bluuebunny/crossref_metadata_2025_split huggingface dataset:
Laparoscopic Colorectal Surgery: Ascending the Learning Curve
Authors: Reissman Petachia , Cohen Stephen , Weiss Eric G. , Wexner Steven D. 
Published: August 2002

AbstractThe aim of this study was to prospectively assess the results of our first 100 consecutive patients who underwent laparoscopic or laparoscopy‐assisted colorectal operations. The parameters studied included the type and length of procedure, intra‐ and postoperative complications, conversion to open surgery, length of ileus, and hospitalization. A total of 100 laparosopic and laparoscopy‐assisted procedures were performed between May 1991 and April 1994. The mean patient age was 49 years (12–88 years). The procedures included 36 total abdominal colectomies (TACs) (ileoanal reservoir 28, ileorectal anastomosis 6, end‐ileostomy 2), 39 segmental resections of the colon and small bowel, 8 resections of the rectum, 7 diverting stoma creations, 7 reversals of Hartmann’s procedure, and 3 other procedures. In seven cases (7%) the laparoscopic procedure was converted to a laparotomy. A group of 22 patients sustained 26 complications that included enterostomy (n= 5), hemorrhage (n= 6), intraabdominal abscess (n= 4), prolonged ileus (n= 4), wound infection (n= 2), anastomotic leak (n= 1), aspiration (n= 1), cardiac arrhythmia (n= 1), upper intestinal bleeding (n= 1), and postoperative small bowel obstruction (n= 1). There were no deaths. When divided into three equal, consecutive groups, the patients in the early (n= 33) and intermediate (n= 33) groups had a significantly higher complication rate (42% and 27%, respectively), than those in the late group (n= 34, 12%;p< 0.05). The complication rate in each group was also directly related to the number of TACs performed (18 in the early, 13 in the intermediate, and 5 in the late group). The overall complication rate in TAC cases was significantly higher (42%) when compared to that of all other procedures (segmental resection 9%, nonresectional 12%;p< 0.01). The mean operating time was 4 hours (2.5–6.5 hours) for TAC, 2.5 hours (1.5–5.5 hours) for segmental colonic resection, and 1.6 hours (1.0–2.5 hours) for the nonresectional procedures. The length of ileus was 3.5 days (2–7 days) after TAC, 3 days (2–7 days) after the segmental resections, and 2 days (1–4 days) after the nonresectional procedures. The mean hospital stay was 7.3 days (2–40 days): 8.4 (5–40), 7.0 (4–12), and 6.8 (2–11) days for the TAC, segmental resection, and nonresectional procedures, respectively. We conclude that the feasibility of laparoscopic colorectal surgery has been well established. The morbidity associated with laparoscopic colorectal surgery correlates with a steep learning curve but is also related to the type of procedure. TAC is associated with a higher complication rate than are other laparoscopic colorectal procedures.
Nutritional Support to Prevent and Treat Multiple Organ Failure
Authors: Bengmark Stig , Gianotti Luca 
Published: August 2002

AbstractEnteral nutrition (EN) has several advantages over parenteral nutrition (PN) for postoperative/posttrauma patients. Modern technologies for tube‐feeding have made early EN possible. Jejunal tube‐feeding has advantages over gastric tube‐feeding: faster metabolic recovery, less vomiting, and less risk of regurgitation and aspiration. Immediate or early EN stimulates the splanchnic and hepatic circulations, improves mucosal blood flow, prevents intramucosal acidosis and permeability disturbances, and eliminates the need for stress ulcer prophylaxis. Saliva containing important antimicrobial substances and gastric acidity are important in sepsis prevention. Chewing, saliva, and gastric acidity support gastric nitric oxide (NO) release, important for mucosal blood flow, gastrointestinal (GI) motility, mucus formation, and bacteriostasis. An oral supply of NO‐donating substances and chewing of nitrate‐rich food, such as lettuce or spinach, can be useful. Oral and mucosa‐protective lipids are recommended. H2 blockers and saliva‐inhibiting drugs are avoided. Immediate EN should be given, starting with 25 ml/hr and increasing to 100 ml/hr over 24 to 48 hours. For the immunocompromised patient special attention should be given to the purity of water. Bottled water can contain bacteria such asPseudomonas. Food antioxidants such as glutathione, vitamin E, and β‐carotenes are important. Ingredients for the colonic mucosa are important. Approximately 10% of caloric need is satisfied by so‐called colonic food (prebiotics), fermented at the level of the colonic mucosa to produce colonic mucosa nutrients and to prevent gut origin sepsis. More than 10 g of fiber per day is recommended. The fermenting flora (probiotic flora) is deranged owing to disease or antibiotic treatment, and resupply of flora is important. A new concept of ecoimmune nutrition is presented for enteral supply of mucosa‐reconditioning ingredients: new surfactants, pseudomucus, fiber, amino acids such as arginine, and mucosa‐adheringLactobacillus plantarum299.
Laparoscopic Treatment of Gallbladder and Common Bile Duct Stones: A Prospective Study
Authors: Lezoche Emanuele , Paganini Alessandro M. , Carlei Francesco , Feliciotti Francesco , Lomanto Davide , Guerrieri Mario 
Published: August 2002

AbstractThe aim of this study was to investigate prospectively the feasibility, success rate, safety, and short‐term results of single‐stage laparoscopic treatment of gallstones and ductal stones in 100 consecutive, unselected patients. Common bile duct (CBD) stones were diagnosed at routine intraoperative cholangiography and choledochoscopy in 100 of 950 patients with gallstones undergoing laparoscopic cholecystectomy (LC). Unsuspected CBD stones were present in 39 patients (4.1% of 950; 39% of 100); 26 patients were referred for surgery after failed endoscopic sphinctertomy (ES) performed elsewhere. Transcystic duct CBD exploration (TC‐CBDE) was the procedure of choice. When it was not feasible, choledochotomy and direct CBD exploration (D‐CBDE) was performed. Use of biliary drainage was liberal. A completion cholangiogram was obtained for all patients. Laparoscopic treatment of CBD stones was successful in 96 patients: after TC‐CBDE in 63 and after D‐CBDE in 33. Four operations were converted to open surgery (4%). Retained stones, observed in five patients, were treated by ES in two cases and by percutaneous endoscopic/fluoroscopic lithotripsy in three. Minor morbidity included biloma (n = 2), port site infection (n = 2), and subumbilical hematoma (n = 1). Major morbidity was bile leakage from the cystic duct stump in two cases due to clips or transcystic duct drainage displacement, respectively. One elderly, high risk patient died after being referred for several failed attempts of endoscopic clearance; she died from cardiogenic shock 3 days after successful laparoscopic treatment. Laparoscopic CBD exploration is feasible and safe in most patients, with short‐term results that compare favorably with the results of sequential ES/LC reported in the literature.
Thyroid Cancer Detected by Ultrasound‐Guided Fine‐Needle Aspiration Biopsy
Authors: Yokozawa Tamotsu , Fukata Shuji , Kuma Kanji , Matsuzuka Fumio , Kobayashi Akira , Hirai Keisuke , Miyauchi Akira , Sugawara Masahiro 
Published: August 2002

AbstractA greater percentage of thyroid cancers can be detected by ultrasound‐guided fine‐needle aspiration biopsy (UG‐FNAB) than by ordinary FNAB. A group of 678 patients were selected sequentially as having been diagnosed with benign nodules by the conventional FNAB method. We reexamined these patients by UG‐FNAB and investigated the types of thyroid cancer that were missed by the conventional FNAB. Of the 678 patients diagnosed with benign nodules (using conventional FNAB), 571 (84.2%) demonstrated the same diagnosis when UG‐FNAB was used. The remaining 107 patients (15.8%) studied were suspected of having a malignancy after UG‐FNAB had been performed. Surgical specimen histology proved thyroid cancer in 99 of the 107 patients: 93 had papillary carcinoma, 4 had follicular carcinoma, 1 had medullary carcinoma and 1 had anaplastic carcinoma. Two drawbacks were noted when conventional FNAB was used: (1) cancer lesions difficult to palpate (n= 55) (e.g., small cancers with or without benign lesions or cancers associated with Hashimoto's thyroiditis or Graves’ disease); and (2) palpable cancers with insufficient cell material for analysis (n= 44) (e.g., cystic carcinoma and cancers with calcified lesions. UG‐FNAB is a powerful technique for detecting microcancers, cystic carcinomas, cancers associated with benign nodules, Hashimoto's thyroiditis, or coarse calcifications.
Islet Cell Carcinoma of the Pancreas
Authors: Lo Chung Yau , van Heerden Jon A. , Thompson Geoffrey B. , Grant Clive S. , Söreide Jon Arne , Harmsen William S. 
Published: August 2002

AbstractIslet cell carcinoma (ICC) of the pancreas is a rare, indolent malignancy associated with higher resectability rate and better survival than ductal carcinoma. This retrospective study presents results of surgical treatment from a single institution. From 1985 through 1993 a total of 64 patients (36 men, 28 women) were surgically treated for ICC. Ages ranged from 22 to 80 years (median 55 years) with a median postoperative follow‐up of 39 months (range 10–97 months). Of the 64 patients, 30 (47%) had functioning and 34 (53%) nonfunctioning tumors. Gastrinoma (n= 11) followed by glucagonoma (n= 6) and insulinoma (n= 4) were the most common functioning tumors. In the patients undergoing a laboratory study, 67% of the nonfunctioning tumors had elevated peptide hormone levels. Potentially curative resections were performed in 17 patients (26%), palliative procedures in 35 (55%), and exploratory laparotomy alone in 12 (19%). One patient (2%) died within 30 days after operation. Symptomatic improvement was achieved in 96% of patients with a mean duration of 22 months. Three‐ and five‐year survivals were 66% and 49%, respectively. In patients with curative resection, the disease‐free survival at 3 years was 53% (95% CI: 32–86%). The presence of diffuse hepatic metastases was a predictor of poor survival at 3 years (74% versus 58%;p= 0.05); there was no statistically significant difference in survival between functioning and nonfunctioning groups (p> 0.1). Although curative resection for ICC is rare, meaningful palliation can be achieved in most patients with rare mortality and acceptable morbidity.
Gastric Smooth Muscle Tumors: Diagnostic Dilemmas and Factors Affecting Outcome
Authors: Sanders Laura , Silverman Mark , Rossi Ricardo , Braasch John , Munson Lawrence 
Published: August 2002

AbstractWe reviewed the 46 gastric stromal tumors that were treated at our institution between 1958 and 1992. The most common presenting symptoms were gastrointestinal bleeding, pain, and fatigue or malaise. The tumors ranged from 4 to 150 mm, with surgery most often being a wedge excision or partial gastrectomy. Abdominal computed tomography was the most specific diagnostic test obtained preoperatively. Factors associated with decreased survival included size ≥ 8 cm (p= 0.02), more than 0–3 mitoses per 10 HPF (p< 0.001), positive margins or unresectability (p= 0.008), and tumor pathologic grade II or more (p= 0.004). These tumors have an unpredictable behavior. Surgical resection with negative margins remains the best therapy, but resection for palliation is sometimes indicated as it can be associated with prolonged survival.
Recurrence after resection for ductal adenocarcinoma of the pancreas
Authors: Sperti Cosimo , Pasquali Claudio , Piccoli Antonio , Pedrazzoli Sergio 
Published: August 2002

AbstractWe analyzed the pattern of failure and clinicopathologic factors influencing the disease‐free survival of 78 patients who died after macroscopic curative resection for pancreatic cancer. Local recurrence was a component of failure in 56 patients (71.8%) and hepatic recurrence in 48 (61.5%), both accounting for 97% of the total recurrence rate. About 95% of recurrences occurred by 24 months after operation. Median disease‐free survival time was 8 months, and cumulative 1‐, 3‐, and 5‐year actuarial disease‐free survival rates were 66%, 7%, and 3%, respectively. Multivariate analysis showed that tumor grade (p = 0.04), microscopic radicality of resection (p = 0.04), lymph node status (p = 0.01), and size of the tumor (p = 0.005) were independent predictors of disease‐free survival. Patterns of failure and disease‐free survival were not statistically influenced by the type of surgical procedure performed. Median survival time from the detection of recurrence until death was 7 months for local recurrence versus 3 months for hepatic or local plus hepatic recurrence (p < 0.05). From our experience and the data collected from the literature, it appears that surgery alone is an inadequate treatment for cure in patients with pancreatic carcinoma. Effective adjuvant therapies are needed to improve locoregional control of pancreatic cancer after surgical resection.
Accuracy of Current Educational Literature on the Staging of Gastric Carcinoma
Authors: Fung Anthony S.Y. 
Published: August 2002

AbstractStaging of gastric adenocarcinoma is important for comparing aspects of the disease in Asia and in the Western countries, and it may be used to direct the treatment strategy. A survey of 13 popular current surgical textbooks and review journals found a high level of inaccuracy. Two texts (15%) did not mention any staging systems, and one (8%) described a nonstandard system. Three (23%) described staging systems that were out of date, and six descriptions (46%) were inaccurate. Only 40% of the cited staging systems was reliable. This level of inaccuracy leads to confusion for the reader and to difficulty interpreting other relevant literature.
Appraisal of Ten‐Year Survival following Esophagectomy for Carcinoma of the Esophagus with Emphasis on Quality of Life
Authors: Baba Masamichi , Aikou Takashi , Natsugoe Shoji , Kusano Chikara , Shimada Mario , Kimura Shigeto , Fukumoto Toshitaka 
Published: August 2002

AbstractCharacteristics of 10‐year survival after esophagectomy for carcinoma were studied retrospectively in 161 patients who underwent curative operation between 1973 and 1984. Of the 161 patients, 44 (27.3%) survived for 10 years after operation (right transthoracic approach with cervical anastomosis in 36 patients and left thoracoabdominal approach with jejunoesophagostomy in 8 patients). Females survived significantly longer than males; 10‐year survival was observed in 10 (50%) of 20 females and 34 (24.1%) of 141 males. TNM factors were significantly linked to the 10‐year survival for 25 patients (56.8%) whose tumors invaded the adventitia and 20 patients (45.5%) who had lymph node metastases, where the total number of involved nodes was less than eight. A questionnaire mailed 10 years after operation revealed that about one‐fifth of the 10‐year survivors could not go up one flight of stairs without taking a rest, and that the daily activity significantly deteriorated if the patient's age at the time of surgery was more than 66 years. One‐third of the 10‐year survivors were not satisfied with the daily quantity of food intake, resulting in no gain of body weight after discharge from the hospital. This complaint was significantly correlated with either weekly reflux or heartburn, resulting in the increasing number of nonmalignancy deaths. Of 13 ten‐year survivors who were alive at 10 years but died after that, 11 (84.6%) died of pneumonia or malnutrition. Duodenogastroesophageal reflux may eventually cause nonmalignancy death 10 years after esophagectomy for carcinoma.
Lack of Benefit of Combined Pancreaticosplenectomy in D2 Resection for Proximal‐Third Gastric Carcinoma
Authors: Kodera Yasuhiro , Yamamura Yoshitaka , Shimizu Yasuhiro , Torii Akihito , Hirai Takashi , Yasui Kenzo , Morimoto Takeshi , Kato Tomoyuki , Kito Tsuyoshi 
Published: August 2002

AbstractOf the 2790 patients with gastric carcinoma who underwent surgery between January 1978 and December 1993, there were 224 who underwent a D2 resection for cancer of the proximal third of the stomach. Survival in these patients was retrospectively analyzed with special reference to the survival benefit of pancreaticosplenectomy (PS). The D2 resection involved a splenectomy in
129 patients, a PS in 38 patients, and neither in 57 patients, with
5‐year survivals of 74%, 59%, and 91%, respectively. Although these differences in survival were attributable to the apparent deviation in the incidence of prognostic variables, no significant survival benefit of PS was observed for patients with the same clinical stage disease
(stages II and III) or the same nodal status (n1 and n2). Because PS was associated with a significant increase in the incidence of anastomotic dehiscence and length of hospital stay, the dismal survival benefit implies that it should not be performed routinely with the D2 resection but should be employed only for lesions with direct invasion of the pancreas.
Comparison of Pancreatogastrostomy and Pancreatojejunostomy after Pancreatoduodenectomy Performed by One Surgeon
Authors: Kim Sun Whe , Youk Eui Gon , Park Yong Hyun 
Published: August 2002

AbstractPancreatogastrostomy (PG) for restoring pancreaticoenteric continuity after pancreatoduodenectomy (PD) has been recommended by a few surgeons on the basis of certain theoretic and practical advantages of this procedure over pancreatojejunostomy (PJ). The purpose of this study was to determine whether PG can be a safe alternative to PJ. Eighty‐six PDs performed by the same surgeon for periampullary carcinoma were analyzed to compare early and late postoperative results of PJ (
n= 38) and PG
(n= 48). The two groups were comparable for age, sex, diagnosis, stage, and operation time. PJ leakage developed in six patients (15.8%) and PG leakage in one (2.1%) (p <
0.05). Overall rates of morbidity/hospital mortality were 34.2/7.9%
and 18.8/4.2% in the PJ and PG groups, respectively. In conclusion, PG showed a more favorable early outcome than PJ. PG is recommended for surgeons who encounter difficulties with PJ for reconstruction after PD.
Bullets and Their Role in Sepsis after Colon Wounds
Authors: Sarmiento Juan M. , Yugueros Patricia , Garcia Alberto F. , Wolff Bruce G. 
Published: August 2002

AbstractThe objective of this study was to determine the relation between the presence of a bullet (gunshot) after injury to the colon and the incidence of sepsis in its track and the soft tissue where it is retained. A retrospective review was carried out of the charts of consecutive patients admitted for abdominal gunshot wounds with proved colon injury during laparotomy where the bullet was either retained in the soft tissue or exited the body. The review covered a period of 4 years beginning January 1, 1990. Three groups were identified for analysis: (1) patients from whom the bullet was surgically removed, with additional cleansing and débridement of the area (
n= 21); (2) patients who did not undergo surgical removal of the bullet (n= 81); and (3)
patients in whom the bullet exited spontaneously and in whom only débridement of the skin was carried out (n=
83). Similar risk factors were noted among the groups (age, ATI score, colostomy rate), except for a higher incidence of shock in group 3
(p= 0.003). The incidence of sepsis in soft tissue was least in group 1. It was five and seven times greater in groups 2 and 3, respectively. After an abdominal gunshot with colon injury, the missile should be removed if feasible and the local tissue débrided. If the bullet has exited spontaneously, its internal track must be débrided and lavaged extensively.
Nonparasitic Cysts of the Liver: Results and Options of Surgical Treatment
Authors: Koperna Thomas , Vogl Sonja , Satzinger Ulli , Schulz Franz 
Published: August 2002

AbstractNonparasitic cysts of the liver (NPHC) are highly variable in respect to appearance and therapeutic approach. The treatment of these cysts varies according to the nature and appearance of the disease. Based on the variable nature of disease and the various therapeutic options, all of which were attempted in our patients, the most suitable mode of treatment for different forms of NPHC are discussed. Ninety‐one patients with NPHC who had been treated surgically from 1977 through 1995 were examined retrospectively. Asymptomatic peripheral cysts measuring up to 10 cm do not require further treatment. Computed tomography (CT)‐guided aspiration (n= 9) should be regarded as a palliative measure. Within a short period, CT‐guided aspiration led to recurrence of symptoms in seven of our patients. Standard treatment of NPHC is fenestration with widest possible excision of the cystic wall, which can be performed laparoscopically (n= 10) or by the conventional surgical mode (n= 54). One patient was initially operated by the laparoscopic technique but developed bleeding, which necessitated conversion to the open mode. Three patients underwent synchronous laparoscopic cholecystectomy. Recurrence rates were similar: 11% in the laparoscopically treated group and 13% in the group that underwent conventional open surgery. Conventional surgical treatment was always successful in cases of solitary cysts. However, in cases of multiple cysts measuring more than 5 cm, conventional surgery was followed by recurrence of symptoms in 26% of patients (7/27), who then had to undergo a second operation. Partial resection of the liver (n= 9) was successfully performed in cases of polycystic disease (n= 5) with concomitant enlargement of the organ as well as in cases of large solitary cysts of the left lobe of the liver (n= 4). In patients in whom we found that the cysts communicated with the ductal system (n= 3), we performed a cystojejunostomy to drain the bile. The complication rate was low. In addition to frequent postoperative ascites, which necessitated no further intervention, we observed infectious complications in four patients. Twenty patients (22%) expired during a mean follow‐up period of 6.2 years. Interestingly, deaths were frequently associated with malignancy (11/20). After fenestration of multiple cysts measuring > 5 cm, the patients are at high risk for recurrence. Hence partial resection of the liver is an excellent therapeutic alternative in selected patients with polycystic disease and massive enlargement of the organ in whom the disease could not be controlled by simple fenestration. The results of this study show that laparoscopic fenestration should replace the conventional surgical technique as the gold standard in cases of NPHC because the laparoscopic technique is less stressful for the patient and is associated with a rate of success similar to that of the conventional technique.