bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intestinal function after total gastrectomy and possible consequences of gastric replacement
Authors: Olbe Lars , Lundell Lars 
Published: May 2005

AbstractAbout half of the patients subjected to total gastrectomy experience weight loss. Malabsorption, particularly fat malabsorption, is a common feature after total gastrectomy. This may be due to shortened intestinal transit time and small bowel bacterial overgrowth, but is less often due to diarrhea or pancreatic exocrine insufficiency. Malabsorption is not closely related to weight loss, which is mainly caused by recurrent malignant diseases and a low postoperative calorie intake. The low calorie intake persists in half of the patients despite supervision of the patients by clinical nutritionists at the outpatient clinic. Roux‐en‐Y reconstruction of the esophago‐intestinal canal has minimized the problem of postoperative reflux esophagitis. Severe postprandial symptoms are uncommon although epigastric oppression and fullness is an obligatory feature in the immediate postoperative period but successively vanishes in half of the patients.Gastric replacement by various enteric reservoirs has been used to improve nutrition after total gastrectomy. The effect of gastric replacement is, however, uncertain since no prospective, randomized studies are available. A gastric substitute seems to have only a marginal effect on meal size, daily caloric intake, and weight gain. A reservoir function of gastric substitutes has been documented but the effect on intestinal transit time is unknown. Stagnation of intestinal contents in a gastric replacement is common, but its significance for bacterial overgrowth, malabsorption, and clinical outcome remains to be determined.
The J ileal pouch‐anal anastomosis
Authors: Taylor Barry A. , Dozois Roger R. 
Published: May 2005

AbstractThe experience at the Mayo Clinic, Rochester, Minnesota, U.S.A., with abdominal colectomy, mucosal proctectomy, and ileo‐anal anastomosis is now approaching 600 patients. The procedure is safe and, with careful timing and selection of patients, can be performed with minimal mortality. Postoperative morbidity, however, is still considerable, even in the most experienced hands. Increasing experience with the procedure has been shown to be associated with a continuing decline in the incidence of postoperative complications, and a defunctioning ileostomy is still a necessity in the majority of patients.Long‐term functional results of the procedure are satisfactory and have been shown to improve both with the experience of the operator and with the passage of time after surgery. Patient acceptance remains the ultimate sanction, and it appears that the majority of patients are satisfied with their outcome after ileo‐anal anastomosis, with only very few being prepared to consider an alternative. The operation appears to provide a superior quality of life relative to that expected after proctocolectomy and Brooke ileostomy.Not all patients with chronic ulcerative colitis or adenomatosis coli are potential candidates for this procedure, however. The problems of age, obesity, indeterminate colitis and Crohn's disease, co‐existing colorectal neoplasia, technical difficulties at the time of the operation, and the wishes of the patient all must be taken into consideration when assessing the optimal operation in a particular situation. Proctocolectomy with Brooke ileostomy or continent ileostomy and total abdominal colectomy with ileo‐rectal anastomosis both still have roles in the management of diseases such as chronic ulcerative colitis and adenomatosis coli. For a patient who is young, relatively fit, and well motivated and in whom there is little or no doubt about the diagnosis, ileo‐anal anastomosis must be considered as the possible treatment of choice. Increasing experience with the procedure and improvements in functional results seem to be confirming this position.
The S ileal pouch‐anal anastomosis
Authors: Vasilevsky Carol‐Ann , Rothenberger David A. , Goldberg Stanley M. 
Published: May 2005

AbstractIn order to determine the results with the S ileal pouch‐anal anastomosis, 116 consecutive patients who had undergone total abdominal colectomy with rectal mucosectomy and endorectal ileal pouch‐anal anastomosis were assessed following ileostomy closure. In 11 patients (9.5%) pouch removal and/or conversion to permanent ileostomy was necessary because of Crohn's disease (3), pelvic sepsis (3), pouchitis (2), incontinence (2), or perineal fistula (1). Although no postoperative mortality was experienced, one or more complications was experienced in 87 patients. These consisted mainly of small bowel obstruction in 35%, pouchitis in 22%, anastomotic stricture in 14%, pelvic sepsis in 9.5%, and perianal abscess or fistula in 5%. Laparotomy was required in 29% of patients mostly for resolution of small bowel obstruction. Follow‐up in the remaining 105 patients ranged from 5 to 67 months with a mean of 28 months following ileostomy closure. Stool frequency was 6.6 bowel movements per day and 1.4 bowel movements per night. Eighty‐nine percent evacuated their pouches spontaneously, and 61% did not require the use of medication for bowel movement regulation. Major daytime incontinence occurred in 4%, while 15% reported nocturnal incontinence. Minor incontinence was experienced by 30% and 48% during daytime and nighttime, respectively. Despite a myriad of complications, 96% of patients unhesitatingly stated that they would undergo the procedure again so that they could avoid a permanent stoma. We conclude that restorative proctocolectomy utilizing the ileal S pouch‐anal anastomosis is an acceptable procedure that should be considered as a viable choice in the treatment of chronic ulcerative colitis and familial polyposis requiring surgical intervention.
The use of the cecum for cecocystoplasty
Authors: Ashken Michael Handley 
Published: May 2005

AbstractCystoplasty is a well‐established technique for the enlargement of a contracted bladder due to tuberculosis or interstitial cystitis. It may also be a practical alternative to urinary diversion for some bladder tumors and in carefully selected forms of neuropathic bladder.The choice of bowel segment used for bladder augmentation or substitution will depend largely on the personal preference of the individual surgeon, for no one segment is clearly any better than many others. My own preference is for the ileocecal segment because it gives a flexibility of reconstruction, particularly for replacing diseased ureters as well as the bladder. Apart from its suitable shape, it also has a good blood supply and relative freedom from compromising pathological conditions.The functional results of a supratrigonal cecocystoplasty are better than those of a subtotal or total cystectomy with ureteroileal cecocystoplasty because the lack of bladder sensation in these latter groups results in nocturnal incontinence. By voiding at suitable intervals, diurnal continence is often achieved.If incontinence becomes a serious problem, it may be corrected with either an artificial urethral sphincter or a colposuspension operation with intermittent self‐catheterization for any urinary retention.It is essential to follow these patients carefully, both clinically and radiologically, and with urodynamic studies. This gives the basis for logical pharmacological and endoscopic control of the voiding balance between bladder pressure and outflow resistance.
Continent urinary diversion by means of a cecal reservoir
Authors: Månsson Wiking , Colleen Stig 
Published: May 2005

AbstractAn ileocecal segment was used to construct a continent urinary reservoir in 30 patients beginning in 1977, with technical modifications successively introduced. An intussuscepted ileal nipple valve protruding into the cecal cavity is responsible for continence. In the current model, valve stability is achieved by means of mesenteric exclusion from the valve, a fascia strip sling around the nipple base, fixation of the valve to the inner cecal wall, and anchoring of the nipple base to the anterior rectus sheath. The ureters are implanted into the cecum with antireflux technique. Most of the early complications were of types associated with any mode of urinary diversion. The most common late complication was malfunction of the ileal nipple valve, and 16 patients required revisional procedures. Of 29 patients eligible for assessment, 25 achieved a good functional result, i.e., a dry stoma and easy catheterization. Augmentation of the reservoir was needed in 1 patient. Apart from low serum cobalamin levels in 2 patients, no metabolic or electrolyte disturbances were seen. Clinical signs of urinary tract infection appeared only in patients with obstruction of the upper urinary tract. The renal function was unaltered at long‐term follow‐up despite intermittently high intrareservoir pressure. For selected patients the continent cecal reservoir should be considered as an important alternative to other forms of urinary diversion.
Biological consequences of exposing ileal mucosa to urine
Authors: Philipson Bertil M. , Höckenström Thomas , Åkerlund Staffan 
Published: May 2005

AbstractSegments of ileum are often used as conduits in connection with supravesicle diversion or sometimes for bladder augmentation. This implies that ileal mucosa will be deprived of the normal intestinal contents and instead exposed to urine. Reports on the morphological consequences of exposure to urine have been contradictory. Either normal structure or various degrees of atrophy have been reported. For this reason, an investigation was designed for systematic follow‐up of effects on the ileal mucosa in patients with continent ileal reservoirs for urinary collection (Kock pouch). These investigations showed that there were significant changes in villous height, crypt depth, and number of goblet cells starting early after construction and leading to complete atrophy in certain areas. Electron microscopy and enzyme histochemistry also showed, in the epithelial cells, that there was a reduction in the number of cell organelles and microvillous units, and also decreased metabolic activity. Reductions were also recorded in studies of net transport of both water and electrolytes across the mucosa of the ileal reservoir used for urinary collection.From the clinical point of view, the adaptive changes recorded in the investigations of ileal mucosa exposed to urine are advantageous, since the risk of metabolic disturbances due to reabsorption of urine is diminished.
Volume capacity and pressure characteristics of various types of intestinal reservoirs
Authors: Berglund B. , Kock N. G. 
Published: May 2005

AbstractThe volume capacity and the pressure characteristics of 3 types of intestinal reservoirs, the continent ileostomy, the continent ileal urostomy, and the continent cecostomy, were studied in patients at intervals after surgical construction of the reservoirs. The volume increases of the ileostomy and the urostomy reservoirs were almost identical but were significantly greater than that of the cecal reservoir. The basal pressure was low in all types of reservoirs, although somewhat higher in the cecal reservoir at greater filling volumes. In the ileal reservoirs, motor activity appeared at a filling volume of about 40% of the maximal capacity, whereas in the cecal reservoir motor activity was recorded at all filling levels. The motor activity increased with greater volumes. The amplitude of the highest pressure wave in the cecal reservoir was twice as high as that of the ileal reservoirs. The motor activity of the cecal reservoir, calculated in 2 different ways, was 10–20 times greater than in the ileal reservoirs. Reflux into the afferent loop was demonstrated in the ileostomy reservoir at a filling volume of approximately 30% of the maximal volume capacity.
Carcinoma of the colon: Long‐term survival and prognosis after surgical treatment in a series of 798 patients
Authors: Moreaux Jean , Catala Marc 
Published: May 2005

AbstractFrom 1964 to 1985, a total of 798 patients (405 female, 393 male) were operated on for a single cancer of the colon. Fifty‐eight percent of the patients were between 60 and 80 years of age. Liver and/or peritoneal métastases were present in 16.3% of the 818 cases. Resection was performed in 754 cases (92.2%), and was considered to be curative in 646 (78.9%). Tumors were differentiated in 90.5% of the cases. Regional lymph nodes were involved in 33.3% and serosal penetration was present in 19.5% of the cases.There were 7 postoperative deaths, 3 (0.5%) of them after curative resection. The actuarial curves of survival showed a probability of survival after all operations of 62% at 5 years and 46% at 10 years, and after curative resection of 78% at 5 years and 58% at 10 years. Prognosis has been established from the 513 patients operated on before 1980; follow‐up data were available for all but 4 of them. Tumor site in the right or left colon did not relate significantly to survival. Tumor staging was the main prognostic factor. The 5‐year survival rate was 40% in patients with positive nodes, 74.7% in those with negative nodes (p<0.001), 97.6% in those with invasion limited to mucosa or submucosa, and 41.9% in those with serosal invasion (p<0.001). Based on Dukes' classification, the 5‐year survival rates for A, B, C., and D tumors were 91%, 76.7% (p=0.01), 53.1% (p<0.001), and 4.7% (p<0.001), respectively. Time elapsed between first symptom and operation did not relate significantly to survival. Prognosis was better in patients less than 50 years old when compared with patients 50–70 years of age (p<0.01), and was better in female patients than in male patients (p =0.02).
The turnover of brain monoamines after total hepatectomy in rats infused with branched chain amino acids
Authors: Bugge Mogens , Bengtsson Finn , Nobin Anders , Jeppsson Bengt , Herlin Per 
Published: May 2005

AbstractThe metabolism of monoamines in the brain of rats in fulminant hepatic failure was studied after administration of branched chain amino acids (BCAA). Male Sprague‐Dawley rats were exposed to a total hepatectomy or a sham operation and infused intravenously for 5 hours with a 10% glucose solution alone or 10% glucose + 0.24 mol/l BCAA (0.08 mol/l of each valine, leucine, and isoleucine). Thirty minutes before decapitation, a decarboxylase inhibitor (NSD 1015®), blocking the conversion of 5‐hydroxytryphtophan (5‐HTP) to 5‐hydroxytryptamine (5‐HT), and dihydroxyphenylalanine (DOPA) to dopamine (DA), was injected intraperitoneally. The concentrations of 5‐HTP, 5‐HT, and 5‐hydroxyindoleacetic acid (5‐HIAA) were analyzed by high‐performance liquid chromatography, DOPA, DA, and norepinephrine (NE) by a radio‐enzymatic method in 8 different regions of the brain and spinal cord. The concentrations of 5‐HTP were increased in the brains of hepatectomized rats, indicating an increased synthesis rate of the indoleamines. After administration of BCAA to hepatectomized rats, the synthesis rate was decreased to normal or, in some brain regions, even to subnormal values. The brain and spinal cord concentrations of DOPA and DA were unchanged in hepatectomized rats compared to sham‐operated animals, indicating an unchanged turnover of the catecholamines. The levels of NE in the diencephalon and in the spinal cord were decreased after hepatectomy. The level of consciousness was not influenced by the BCAA infusions.It is concluded that BCAA infusion may normalize brain indoleamine synthesis in hepatectomized rats, whereas the catecholamine synthesis and the level of consciousness are unaffected by the BCAA administration.
Basal and dose‐response studies of gastric mucosal blood flow: Comparison of duodenal ulcer patients before and after highly selective vagotomy with normal volunteers
Authors: McIsaac Richard L. , Johnston Belinda J. , Fielding L. P. , Dudley Hugh A. F. 
Published: May 2005

AbstractGastric mucosal blood flow (neutral red clearance, NRC) and acid secretion were measured before and after highly selective vagotomy (HSV). Eleven patients with duodenal ulcer were studied before and 12–21 days after HSV. Eight volunteers were also studied using the histamine‐H2‐receptor antagonists cimetidine and ranitidine. Basal secretion was collected for 40–50 minutes and pentagastrin was given in increasing doses each for 40 minutes. Data were analyzed using Wilcoxon's signed‐ranks test for paired samples and an analysis of covariance. Basal NRC was similar both for patients and for volunteers and was unaffected by HSV. There was a linear correlation between NRC and acid output. The patients with duodenal ulcer had a lower ratio of NRC to acid during pentagastrin stimulation than was found in normal subjects, but the regression line after HSV was comparable to that found for the volunteers. Although stimulated acid output was reduced by HSV, NRC was significantly higher after HSV than before. The 2 histamine‐H2‐receptor antagonists reduced both NRC and acid to a similar extent, and this could not be overcome by increasing the dose of pentagastrin. These results indicate that mucosal blood flow and acid secretion may not be unconditionally linked, although a linear relationship was always found. HSV produces an effect on blood flow that is not linked to the reduction in acid output.
Bronchoplasty for bronchogenic carcinoma
Authors: Ayabe Hiroyoshi , Nakamura Yuzuru , Miura Toshio , Kugimiya Toshiyasu , Koga Yasunori , Tsuji Yasukuni 
Published: May 2005

AbstractThis report details our experience in 34 patients with primary bronchogenic carcinoma who underwent broncho‐plastic lobectomy between 1969 and 1981. Twenty‐four had squamous cell carcinoma, 6 had adenocarcinonia, 2 large‐cell carcinoma, 1 small‐cell carcinoma, and 1 combined type. Twelve patients had no lymph node involvement, while 10 had hilar node metastasis and 12 had mediastinal node metastasis.Sleeve lobectomy was accomplished in 19 patients and wedge lobectomy in the remaining 15. Bronchoplasty was performed for direct tumorous invasion in 26 patients, whereas in 8 patients this procedure was done when metastatic cancer had involved the main bronchus.There were 3 operative deaths (8.8%). One was ascribed to tension pneumothorax, one to postoperative bleeding, and the other to myocardial infarction. One patient developed a bronchopleural fistula and died 44 days after completion pneumonectomy. Another died of massive hemorrhage from a bronchopulmonary artery fistula in the fourth postoperative month. Bronchial stenosis was observed in 4 patients: 3 granulation formation and 1 local recurrence.The 5‐year survival rate was 17%, which was higher than that of pneumonectomy. Early postoperative pulmonary function studies revealed good function of the reconstructed lung.Bronchoplasty for bronchogenic carcinoma is an effective procedure for preserving pulmonary parenchyma and controlling the disease.
Rate of wound sepsis with “selective” short‐term antibiotic prophylaxis in gastric surgery
Authors: Keighley Michael R. B. , Burdon Douglas W. , Gatehouse David 
Published: May 2005

AbstractA policy of selective antibiotic prophylaxis was used in 75 consecutive patients undergoing elective gastric operation. Only patients with preoperative bacterial counts in the gastric aspirate exceeding 106 organisms/ml were given antibiotics, and the choice of agent was determined by preoperative gastric culture. Using this policy, only 8% of patients developed wound sepsis and only 19 patients received an antibiotic. There was a close correlation between the pH of the gastric aspirate and bacterial contamination, which indicates that the measurement of the pH may serve as a basis for prophylactic antibiotic administration and obviate the need for elaborate preoperative bacteriological studies. The results were significantly better than in a previous group of 73 patients who were given no antibiotic cover irrespective of the preoperative gastric microflora.
A modification of the Warren shunt
Authors: Raju Seshadri 
Published: May 2005

AbstractA technical modification of the Warren distal splenorenal shunt is described. A segment of internal jugular vein is utilized to connect the distal splenic vein to the renal vein. This technical modification results in significant reduction in operating time and intraoperative blood loss and is technically easier to perform. These benefits accrue primarily by avoiding extensive mobilization of the splenic vein, a step otherwise necessary in performing the original Warren shunt. The modified shunt was successfully carried out in 10 patients. There was a single in‐hospital death following the procedure. In a follow‐up period ranging from 3 months to 5 years and 6 months, shunt patency was demonstrated to be excellent.
Transaxillary thoracic sympathectomy for primary hyperhidrosis of the upper limbs
Authors: Sternberg Ahud , Brickman Shmuel , Kott Itamar , Reiss Raphael 
Published: May 2005

AbstractAlthough a benign condition, primary hyperhidrosis of the upper limbs (palmar and axillary) may cause considerable psychological, social, and occupational disturbances. Definitive surgical treatment (i.e., upper dorsal sympathectomy) is justified after failure of conservative measures. Of the various surgical approaches to the upper thoracic sympathetic chain, one must select the approach that combines excellent results (cosmetic outcome included) with only minor and infrequent complications and side effects.Our experience with 70 thoracic sympathectomies (initially performed through a wide thoracotomy, currently by the transaxillary approach) followed up for an average of 25 months (range 1–87 months), corresponds with these strict criteria: 94% completely dry hands; 86% total, and an additional 10% partial, subjective satisfaction with the results; minimal and relatively mild side effects and complications.These results compare favorably with reports in the literature regarding thoracic sympathectomies performed through alternative approaches, indicating that the transaxillary approach is at least as good as the other approaches. At the same time, side effects and complications are less frequent and of a milder character with the transaxillary approach. We, therefore, recommend the axillary approach for thoracic sympathectomy in cases of hyperhidrosis of the upper limbs.
A clinical and physiological evaluation of bowel preparation for elective colorectal surgery
Authors: Keighley M. R. B. 
Published: May 2005

AbstractEfficient mechanical bowel preparation is essential for satisfactory double‐contrast barium enema and colonoscopy. Satisfactory mechanical preparation is also important for reducing the risk of anastomotic dehiscence and sepsis in elective colorectal surgery. Traditional mechanical preparation by fasting, purgation, and enemas is timeconsuming, unpleasant for patients and nursing staff, and in our center, results in a perfect preparation in only 23% of patients. Elemental diets are expensive and inefficient when used for only 5 days. Whole bowel irrigation involves the use of a nasogastric tube and provides a rapid preparation with a perfect result in 61% of patients, but is not recommended for patients with stenosing tumors. Furthermore, irrigation with saline causes sodium and water retention which may precipitate heart failure in the elderly unless preceded by furosemide. The use of a balanced electrolyte solution reduces the risk of these side effects. Recently, oral irrigation with mannitol has become popular, but in our experience, results in a perfect preparation in only 41% of patients unless followed by a short saline lavage (85% satisfactory). Mannitol also produces potentially explosive gas mixtures by bacterial fermentation unless oral antimicrobials (neomycin and metronidazole) are used immediately before operation. Therefore, we recommend mannitol, saline lavage, and antibiotics in most cases, but still find a place for traditional preparation over 5 days for patients with tumors associated with severe stenosis of the left colon.