bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sclerotherapy for emergency variceal hemorrhage
Authors: Terblanche John 
Published: May 2005

AbstractThis report emphasizes the importance of emergency endoscopy in the diagnosis of suspected variceal hemorrhage and reviews the role of sclerotherapy at the time of the initial diagnostic endoscopy. With actively bleeding varices, initial control with vasopressin and/or balloon tube tamponade is preferred. Sclerotherapy has been successfully performed by injecting sclerosants intravariceally, paravariceally, or by a combined technique. The best sclerosant to use and the ideal timing of emergency sclerotherapy is as yet unresolved. Successful results have been achieved in Cape Town with intravariceal injections using the rigid endoscope under general anesthesia and recently with a combined technique using a flexible endoscope without an anesthetic. The rare failures of sclerotherapy should be identified early and treated surgically. Injection sclerotherapy is currently the best management for patients who present with proven continued active variceal bleeding. More extensive procedures are unjustified in patients in whom a simple measure such as sclerotherapy is effective in controlling acute variceal bleeding.
Bleeding esophageal varices
Authors: McDermott William V. 
Published: May 2005

AbstractBleeding esophageal varices remain a major problem which has not been solved despite the number of ingenious and imaginative efforts to control and prevent hemorrhage through a variety of surgical, radiologic, pharmacologic, and endoscopic techniques.A surgically constructed portal systemic shunt still remains the most effective method of permanent control, but the high morbidity and mortality rates have led to efforts to explore other types of therapy. Variations of shunt surgery, such as the selective procedure described by Warren, are promising as are types of portal azygous disconnections and transections.There has been a revival of endoscopic sclerosis of varices stimulated by the development of more sophisticated equipment. Radiologic obliteration of the coronary vein and other portal systemic collaterals is under evaluation.In the face of the catastrophic emergency of exsanguinating hemorrhage, balloon tamponade is the most effective means of temporary control prior to definitive therapy in those patients who have not responded to other conservative approaches such as vasopressin or pituitrin. Success is primarily determined by the degree of hepatocellular function, and biochemical evaluations such as amino‐acid tolerance appear to be more predictive than the simpler and widely used Child's classification which has been the yardstick for 3 decades.In short, the multiplicity of recommended methods of therapy indicates the lack of unanimity and thus the absence of a single universally accepted algorithm for management of this difficult and multifactorial clinical problem.
Injection sclerotherapy for the long‐term management of variceal bleeding
Authors: Westaby David , Williams Roger 
Published: May 2005

AbstractInjection sclerotherapy for the long‐term management of variceal bleeding is discussed with particular reference to our experience at King's College Hospital. The important questions of which techniques to use, which sclerosing agent to inject, the timing of the first and subsequent treatments, and the periods between follow‐up endoscopic examinations are reviewed. The efficacy of sclerotherapy both with respect to rebleeding and survival are assessed on the basis of 2 completed controlled trials and a third study from which preliminary data are available. A possible role for the prophylatic use of sclerotherapy in selected high‐risk patients is discussed. The complications associated with sclerotherpy are detailed and attention is drawn to the very low mortality rate of the procedure.
Esophageal transection with paraesophagogastric devascularizations (the Sugiura procedure) in the treatment of esophageal varices
Authors: Sugiura Mitsuo , Futagawa Shunji 
Published: May 2005

AbstractThe Sugiura procedure was performed in 671 patients with esophageal varices. Of these, 203 (30%) had prophylactic, 363 (54%) had elective, and 105 (16%) had emergency procedures. Portal hypertension was due to liver cirrhosis in 495‐alcoholic in 52 and cryptogenic in 443‐idiopathic portal hypertension in 100, extrahepatic portal vein occlusion in 39, hepatoma in 23, schistosomiasis in 4, Budd‐Chiari syndrome in 3, and other causes in 7. Operative mortality rate was as follows: emergency, 13.3%; elective, 3.0%; prophylactic, 3.9%; overall, 4.9%. The operative mortality rate by Child's classification was 0% for 244 class A patients, 2% for 251 class B patients, and 16% for 176 class C patients. There were no operative deaths in prophylactic cases of class A and B. The 10‐year actuarial survival rate in patients with liver cirrhosis was 55% in emergency cases, 72% in prophylactic cases, and 72% in elective cases. The similar survival rate in patients without cirrhosis was 90% in emergency cases, 96% in prophylactic cases, and 95% in elective cases. The incidence of recurrent variceal bleeding was only 1.5%, and 5.2% had recurrent varices. There was no postoperative variceal bleeding in prophylactic cases. Five class C patients with suture insufficiency developed empyema and died. Our procedure is safe and effective in controlling esophageal varices and able to prolong the long‐term survival.
Splenic artery and coronary vein occlusion for bleeding esophageal varices
Authors: Del Guercio Louis R. M. , Hodgson W. John B. , Morgan Jean C. , Berman Howard L. , Kinkhabwalla Mahesh N. 
Published: May 2005

AbstractFifty consecutive, unselected, endoscopically confirmed patients with bleeding esophageal varices received splenic artery and coronary vein occlusion as their primary treatment. This was accomplished surgically in the first 30 patients and by interventional angiography in the last 20. The in‐hospital mortality rate was 22% and the actuarial 5‐year survival rate was 52%. The incidence of recurrent gastrointestinal bleeding from all causes was 43.6% with a mortality rate of 13%.The mean decrease in portal pressure was 8.5 cm H2O, and subsequent angiograms in 14 survivors revealed significant increases in the diameter of the proper hepatic artery, and decreases in the diameter of the portal vein. Hepatic function improved in 10 of the 32 Child's class B cirrhotics. The increase in the blood platelets of the survivors was statistically significant when compared with the decline in those who died.The long‐term results of splenic artery and coronary vein occlusion, performed surgically or angiographically, compare favorably with other methods used to control bleeding esophageal varices.
An update of portal systemic shunting and its complications
Authors: Voorhees Arthur B. , Price John B. 
Published: May 2005

AbstractA clinical retrospective review of 66 patients with portal hypertension who were surgically treated with portal systemic shunting, during a 6‐year period, is presented. Some broad comparisons can be made with a similar review undertaken in 1970. Portal systemic shunting is currently being performed with less frequency, enjoys less popularity as a primary form of therapy, and is reserved for patients in an advanced stage of the disease. The operative mortality rate has understandably risen to over 30% as a result of the shift toward treating surgically only severely ill patients. The degree of liver function impairment is the most important factor for survival; shunt type plays but a minor role. Portal systemic encephalopathy is probably present in all patients and its severity is determined by numerous variables.
Surgical management of patients with the Budd‐Chiari syndrome
Authors: Sanfey Hilary , Boitnott John K. , Cameron John L. 
Published: May 2005

AbstractTwelve patients with the Budd‐Chiari syndrome were managed surgically at The Johns Hopkins Hospital over a 10‐year period. Ten patients were female and 2 were male. Nine were white, 2 were black, and 1 was Asian. Three patients had polycythemia vera, one had paroxysmal nocturnal hemoglobinuria, and one was taking estrogens. The diagnosis was confirmed in all 12 patients by liver biopsy and angiography. Five patients had a patent inferior vena cava and underwent a mesocaval shunt. There were 2 hospital deaths in this group. Ascites redeveloped in 1 patient and was controlled with a Le Veen shunt. The remaining 2 patients did well, are ascites free, and have angiographically demonstrated patent shunts. Histological findings in these 2 patients showed the condition of the liver to have improved markedly. Seven of the 12 patients had occlusion of the inferior vena cava due to thrombosis (6) or compression by the enlarged liver (1), and underwent mesoatrial shunts. There were 2 hospital deaths in this group. One late death occurred from liver failure following thrombosis of the entire mesenteric venous system. Ascites redeveloped in another patient and was controlled with a Le Veen shunt. The remaining 3 patients did well and were demonstrated angiographically to have patent shunts. Two of the 3 patients redeveloped ascites at 4 and 10 months postoperatively and required a second mesoatrial shunt. They are now ascites free, with angiographically demonstrated patent shunts 10 months and 12 months, respectively, following their second operation. The follow‐up for the 6 patients still alive ranges from 15 to 74 months.
The distal splenorenal shunt: An update
Authors: Henderson J. Michael , Millikan William J. , Warren W. Dean 
Published: May 2005

AbstractThe distal splenorenal shunt (DSRS), as the prototype for selective variceal decompression, has evolved over the 17 years since its introduction. Attention to detail in the preoperative assessment and perioperative management will minimize morbidity. Reported experience from over 25 centers has shown an average overall operative mortality rate of 9%, shunt patency and bleeding control rates in excess of 90%, encephalopathy in from 0 to 18% of cases, and a 5‐year survival rate between 50 and 60%. Non‐alcoholic cirrhotics (70–80%) have a significantly (p< 0.05) greater 5‐year survival rate than do alcoholic cirrhotics (45%). The 6 prospective randomized trials comparing DSRS to total portal systemic shunts have been conducted primarily in alcoholic cirrhotics; they show no significant difference in survival. Current experience in schistosomiasis and portal vein thrombosis shows selective variceal decompression to be superior to total shunt. Quantitative data prior to and 1 year after DSRS show a fall in liver volume, stabilization of hepatocyte function, and variable change in hemodynamics: alcoholic cirrhotics have a 70% chance of losing portal venous flow, while nonalcoholics maintain portal perfusion. Loss of portal venous flow is associated with a systemic hyperdynamic response in those with poorer hepatocyte function. Splenopancreatic disconnection is currently being studied in an attempt to maintain portal perfusion better and preserve liver volume. We conclude that the DSRS has achieved its pathophysiological goals of preventing recurrent variceal bleeding, while maintaining hepatocyte function. Modifications in management and the operative procedure are evolving from increased understanding of the pathology of the underlying causes of the portal hypertension leading to variceal bleeding.
Factors influencing survival after distal splenorenal shunt
Authors: Zeppa Robert , Hutson Duane G. , Levi Joe U. , Livingstone Alan S. 
Published: May 2005

AbstractProspective study of 206 patients treated by distal splenorenal shunts for esophagogastric hemorrhage due to portal hypertension reveals a probability of survival at 6 years of 0.53. The actuarial analyses show a marked difference in survival between alcoholic patients (0.39) and non‐alcoholics (0.68) during the same interval. In the latter group, those patients with stable liver disease had a probability of survival of 0.78.The leading causes of death for alcoholic patients were liver failure, liver cancer, and trauma. In the nonalcoholic group, there were two leading causes: liver failure and complications of arteriosclerosis.
Surgical treatment of portal hypertension in schistosomiasis
Authors: Raia Silvano , Mies Sergio , Macedo Antonio Luiz 
Published: May 2005

AbstractPatients with mansonic schistosomiasis and portal hypertension are usually young, with good liver functional reserve, huge splenomegaly, and hypersplenism detectable only by alterations seen in laboratory tests. Patients who are not operated on do not develop portosystemic encephalopathy (PSE). Angiographic alterations are characteristic and totally different from those observed in patients with liver atrophy or cirrhosis. Digestive tract hemorrhage is the most severe complication. The patient with schistosomiasis is, therefore, a good model for the study of the consequences caused by the surgical treatment of portal hypertension. The evaluation, however, of results published in the literature regarding schistosomiasis is practically impossible. In a review of 130 publications referring to 4,516 surgically treated patients, the absence of prospective or retrospective studies with adequate controls was observed, and only 3.2% of the patients were followed for 5 years. According to available data, a total of 29 different surgical techniques has been employed, 81.6% of which are represented by simple splenectomy, esophagogastric devascularization (EGDS), and splenorenal shunt (SRS). Splenectomy was the surgical procedure showing the highest rate of recurrent hemorrhage (54.3%), and the portocaval shunt had the highest PSE incidence (60%). Portosystemic encephalopathy incidence after SRS was 29%. Thus, in view of a lack of objective information, in 1977 our group started a prospective, randomized study comparing the results of the surgical procedures most widely used in our country: selective portal decompression (SPD), EGDS, and SRS. The randomization was interrupted after 94 patients had been operated on (32 SRS, 30 SPD, and 32 EGDS) because of a highly significant PSE incidence in the SRS group. Preliminary results as of January, 1984, refer to an average follow‐up period of 53 months (minimum 29, maximum 77 months). In the SRS group, the late mortality rate was 18.7%, and the incidence of PSE was 31.2%. Among the patients included in this group, 18.7% had arterial hypertension. In the SPD group, late mortality occurred in 10% of the cases, and PSE in 13.3%, while a mild hyperbilirubinemia was seen in 43.3% of patients. Recurrent hemorrhage and ascites had an approximately similar incidence in the 3 groups.
Hepatic secondaries: Minimal tumor and resectable tumor
Authors: Little J. M. 
Published: May 2005

AbstractFifteen patients undergoing hepatic resection for secondary tumor, mostly of colonic origin, have been compared to 9 with unresectable secondaries of low volume. There were no statistically significant differences in age or sex distribution between the groups. The Karnovsky index was 90 or better in those with unresectable tumor at the time of laparotomy for diagnosis and staging. Patients undergoing liver resection fared much better than those with unresected disease. Three and five‐year survival rates were both 49%, and there were no operative deaths. No patient in the unresected group has survived for 3 years. The improved prognosis noted in patients undergoing resection of liver metastases does not depend on tumor volume at the time of laparotomy. There is evidence that hepatic resection can influence favorably the prognosis of individual patients.
Surgical management of esophageal diverticula
Authors: Fegiz Gianfranco , Paolini Antonio , De Marchi Carlo , Tosato Filippo 
Published: May 2005

AbstractThe therapy of esophageal diverticula has not yet been defined, even if our knowledge of the functional alterations involved seems to have clarified the pathogenesis of this disease. The objective of this study was to verify the results of surgical therapy carried out following physiopathological criteria.Out of 49 patients seen with esophageal diverticular disease, 18 had cervical diverticula, 9 had epibronchial diverticula, and 22 had epiphrenic diverticula. Thirty‐one patients had an operation performed: 15 had a diverticulectomy only, 13 had a diverticulectomy with subdiverticular myotomy, and 3 had a subdiverticular or Heller myotomy plus a Nissen procedure. There was no operative mortality. Three patients operated on for epiphrenic diverticula developed an intrathoracic esophageal fistula which healed spontaneously. One patient who had a cervical diverticulectomy developed a recurrence.Long‐term results in 29 cases were good. In 2 cases the results could be considered as poor (recurrence, persistent dysphagia).It is concluded that the most effective surgical procedure for esophageal diverticula is to be chosen for each patient on the basis of an accurate preoperative functional study.
Intraoperative irradiation combined with radical resection for cancer of the head of the pancreas
Authors: Hiraoka Takehisa , Watanabe Eiji , Mochinaga Mizuho , Tashiro Seiki , Miyauchi Yoshimasa , Nakamura Ikuo , Yokoyama Ikuzo 
Published: May 2005

AbstractSince December, 1976, intraoperative irradiation combined with resection for cancer of the head of the pancreas has been used in our clinic to prevent local recurrence. Thirty Gy of the electron beam from a linear accelerator were administered to the operative field including the celiac axis and mesenteric artery following pancreaticoduodenectomy. Results of the combined therapy in 12 patients were compared to results in 12 patients who underwent pancreaticoduodenectomy alone. The combined therapy group compared to pancreaticoduodenectomy alone showed improvement in the 1‐year survival rate, but not in the 2‐year survival rate. Autopsy of 3 paients who underwent the combined therapy did not reveal any involvement of the lymph nodes in the irradiation field. However, there was involvement of the lymph nodes around the aorta from the diaphragm above to the inferior mesenteric artery below (except in the irradiation field). Additionally, there were metastases to the liver in all autopsied patients and recurrence in the pancreatic remnant in 1 patient. In spite of the local effect of irradiation therapy, there was no prolongation of survival. These results suggest that treatment for carcinoma of the head of the pancreas should be intensified toward liver metastases and the lymph nodes around the aorta from the diaphragm above to the inferior mesenteric artery below.
Clinical significance of intraoperative sonography on hepatectomy in primary carcinoma of the liver
Authors: Igawa Sumito , Kinoshita Hiroaki , Sakai Katsuji 
Published: May 2005

AbstractThe development of diagnostic equipment for sonography has not only caused a marked improvement in the preoperative diagnostic rate of primary carcinoma of the liver, but also has enabled us to conduct sonography during operations.During the past 2 years, intraoperative sonography was used in 41 cases of primary carcinoma of the liver. The main tumor was detected in 39 patients (95.1%), and daughter tumors were detected in 14 (63.6%) out of the 22 who had them. Tumor thrombi in the portal vein were detected in 2 (50%) of the 4 patients in whom they occurred.Since intraoperative sonography can clearly demonstrate intrahepatic ductal structures, it is useful for identification of hepatic and portal veins and the subsegment containing tumors (by a sonographically guided puncture). Of the various kinds of medical imaging available to us, intraoperative sonography is the final diagnostic procedure used before the last details of the operation are decided.
Long‐term evaluation of patients treated by radical operation for carcinoma of the thoracic esophagus
Authors: Nishihira Tetsuro , Watanabe Toshio , Ohmori Norio , Kitamura Michihiko , Toyoda Tsuneo , Hirayama Katsu , Kawachi Saburo , Kuramoto Jun ‐ichi , Kanoh Tadamichi , Akaishi Takashi , Sekine Yoshito , Kasai Morio 
Published: May 2005

AbstractDuring the past 19 years, resection has been performed on 457 (72.9%) of 627 patients with carcinoma of the thoracic esophagus; curative resection was done in 388 patients. Among the 259 (57%) patients who underwent reconstruction through the retromediastinal space, thoracic esophagogastrostomy accounted for 181 and interposition of jejunal segments between the thoracic esophagus and the stomach accounted for 78 patients. Among the 171 (37.4%) patients who underwent reconstruction through the retrosternal space, there were 110 with esophagogastrostomy, 57 with interposition of jejunal segments, and 4 with colonic segments between the esophagus and the stomach. Comparing the reconstructive organs or the reconstructive routes used, there were no significant differences in the incidences of pulmonary complication, leakage, or operative death.Among the patients who tolerated curative surgery, the 5‐year and 10‐year survival rates were 31% and 23.1%, respectively. Comparing operative procedures, there were no significant differences in survival rates. Reconstruction was also performed in postgastrectomized patients using jejunal segments.There was a considerable number of complaints of passage failure and reflux esophagitis such as heartburn among patients who underwent esophagogastrostomy performed in the thoracic cavity, even 5 years after surgery.The performance status of patients in whom jejunal segments were used was better than that of patients in whom gastric tubes were used.
Intrabiliary rupture of the hydatid cyst of the liver
Authors: Dadoukis Johannes , Gamvros Orestis , Aletras Homeros 
Published: May 2005

AbstractDuring the last 20 years, 265 patients underwent surgery for liver echinococcosis. Forty‐five (17%) had frank rupture of the hydatid cyst into the intrahepatic bile ducts. The most common clinical manifestations were colicky right hypochondrial pain and obstructive, jaundice accompanied by fever and chills. A correct preoperative diagnosis was made in 35 patients, based mainly on the history, clinical manifestations, and laboratory findings. In the remaining 10 patients, the diagnosis was established at operation. The parasitic cyst was removed and the common bile duct explored in all patients. The latter was usually drained with a T‐tube, except for 3 patients in whom a choledochoduodenostomy was performed. The residual cyst cavity was drained in most patients with a Pezzer catheter and closed following partial pericystectomy. Our results were satisfactory. There was only 1 death due to suppurative cholangitis.
Preoperative radiotherapy in rectal cancer
Authors: Duncan William 
Published: May 2005

AbstractA review is made of the clinical experience of preoperative radiotherapy in patients with operable cancer of the rectum or rectosigmoid. The randomized clinical trials that have been reported are evaluated. It is concluded that preoperative irradiation using a dose of no less than 34.5 gray in 15 daily fractions [Nominal Standard Dose (NSD) 1,290] can reduce locoregional recurrences and improve disease‐free survival. Doses of this order are not associated with any significant increase of morbidity. The administration of lower doses has not been confirmed to be of any benefit.It is suggested that patients with fixed or partially fixed cancers of the rectum or rectosigmoid should be selected for preoperative adjuvant radiotherapy. This group has a low probability of undergoing curative resection without adjuvant treatment. Local recurrence is high and survival poor in this group of patients.Patients with mobile cancer of the rectum should probably proceed to definitive resection and be considered for postoperative radiotherapy (perhaps combined with chemotherapy) if found to have Dukes' stage B or C cancer. This policy also minimizes the probability of irradiating patients with Dukes' A cancer who are unlikely to benefit from such adjuvant treatment.