bluuebunny/crossref_metadata_2025_split huggingface dataset:
Preoperative preparation of the colon
Authors: Lagache G. 
Published: May 2005

AbstractIn a series of 122 patients prepared for colorectal operations, we have compared the efficacy of 4 methods:
Conventional mechanical preparation included a low‐residue diet, paraffin and castor oil, and repeated enemas for 2 days before operation. It was administered to 48 patients, whose gut was judged at operation to be very clean in 29 (60%), fairly clean in 10, and dirty in 9. Despite additional antibiotic prophylaxis, there were complications in 14 (29%) and fistulas in 4.
Whole gut irrigation was administered via a nasogastric tube to 15 patients. Eight to 16 liters of normal saline were perfused in 3 to 5 hours on the day before operation. This resulted in the patients' having fluid retention due to absorption. It resulted in a very clean gut at operation in 13 (87%) and in a dirty gut in 2. Complications occurred in only 1 patient, who also developed a fistula.
Mannitol 5% solution in volumes of 4–5 liters was given by nasogastric tube, in a manner similar to that of the saline in the previous method, to 21 patients. Similar problems of fluid retention were observed and a very clean bowel was produced in only 14 (67%), with a fairly clean bowel in 5, and dirty in 2. Complications occurred in only 2 patients (9%), one of whom developed a fistula.
Mannitol 10% solution, 2–2.5 liters, was given by mouth over a period of 2 to 3 hours to 38 patients on the day before operation. It was well tolerated and produced a very clean bowel in 30 (79%), a fairly clean bowel in 6, and a dirty bowel in only 2. Complications were seen in only 3 patients (8%), one of whom developed a fistula. There was no significant difference in the complication rate whether or not prophylactic antibiotics were given.
The oral or intra‐luminal use of anti‐helminthic drug in bowel anastomosis operations
Authors: Kuczynski L. B. 
Published: May 2005

AbstractThe ascariasis is a cosmopolitan helminthiasis occurring mostly in countries with poor sanitation. It can occur, more rarely, in developed countries due to immigration of the hosts.Patients can be hosts of ascariasis with a negative faeces examination.Having had one death due to endotoxic shock, peritonitis and dehiscence of an oesophago‐jejunal anastomosis due toH. lumbricoides in a patient with a negative pre‐operative faeces examination we began to take prophylactic care for the elective and emergency intestinal anastomoses.We had 15 patients with negative faeces examination submitted to an elective digestive anastomosis who were first given 150 mg of levamisole: six (40%) eliminatedAscaris lumbricoides.We had 19 patients having emergency operations who had one 150 mg levamisole tablet inserted into the lumen of the gut before completion of the intestinal anastomosis: 15 (78.94%) eliminated A. lumbricoides.
Results of pelvic exenteration
Authors: Mori Takeo , Tominaga Takeshi , Itoh Ichiji 
Published: May 2005

AbstractTotal pelvic exenteration is the most radical and most dangerous operation for advanced malignant tumor widely invading the pelvic cavity. As the result of refinement of the surgical technique, we believe that this operation can now be performed safely. In the last 5 years, we have enlarged the indications for this method to include not only curative excision but also palliation.
Comparison of ileostomists' sexual life before and after conversion to continent ileostomy
Authors: Myrvold H. E. , Nilsson L. O. , Palselius Inger , Kock N. G. 
Published: May 2005

AbstractTo compare ileostomists' sexual life before and after conversion from a conventional spout to a continent pouch ileostomy, questionnaires were sent to 48 ileostomists with experience with both types of ileostomy. Forty‐two patients (88%) returned their questionnaires; 29 were women. In answer to the question about the effect of their ileostomy on their sexual performance, 98% replied that they had sometimes felt embarrassed, uncertain, or inhibited because of the conventional ileostomy, whereas only 24% felt so after conversion to a continent ileostomy. Eighty‐five percent felt that the conventional ileostomy negatively influenced their body image, whereas only 5% considered this to be the case after conversion to continent ileostomy. Eighty‐five percent of the patients claimed that the quality of their sexual life had improved after conversion to continent ileostomy. The results suggest that a conventional ileostomy influences sexual life more than is generally recognized, and that conversion to continent ileostomy can improve the quality of sexual life in such patients.
Iatrogenic strictures of the bile ducts: Our experience with 66 cases
Authors: Castrini Guido , Pappalardo Giuseppe 
Published: May 2005

AbstractThe authors report their experience with 66 patients operated on for iatrogenic strictures of the bile ducts. Among the factors that are considered to predispose to or to cause iatrogenic strictures, all of which have been accurately analyzed, urgent operations for acute cholecystitis have particular importance. The percutaneous transhepatic and duodenoscopic retrograde cholangiographies represent a complementary means for a precise diagnosis of the stricture. Treatment consists of a Roux‐en‐Y hepaticojejunostomy, but in recent years, a biliary‐duodenal interposition utilizing a defunctionalized jejunal limb was preferred. Postoperative morbidity was 22.7%, mortality 3%. Consideration is given to the technique of anastomosis and to the use of transanastomotic drainage. Finally, the results of follow‐up with particular reference to the treatment of strictures of the hepaticojejunostomy, with an incidence of 15.4% in this series of patients, have been analyzed.
A clinical study on an appropriate treatment of acute pancreatitis
Authors: Kinami Y. , Konishi K. , Miyazaki I. 
Published: May 2005

AbstractOne hundred thirty‐nine patients with acute pancreatitis were treated in our clinic during the past 14 years. Seventy‐seven patients had a surgical procedure and 62 patients were managed conservatively. Although 44 patients with edematous pancreatitis were treated with various surgical procedures, 11 patients with the hemorrhagic type had a sump drainage alone. Of the 16 patients with necrotizing pancreatitis, only 2 had a pancreatic resection. The overall operative mortality rate was 18%.Eighty‐five percent of the patients received antienzymatic drugs: Trasylol® (10–820 × 104), FOY (200–8,600 mg), and others. Dosage of these drugs was determined according to the severity of disease. Of 12 patients who were given 5‐FU, one had mild, 8 had moderate, and 3 had severe acute pancreatitis. Two hundred fifty to 500 mg of 5‐FU was administered daily for 2 to 24 days. Some other antienzymatic drugs were also given in 9 patients, in addition to 5‐FU. Ten patients revealed a beneficial effect from this treatment. Overall, 78% of patients showed a favorable course, 7% developed relapsing acute pancreatitis, and 4% had chronic pancreatitis after discharge from hospital. The mortality rate was 11%. The patients with hemorrhagic or necrotizing type had a higher mortality rate (27–37%) and less therapeutic effect than patients with an edematous type.These results indicate that early appropriate treatment is important to obtain a favorable therapeutic result.
Surgical therapy of hyperinsulinism
Authors: Hirner A. , Haring R. , Karavias T. , Stallkamp B. 
Published: May 2005

AbstractOrganic hyperinsulinism is rare: the incidence is 1:100,000. In newborns, often of diabetic mothers, there may be islet cell hyperplasia. Rare cases may require partial pancreatectomy. In adults, the condition is always due to an insulinoma.
Pathological anatomy and pathogenesis of acute pancreatitis
Authors: Becker Volker 
Published: May 2005

AbstractAcute pancreatitis involves autodigestion of the pancreas by its own secretions. The anatomical signal is tryptic necrosis. The so‐called edematous pancreatitis cannot be compared with acute tryptic pancreatitis as it is caused by swelling of the pancreas, with pancreatic juice in the parenchyma, but no necrosis occurs. The severity of acute pancreatitis is determined by the state of preservation of the pancreatic capsule. Three stages may exist: (a) the gland is enlarged with solitary areas of necrosis and the capsule is preserved; (b) confluent necrosis with necrosis of the lipid tissue occurs, but the capsule is preserved; and (c) necrosis extends into surrounding areas, especially into the omental bursa and the retroperitoneum, and the capsule is destroyed. Peritonitis, ileus, and pleural effusion may represent regional extension of acute pancreatitis. Shock is the most dangerous complication and is the most frequent cause of death.
Pancreatic necrosis and acute pancreatitis
Authors: Leger L. , Chiche B. , Louvel A. 
Published: May 2005

AbstractThe surgeon should take pains to section and study himself the operative specimen after excision for acute pancreatitis, in order to understand the true nature of the lesions, which the most attentive and competent pathological examination cannot describe as vividly as direct examination by the operator. Often he will be surprised to find that the lesions, predominant in the capsule, are less profound and less severe than he had thought at first sight. The necrosis, which is sometimes limited to the peripheral and interstitial tissue, sparing the gland itself (its prognosis is less serious and has led many surgeons to perform surgical excision). However the problems encountered postoperatively have given rise to doubts a posteriori as to whether this is legitimate. Reference is made to the decapsulation of the pancreas described by Romanian authors, and a method for future operative diagnosis of glandular necrosis is proposed.
Intensive medical treatment of severe acute pancreatitis
Authors: Creutzfeldt Werner , Lankisch Paul G. 
Published: May 2005

AbstractTherapeutic measurements for acute pancreatitis depend on the severity of the disease and its complications. Since complications of acute pancreatitis may develop at any time, patients should be admitted to an intensive care unit for assessment (and frequent reassessment) of the severity of the disease and of the development of complications; they should remain in the intensive care unit for the first 48 hours at least, even if no signs of shock are apparent. The only exceptions to this rule are mild cases without signs of peritonitis. Basic therapy should include relief of pain, total fasting, nasogastric suction, parenteral replacement of fluids, electrolyte, albumin, and blood, and antibiotics. Hyperglycemia should be corrected and heparin should be given in cases of disseminated intravascular coagulation. In renal insufficiency, peritoneal dialysis is important, and in respiratory complications, humidified oxygen or artificial ventilation including positive end expiratory pressure therapy should be applied. Although the effect of peritoneal dialysis has been proven only in animal experiments and in retrospective studies in man, it is recommended in severe cases for shock therapy and for correction of electrolyte imbalance when ascites is present, even before anuria occurs.
Conservative surgical treatment of acute pancreatitis
Authors: Ranson John H. C. 
Published: May 2005

AbstractThe influence of early management on morbidity in 133 patients with severe acute pancreatitis has been reviewed. Patients with severe pancreatitis (33% mortality rate) were separated from those with mild pancreatitis (0.9% mortality rate) by early objective prognostic signs. Early management (days 0–7) included intra‐abdominal operation in 31 patients and there were 20 deaths (65%). No early intraabdominal surgery was undertaken in 102 patients and there were 18 deaths (18%). Early intra‐abdominal surgery was limited to placement of catheters for peritoneal lavage in 10 patients, and nonoperative management included peritoneal lavage by catheters placed percutaneously in 23 patients. In these 33 patients, there was 1 early death (days 0–10). In contrast, 43% of deaths in nonlavaged patients occurred during this period primarily from cardiovascular or respiratory causes. Overall mortality was slightly reduced in some groups of lavaged patients but the improvement was disappointing.Early intra‐abdominal surgery may be required for diagnosis but it is associated with an increased mortality rate. Peritoneal lavage is an effective adjunct to the management of early complications of severe pancreatitis, but does not prevent the late sequelae of peripancreatic necrosis.
Role of total pancreatectomy in the treatment of necrotizing pancreatitis
Authors: Alexandre Jean ‐Henri , Guerrieri M. T. 
Published: May 2005

AbstractThe place of pancreatic resection in the treatment of acute pancreatitis is still much debated. Because of the bad results after insufficient resection, such as recurrence of extensive pancreatitis and infection, we decided to perform gastroduodenopancreatectomy (GDP) if more than 75% of the gland was necrotic.We have performed 52 operations for acute necrotizing pancreatitis since 1972 in the Surgical Clinic of Broussais Hospital; of 20 GDP patients, 8 are still alive. All have easily controlled diabetes,S were able to resume work, and 3 retired. After study of the deaths of the other patients, we conclude that it is important to carry out operative excision early, resecting all areas of necrosis before the lesions become the focus of uncontrollable infection. Four categories of patients are described on the basis of creatinine level, blood culture, appearance of the pancreas, and spread of necrosis. According to the gravity of the lesions treated with this method (necrosis of more than 75% of the pancreas), the death rate is usually 90% or higher. We believe that GDP offers the possibility of improvement.
Experimental basis and first application of clinical lymph vessel transplantation of secondary lymphedema
Authors: Baumeister Rüdiger G. H. , Scifert Jürgen , Wiebecke Baldur , Hahn Dietbert 
Published: May 2005

AbstractLymphedemas due to a blockage of the lymph vessels in the root of the extremities were treated experimentally and clinically by autotransplantation of lymph vessels under the operating microscope. In experimental lymphedema of the hind leg of 10 dogs, an increased circumference of about 50% was reduced to 10% within 7 weeks by lymph vessel transplantation. After removal of the transplants, the circumferences returned to pre‐transplantation values. The pre‐transplantation elevated intralymphatic pressure of 12.5 torr (controls: 2.5 torr) was reduced to the normal range of 3.5 torr after the transplantation. In 8 of 10 dogs, the patency of the transplants could be demonstrated by inspection, lymphography, and isotope injections. In all 10 dogs, patency could be proved by histologic examination. The data indicate that lymph vessel transplantation can restore the diminished lymph‐transporting capacity brought on by lymphedema.In 2 patients, it was possible to prepare lymph collectors about 25 cm long. After the transplantation, the circumferences diminished. By isotopes improved lymphatic transport could be demonstrated after the operation. Autologous transplantation of lymph vessels is a promising method for the treatment of secondary lymphedema especially in the early stages.
Significance of hemorrheology in the management of the ischemic limb
Authors: Dormandy John A. 
Published: May 2005

AbstractClinicians have become interested in hemorrheologically oriented treatment of limb ischemia because of the increasing evidence that (a) hemorrheological abnormalities play an important role in the pathophysiology of circulatory diseases, and (b) such treatment may also be useful in the management of ischemia due to other causes. Possible hemorrheological approaches to management of limb ischemia can be classified according to the primary hemorrheological determinant being treated: the red cell concentration, plasma proteins, or the flow properties of individual red cells. Hemodilution, difibrinogenation with an oral agent, and the use of drugs to improve red cell deformability represent possible therapeutic approaches. The feasibility, advantages, and shortcomings of each of these treatment modalities are explored.
The choice of operation in aortoiliac reconstructions for intermittent claudication
Authors: King R. Barry , Myers Kenneth A. , Scott David F. , Devine Terence J. 
Published: May 2005

AbstractThis report describes the results of 290 aortoiliac reconstructions performed for intermittent claudication and particularly analyzes the results for different techniques of operation and their indications. The accumulative patency rate for all operations was 79% at 5 years in surviving patients. The patency rate was significantly better in patients who stopped smoking after the operation. Dacron® grafts had a significantly higher patency rate than endarterectomy in men. Dacron® grafts and endarterectomy had equal patency rates in patients who had patent superficial femoral arteries, but Dacron® grafts had a significantly higher patency rate than endarterectomy if the superficial femoral arteries were occluded or severely stenosed. If the success rate for relieving intermittent claudication is considered rather than the patency rate, then Dacron® grafts gave even better results than endarterectomy in patients with severe superficial femoral artery disease. Limited unilateral extraperitoneal operations gave satisfactory long‐term results in selected patients, as did extra‐anatomical operations in patients in whom conventional reconstructions seemed inappropriate.
Objective analysis of factors contributing to failure of tibial bypass grafts
Authors: Ricco Jean‐Baptiste , Flinn William R. , McDaniel Martha D. , Yao James S. T. , Bergan John J. 
Published: May 2005

AbstractA retrospective study of 204 femoro‐tibial bypass procedures performed from 1979 through 1982 is reported. The effect of various parameters—patient age, graft material, type of bypass, bypass outflow, presence or absence of pedal arterial arches, and degree of preoperative ischemia as judged by the ankle—brachial index‐on tibial bypass patency was examined. The only obvious factor in graft failure was the type of graft material utilized, with autogenous saphenous vein grafts faring much better than the polytetrafluoroethylene (PTFE) grafts.
Prostaglandin therapy in severe limb ischemia
Authors: Pardy Bruce J. , Eastcott H. H. G. 
Published: May 2005

AbstractThe use of prostaglandin E, and prostacyclin in the treatment of severe limb ischemia is evaluated and the literature reviewed. Conclusions are the following: PGE1 is easier to administer than PGI2. PGE1 does not require buffering to an alkaline pH, is more stable, has a less critical dose rate, and has less serious and more easily managed side effects. PGE1 8–10 ng/kg per min intravenously for 72 h increases terminal phalangeal blood flow in severe Raynaud's phenomenon. Healing will occur after antibiotic therapy, PGE1 intravenously for 72 h, and surgical debridement during general anesthesia of all necrotic and septic tissue from the fingers of patients with severe Raynaud's phenomenon. When nail‐related sepsis and necrosis is recurrent, removal of the nail and nail bed has prevented recurrence of terminal phalangeal sepsis and ulceration. Patients with severe Raynaud's phenomenon who have not suffered finger amputation, and who have no history of finger necrosis or severe sepsis, are unlikely to be helped by PGE1. Upper limb sympathectomy provides short‐term enhancement of digital blood flow which may tide a patient over an acute episode of severe ulceration, sepsis, or necrosis, but the duration of benefit is short. Conversely, lumbar sympathectomy may provide prolonged symptomatic relief. The thromboxane synthetase inhibitor dazoxiben is currently being investigated in Raynaud's phenomenon. In Buerger's disease, foot pain is usually relieved by intravenous PGE1, provided the popliteal pulse is palpable and closed sepsis is not present. Toenail removal in Buerger's disease after intravenous PGE1 may not result in rapid healing. The more favorable response of Buerger's disease compared with arteriosclerosis may be related to the nature of the disease or to the more distal site of arterial occlusion in Buerger's disease. Prostaglandin therapy may not be effective in diabetic patients with lower limb ischemia. Long‐term (weeks or months) intra‐arterial infusion of PGE1 may promote healing after minor amputation in critical atherosclerotic lower limb ischemia in the nondiabetic patient, and prevent the need for major amputation. While prostaglandin therapy is associated with many side effects, complications are almost nonexistent. Clinical trials are very difficult to design. When reporting results, distinction should be made between diabetic and nondiabetic patients with arteriosclerosis, between those with and those without a palpable popliteal pulse, and between those who do and those who do not have extremity closed sepsis.
Surgical aspects of thyroid autonomy in multinodular goiter
Authors: GemsenjÄger E. , Heitz P. U. , Staub J. J. , Girard J. , Barthe P. , Benz U. F. 
Published: May 2005

AbstractIn a prospective study of 217 consecutive patients with multinodular goiter selected for surgical treatment, 43% had significant autonomous thyroid hormone secretion as evidenced by TRH unresponsiveness [TSH<1.0 ΜU/ml after intravenous (200 Μg) or oral (40 mg) TRH], with normal values of the FT4‐Index and FT3‐Index (preclinical hyperthyroidism) in 74%, and with hyperthyroidism in 26% of these cases. The amount of autonomous thyroid hormone secretion increased with the mean goiter weight and age of patients. Nodular goiter growth is considered a further manifestation of escape from normal TSH dependence, namely, with respect to follicular epithelium cell replication. Goiter recurrence may, therefore, not only be TSH dependent, but it may also evolve from autonomously growing goiter tissue left behind. This implies a selective nodular goiter resection instead of the uniform subtotal resection leaving remnants at the hilus. Prospective results of this operative tactic and technique are presented: (a) operative morbidity was low; (b) in TRH‐unresponsive patients, the postablative autonomous thyroid hormone secretion was usually low. The thyrotropic and TSH‐mediated thyroid function recovered within 2–4 months; (c) no hypothyroidism occurred, but slightly elevated TSH secretion resulted in 40% of the patients; and (d) follow‐up of 76 selected patients during a mean of 3.5 years revealed the occurrence of TSH‐dependent and of autonomous recurrences, developing in nonresected lobes. Selective goiter resection is advocated on the basis of newer pathophysiological concepts in benign multinodular goiter and on the basis of refinement of the thyroid surgical technique.
Elevated plasma levels of noradrenaline in duodenal ulcer
Authors: JÄrhult J. , Angerås U. , Farnebo L. ‐O. , Graffner H. , Hamberger B. 
Published: May 2005

AbstractThe changes in plasma catecholamine and gastrin concentrations and gastric acid secretion in response to modified sham feeding were investigated in 7 duodenal ulcer (DU) patients before and 6 weeks after highly selective vagotomy (HSV). Both basal and peak acid secretion in response to modified sham feeding were significantly reduced by HSV. Basal plasma noradrenaline concentrations were elevated in DU patients but fell to normal values after HSV. Plasma adrenaline concentrations were within the normal range and did not change after HSV. Basal gastrin concentrations were significantly higher after HSV than before. Modified sham feeding caused no significant changes in plasma catecholamine and gastrin concentrations either pre‐ or postoperatively. It is concluded that noradrenaline is involved in, or reflects, DU disease.