bluuebunny/crossref_metadata_2025_split huggingface dataset:
Breast‐conserving surgery with radiation therapy for operable mammary carcinoma: A 25‐year experience
Authors: Spitalier J. M. , Gambarelli J. , Brandone H. , Ayme Y. , Hans D. , Brandone J. M. , Bressac C. , Amalric R. , Santamaria F. , Robert F. , Seigle J. , Amalric F. , Pollet J. F. , Kurtz J. M. 
Published: May 2005

AbstractThis article describes the long‐term results of breast‐conserving treatment for 1,133 consecutive patients with operable mammary cancer treated from 1961 to 1979 by limited surgery followed by curative irradiation. Follow‐up ranged from 5 to 23 years. The percentage of patients (clinical stages I and II combined) alive and well at 5, 10, and 15 years was 86%, 80%, and 62%, respectively. The percentage of cured patients having retained their treated breast was 85% at 15 years. One hundred forty‐nine patients (13.2%) developed recurrence in the treated breast and 67 patients (5.9%) recurred in the axilla, most commonly in conjunction with breast failure. Ninety‐one percent of the local‐regional recurrences were operable, and the 5‐year survival following salvage surgery was 61%. The cosmetic results of therapy were judged to be good or excellent in 70% of patients at 15 years, with 2–4% of the patients having unacceptable results. It is concluded that breast‐conserving surgery followed by radiation therapy for clinical stages I and II results in survival rates equivalent to those achieved by primary radical surgery. This method allows reliable local‐regional disease control while permitting the majority of patients to retain their breasts in an esthetically acceptable condition. In contrast to recurrences after radical surgery, local‐regional recurrences after conservative therapy can be successfully treated by further surgery.
Lobar and segmentai atrophy of the liver
Authors: Ham J. M. 
Published: May 2005

AbstractLobar atrophy of the liver has been recognized as a complication of hepatic and biliary disease for many years. Previously regarded as rare and clinically unimportant, it is now accepted as reasonably common and clinically significant in many patients. Atrophy of liver lobes and, now, also segments, is much more frequently diagnosed because of the routine use of ultrasound and computed tomography scanning in the assessment of hepatobiliary disease, together with its recognition on angiograms and at laparoscopy.
Hepatic vein and retrohepatic vena caval injury
Authors: Ciresi Kevin F. , Lim Robert C. 
Published: May 2005

AbstractRetrohepatic venous injury presents as a rare but frequently lethal complication of trauma. The anatomic arrangement makes management of these injuries difficult at best. Operative exposure and isolation techniques ranging from cross‐clamping the aorta, portal triad, suprarenal vena cava, and suprahepatic vena cava to the use of internal shunts are described in this report.Our experience from 1968 to 1987 with internal shunting techniques includes 27 patients. We have successfully resuscitated 12 patients for an acute mortality of 55 %. We believe that this figure is high but compares favorably with published results. Late deaths from sepsis, disseminated intravascular coagulation, or multiple systems organ failure remain as significant causes of overall mortality.Many techniques have been successfully employed over the years in achieving vascular isolation of the liver. The methods all have their own merits, but the key factor in each is the recognition that they need to be employed. Conservative selection of patients is undoubtedly justified, but aggressive approaches should not be delayed until they are the methods of last resort.
Conservative treatment of liver trauma
Authors: Andersson Roland , Bengmark Stig 
Published: May 2005

AbstractA marked change toward a more conservative approach in the treatment of abdominal trauma has been noted, especially during the last decade. This change in regimen was first seen in the handling of splenic trauma, initiated by pediatric surgeons. Later, the concept of conservative management was also introduced among adults and it is now widely accepted. Here, an almost mandatory splenectomy has been replaced by attempts at various forms of splenic salvage. The development followed an initial report by King and Shumacker in 1952 [1] on an increased susceptibility to overwhelming sepsis in splenectomized children, findings which later also were demonstrated among adults [2, 3]. It has also been shown that the bleeding from intraparenchymal lesions with an intact splenic capsule or minor capsular tears frequently ceases spontaneously, hereby making nonoperative management possible in selective cases [4, 5].
Current management of intrahepatic stones
Authors: Choi T. K. , Wong J. 
Published: May 2005

AbstractA high incidence of intrahepatic stones occurs in East Asia. The surgical management of intrahepatic stones is problematic because it is difficult to locate and remove all the stones and relieve the accompanying biliary strictures. Consequently, the rate of recurrent cholangitis is high. Many new techniques have been introduced to locate, fragment, and retrieve gallstones. Operative procedures to relieve biliary strictures have also undergone development. These new procedures and techniques have been applied to intrahepatic stones. The initial results are good. Whether these good results can be maintained in the long‐term remains to be seen.
Pancreatic abscess and other pus‐harboring collections related to pancreatitis: A review of 108 cases
Authors: Bassi Claudio , Vesentini Sergio , Nifosì Filippo , Girelli Roberto , Falconi Massimo , Elio Amedeo , Pederzoli Paolo 
Published: May 2005

AbstractThis is a report on 108 cases collected from 1970 to 1987, in the same department, of surgically‐detected pancreatic abscesses or pus‐harboring collections. The purulent areas were either of a spreading pattern or represented a clearly localized mass. To the spreading pattern belong 47 cases of necrotizing pancreatitis, without discontinuity in the clinical course from the early toxic to the late septic phase, 4 cases of acute pancreatitis, initially in remission and later complicated by septic collections, and 4 cases which developed after an acute attack of chronic pancreatitis. The abscess pattern was made up of 19 each of pseudocysts and predisposing pancreatitis, 10 cases of chronic pancreatitis, and only 5 necrotizing “nonstop” pancreatitis.The surgical treatment in all cases consisted of multiple drainages and postoperative irrigation. We exclude 3 cases of associated open packing. The etiological, clinical, and biochemical features of each group of patients are reported and discussed. Computed tomography availability seems to be the most important improvement reported as regards diagnosis and surgical tactics. The overall mortality rate was 15.7% with a significant difference between the 2 patterns (23.6% for the spreading pattern versus 7.5% for the abscess pattern). On the basis of this experience, it is possible to establish a relationship between the gross appearance of the collection and the underlying pancreatic disease with differences in terms of prognosis, morbidity, and mortality. Finally, a simple nomenclature can be chosen which is capable of distinguishing between the diverse pancreatic purulent collections. While the presence of pus may characterize the course of severe acute pancreatitis in many cases, the low incidence of “true” pancreatic abscess is emphasized.
Electromyographic activity of the gastrointestinal tract following cholecystectomy
Authors: Coelho Julio C. U. , Pupo Cesar A. , Campos Antonio C. L. , Moss Adyr A. 
Published: May 2005

AbstractElectromyographic activity of the stomach and small bowel, both in the fasting and fed states, was evaluated in the postoperative period of 8 patients subjected to cholecystectomy. The migrating motor complex (MMC) was recorded on the first postoperative day in 5 patients, on the second day in 2, and on the third day in 1. Vomiting occurred in 1 patient in whom the MMC was recorded only on the third postoperative day. Feeding caused substitution of the MMC by the fed pattern in the stomach and small bowel in all patients. It is concluded from this study that gastric and small bowel motility is normal on the first 2 days of the postoperative period in most patients subjected to cholecystectomy.
Hepatic segmentectomy with caudate lobe resection for bile duct carcinoma of the hepatic hilus
Authors: Nimura Yuji , Hayakawa Naokazu , Kamiya Junichi , Kondo Satoshi , Shionoya Shigehiko 
Published: May 2005

AbstractFrom 1979 through 1989, surgical resection was performed in 55 of 66 patients with carcinoma of the hepatic hilus after improving jaundice by percutaneous transhepatic biliary drainage (PTBD). Selective cholangiography through PTBD was done to define precisely the anatomical location—extent of the obstructing lesion in each segmental hepatic duct. Percutaneous transhepatic cholangioscopy was performed through the sinus tract of PTBD after replacing the drainage catheter with a 15 French catheter for superselective cholangiography and biopsy to make the definitive diagnosis of the histological extent of the tumor and any variation of each segmentai hepatic duct that joins the hepatic hilus.In 46 (69.7%) of 66 patients, curative resection was possible. Forty‐five of these underwent various types of hepatic segmentectomy with caudate lobectomy for a morbidity rate of 41.3% and an operative mortality rate of 6.4%. Fourteen (31.1%) advanced cases underwent combined resection of the portal vein together with hepatectomy. Microscopic tumor involvement in the caudate branches was confirmed in 44 of 45 patients who underwent caudate lobe resection. The 3‐year survival rate for all 43 patients surviving the curative excision was 55.1% and the 5‐year survival rate was 40.5%. All 11 patients who had an unresectable advanced tumor died within 9 months.Curative resection should be designed according to the preoperative findings of the extent of cancer in each segmental duct, and caudate lobe resection should be performed together with the smallest necessary hepatic segmentectomy possible.
Duodenal atresia and stenosis: Reassessment of treatment and outcome based on antenatal diagnosis, pathologic variance, and long‐term follow‐up
Authors: Grosfeld Jay L. , Rescorla Frederick J. 
Published: May 2005

AbstractDuodenal atresia and stenosis was observed in 103 infants and children from 1972 to 1991. There were 59 girls and 44 boys. Atresia was noted in 79 instances and stenosis in 24. Maternal hydramnios was detected in 33 cases, 46 babies were premature, and 31 had Down's syndrome. Fifty‐four infants had significant associated anomalies including 35 with cardiac defects. Diagnosis was achieved by prenatal ultrasound examination in 14 cases, observation of a double‐bubble sign on abdominal radiograph in 73, and contrast studies in 30 infants including 24 with stenosis. At operation annular pancreas was noted in 37 cases, malrotation in 37 cases, anterior portal vein in 4, and a second web in 3. Surgical treatment included duodenoduodenostomy in 85, duodenotomy and web excision in 8, and duodenojejunostomy in 10. Operative survival was 95%. Deaths were related to complex cardiac defects. Despite antenatal diagnosis, prompt intervention, and apparent early surgical success (95% survival), late deaths (5%) and late complications including motility disorders, megaduodenum, gastroesophageal reflux, duodenal‐gastric reflux, gastritis, peptic ulcer disease, blind loop syndrome, and biliary‐pancreatic conditions may be observed months to years after management during the neonatal period. Modifications in surgical technique including early tapering duodenoplasty may be useful, and close long‐term follow‐up is an essential component of patient care.
Contemporary management of meconium ileus
Authors: Rescorla Frederick J. , Grosfeld Jay L. 
Published: May 2005

AbstractMeconium ileus was noted as an early manifestation of cystic fibrosis in 60 neonates between 1972 and 1991. There were 20 girls and 40 boys. A family history of cystic fibrosis was present in six children. Twenty‐five neonates had uncomplicated meconium ileus due to inspissated meconium within the terminal ileum. Thirty‐five neonates presented with 56 complications of meconium ileus, including volvulus (n=22), atresia (n=20), perforation (n=6), and giant cystic meconium peritonitis (n=8). Clinical presentation included abdominal distension, bilious vomiting, and failure to pass meconium. In two recent cases, prenatal ultrasonography detected a mass with proximal bowel distension indicative of cystic meconium peritonitis. Mechanical bowel obstruction in the other neonates was diagnosed from plain abdominal radiographs and barium enema. Ten patients with uncomplicated meconium ileus were successfully treated with a diatrizoate meglumine (Gastrografin) enema. The remaining 15 patients required a laparotomy, with 9 treated by bowel resection and enterostomy and 6 recent cases managed with enterotomy and irrigation. Complicated cases were managed by bowel resection and anastomosis (n =15) or enterostomy (n=20). Survival at 1 year was 92% in patients with uncomplicated meconium ileus and 89% for those with complicated meconium ileus. The therapy of choice for uncomplicated meconium ileus is nonoperative Gastrografin enema, with enterotomy and irrigation reserved for enema failures. Complicated cases require exploration and, in the absence of giant cystic meconium peritonitis, are usually amenable to bowel resection and primary anastomosis.
Current concept of the treatment of biliary atresia
Authors: Miyano Takeshi , Fujimoto Takao , Ohya Toshiki , Shimomura Hiroshi 
Published: May 2005

AbstractHepatic portoenterostomy (Kasai operation) for the patient with biliary atresia (BA) can restore the bile flow in approximately 80% of children operated on before 60 days of life [1]. However, in terms of long‐term survival, according to a recent nationwide survey among the major pediatric centers in Japan, only 325 of 2013 patients had more than 10 years' survival, and only 157 patients (7.8%) remained jaundice‐free with normal liver function [2]. About 20% of BA cases without jaundice are generally able to survive for long periods; and most of those patients have portal hypertension or abnormal liver function [3–5].As the results of liver transplantation have improved, controversy has arisen over the optimal care of these children [4, 6, 7]. Some investigators have claimed that transplantation is the favored primary therapy for most patients with BA [8]. We are thus at a turning point concerning the primary therapy of BA, which makes it necessary to determine the exact indications for the Kasai portoenterostomy and the timing of liver transplantation. This paper describes our strategy for the optimal treatment of BA patients based on our 117 patients who have had various form of portoenterostomy.
Contemporary management of congenital diaphragmatic hernia
Authors: Butler Marilyn W. , Stolar Charles J. H. , Altman R. Peter 
Published: May 2005

AbstractDespite advances in infant transport and intensive care, congenital diaphragmatic hernia (CDH) still poses a serious threat to life during the neonatal period. Only with the introduction of extracorporeal membrane oxygenation (ECMO) has mortality declined significantly. Understanding the pathophysiology of CDH and its devastating effect on the lungs' bronchial and vascular development assists the clinician in rational management during the perioperative period. Successful treatment demands prompt diagnosis, informed preoperative assessment and preparation, carefully timed surgical repair, and aggressive postoperative intensive care with a thorough understanding of the role of ECMO. Improvements in ventilatory support and pharmacologic management of pulmonary hypertension have allowed surgeons to delay repair until circulatory hemodynamics, electrolytes, and oxygenation can be optimized, even resorting to preoperative ECMO in selected cases if needed. Patients with severe bilateral pulmonary hypoplasia pose serious dilemmas in terms of selection for ECMO, as well as for surgical repair. Long‐term follow‐up of patients after CDH repair reveals persistent hypoperfusion of the involved lung but no debilitating pulmonary disease. Future therapies may include early fetal intervention or lung transplantation, although these areas remain controversial and experimental, and clinical experience is limited.
New trends in the management of congenital heart disease
Authors: Heimansohn David A. , Turrentine Mark W. , Kesler Kenneth A. , King Harold , Brown John W. 
Published: May 2005

AbstractConsiderable improvements have been made in the diagnosis and treatment of congenital heart disease during the last decade. Many congenital heart lesions are now treated successfully during the neonatal period that previously were associated with high mortality. Improved echocardiographic imaging, catheterization techniques, and earlier surgical repair are factors that have resulted in greater success in the treatment of congenital cardiac disease. Diagnosis has been improved greatly with advancements in echocardiography and angiography. Better ultrasound technology combined with doppler techniques and transesophageal echocardiography allow more accurate preoperative assessment and therefore more successful surgical repair. Cardiac catheterization techniques have also improved and, when combined with treatment such as balloon angioplasty, have changed the treatment of certain cardiac anomalies such as pulmonary stenosis or coarctation of the aorta. Operative treatment of congenital heart disease has improved the short‐ and long‐term survival of most infants with congenital cardiac anomalies. Improved cardiopulmonary bypass techniques, better suture material, and the ability to perform cardiac transplantation are examples of technology that allows earlier, more complete repair of these complex cardiac defects. Reviewed here are improvements in the treatment of four complex cardiac anomalies that occur in newborns and are associated with high mortality when left untreated. All four anomalies have undergone significant changes in the approach to their treatment with dramatic improvements in survival.
Effect of peritoneal fluid pH on outcome of aminoglycoside treatment of intraabdominal infections
Authors: Simmen Hans‐Peter , Battaglia Hugo , Kossmann Thomas , Blaser Jürg 
Published: May 2005

AbstractNetilmicin and clindamycin were administered to 47 patients with an intraabdominal infection who underwent emergency laparotomy. Thirty‐one patients were cured, seven were improved, and therapy failed in nine patients despite the fact that all aerobic bacteria isolated from these patients were sensitive to netilmicin as determined by standard in vitro susceptibility tests. The pH of peritoneal and drainage fluid collected intraoperatively and during follow‐up correlated with clinical outcome. Acidic pH was found in 21 of 33 (64%) specimens sampled from patients with therapeutic failure compared to 17 of 80 (21%) obtained from the categories “cured” and “improved” (p<0.001).Netilmicin concentrations in serum or peritoneal/drainage fluid did not correlate with clinical outcome. Netilmicin levels were above the minimal inhibitory concentration of the pathogens in 59 of 64 (92%) drainage fluid specimens in which aerobic bacteria were isolated. Aerobic bacteria were isolated in 91% of drainage fluid specimens if the pH was less than 7.0, compared to 37% if pH was more than 7.0 (p<0.001). Reduction of pH antagonized aminoglycoside activity in vitro against clinical isolates ofEscherichia coli.Surgical reexploration should be considered in cases of deterioration following a laparotomy associated with detection of acidic drainage fluid.
Follow‐up of anal dynamic graciloplasty for fecal continence
Authors: Konsten Joop , Baeten Cor G. , Spaans Frank , Havenith Miek G. , Soeters Peter B. 
Published: May 2005

AbstractThe feasibility of anal dynamic graciloplasty (transposition of the gracilis muscle and subsequent implantation of a stimulation device) to restore continence, was assessed in a case‐control study of 26 patients with severe fecal incontinence. It was shown that anal dynamic graciloplasty is capable of achieving the sphincter tone of healthy persons, as stimulated graciloplasty increased anal pressure from 46 mmHg without stimulation to 65 mmHg with stimulation (mean increase 19 mmHg; 95% confidence interval 13, 25;n=25;p<0.01). Time to retain a 250‐ml phosphate enema increased from 52 seconds before to 204 seconds after 8 weeks of electrical stimulation (mean increase 151 seconds; 95% confidence interval 61, 241;n=25;p<0.01). Complete fecal continence was achieved in 17 patients (65%); two of these patients developed a wound infection, but one of the two realized continence without stimulation and the other patient became continent after reimplantation. Three other patients improved after anal dynamic graciloplasty, but infection necessitated removal of the stimulation device. One patient developed a fistula. Failures were encountered in five patients. Although our long‐term follow‐up results suggest a learning curve, it is concluded that electrical stimulation improves the results of conventional graciloplasty and avoids construction of a colostomy.
Comparison of factors influencing the prognosis of Japanese, German, and Dutch gastric cancer patients
Authors: Bonenkamp J. J. , van de Velde C. J. H. , Kampschöer G. H. M. , Hermans J. , Hermanek P. , Bemelmans M. , Gouma D. J. , Sasako M. , Maruyama K. 
Published: May 2005

AbstractAs a result of Japanese reports of improved survival of gastric cancer patients after extended lymph node dissection, a study was undertaken to evaluate factors that might influence these results. The influence of staging was evaluated by stratifying 1085 patients of the National Cancer Center of Japan and grouping them according to the three commonly used systems; UICC's old and new TNM systems (fourth edition) and the system of the Japanese Research Society for the study of Gastric Cancer (JRSGC). No survival difference was found between the stages of the three systems, except for stage II, where the new TNM and the JRSGC differed(p<0.05). In a second analysis, the incidence of the most important prognostic factors for advanced gastric cancer was compared among three institutions: the National Cancer Center Tokyo, Japan (NCC), the University Hospital Erlangen, Germany (UHE) and the University Hospital Maastricht in The Netherlands (UHM). Japanese patients were on average 3 years younger than the German patients and 8 years younger than the Dutch patients, and had a higher proportion of advanced (T4) carcinomas. Male‐female distribution, histology, and lymph node invasion were comparable in the three groups. From these data a rather worse prognosis for Japanese advanced gastric cancer patients could be expected. However, the observed 5‐year survival rates show a marked advantage for the Japanese patients: 57% (NCC) versus 34% (UHE) and 31% (UHM). The survival difference for stage II patients between the new TNM and the JRSGC staging systems is not sufficient to explain this advantage. This result underlines the importance of the Japanese therapeutic approach. Whether this approach (i.e., extended lymph node dissection) actually improves survival or merely improves classification, is currently the subject of a prospective randomized trial in The Netherlands.