bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of deoxyribonucleic acid ploidy and nuclear expressed p62 c‐myc oncogene in the prognosis of colorectal cancer
Authors: Rowley S. , Newbold K. M. , Gearty J. , Keighley M. R. B. , Donovan I. A. , Neoptolemos J. P. 
Published: May 2005

AbstractA simultaneous flow cytometric assay of the nuclear expressed protein product of the c‐myc oncogene p62 and deoxyribonucleic acid (DNA) ploidy in archival paraffin‐embedded tumor material was undertaken in 179 patients with colorectal cancer, followed for up to 9 years. DNA ploidy showed a survival advantage for diploid tumors (χ12=5.39,p= 0.020) and could be used to further divide patients with Dukes' A tumors (χ12=4.87,p=0.027) and Dukes' C tumors (χ12=5.33,p=0.021). By dividing patients into 2 levels of tumor expression of p62 c‐myc, there was a trend for improved survival in patients with low expression (χ12=3.65,p=0.056). A combination of ploidy status and p62 c‐myc expression improved upon survival prediction by ploidy alone in providing 3 groups (χ22=7.86,p=0.0197). While these results do not suggest a replacement for the Dukes' staging for prognosis (χ32=33.82,p<0.00001), they strongly support the concept that enhanced expression of c‐myc oncogene is associated with the progression of colorectal cancer.
Management of esophageal atresia
Authors: Spitz L. , Kiely E. , Brereton R. J. , Drake D. 
Published: May 2005

AbstractA total of 303 infants with esophageal atresia and/or tracheoesophageal fistula were treated over 10 years (1980–1989). The overall survival rate was 86.5%. Associated anomalies were identified in 51.8% of patients, the most common being cardiac malformations which affected 24.4% of infants and was responsible for the majority of deaths. The dramatic increase in survival of infants with esophageal atresia in the past half century is due to improvements in pre‐ and postoperative management, meticulous operative technique to reduce anastomotic complications, and aggressive treatment of associated congenital anomalies.
Diagnosis and treatment of jejunoileal atresia
Authors: Touloukian Robert J. 
Published: May 2005

AbstractA total of 116 cases of intestinal atresia or stenosis were encountered at the Yale‐New Haven Hospital between 1970 and 1990. Sites involved were the duodenum (n=61; 53%), jejunum or ileum (n=47; 46%), and colon (n =8; 7%). All but two patients underwent operative correction, for an overall survival rate of 92%. Challenging problems were the management of apple‐peel atresia (five patients), multiple intestinal atresia with short‐gut syndrome (eight patients), and proximal jejunal atresia with megaduodenum requiring imbrication duodenoplasty (four patients). Major assets in the improved outlook for intestinal atresia are prenatal diagnosis, regionalization of neonatal care, improved recognition of associated conditions, innovative surgical methods, and uncomplicated long‐term total parenteral nutrition.
Malrotation of the intestine
Authors: Torres A. Margarita , Ziegler Moritz M. 
Published: May 2005

AbstractMalrotation of the intestinal tract is a product of a well defined aberrant embryology. Because the consequences of malrotation associated with a midgut volvulus may be catastrophic, an understanding of the anatomy, diagnostic criteria, and appropriate therapy for this putative emergency illness is imperative. This report summarizes a recent 18‐month experience with this diagnosis and contrasts this experience with that in the published literature. More than half (14/22) of the patients presented during the first month of life, and all had vomiting, which in most cases was bilious. The barium upper gastrointestinal series was the preferred diagnostic study, being both sensitive (18/19, 95%) and accurate (18/21, 86%). In this series two‐thirds of the patients presented with volvulus (15/22, 68%) of whom five had ischemic intestine requiring resection. One of these children died of overwhelming sepsis. A Ladd procedure was the preferred treatment, which as defined by us includes evisceration and inspection of the mesenteric root, counterclockwise derotation of a midgut volvulus, lysis of Ladd's bands with straightening of the duodenum along the right abdominal gutter, inversion‐ligation appendectomy, and placement of the cecum into the left lower quadrant. A high index of suspicion in the neonate with vomiting, rapid diagnosis, and appropriate operative therapy results in a predictable favorable outcome for children with intestinal malrotatioh.
Gastroschisis and omphalocele
Authors: Molenaar Jan C. , Tibboel Dick 
Published: May 2005

AbstractIt has been widely acknowledged that exomphalos and gastroschisis are two different clinical entities. Their etiology and pathogenesis, however, remain controversial. Several techniques are available for making a prenatal diagnosis of these as well as many other malformations. Some prenatal treatment is possible, but operative management is the more usual course. In most cases, of omphalocele and gastroschisis, treated either conservatively or by any kind of surgery, intensive care is mandatory to support nutrition and often ventilation as well. Enterai nutrition at an early stage during the postoperative period might lead to bouts of necrotizing enterocolitis requiring aggressive medical treatment and sometimes even operative treatment.
Management of the fetus with a cystic adenomatoid malformation
Authors: Adzick N. Scott , Harrison Michael R. 
Published: May 2005

AbstractPrenatal detection and serial sonographic study of fetuses with congenital cystic adenomatoid malformation (CCAM) now makes it possible to define the natural history of this lesion, determine the pathophysiologic features that affect clinical outcome, and formulate management based on prognosis. In a series of 22 prenatally diagnosed cases, the overall prognosis depended on the effects of the lung mass and the consequent physiologic derangement: A large mass may cause mediastinal shift, hypoplasia of normal lung tissue, polyhydramnios, and cardiovascular compromise leading to fetal hydrops. Two types of CCAM were distinguished by gross anatomy, ultrasonographic findings, and prognosis. Microcystic lesions (cysts < 5 mm; solid appearance) are often associated with fetal hydrops and have a poor prognosis. Macrocystic lesions (single or multiple cysts > 5 mm) are not usually associated with hydrops and have a more favorable prognosis. Four initially large lesions partially disappeared on serial prenatal sonography, suggesting that improvement can occasionally occur during fetal life. The finding that fetuses with hydrops are at high risk for fetal or neonatal demise led to fetal surgical resection of the massively enlarged pulmonary lobe (fetal lobectomy) in two cases. Fetuses with CCAM but without hydrops have a good chance for survival with maternal transport, planned delivery, and immediate neonatal resuscitation and surgery.
Necrotizing enterocolitis: A continuing problem in the neonate
Authors: Amoury Raymond A. 
Published: May 2005

AbstractNecrotizing enterocolitis (NEC) is a syndrome of diverse etiologies with a significant mortality rate affecting mostly prematurely born stressed infants. Now recognized as a discrete entity, it had been poorly defined because other conditions seem to represent the same entity. A number of risk factors have been identified that appear to “trigger” NEC, though these have been questioned because they have been present just as frequently in premature and older infants who did not develop NEC as in those that did. Recently, maternal cocaine use has been added to the suspected risk factors. A steady improvement in the survival of babies with NEC has been due largely to a high index of suspicion of the disease and early, aggressive medical management.
Hirschsprung's disease: Clinical and experimental observations
Authors: Puri Prem 
Published: May 2005

AbstractHirschsprung's disease (HD) is a relatively common cause of intestinal obstruction in the newborn. It is characterized by an absence of ganglion cells in the distal bowel beginning at the internal sphincter and extending proximally for varying distances. The etiology of HD‐associated enterocolitis remains a complex issue. This study has provided further support for a possible infectious etiology of enterocolitis complicating HD.
Management of anorectal malformations during the newborn period
Authors: Peña Alberto 
Published: May 2005

AbstractAnorectal malformations comprise a spectrum of disease. Some of these defects are minor, with an excellent functional prognosis. Others are complex and may be associated with other defects in the urinary tract that may risk the patient's life. The decision‐making process for the management of a newborn with anorectal malformations is crucial; the timing and establishment of priorities are the key to success. Because the management of affected males and females differs significantly, they are discussed separately.
Successful treatment of early hepatocellular carcinoma and concomitant esophageal varices
Authors: Higashi Hidefumi , Matsumata Takashi , Utsunomiya Tohru , Koyanagi Nobuhiro , Hashizume Makoto , Sugimachi Keizo 
Published: May 2005

AbstractTwenty‐two cirrhotic patients with hepatocellular carcinoma (HCC) and concomitant esophageal varices underwent aggressive hepatic resection accompanied by simultaneous devascularization, perioperative endoscopic injection sclerotherapy, or both (group A). To evaluate this treatment, 37 cirrhotic patients without esophageal varices who underwent hepatic resection for small HCC (2 cm or less) during the same period (group B) were studied to compare clinical data, preoperative laboratory data, pathologic findings, disease‐free rates, and survival rates. The operative time, blood loss, and resected liver weight did not differ between the two groups; however, the tumor size of group A (2.7±1.6 cm, mean±SD) was significantly larger than that of group B (1.5±0.3 cm). The preoperative liver function of group A was also more severe than that of group B except for prothrombin time. Despite these disadvantages, the 1‐, 3‐, and 5‐year disease‐free rates of the two groups were 72% versus 94%, 48% versus 54%, and 38% versus 45%, respectively, and the 1‐, 3‐, and 5‐year survival rates were 91% versus 97%, 79% versus 79%, and 54% versus 67% (group A versus group B), respectively, which showed no significant differences. Furthermore, there was no variceal bleeding in group A after treatment. Based on the above findings, for treatment of HCC and concomitant esophageal varices, aggressive hepatic resection accompanied by simultaneous devascularization, perioperative endoscopic injection sclerotherapy, or both is the preferred form of treatment.
Impact of recent advances in hepatobiliary imaging techniques on the preoperative diagnosis of carcinoma of the gallbladder
Authors: Chijiiwa Kazuo , Sumiyoshi Kinjiro , Nakayama Fumio 
Published: May 2005

AbstractAmong 26 patients with gallbladder carcinoma, 11 resected cases were studied retrospectively with respect to the preoperative imaging techniques and the operative procedures employed. Ultrasonography, endoscopic ultrasonography, and computed tomography were valuable in detecting gallbladder carcinoma preoperatively while direct cholangiography and angiography were helpful in designing operative strategy. The ultrasonographic findings were: a polypoid (fungating) mass protruding into the gallbladder lumen in 45%, abnormal thickening of the gallbladder wall in 18%, and a mass in the gallbladder invading adjacent organs in 18% of cases. Approximately 80% was diagnosed preoperatively by ultrasonography. Correct diagnosis was made by computed tomography in 60% of the cases. Endoscopic ultrasonography offered valuable information on the depth of tumor invasion. Direct cholangiography and angiography were useful in assessing the extent of the tumor spread. Recent advances in hepatobiliary imaging techniques, especially ultrasonography and computed tomography, contributed greatly to the detection and evaluation of gallbladder carcinoma at an early and resectable stage.
Radical operations for carcinoma of the gallbladder: Present status in Germany
Authors: Gall Franz Paul , Köckerling Ferdinand , Scheele Johannes , Schneider Claus , Hohenberger Werner 
Published: May 2005

AbstractDespite the overall poor prognosis of gallbladder carcinoma, it appears that, in resectable lesions, an aggressive surgical approach promises improvement in survival rates. Radical treatment of gallbladder carcinoma is based on a detailed knowledge of the lymphatic, venous, direct, and intraductal modes of spread of gallbladder carcinoma. Customized therapy of gallbladder carcinoma takes staging into consideration: if one is dealing with gallbladder carcinoma with macroscopic liver infiltration (T3 or T4), or with a pre‐ or intraoperatively diagnosed gallbladder carcinoma with an unknown depth of infiltration, an en bloc resection of the gallbladder with adjacent liver segments IVb and V, perhaps including VI, as well as a dissection of the hepatoduodenal ligament should be performed. If the carcinoma is missed intraoperatively at the time of cholecystectomy for other indications, in the presence of a T2 gallbladder carcinoma in proximity to the liver bed, reoperation with dissection of the hepatoduodenal ligament and resection of liver segments IVb and V should be performed. In the presence of T1 gallbladder carcinoma, simple cholecystectomy is adequate.This concept is based on our experience with 113 patients with gallbladder carcinoma who underwent treatment in our department from January, 1970 to June, 1989. Sixty‐seven percent of the gallbladder carcinomas were resected, 30% for cure and 37% palliatively. In 33%, the operation was limited to an exploratory laparotomy or a palliative operation, or no operation was performed. Of the curatively resected carcinomas (n=34), 7 were Stage I, 7 Stage II, 9 Stage III, and 11 Stage IV.The average follow‐up or survival time following curative resection at first operation (n=21) was 48.1 months; survival in patients who underwent curative resection at reoperation, in the presence of distant metastases, if there was tumor spillage, and in the presence of synchronous tumor was 14.0 months; survival following palliative resection was 5.8 months, and after exploratory laparotomy, palliative operation, or no operation was 3.6 months.Compared to palliative resection, customized therapy of gallbladder carcinoma for cure at the time of initial operation leads to a significant improvement in prognosis.
Radical operations for carcinoma of the gallbladder: Present status in Japan
Authors: Ogura Yoshifumi , Mizumoto Ryuji , Isaji Shuji , Kusuda Tsukasa , Matsuda Shinsuke , Tabata Masami 
Published: May 2005

AbstractBased on the histological findings of 1,686 resected cases of gallbladder carcinoma and operative results collected from 172 major hospitals in Japan, the present status of radical operation was assessed with respect to the relationship between the depth of carcinoma invasion and the operative results. The depth of carcinoma invasion was classified into 5 groups, i.e., limited to the mucosal layer (m) in 11.9%, advanced to the proper muscle layer (pm) in 9.8%, extending to the subserosal layer (ss) in 29.6%, serosal involvement (se) in 21.8%, and carcinoma invading the adjacent organs (si) in 26.9%. Tumor extension, such as lymph node metastasis, invasion of lymphatic and venous vessels, and perineural infiltration, were observed more frequently in patients with ss, se, and si than in those with m and pm. The cumulative 5‐year survival rates were 82.6% and 72.5% in patients with m and pm, which were significantly higher than 37.0%, 14.7%, and 7.5% in those with ss, se, and si, respectively. The choice of operative procedures should depend on the depth of carcinoma invasion. Cholecystectomy alone is done only in patients with tumor limited to the mucosa, and more radical procedures such as extended Cholecystectomy should be performed in those with carcinoma invasion beyond the mucosa. Pancreatoduodenectomy is indicated in those with lymph node metastasis posterior to the head of the pancreas and with invasion to the duodenum. When the tumor directly invades the liver, major hepatic resection is recommended. Extended right hepatic lobectomy with pancreatoduodenectomy should be reserved only for those younger than 70 years of age with advanced carcinoma and in a good nutritional state because of the high postoperative morbidity and mortality.
Radical operations for carcinoma of the gallbladder: Present status in North America
Authors: Gagner Michel , Rossi Ricardo L. 
Published: May 2005

AbstractExperience in the United States of America with the use of radical operations for carcinoma of the gallbladder was reviewed. Four studies using the Nevin clinicopathologic classification were combined for analysis. The 5‐year survival rate for patients with stage I disease was 59%; stage II disease, 40%; stage III disease, 9%; stage IV disease, 7%; and stage V disease, 1%. Only one study analyzed the results of surgical procedures according to Nevin staging. No conclusions can be drawn from retrospective studies on the value of operations more radical than simple cholecystectomy. Responses to a questionnaire sent to prominent North American surgeons emphasized the controversial management of patients with this disease.
Palliative operative procedures for carcinoma of the gallbladder
Authors: Jones R. Scott 
Published: May 2005

AbstractGallbladder cancer afflicts predominantly women, the elderly, and persons with gallstones. Despite its producing symptoms of abdominal pain, nausea and vomiting, weight loss, jaundice, and anorexia, this disease remains difficult to detect. Even with contemporary imaging techniques, most gallbladder cancers escape diagnosis until the time of laparotomy. The aggressive character of this malignancy permits an overall 5‐year survival rate of 3–5%. Although cures occur, the majority of operations performed for gallbladder cancer are for palliation. The objects of palliation include relief of pain, relief of jaundice, relief of intestinal obstruction, and the restoration of normal food intake. Resection of the tumor should be performed whenever possible; however, extensive operations including large liver resections and pancreaticoduodenectomy should be avoided in the presence of distant metastases. In the presence of large unresectable hilar masses, internal biliary bypass may relieve jaundice. Biliary‐enteric anastomosis using the segment III duct exposed via the umbilical fissure may offer satisfactory relief of jaundice in selected cases.
Intraoperative radiation therapy for carcinoma of the gallbladder
Authors: Busse Paul M. , Cady Blake , Bothe Albert , Jenkins Roger , McDermott William V. , Steele Glenn , Stone Michael D. 
Published: May 2005

AbstractThe recognition of a high incidence of local failure following surgical management of adenocarcinoma of the gallbladder has led to the use of adjuvant radiation therapy. In order to deliver higher doses to the gallbladder bed, intraoperative radiation therapy (IORT) has been used both with and without external beam radiation.The experience to date is reviewed. Ten patients have been treated, all of whom had either gross residual or unresected disease. The median survival for the group was approximately 1 year. There were no long‐term survivors. The IORT did not contribute to the overall morbidity.Because of the limited number of patients and the advanced nature of the disease, the role of IORT in the management of gallbladder carcinoma has yet to be determined. The utility of this modality will most likely reside in the treatment of minimal residual disease at the time of cholecystectomy rather than in the palliative treatment of unresectable tumors.
Resection combined with intraoperative radiation therapy (IORT) for stage IV (TNM) gallbladder carcinoma
Authors: Todoroki Takeshi , Iwasaki Yoji , Orii Kazuo , Otsuka Masaaki , Ohara Kiyoshi , Kawamoto Toru , Nakamura Kyoichi 
Published: May 2005

AbstractFrom October 1976 to May, 1990, a total of 86 patients with stage IV (TNM) gallbladder cancer were treated at Tsukuba University Hospital. Twenty‐seven of the 86 patients underwent tumor resection; 43 patients received palliative surgery. The remaining 16 were too advanced to have surgery. Of 27 patients who had tumor resection, 9 had resection alone, 17 had intraoperative radiation therapy (IORT)±postoperative external radiotherapy (ERT), and 1 had postoperative ERT.The procedures used were: extended right hepatic lobectomy plus hepaticobiliary resection (HBR) (n=2), hepatic segmentectomy (SIVb, SV) plus HBR (n=9), hepatic segmentectomy (SIV, V, VI) with HBR (n =1), hepatic segmentectomy (SIV, V) plus HBR with pancreaticoduodenectomy (PD) (n=3), PD plus HBR (n=1), cholecystectomy with wedge resection of the gallbladder fossa plus HBR (n=3), and cholecystectomy plus HBR (n=3), and cholecystectomy (n=4). Regional lymph node dissections were performed in every patient and 17 of 27 patients underwent additional resections of adjacent organs such as the stomach, duodenum, colon, and abdominal wall.A single dose of 20–30 Gy was delivered intraoperatively for 17 patients. A mean total dose of 36.4 Gy (1.8/fraction) was added to IORT for 10 patients.The three‐year cumulative survival rate was 10.1% for resection plus IORT but 0% for resection alone. The longest survivor is alive and well at 3 years and 3 patients are alive 16,13, and 4 months after tumor resection followed by IORT plus ERT.
Cecal diverticulitis: A continuing diagnostic dilemma
Authors: Schmit Paul J. , Bennion Robert S. , Thompson Jesse E. 
Published: May 2005

AbstractCecal diverticulitis is a rare entity and remains a difficult diagnostic problem. A retrospective review was undertaken of 16 patients (11 men, 5 women; average age, 33.2 years) with a pathologic diagnosis of cecal or right colon diverticulosis who received treatment from 1979 to the present. Preoperative symptoms were difficult to distinguish from appendicitis. The majority complained of right lower quadrant pain and tenderness. Diagnostic studies were not helpful. Preoperative diagnosis was appendicitis in 88% (14 of 16) and correct in 1 patient (6%). At exploratory celiotomy, the surgeon was able to make the diagnosis of cecal diverticulitis in 9 (60%) of the 15 patients in whom the correct diagnosis had not been made preoperatively. Neoplasm was suspected in 5 patients, and an appendiceal abscess was suspected in 1. Treatment was colectomy in 9 and local excision in 4 patients. In 3 patients, the inflamed diverticulum was left in situ at initial exploration; all underwent later excision, one of these urgently for sepsis. No patient died; however, one anastomotic leak requiring reoperation occurred. On the basis of this experience, we recommend excisional therapy in all cases in which the intraoperative diagnosis is certain. Suspicion of a neoplastic process continues to prompt colectomy in an emergency setting.
Pyogenic liver abscess: Multivariate analysis of risk factors
Authors: Lee King‐Teh , Sheen Pai‐Ching , Chen Jong‐Shyong , Ker Chen‐Guo 
Published: May 2005

AbstractSeventy‐three patients with pyogenic liver abscess during the year 1978–1988 were studied in the Kaohsiung Medical College Hospital. The overall mortality rate was 19.2% in this study. By using univariate analysis, it was revealed that clinical jaundice, pleural effusion, bilobar abscess, profound hypoalbuminemia (<2.5 g/dl), hyperbilirubinemia (>2 mg/dl), elevated level of serum AST (>100 IU/L), alkaline phosphatase (>150 IU/L), and marked leukocytosis (>20,000 mm3) were associated with a higher mortality rate. Multivariate stepwise logistic regression analysis detected only 3 factors of marked leukocytosis (>20,000 mm3), profound hypoalbuminemia (<2.5 g/dl), and presence of pleural effusion with independent significance in predicting mortality. Meanwhile, it was also revealed that the laboratory data could not predict a risk factor to mortality unless they became markedly abnormal.