bluuebunny/crossref_metadata_2025_split huggingface dataset:
Radiation damage to the small intestine
Authors: Smith Daniel H. , DeCosse Jerome J. 
Published: May 2005

AbstractAlthough radiation therapy has proven effective in both cancer control and cure, grave side effects may occur. Among the most serious treatment complications encountered by a patient with malignant disease is that of radiation injury to the small intestine. Patients with gynecologic malignancies are most often found to have these problems of therapy. The etiology of radiation damage at the cellular level is mostly molecular damage resulting in lethal cellular injuries. Accompanying vascular and connective tissue may also be altered and cause later complications. Because of the complex nature of the patient's malignant disease and treatment, diagnosis of radiation injury to the small bowel and other pelvic structures can be most difficult to determine. The management of acute manifestations of enteric radiation injury includes diet modification and drugs that affect intestinal motility. Long‐term manifestations of enteric radiation injury present more serious difficulties. Initially, the patient must be stabilized to reverse the effects of chronic malnutrition, sepsis, and electrolyte imbalance. Immediate surgery may be necessary in patients with suspected perforation. Most patients, however, require further studies for complete assessment of clinical damage. In patients with enteric fistulas, an operation is always necessary for fistula control. Complete enteric bypass utilizing minimally affected intestine is mandatory to ensure the least morbidity and mortality. Prevention of enteric radiation injury requires efforts to minimize postoperative adhesions, avoidance of excessive therapy to segments of fixed small bowel, and dosimetry alteration when complications arise during initial therapy.
Repair of the radiation‐induced vaginal fistula utilizing the martius technique
Authors: Boronow Richard C. 
Published: May 2005

AbstractThe radiation‐induced vaginal fistula is an extremely difficult rehabilitative challenge to the surgeon. Historically there has been a sense of frustration about prospects for success with these defects and many patients have been managed by either permanent colostomy or permanent urinary diversion. This report reviews a personal experience of 25 radiation‐induced vaginal fistulas in 22 patients utilizing the Martius bulbocavernosus‐labial fat flap technique. Successful closure was accomplished in 84.2% of the rectovaginal fistulas and 50% of the vesicovaginal fistulas. Only 1 patient required a second surgical effort for successful closure. There was no surgical mortality and no significant surgical morbidity. No patient with a rectovaginal fistula closure required subsequent colostomy for stricture. These results, coupled with the relative simplicity of the procedure, allow us to recommend this technique as firstline therapy for these difficult management problems. The majority of patients will be rewarded with successful rehabilitation.
Repair of chronic radiation wounds of the pelvis
Authors: Mathes Stephen J. , Hurwitz Dennis J. 
Published: May 2005

AbstractRadiation therapy is currently utilized for primary or adjuvant therapy for pelvic tumors. Although improvements in radiation delivery techniques have largely eliminated acute complications in the radiation field, occurrences of late wound complications persist and result in complex pelvic and perineal wounds. Since these wounds reflect underlying impaired local circulations secondary to obliterative endarteritis, local wound management frequently fails either to control secondary infection or to allow spontaneous wound closure. Twenty‐four patients with chronic pelvic wounds have recently undergone successful wound repair with use of muscle, musculocutaneous, and fasciocutaneous flaps. This review of these patients will demonstrate the physiologic basis for vascularized flaps for wound closure. Specific flap selection is based on the location of the pelvic radiation wound in the anterior pelvis and inguinal region, perineum and pelvic cavity, and sacrum. Well‐vascularized flaps must have an independent source of circulation distant to the site of radiation damage for reliable wound coverage. Muscle and skin fascial flaps are available based on reliable pedicles located in the anterior abdominal wall, anterior and posterior thigh, and posterior pelvic region with adequate arc of rotation to cover most pelvic defects. Flaps frequently utilized in this study included: rectus femoris, rectus abdominis, gracilis, and gluteus maximus muscle and musculocutaneous flaps, and the gluteal thigh skin fascial flap. Wound debridement and simultaneous coverage with well‐vascularized flaps have been established as a useful and reliable method to repair complex wounds of pelvic radiation necrosis.
Ramification of the intrahepatic portal vein identified by percutaneous transhepatic portography
Authors: Inoue Tadashi , Kinoshita Hiroaki , Hirohashi Kazuhiro , Sakai Katsuji , Uozumi Akira 
Published: May 2005

AbstractWe carried out percutaneous transhepatic portography (PTP) in 182 patients with liver, biliary tract, or pancreatic disease. With anterior and lateral views of selective portograms and stereoscopic x‐rays, we investigated the ramifications of the intrahepatic portal vein. There were 3 patterns of branching of the portal trunk and of the left branch of the portal vein. There were 8 such patterns for the right anterior branch, with either 4 or 5 major branches arising from it. Branching of the right posterior branch was classified into 4 patterns; simple branching into 2 (one, the posterior superior branch, the other, the posterior inferior branch) was found in only 97 of the 164 cases inspected. These results suggested that the liver cannot necessarily be divided into 8 segments. Branching of the intrahepatic portal vein is very complex; therefore, the pattern of ramifications of the portal vein must be ascertained anew for every patient for whom systematic segmentectomy is contemplated.
Liver resections in cirrhotic patients: A western experience
Authors: Bismuth H. , Houssin D. , Ornowski J. , Meriggi F. 
Published: May 2005

AbstractSystematic screening for hepatocellular carcinoma (HCC) in cirrhotic patients by alpha‐fetoprotein and ultrasound permits the detection of small asymptomatic tumors. Owing to the small tumor size, more liver resections can now be performed than in the past. These resections are performed in a more economical way in terms of loss of functional parenchyma and in a more appropriate manner with regard to carcinology: surgical techniques of liver segmentectomy and use of intraoperative echography are mandatory. Favorable long‐term results obtained in Eastern countries by resecting such lesions are encouraging but remain to be confirmed in the Western hemisphere.
Endotoxin inactivation in plasma from septic patients: An in vitro study
Authors: Olofsson Pär , Olofsson Christina , Nylander Gunnar , Olsson Per 
Published: May 2005

AbstractPatients with suspected septicemia were screened for endotoxemia with a quantitative chromogenic assay. In some patients endotoxin concentrations were within the range of healthy controls. Eleven of these were patients on intensive care with severe, culture‐verified, gram‐negative infections in blood or other foci. One possible explanation for this paradoxical absence of endotoxin is increased plasma inactivation. In order to test this hypothesis, endotoxin was added to platelet‐rich plasma from these patients to give a concentration of 100 ng/l, and serial quantitative determinations were made for 2 hours. Plasma from 11 healthy individuals served as controls. In the first sample, measured immediately after addition of endotoxin, a mean of 97.3 ng/l was recovered in plasma from healthy individuals and only 75.8 ng/l in the septic plasma (p<0.05). When kept on ice, these concentrations were maintained, while at +37‡C they decreased rapidly at rates that were equal in both septic and control plasmas. In a corresponding study in platelet‐free plasma, it was found that the platelets could not account for this inactivation. The results demonstrate the possibility of immediate endotoxin inactivation in plasma from patients with sepsis, probably caused by chemical binding.
Clinical reliability of perioperative fluorocholangiography
Authors: Reiss Raphael , Deutsch A. A. , Nudleman I. , Cohen M. 
Published: May 2005

AbstractThe use of mobile image intensifier and television monitor permits easy performance of direct visualization of the biliary tract during surgery (fluorocholangiography). The routine use of fluorocholangiography has certain advantages over the standard technique of operative cholangiography: rapid direct visualization permits proper positioning of the instrument and the patient, thus many pitfalls can be avoided (gas, air bubbles, superposition of bone structures); multiple exposures at varying angles can be obtained if suspicious areas are seen; the intrahepatic ducts can be fully visualized; the functioning of the sphincter can be evaluated under direct vision; and direct visualization permits considerable time savings. In this study, operative cholangiography was routinely performed on 1,600 consecutive operations on the biliary tract using this technique. The reliability of operative fluorocholangiography was evaluated and compared to other published forms of operative cholangiography. The principal conclusions of the authors are as follows: the false‐positive results of operative fluorocholangiography are 16.8% (57 of 339 common bile ducts explored, 57 of 1,600 cholangiographies); 22 retained stones were subsequently found in the 1,600 patients; the reliability of operative fluorocholangiography is, therefore, approximately 95%; and operative fluorocholangiography is superior to conventional cholangiography, and its routine use contributes significantly to the reduction of the rate of negative choledochal explorations and residual stones.
Polytrauma in the elderly
Authors: Marx Axel B. , Campbell Robert , Harder Felix 
Published: May 2005

AbstractTwenty‐seven patients over 70 years old in a consecutive series of 300 patients (mean age 75.1 years) who had sustained polytrauma were compared to a group of 27 younger patients of that series (mean age 36.1 years) and were matched for similar patterns of injuries. The injury severity scores (ISS) were nearly equal in both groups. The amount of blood transfused, the shock index on arrival, the number of peritoneal lavages performed, and the number of chest drains inserted were similar in both groups. In general, the trauma‐causing injury in the older patients was substantially less severe than in the younger age group. Nearly all fractures were treated operatively in the younger patients, while equivalent fractures in the older group were more often treated conservatively. The greater mortality in the older patients was due to preexisting handicaps, which are disregarded by the ISS. Most of the older patients who survived could be satisfactorily rehabilitated. What causes and what are the injuries of the elderly polytrauma patient? How aggressive should the treatment be and to what degree is rehabilitation of survivors possible?
Acute volvulus of the right colon: An analysis of 69 patients
Authors: Anderson John R. , Welch George H. 
Published: May 2005

AbstractSixty‐nine patients with acute volvulus of the right colon have been analyzed; the overall mortality was 19%. Nonviable colon was present in 20 patients; the mortality rate in these patients was 40%. When the cecum is viable, a combination of simple cecopexy and tube cecostomy was as effective as resection in preventing long‐term recurrence. Cecopexy alone was followed by recurrence in 20%. In the presence of cecal perforation or a large area of confluent gangrene, resection with the formation of an ileostomy and a distal mucous fistula is the procedure of choice; resection with primary anastomosis should be avoided. When the gangrene is patchy, resection and primary anastomosis appears to be a safe procedure.
Stress ulceration: The clinical problem
Authors: Lucas Charles E. 
Published: May 2005

AbstractAs the ability to prolong life in severely traumatized patients increased, the incidence of clinically apparent upper gastrointestinal hemorrhage also increased. By 1970, it was recognized that the most common cause of such bleeding was so‐called stress ulceration, consisting of multiple, punctate, superficial erosions, confined initially to the proximal gastric mucosa. “Stress” ulcers develop in association with shock which requires massive transfusion, with certain types of central nervous system injury, with respiratory insufficiency, with acute renal failure, and, most particularly, with sepsis. Active bleeding from “stress” ulcer is usually preceded by a striking increase in the volume and acidity of aspirated gastric content, which is also heavily bile stained. Abnormalities in coagulation are frequently present. The nasogastric tube, per se, does not contribute to “stress” bleeding. Intraoperative endoscopy for diagnosis is of value in selected instances.
The role of histamine and histamine receptors in the pathogenesis and treatment of erosive gastritis
Authors: Gurll Nelson J. , Damianos Aristotle J. 
Published: May 2005

AbstractExperiments have demonstrated the importance of histamine and intraluminal acid in the pathogenesis of gastric stress erosions. Histamine H2 receptor antagonists were found to protect against stress ulcers and bleeding in experimental animals and in patients at risk. The seriousness of this clinical problem has been almost eliminated by the use of antacids or histamine antagonists designed to reduce intraluminal gastric acidity.
Role of bile acid reflux in acute hemorrhagic gastritis
Authors: Ritchie Wallace P. 
Published: May 2005

AbstractA model was developed to assess the influence of bile acids on the ability of proximal canine gastric mucosa to maintain an intraluminal pH gradient and to resist acute morphologic injury. It was found that the combination of topical acid, topical bile acid, and mucosal ischemia is acutely and severely ulcerogenic. Lesion severity is a function of the absolute amount of H+; diffusing into the mucosa which is, itself, a function of the intraluminal concentrations of both bile and H+. Morphologic injury is associated with the development of a marked gastric venous acidosis. Bile acid species differ in their capacity to induce lesions. Topical application of bile acids to nonischemic mucosa is not acutely ulcerogenic because a compensatory increase in mucosal blood flow occurs which is proportional to the degree of H+ loss induced. In the present model, steroids are “cytoprotective” by virtue of this mechanism, while histamine H1 and H2 receptor antagonists, either along or in combination, are not. The clinical applicability of these findings is discussed.
Treatment of established stress ulcer disease
Authors: Cheung Laurence Y. 
Published: May 2005

AbstractAll patients who are at risk of developing stress ulcers or who may have stress ulcers without hemorrhage should be treated with vigorous antacid therapy with or without cimetidine to prevent the deeper penetration of these erosions into the larger blood vessels of the submucosa. Bleeding from stress ulcers should be treated initially with iced saline lavage, since this maneuver serves to arrest hemorrhage in most patients. Replacement of blood, treatment of underlying sepsis, avoidance of gastric irritants such as aspirin, and correction of coagulation defects are all important parts of the management program. Endoscopy enables the positive identification of the lesions that are bleeding and provides an opportunity for direct control by electrocoagulation at institutions where this technique is available. Persistent bleeding from acute stress ulcers may be treated with intra‐arterial infusion of vasopressin into the left gastric artery, if trained personnel are present. If all nonsurgical measures fail to control bleeding, then vagotomy, pyloroplasty, and suture ligation of the bleeding site should be performed. Rebleeding after this procedure will require a near total gastrectomy. Surgical mortality rate in these patients exceeds 30%, indicating the lethal nature of this complication and the seriousness of the underlying illness associated with stress ulcers. Therefore, one must combat ongoing illness, such as sepsis, as well as control the massive hemorrhage when established stress ulcer disease is present.
Total and proximal gastrectomy in the treatment of gastric carcinoma: A series of 305 cases
Authors: Inberg Markku V. , Heinonen Reijo , Laurén Pekka , Rantakokko Veikko , Viikari Sauli J. 
Published: May 2005

AbstractA total of 305 total or proximal gastrectomies for gastric carcinoma were performed in 291 patients. Of the tumors 51.5% were of the intestinal‐type and 35.7% were of the diffuse‐type of carcinoma. Proximal gastrectomy was performed in 68 patients, total gastrectomy in 230, and anastomotic resection in 7. In 25 patients a reresection for recurrent carcinoma was performed. After total gastrectomy the main reconstructive procedures were end‐to‐side esophago‐jejunostomy and Roux‐en‐Y esophagojejunostomy. The hospital mortality rate was 13.4%. The main causes of death were anastomotic leakage and pulmonary embolism. The incidence of leakage was 10.8% and the complication proved fatal in 36.4% of the patients who developed it. After Roux‐en‐Y reconstruction only 8% of the patients with leakage died. After curative operations 27% of the patients survived for over 5 years (relative survival rate of 33%). The 5‐year survival rates for the intestinal‐type and diffusetype of carcinoma were similar, but the 10‐year survival rate for intestinal‐type of carcinoma was significantly better. In our view a relatively high mortality rate after total or proximal gastrectomy has to be accepted when older patients are concerned, and when no other curative procedure is possible on account of the site and extent of invasion of the tumor. However, in cases where radical resection can be achieved by means of subtotal gastrectomy, this method is best. At present, in cases of the diffuse‐type of carcinoma of the corpus, we perform a total gastrectomy instead of subtotal gastrectomy. In the small series of reresections the results were encouraging.
The effect of highly selective vagotomy on canine gastric mucosal blood flow
Authors: Natsikas Nick B. , Konstantaras Christos , Psarrakos Kyriakos P. , Kappas Angelos M. , Lazarides Demetrius P. 
Published: May 2005

AbstractGastric mucosal blood flow (GMBF) was studied before and after highly selective vagotomy (HSV) by the pertechnate clearance technique. The studies were done on 24 mongrel dogs (Group A) under general anesthesia. Betazole was used to increase GMBF and gastric secretion (GS), and phenolred solution was used to correct the volume of GS collected by continuous aspiration. In all animals the measurements were done under resting, betazole‐stimulated conditions, and then immediately after HSV. In 12 of the 24 dogs (Group B) the same measurements were done again 2 months later. The findings of the study indicate that betazole‐stimulated GMBF was significantly decreased immediately after HSV (p<0.001). Betazole stimulation resulted in a 6‐fold increase of GMBF from the resting state before HSV, but only a 2‐fold increase 2 months after HSV. GS showed a significant decrease right after HSV without a significant difference (p<0.30) from the resting state. Two months postoperatively GS showed no significant difference from the resting state after betazole stimulation. There was a linear correlation between GMBF and GS before and after HSV but the correlation coefficients were not statistically significant.
An improved microsurgical course for a mixed group of surgeons
Authors: Lee Sun , Diez‐Pardo Juan , Olszewski W. , Rowinski W. , Hirner A. , Brekke Inge , Swedenborg J. , Flatmark U. , Häring A. , Nylander G. , Orloff Marshall J. 
Published: May 2005

AbstractAlthough the participants in the various microsurgical courses were of varied backgrounds and experience, and published materials that can serve as an adequate text are limited, the principles of microsurgery can be learned by skilled surgeons determined to become microsurgeons. Fundamental training depends upon the proper text and suitable models for practice under the guidance of a properly trained microsurgeon instructor. In particular, audiovisual aids are of substantial value. Techniques from the fundamental, simple vascular anastomosis to highly sophisticated organ transplantation in rodents may be mastered in a course of several days' duration. A 7‐ to 10‐day course should be repeated annually to enable participants to polish their skills. Further, during an annual course, a half to whole day can be set aside for a microsurgical scientific program to allow exchange of scientific and clinical information, and to stimulate junior participants.
Nonendocrine theories of the etiology of benign breast disease
Authors: Minton John Peter , Abou‐Issa Hussein 
Published: May 2005

AbstractThis article summarizes 15 years of clinical and laboratory studies that have continued the search for a biochemical basis for the development and resolution of symptomatic benign fibrocystic disease. The clinical response to diet modifications is presented along with simultaneous laboratory tissue and serum studies. An ongoing study of the clinical response to complete and total methylxanthine abstention, especially caffeine, is presented in the initial part of the article. Following the clinical observations, is a series of laboratory studies, some of which actually preceded the clinical investigation and, in fact, pointed out that a beneficial clinical response might occur in some women following complete abstention. In the last paragraph, we present current information that may identify which women are susceptible to fibrocystic breast disease development.
Management of breast pain and nodularity
Authors: Maddox Paul R. , Mansel Robert E. 
Published: May 2005

AbstractThe management of mastalgia consists of classification into its various patterns: reassurance, drug therapy for severe cases, and, rarely, surgery. Differentiation into cyclical and noncyclical patterns on a simple pain chart is useful for objective assessment of pain severity and for selection of appropriate drug therapy and subsequent monitoring of response. About 85% of new patients will be satisfied with adequate reassurance, but some 15% will have persistent pain and warrant medical treatment. Only a small number of drugs have been adequately tested in controlled trials and have been demonstrated to be more effective than placebo; these are bromocriptine, danazol, evening primrose oil, and tamoxifen. No ideal agent exists and the choice of drug will depend on efficacy, side effects, and cost.Noncyclical pain has a lower response rate compared to cyclical mastalgia, but differentiation of a subgroup with chest wall pain leads to an overall 90% response to treatment by local infiltration with steroid and lignocaine. Newer agents such as LHRH agonists are currently undergoing evaluation in double‐blind controlled trials against placebo.The management of nodularity is based on the clinical differentiation of the normal spectrum of physiological change within the breast (ANDI), requiring simple reassurance, from a true dominant breast nodule that will require excision biopsy to exclude malignancy. When pain and lumpiness coexist, some reduction in overall nodularity (with the use of agents given for mastalgia) may occur.