Mehmet , Kirimlioglu Vedat , Akoglu Musa , Oner Koksal , Pekcan Mesut 
Published: October 2003

AbstractThe objective of this study was to determine the scolicidal effects of saline in different concentrations using different exposure times and to examine whether hypertonic saline can be used to irrigate the abdomen when there is a free intraperitoneal perforation of hydatid disease. Various concentrations of saline solutions (0.09%, 3.0%, 6.5%, 10%, 15%, 20%, 25%, 30%) were added to concentrated echinococcus granulosus sediments for the following times: 1, 2, 3, 4, 5, 10, 15, 30, 45, and 60 minutes. Normal (0.09%), 3.0%, and 6.5% saline resulted in high viability ratios after 60 minutes' exposure. Complete lethality for 10%, 15%, 20%, 25%, and 30% saline occurred at the end of 75, 10, 6, 3, and 3 minutes, respectively. During the second part of the study, 20 Sprague‐Dawley rats were used for abdominal saline irrigation in four groups: 30% NaCl for 3 minutes; 20% NaCl for 6 minutes; intravenous isotonic dextrose water and furosemide plus 30% NaCl irrigation for 3 minutes; the same prophylactic therapy plus 20% NaCl irrigation for 6 minutes. Sodium and chloride values rose significantly (20–30%) shortly after hypertonic saline irrigation in each group (p < 0.01). Support with isotonic dextrose and furosemide before irrigation did not have any beneficial effect on biochemical values or mortality. The 24‐ and 48‐hour mortality rates were 70% and 90%, respectively. These studies illustrate that the scolicidal effect of hypertonic saline is limited in low concentrations, but an increase in the concentration can augment its adverse effects. Peritoneal irrigation with hypertonic saline should be avoided for intraabdominal perforated hydatid disease. Therefore, we concluded that hypertonic saline is not a good scolicidal agent to prevent recurrence of hydatid disease.