bluuebunny/crossref_metadata_2025_split huggingface dataset:
The microbiology of postoperative bacteremia
Authors: Eykyn Susannah J. 
Published: May 2005

AbstractThe results of a 10‐year prospective survey of postoperative bacteremia are presented. The majority of episodes of bacteremia occurred after urological instrumentation or gastrointestinal operations. Most episodes of bacteremia were due to aerobic gram‐negative organisms, principallyEscherichia coli.Bacteremia carried an overall mortality rate of 29%, but this was much higher (59%) in patients with bacteremic shock. In view of the antibiotic sensitivity of the isolates from blood cultures in this series, a combination of gentamicin and ampicillin is still advised for therapy. More important, perhaps, is the prevention of this complication by appropriate antibiotic prophylaxis in urological and gastrointestinal surgery.
Antimicrobial prophylaxis in urology and transplantation
Authors: Chisholm Geoffrey D. 
Published: May 2005

AbstractThe main source of infection in urological practice is from the presence of an indwelling catheter. The risk of catheteracquired infection is determined by the duration of catheterization, the adequacy of free drainage, and the efficiency of the closed drainage system. Many catheter‐acquired infections are due to multiresistant strains ofEscherichia coli, Klebsiella sp.,Pseudomonas aeruginosa, Proteus sp., and Providentia sp. Antibiotic prophylaxis has no place in the prevention of catheter‐acquired infections, and prophylaxis should be achieved by scrupulous aseptic technique and reducing the duration of drainage. The problems of catheters in the paraplegic are discussed. Septicemia and endotoxemia are the most feared complications of cystoscopy and retropubic prostatectomy if the urinary tract is infected and of transrectal biopsy of the prostate. For this reason, antibiotic cover is generally advised for these procedures.Sepsis is still a major cause of death in patients who have received a renal transplant. These infections are not only bacterial, but viral, protozoal, and fungal. The severity and frequency of these infections have been reduced by less aggressive immunosuppression. There is probably a place for perioperative antibiotic cover, but long‐term antibiotics should be avoided.
Antimicrobial prophylaxis in appendectomy patients
Authors: Gottrup Finn , Hunt Thomas K. 
Published: May 2005

AbstractInfection commonly follows removal of the gangrenous or perforated appendix. However, if the appendix is normal or simply acutely inflamed, the rate of infection is low. The organisms most frequently isolated from the wound after appendectomy are Bacteroides (especiallyB. fragilis) andEscherichia coli. A combination of chemoprophylaxis effective against these 2 groups of organisms is the most rational choice of antimicrobial cover. Such antimicrobial cover should be given to all patients with a gangrenous or perforated appendix and to all other patients with appendicitis who have compromised immune systems. Prophylaxis is probably unnecessary in patients with a normal immune system who present with uncomplicated appendicitis.
Prevention and treatment of infection in colorectal surgery
Authors: Keighley M. R. B. 
Published: May 2005

AbstractThe results of a personal series of clinical trials on the use of antimicrobial agents for treatment and prevention of infection in colorectal surgery are presented, together with a review of the recent literature. The studies indicate that colorectal surgery is associated with a high sepsis rate which may lead to serious complications. In elective operations, an efficient mechanical bowel preparation is extremely important if antimicrobial prophylaxis is to succeed. Short‐term systemic antimicrobial prophylaxis with an agent specifically active against anaerobic bacteria is effective for elective operations. In emergency colorectal operations in which mechanical bowel preparation is not possible and the operative field is already contaminated, more prolonged antimicrobial cover is advised using a combination of agents effective against both the principal aerobic and anaerobic pathogens. In contaminated operations, wounds should also be left open to avoid synergistic infection in the subcutaneous tissues.
Preservation of the ruptured spleen by gluing with highly concentrated human fibrinogen: Experimental and clinical results
Authors: Brands W. , Mennicken C. , Beck M. 
Published: May 2005

AbstractPreservation of the ruptured spleen with fibrin glue was accomplished in 2 series of laboratory studies with Wistar rats. Subsequent clinical trials in repair of ruptured spleens in children are also reported. Direct gluing constitutes an excellent alternative in preserving functional splenic tissue.
Catheterization of the internal jugular vein for total parenteral nutrition
Authors: Yakoun M. , Joyeux H. , Solassol C. 
Published: May 2005

AbstractA safe technique of catheterization by surgical denudation of the internal jugular vein is presented. Through a radiopaque silicone catheter, total parenteral nutrition can be infused for more than 2 months. This vascular access avoids the risks of the blind punctures such as pneumothorax or arterial punctures.
Historical development of intestinal antisepsis
Authors: Poth Edgar J. 
Published: May 2005

AbstractThe study of intestinal antisepsis has been the concern of the author for the past 40 years. Pioneer studies of sulfanilamide, sulfanilylguanidine, succinylsulfanilamide, succinylsulfathiazole, and phthalylsulfathiazole in dogs are reported, and subsequent clinical trials are detailed. By 1948, intestinal antisepsis had become an established procedure to complement adequate mechanical cleansing. Careful attention to meticulous, gentle handling of tissues, preservation of maximum blood supply, and strict aseptic technique should be continued; intestinal antisepsis is not a substitute for surgical principles. A combination of neomycin‐phthalylsulfathiazole, together with the above‐named practices, has resulted in an abdominal wall wound infection rate below 3%, with no intra‐abdominal complications due to postoperative infection.
The effect of bowel preparation on colonic surgery
Authors: Hares Mark M. , Alexander‐Williams John 
Published: May 2005

AbstractIn colorectal surgery, formed feces within the colon pose an obstructive threat to a colonic anastomosis and an infective threat to the patient. If the colon is not cleared of feces before operation, and if antibiotic prophylaxis is not given, anastomotic dehiscence and postoperative sepsis are common after colorectal operations. Preoperative mechanical bowel preparation reduces the obstructive threat by clearing the colon of feces, and with good bowel preparation the incidence of anastomotic dehiscence is reduced from 24% to 7%.Sepsis after colorectal surgery is caused by aerobic and anaerobic bacteria. Antibiotics effective against both types of organisms are, therefore, required for effective prophylaxis. Oral antibiotic prophylaxis does not diminish significantly the fecal infective threat but, nevertheless, reduces the incidence of postoperative sepsis to 15–20%. Oral prophylaxis may be complicated by diarrhea and antibiotic‐associated colitis. After systemic prophylaxis, the incidence of postoperative sepsis can be reduced to 5–10%, and antibiotic‐associated diarrhea and colitis are less common.
The influence of antibiotics on infection and anastomotic recurrence after colon resection for cancer
Authors: Herter Frederic P. , Colacchio Thomas A. 
Published: May 2005

AbstractTwo hundred‐thirty bowel resections for cancer, performed during the 3‐year period 1975–1977, were reviewed with respect to the influence of antibiotic prophylaxis on wound infection rates and anastomotic recurrences. A large number of surgeons were involved, offering a variety of approaches and skills.The overall infection rate after surgery was a disappointing 16.8%. Sixty‐seven patients had no antibiotic prophylaxis of any kind, and the infection incidence in this group was 32.8%. In contrast, there was a 9.8% infection rate in the 163 patients who had received antibiotic prophylaxis in one form or another, a highly significant difference. Systemic perioperative therapy reduced the incidence of infection to 6.9%, and a combination of preoperative oral antibiotic therapy with perioperative systemic treatment resulted in a further reduction to 3.1%. There were no untoward consequences of short‐term oral antimicrobial therapy in terms of postoperative enterocolitis.Anastomotic recurrences were noted in 4 patients only, an incidence of 1.7%, all following anterior resection. Because of the small number, no correlations could be drawn between this form of recurrence and the use of oral intestinal antibiotics.It is concluded that both short‐term oral antibiotic bowel preparation and the systemic perioperative use of antimicrobial agents are effective in the control of infection after bowel surgery and carry little risk of “superinfection.” The combination of these 2 regimens appears to offer the highest degree of protection. The use of antibiotics should not be curtailed because of the theoretical risk of encouraging anastomotic recurrences.
Septic complications and bile cultures in 800 consecutive cholecystectomies
Authors: Reiss Raphael , Eliashiv Avinoam , Deutsch Alexander A. 
Published: May 2005

AbstractBenign disease of the biliary tract has become the most common indication for major abdominal surgery. Septic complications play an increasingly important role in the morbidity and mortality of biliary tract disease and biliary surgery. This prospective study deals with 800 consecutive cholecystectomies in which bacteriology data were studied and correlated with clinical data. The general incidence of positive bile cultures was 27%. Patients with a high incidence of positive cultures (high‐risk group) included those with acute cholecystitis, jaundice, choledochal stones, diabetes mellitus, nonfunctioning gallbladders, and patients over 70. Patients not presenting any of the above features (low‐risk group) had a very low incidence of positive bile cultures (less than 7.1%). The types of bacteria cultured were gram‐negative bacteria in the great majority of cases, gentamicin showing the highest sensitivity rate (91%). Close correlation was found between positive bile cultures and the incidence of septic complications. The results of this study support the view that perioperative antibiotic prophylaxis in biliary surgery should be given only to those patients defined as high risk. In the low‐risk group, about 60% of all cases, antibiotics can be omitted safely.
Resection of liver metastases
Authors: Mühe E. , Gall F. P. , Angermann B. 
Published: May 2005

AbstractAt the Erlangen Surgical Clinical Hospital, we have resected 49 liver metastases in 38 patients. The 5‐year survival rate is 20%. One female patient has survived for 17 years. The prognosis is most favorable in solitary metastases, and in cases in which local resections of metastases have proven adequate for the removal of metastases. If primary tumors and liver metastases are removed at the same time, obviously the prognosis is better than in cases of later diagnosis and resection. If the liver is the first filter for disseminated cells from the primary tumor, the survival rates are higher than if the lungs represent the primary filter.Solitary liver metastases must be removed in any case. If the patient has been operated on locally and curatively with extirpation of the primary tumor, solitary liver metastases should be removed at the same operation. Lobectomies are required only in cases in which substantial metastases already are present. Local resection with a 2‐cm margin of normal tissue is adequate.
Reconstruction of the pylorus
Authors: Martin C. J. , Kennedy T. 
Published: May 2005

AbstractReconstruction of the pylorus has been performed on 12 patients who had previous vagotomy and pyloroplasty and whose symptoms of bile reflux and vomiting, dumping, or diarrhea had not been satisfactorily controlled medically. This technically simple operation was followed by marked improvement in 60% of patients. We have not had problems with gastric outlet obstruction in the long term.
Remote salmonella infections
Authors: Higgins George A. , Sandiford John A. , Blair Willie C. 
Published: May 2005

AbstractThe salmonella group of bacteria, consisting of over 1,700 subtypes, causes widespread gastroenteric disease throughout the world, there being approximately 2,000,000 cases yearly in the United States alone. An uncommon but interesting complication is the hematogenous lodgment of organisms in other areas of the body with resultant localized abscess formation, often months or years later.Remote salmonellosis most often occurs in patients with underlying disease such as lupus, malignancy, diabetes, or anemia (especially sickle cell disease), or in association with factors that suppress host resistance including steroids and cancer chemotherapy. The most frequent sites of involvement are bone marrow, joints, meninges, pleura, and blood vessels (mycotic aneurysms), or in an area of “locus minoris resistentiae.” These latter include scars, hematomas, fracture sites, prosthetic devices, and neoplasms.Our experience would suggest that salmonella infections, remote both in location and in time from the original gastrointestinal episode, are perhaps more frequent today than is generally realized. This has led us to present our recent experience with a group of 13 patients suffering from this intriguing problem which frequently goes undiagnosed because it is often omitted from the list of diagnostic possibilities. Treatment consists of drainage of the localized abscess process combined with appropriate long‐term antibiotics.
Nitroprusside‐ and nitroglycerin‐induced hypotension: Effects on hemodynamics and on the microcirculation
Authors: Hauss Jan , Schönleben Klaus , Spiegel Hans Ullrich , Themann Hermann 
Published: May 2005

AbstractAfter a short summary of the effects and metabolism of sodium nitroprusside (SNP) and nitroglycerin (NTG), the influence of induced hypotension on hemodynamics and on the microcirculation is investigated. The continuous registration of the local tissue pO2in skeletal muscle, myocardium, and liver with the multiwire surface electrode provides the opportunity to recognize immediately a change in the microcirculatory bed. This new method shows in animal experiments that the local oxygen supply during SNP‐induced hypotension is dramatically reduced, while the arterial pO2remains in a normal range. These changes are not found during NTG‐induced hypotension. Electron microscopic examination of various organs, and especially of the myocardium, shows that the alterations of the oxygen supply found after application of SNP were connected with changes in the ultrastructure.
Cytomegalovirus cecal erosion causing massive hemorrhage in a bone marrow transplant recipient
Authors: West John C. , Armitage James O. , Mitros Frank A. , Klassen Lynell W. , Corry Robert J. , Ray Thomas 
Published: May 2005

AbstractA 24‐year‐old male underwent bone marrow transplantation for severe aplastic anemia. Posttransplantation complications included severe graft‐versus‐host disease and cytomegalovirus (CMV) infection manifested by gastrointestinal bleeding and apparent pneumonitis. Massive rectal bleeding necessitated exploratory laparotomy at which time a right colon resection was performed. Fifteen cecal ulcers were present which on histologixc examination revealed numerous cells containing characteristic intranuclear inclusions.Life‐threatening gastrointestinal lesions associated with CMV infection will be seen with increasing frequency as more patients undergo the severe immunosuppression associated with bone marrow and organ transplantation. Prompt recognition and expeditious surgical management will result in improved survival in this high‐risk population.
Thirty years' experience with gastrinoma
Authors: Zollinger Robert M. , Ellison E. Christopher , O'Dorisio Thomas M. , Sparks Joann 
Published: May 2005

AbstractOver a 30‐year period (1947–1977), 40 patients with gastrinoma have been studied. Fifteen of the 19 survivors have lived 10 to 28 years following surgical treatment. Recent multiple endocrine studies in the long‐term survivors have verified the clinical importance of including at least prolactin, parathormone, and catecholamine levels in addition to gastrin and calcium in every patient whose risk of other endocrine adenomas increases with time. Five‐year survival was 62.5%, and 10‐year, 47.5%. The absence of gross tumor at operation, origin within the submucosa of the duodenum or antrum, or proof of hyperparathyroidism favorably influenced long‐term survival, regardless of the type of surgical procedure. Survival was improved following removal of a rare solitary tumor or combined aggressive tumor removal, hemipancreatectomy, and total gastrectomy for extensive disease.
Mechanisms for increased adenylate cyclase responsiveness to TSH in neoplastic human thyroid tissue
Authors: Clark Orlo H. , Gerend Patricia L. , Nissenson Robert A. 
Published: May 2005

AbstractWe have previously examined TSH receptors and adenylate cyclase (AC) activity in normal and neoplastic human thyroid tissue. We found only minor differences in the affinity and capacity of the TSH receptor between the normal and neoplastic tissue, and yet there was a five‐fold greater AC responsiveness in the neoplastic thyroid tissue. To determine why there was a greater AC responsiveness to TSH in most differentiated thyroid neoplasms, we probed the receptor‐cyclase unit which consists of at least 3 classes of components: the receptor (R), the guanyl nucleotide regulatory unit (G), and the catalytic unit (C). The G unit binds GTP and forms a link between R and C. We studied the effects of TSH, Gpp(NH)p (a non‐hydrolyzable GTP analog) and sodium fluoride (NaF) (which act on G), and forskolin (which acts on C) on the receptor‐cyclase unit. The results of these studies demonstrate that: (a) there was a greater AC response to TSH (5/6), Gpp(NH)p (3/5), and NaF (5/6) in T than N; (b) the AC response to forskolin was comparable in T and N in 5/6 patients and higher in T in 1 patient; (c) Gpp(NH)p, NaF, and forskolin all had an additive or synergistic effect when added to TSH in both N and T; (d) NaF and forskolin also had an additive or synergistic effect on AC, whereas Gpp(NH)p and forskolin together in N and Gpp(NH)p and NaF together in T caused a considerably less than additive AC response.These studies demonstrate that Gpp(NH)p, NaF, and forskolin at optimal concentrations have an additive effect on the AC response to TSH in both normal and neoplastic thyroid tissue and that the altered AC responsiveness to TSH in most, but not all, benign thyroid tumors and differentiated thyroid carcinomas appears to be secondary to an altered guanyl nucleotide regulatory protein.
Chromosomal instability in medullary carcinoma of the thyroid
Authors: Samaan Naguib A. , Pathak Sen , Saad Mohammed F. , Ordonez Nelson G. , Hickey Robert C. 
Published: May 2005

AbstractMeasurement of serum calcitonin (CT) at basal levels and after pentagastrin stimulation is presently the most reliable method for detection of medullary carcinoma (MCT), but not for detection of patients who carry the disease while in the pretumorous stage. Our aim is to use cytogenetic analyses to identify the phenomenon of genetic instability in patients and family members as a second marker to predict the possibility of neoplastic development. We found that in cultured lymphocyte samples taken from MCT patients, the chromosomes exhibited a relatively higher frequency of spontaneous aberrations (average 10.2±3.1% metaphases). The close relatives of 3 families with high CT levels and surgical neoplastic findings showed such a trait. In lymphocytes of normal persons, chromosome aberrations, usually of chromatid type, are rarely encountered (average about 3.2±1.6%). Our conclusions are: (a) patients with MCT show an increased spontaneous chromosomal aberration rate (SCAR), in brief a chromosomal instability (CI); (b) increased chromosomal aberration in family members with multiple endocrine neoplasia type IIa (MEN IIa) kindreds is present; (c) such patients with high SCAR should be tested with CT measurement at basal levels and after stimulation; (d) if serum CT is high, thyroidectomy should be considered; (e) if CT is low, the patient should be followed at regular intervals; and (f) SCAR is a useful practical marker; it may be used in screening, especially when pentagastrin studies are impractical, as with children.
Localization procedures in patients requiring reoperation for hyperparathyroidism
Authors: Clark Orlo H. , Stark David D. , Gooding Gretchen A. W. , Moss Albert A. , Arnaud Sara B. , Newton Thomas H. , Norman David , Bank William O. , Arnaud Claude D. 
Published: May 2005

AbstractNumerous techniques have been described for the preoperative localization of hyperfunctioning parathyroid glands. During the past 2 years, 18 patients have had operations for persistent (14) or recurrent (4) hyperparathyroidism. One or more hyperfunctioning parathyroid glands were identified at operation in all but 1 patient and all but 2 patients became normocalcemic.Eighteen patients had ultrasonography, 17 patients had computed tomography (CT) scanning, and 13 patients had selective venous sampling (SVS) for parathyroid hormone (PTH) assay. These studies correctly identified the lesion(s) in 9 (50%), 8 (47%), and 9 (69%) of the patients, respectively. In 3 patients, probable parathyroid tumors were identified by ultrasonography and confirmed by aspiration biopsy cytology under ultrasonic guidance. All had parathyroid tumors confirmed at operation. The smallest tumor localized by ultrasonography was 0.6×0.6×0.6 cm and by CT scanning was 0.9×0.9×0.8 cm. There was 1 false‐positive CT scan and 1 false‐positive SVS. In the 2 patients who failed to become normocalcemic no localization study was positive. One of these patients subsequently had a 0.6×0.6×0.5 cm mediastinal adenoma localized by CT scan, nuclear magnetic resonance, and SVS. The tumor was removed via median sternotomy and the patient is now normocalcemic.Digital angiography has recently been helpful for “mapping out” the venous pattern for venous sampling for PTH. Ultrasonography and CT scanning complemented each other, since one or the other of these studies was positive in 15 patients, yet only 2 patients had both a positive ultrasound and CT scan. When any 2 localizing tests suggested the same site for the parathyroid lesion, the tumor was found in all cases.One patient developed post‐pericardotomy syndrome after a medium sternotomy, but there were no other complications. Localization procedures expedite surgical treatment, decrease morbidity, and are strongly recommended in patients requiring reoperation for hyperparathyroidism.
The density test for the intraoperative differentiation of single or multigland parathyroid disease
Authors: Welsh Christopher L. , Taylor Gerard W. 
Published: May 2005

AbstractThe differentiation between parathyroid adenoma and hyperplasia can be difficult even for the experienced pathologist working with definitive material. The surgeon must make this distinction at the time of surgery so that the extent of the resection can be determined.A simple density test has been used in 100 patients undergoing neck explorations for parathyroid disease. Eight tests were invalid for various technical reasons, leaving 92 for analysis. On the basis of the density test, 65 were graded as single gland disease and 27 as multi‐gland disease. The extent of the resection was in accord with the density test findings. The follow‐up period ranges from 9 to 64 months (mean 31.7 months). There has been 1 case of persistent hypercalcemia, but the remainder are normocalcemic. Of interest is the discrepancy between the density test grading and the histological report. To date the clinical outcome favors the density test result rather than the histological diagnosis.