bluuebunny/crossref_metadata_2025_split huggingface dataset:
Conduction tissue in congenital heart surgery
Authors: Ho Siew Yen , Anderson Robert H. 
Published: May 2005

AbstractThe anatomy of the cardiac conduction system in normal and malformed hearts reconstructed from histological serial sections is reviewed. The sinus node and its arterial supply are located in the right superior cavoatrial junction except in hearts with left‐sided juxtaposition of the atrial appendages, mirror‐image, and isomeric arrangements of the atria. In the presence of normally positioned atrial and ventricular septal structures, the triangle of Koch is a useful guide to the location of the atrioventricular node and the penetrating bundle. In hearts with “isolated” ventricular septal defects, it is necessary to distinguish between a perimembranous defect and a muscular inlet defect. The conduction axis runs in the area of fibrous continuity at the posteroinferior edge of a perimembranous defect but in the anterosuperior rim of a muscular inlet defect. In most hearts with tetralogy of Fallot, the danger area is the region of aortic‐mitral‐tricuspid fibrous continuity where the axis penetrates. In hearts with atrioventricular septal defects, the lack of contiguity between atrial and ventricular septum results in a posterior displacement of the nodal triangle and coronary sinus and an elongation of the nonbranching bundle. Hearts with abnormally located atrioventricular nodes and conduction axes are mainly those with atrioventricular discordance, ambiguous atrioventricular connection in presence of left‐hand pattern ventricular topology, hearts with univentricular atrioventricular connection to a morphologically left or indeterminate ventricle, and hearts with a straddling tricuspid valve. The location of the atrioventricular node is governed by the orientation of the ventricular septum and by the pattern of ventricular topology.
Surgical management of double inlet ventricle
Authors: Pacifico Albert D. , Kirklin James K. , Kirklin John W. 
Published: May 2005

AbstractSurgical experience with the management of patients with double inlet ventricle (DIV) has undergone continued evolution over the past decade. We report our experience with all forms of surgical treatment for this malformation. Systemic‐pulmonary artery shunts were constructed in 55 patients with 1 hospital death (mortality 2%) from 1967 to 1982. The 10‐year actuarial survival was 85%, but onethird of the group required additional operations during the follow‐up period. Good late functional status was achieved from this procedure. Pulmonary artery banding was performed in 11 patients with no hospital mortality and their 10‐year actuarial survival was 74%.Our overall experience with ventricular septation indicates that it remains the best definitive surgical option for those with mild or absent pulmonary stenosis. It is best advised for those with a dominant chamber of left ventricular morphology. The need for concomitant valve replacement, the use of an extracardiac conduit, and less‐than‐moderate ventricular enlargement have been associated with increased hospital mortality. In the absence of these, the hospital mortality rate was 6%. The Fontan‐Kreutzer operation was performed in 73 patients with 16 hospital deaths. Fourteen of these had DIV. A multivariate logistic analysis showed that young age at operation, primary cardiac anomaly other than tricuspid atresia, and complex additional procedures are incremental risk factors associated with hospital mortality. The overall 10‐year actuarial survival was 71%, and there was no difference among those with tricuspid atresia or other anomalies including DIV. This report presents our results and discusses our current management program for patients with this cardiac malformation.
Functional assessment after colectomy, mucosal proctectomy, and endorectal ileoanal pull‐through
Authors: Becker James M. , Hillard Alan E. , Mann Frederick A. , Kestenberg Abraham , Nelson James A. 
Published: May 2005

AbstractRadiographic, manometric, and clinical techniques were used to assess the functional results after colectomy, mucosal proctectomy, and endorectal ileoanal pull‐through (IAP). In 40 patients with ulcerative colitis, Gardner's syndrome, or familial polyposis, anorectal manometry was performed before IAP and 2 months and 1 year afterward. At 4 weeks after IAP, a standardized water contrast radiograph allowed an estimation of the dimensions of the ileal pouch and the integrity of the ileoanal anastomosis. Radiographically, the mean ± SE length, width, and depth of the ileal pouch were 10.9±0.6 cm, 4.5±0.6 cm, and 3.9±0.2 cm, respectively. No anastomotic leaks were identified; however, 2 patients were incontinent to the contrast material. The mean maximal anal sphincter resting pressure decreased from a mean ± SEM of 87.1±3.2 mmHg preoperatively to 68.1±3.1 mmHg 8 weeks after operation, but by 1 year resting pressure increased to 72.3 ±4.9 mmHg. The change in sphincter pressure with voluntary squeeze was greater 8 weeks after IAP than before the operation (114.0±8.2 mmHg versus 97.7±6.2 mmHg) and increased further by 1 year. No patient experienced major episodes of incontinence. Mean ± SEM stool frequency per 24 hours decreased from 7.5±0.5 at 1 month after ileostomy closure to 6.4±0.7 at 12 months. Ileal pouch capacity increased with time and was inversely related to stool frequency. It was concluded that endorectal pull‐through of an ileal J pouch, by providing an adequate intestinal reservoir and preserving nearly normal anal sphincter function, results in anal continence and acceptable stool frequency.
Screening procedures for identifying patients after gastric operations at high risk of developing premalignant histological changes
Authors: Mosimann François , Donovan Ian A. , Thompson Henry , Fielding John W. L. , Harding L. Keith , Alexander‐Williams John 
Published: May 2005

AbstractThirty‐six asymptomatic patients at a mean time interval of 12.7 years after gastric surgery were assessed by endoscopy, intragastric pH measurement, and multiple biopsy at a single endoscopy and by99mTc Imino Diacetic Acid (HIDA) scanning for enterogastric reflux: 9 patients had had Polya gastrectomy, 10 patients truncal vagotomy and antrectomy (Billroth I anastomosis), 9 patients truncal vagotomy and pyloroplasty, and 8 patients proximal gastric vagotomy. In the resection group the 9 patients with histological evidence of mucosal risk factors (dysplasia, chronic atrophic gastritis, intestinal metaplasia) had a fasting intragastric pH of more than 4. However, fasting pH was of no value in predicting the occurrence of risk factors after vagotomy (6 of 17 patients). The amount and duration of enterogastric reflux as measured by HIDA scanning over 50 minutes did not correlate with risk factors after resection. The amount and duration of reflux after vagotomy were greater in the patients with risk factors but were not discriminatory. We conclude that HIDA scanning is of little value as a screening procedure and that single sample pH testing is useful only in patients after a gastric resection.
Surgical technique for repair of benign stricture of the bile ducts, preserving the papilla of vater
Authors: Okamura Takao , Orii Kazuo , Ono Atsushi , Ozaki Azusa , Iwasaki Yoji 
Published: May 2005

AbstractFrom March 1977 to October 1983, we examined 6 patients with benign bile duct stricture. Four were female and 2 were male, ranging in age from 55 to 69 years. These patients were treated by operative methods in which the papilla of Vater was preserved. These operative methods were end‐to‐side anastomosis of the bile ducts, repair of the bile duct utilizing a part of the gallbladder or a remnant of the cystic duct, and repair of the bile duct using a patch of jejunal wall. The postoperative observation period is 8 months to 7 years and 4 months. It is our policy to preserve the function of the papilla of Vater when possible because with this method the flow of bile is uninterrupted. We especially recommend a jejunal patch for repair of the bile duct, when no remnant of the cystic duct is available. This method is applied when the bile duct stricture is less than 3 cm long. We have operated on 2 patients with this method and the results have been completely satisfactory.
Surgical treatment for malignant lesions of the distal part of the esophagus and the esophagogastric junction
Authors: Bertelsen S. , Aasted A. , Vejlsted H. 
Published: May 2005

AbstractThe treatment of 364 patients with carcinoma of the distal part of the esophagus and the esophagogastric junction is reported. Eighty‐two percent of the patients were subjected to operation and the resect ability rate was 52%. At operation 230 patients had lymph node metastases and 115 patients had distant metastases to abdominal organs. The resection rate was significantly higher in patients with squamous cell carcinoma than in patients with adenocarcinoma, and about two‐thirds of the resections were considered as “curative” treatment. The operative mortality rate for the entire period was high (24%), but the mortality decreased in the last 10‐year period. The 5‐year survival rate after resection was in the same level as in other series; the survival rate for patients with squamous cell carcinoma was considerably higher than for patients with adenocarcinoma.If surgical resection is not feasible, surgical bypass of the obstructing lesion is indicated. This alternative procedure gives satisfactory palliation in the majority of patients.
Lesser curve ischemia after proximal gastric vagotomy and splenectomy: Conservative management with endoscopical surveillance
Authors: Choi Samuel , Wong John 
Published: May 2005

AbstractA case of lesser curvature ischemia after proximal gastric vagotomy and splenectomy is described. Division of the right gastroepiploic vessels had caused further impairment of the stomach circulation. Deep seromuscular invagination of the lesser curvature was performed at the end of the operation to protect the ischemic area. Sequential changes were seen at repeated endoscopic examinations, and further operation was not necessary.
Intrathoracic esophagojejunostomy following the resection of the lower esophagus—Tohru Ohsawa, pioneer in surgery of the esophagus
Authors: Imamura Masayuki , Tobe Takayoshi 
Published: May 2005

AbstractIn 1929 Ohsawa of Kyoto performed an intrathoracic esophagojejunostomy on a 52‐year‐old male through the thoracoabdominal route. This was the first successful case of anastomosis between the intrathoracic esophagus and the intra‐abdominal digestive tract, previously attempted so many times the world over. This marked the opening of the era of esophageal surgery. As early as 1938, Ohsawa detected esophageal cancer of 1 × 2 cm size by fluoroscopy. Successful surgery on this tumor highlighted the ultimate approach for the satisfactory treatment of esophageal cancer, i.e., early detection and early treatment.
New aspects of parenteral nutrition with fat emulsions in injured patients
Authors: Kleinberger G. 
Published: May 2005

AbstractAdequate nutrition is essential to recover from injury. There is a close correlation between the severity of injury and the catabolism in the flow phase. During the last few years, many contraindications against the intravenous infusion of fat emulsions have been discussed and determined to be invalid. The development of clinical applicable intravenous fat emulsions and the introduction of all‐in‐one (AIO) solutions for continuous intravenous nutrition have been a great success in the care of injured patients with and without major complications. Careful investigations of the stability of fat emulsions in AIO solutions by examination of visible changes, light and electron microscopic abnormalities, zeta potential, and coulter counting of the size distribution of liposomes revealed that fat emulsions are now safe for long‐term complete parenteral nutrition.The metabolic response to trauma and operation is characterized by the ebb and flow phase. While the patients in the ebb or shock phase should not receive nutrition, patients in the flow or catabolic phase resulting from the combination of decreased nutritional intake and increased nutritional requirement due to injury and its complication as sepsis and organ failure should receive sophisticated intravenous nutrition. The most probable means of achieving sufficient nutrition without metabolic derangement is the partitioning of the energy supply on carbohydrates and fat and the continuous intravenous administration of an AIO solution. Data that have been gathered reveal that the partial use of fat as energy source in injured patients with and without major complications (diabetes mellitus, acute pancreatitis, acute renal failure, liver insufficiency, and sepsis) diminishes the metabolic derangements and improves the standard of nutritional care. After many years of worldwide experimental and clinical investigations, fat is contraindicated only in the shock phase and in primary or secondary disturbances of fat metabolism that lead to a triglyceride level in serum above 4.5 mmol/l during continuous intravenous nutrition.
Medium‐chain triglycerides (MCT) for total parenteral nutrition
Authors: Wolfram G. 
Published: May 2005

AbstractTotal parenteral nutrition is an important measure in optimal treatment of patients under intensive care. Recently, the administration of macronutrients protein, carbohydrates, and fat has been extended to medium‐chain triglycerides. Meanwhile, the well‐known advantages of these fats in enteral feeding has also been confirmed for parenteral application. Medium‐chain triglycerides are quickly removed from the blood, taken up by extrahepatic tissues, carnitine‐independent transported into mitochondria, and oxidized more quickly than long‐chain fatty acids. Simultaneously formed keton bodies from the liver may be an additional energy source. Medium‐chain triglycerides, in combination with long‐chain fatty acids for essential fatty acid supply, provide easily available energy and have a protein‐sparing effect in patients after operation or injury.
Metabolic studies of a lipid emulsion containing medium‐chain triglyceride in perioperative and total parenteral nutrition infusions
Authors: Dawes Raymond F. H. , Royle Gavin T. , Dennison Ashley R. , Crowe Phillip J. , Ball Madeline 
Published: May 2005

AbstractThe effects of infusion of a 10% lipid emulsion containing equal proportions of long‐chain and medium‐chain triglyceride were studied in elective surgical patients and others receiving total parenteral nutrition (TPN). Nitrogen balance was better when the TPN patients received lipid containing medium‐chain triglyceride than during a similar period when long‐chain triglyceride alone was given. Only in the malnourished patients did the medium‐chain triglyceride lipid emulsion produce a significant ketonemia. This emulsion was administered without side effects.
Principles and indications of hypocaloric parenteral nutrition
Authors: Löhlein D. 
Published: May 2005

AbstractPostoperative metabolism is characterized by increased energy demand and nitrogen loss. Whereas autoregulatory mechanisms are able to meet the energy needs by enhanced lipolysis without endogenous problems, nitrogen loss mainly affects functionally and metabolically important proteins. In order to prevent these protein losses during the acute postoperative period, hypocaloric parenteral nutrition is suggested. The concept of hypocaloric nutrition consists of adequate amino acid substitution of 1.2–1.5 g/kg body weight per day and a low‐dosed carbohydrate supply not to exceed 150–200 g per day. According to our own experience, this carbohydrate supply is best done with glucose substitutes like polyoles, since these substrates do no greater damage to the endogenous autoregulatory mechanism and give additional support to hepatic gluconeogenesis so that amino acids can be spared. Analyzing a 6‐year period of using both hypocaloric and caloric‐adequate postoperative parenteral nutrition we believe that hypocaloric nutrition is as beneficial as higher caloric parenteral nutrition, which in its application and monitoring is more expensive and time‐consuming.
Perioperative parenteral nutrition in the stressed diabetic patient
Authors: Vandewoude Maurits F. J. , Van Gaal Luc F. , De Leeuw Ivo H. 
Published: May 2005

AbstractIn the diabetic surgical patient, the effects of absolute or relative insulin deficiency are superimposed on the metabolic alterations of stressed nondiabetic subjects. Stress hyperglycemia, ketosis, and insulin resistance in the perioperative period should be interpreted differently when adequate parenteral nutrition must be provided in a diabetic. Insulin must be added following rigid but sliding scales. Depending on stress levels the administration of calories must be chosen from different possible energy substrates: carbohydrates, lipids, and amino acids. Only during high stress levels with concomitant severe insulin resistance does enrichment of the feeding solution with branched‐chain amino acids seem appropriate. In metabolically more stable situations, preference should be given to carbohydrate and fat calories. Although recent innovations such as nonglucose carbohydrates and medium‐chain triglyceride infusions are very promising, their use in diabetics should be under close clinical and metabolic control to avoid major side effects such as intracellular substrate accumulation and ketosis.
Parenteral nutrition in pediatric surgery
Authors: Schärli A. F. 
Published: May 2005

AbstractMalnutrition in childhood alters the defense mechanisms toward infections and leads to hypoalbuminemia. The risk of delayed wound healing and infections is highly increased. Parenteral nutrition is always indicated when a child will be unable or presently cannot or will not eat for more than 3 days. More than 50 substances are currently employed to fulfill the metabolic requirements. The needs for water, electrolytes, and energy are well understood, but the adequate amounts of amino acids, lipids, vitamins, and trace elements still need to be investigated. Although parenteral nutrition has become a lifesaving measure for many conditions in infants and children, the intravenous route is still far from being a substitute for the bowel. A number of complications related either to the catheter or to the metabolism are more frequently seen in children than in adults. Among these, rickets, anemia, hypoalbuminemia, and cholestatic jaundice are the most frequent. Ten recommendations are given to increase the utilization of infused substances and to minimize the risk of adverse reactions.
All‐in‐one: Conventional versus two different all‐in‐one solutions for total parenteral nutrition of surgical intensive care patients
Authors: Leutenegger Adrian F. , Frutiger Adrian 
Published: May 2005

AbstractThree randomly selected groups of 10 surgical patients under intensive care were prospectively studied concerning the utility and effectiveness of postoperative or posttraumatic parenteral nutrition during 7 days with different solutions: conventional total parenteral nutrition (TPN) with amino acids and glucose (AA/G), or all‐in‐one solutions with amino acids, fat, and carbohydrates either as glucose (AIO/G) or as a mixture of the polyoles sorbitol and xylitol (AIO/P). The AIO solutions were delivered in stable ready‐to‐use mixtures and needed no further processing before administration. Efficiency of all regimens in improving nutritional status was documented. Comparing the 3 groups, we found one important difference: the blood glucose level was significantly lower in the AIO/P group than in the other 2 groups with glucose as the carbohydrate (p<0.001). Furthermore, the bilirubin increase observed in all 3 groups, probably a sign of cholestasis, was significantly higher in the AIO/P group versus conventional TPN. We, therefore, conclude that immediate postoperative or posttraumatic nutrition with an AIO solution was safe and its handling simple. In our patients with stress‐induced glucose intolerance early after major surgery or trauma, the AIO/P solution without glucose produced less hyperglycemia and compared favorably with conventional TPN or an AIO glucose solution. Both AIO solutions were well tolerated and side effects requiring interruption of the therapy did not occur.
Rupture of splanchnic artery aneurysms
Authors: Salo Jarmo A. , Salmenkivi Kari , Tenhunen Anssi , Kivilaakso Eero O. 
Published: May 2005

AbstractThe results of surgical therapy for acute ruptured splanchnic artery aneurysms in 6 patients treated at Helsinki University Central Hospital from 1964 to 1984 were analyzed. There were 3 patients with ruptured splenic, 2 with ruptured hepatic and 1 with ruptured superior mesenteric artery aneurysms. The condition remained undiagnosed in all patients preoperatively, and the diagnosis was obtained only at emergency laparotomy performed for severe shock, abdominal pain, and distension. Five of the 6 patients survived, including a pregnant woman, who gave birth to a living baby by ceserean section. The results indicate that immediate, aggressive surgical approach dictated by the clinical condition of the patient affords good survival in patients suffering from acute rupture of splanchnic artery aneurysms.
Stomal ulcer complicating bypass for duodenal crohn's disease
Authors: Shepherd A. F. I. , Alexander‐Williams J. 
Published: May 2005

AbstractCrohn's disease of the duodenum is a relatively rare condition. It is observed in 0.5–4% of patients with Crohn's disease, and about 200 cases have been reported in world literature. Obstruction is the main indication for operation, and the most common procedure is gastrojejunostomy. Opinion is divided as to whether or not a vagotomy should be performed. We report a patient treated by gastrojejunostomy without vagotomy who developed a stomal ulcer within 8 weeks of operation.
Experimental and clinical results with a simplified left heart assist device for treatment of profound left ventricular dysfunction
Authors: Rose Daniel M. , Laschinger John , Grossi Eugene , Krieger Karl H. , Cunningham Joseph N. , Spencer Frank C. 
Published: May 2005

AbstractDuring the last few years patients with profound heart failure following cardiac surgery have been managed with increasing success with the use of a variety of left heart assist devices. Although some previous experimental studies suggested that cannulation of the left ventricle was superior to that of the left atrium, present studies demonstrate that left atrial cannulation can effectively unload the left ventricle, and significantly decrease left ventricular work. Since 1978, a roller pump type of left heart assist device with cannulation of the left atrium and ascending aorta has been employed in 46 patients with severe postoperative cardiac failure. Twenty‐one patients were successfully weaned from the device; 5 patients died within 90 days of removal of the device, and there were 2 other late deaths 4 months and 4 years postoperatively. There were 14 long‐term survivors (6 months to 54 months). Thirteen of these patients are New York Heart Association class I or II, and 1 patient is New York Heart Association class III. Thus, satisfactory early and late results can be attained with this system. However, it has been postulated that if more complete left heart bypass were utilized, more patients would ultimately survive.