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  • 1
    ISSN: 1365-2559
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: To describe in detail an uncommon pancreatic condition, which generally presents with cholestasis and a mass lesion suspicious of malignancy, and which is characterized histologically by proliferation of fibrous tissue with associated moderate or marked inflammation, as well as obliterative phlebitis.〈section xml:id="abs1-2"〉〈title type="main"〉Methods and results:Out of a consecutive series of 23 pancreaticoduodenectomy specimens which on histological evaluation were found to contain no malignant tumour, six cases characterized by the features mentioned above were identified and investigated further. Poor circumscription, firm consistence, histology of dense sclerosis with scattered round cell infiltrates and associated obliterative phlebitis and often perineural accentuation of inflammation were the distinguishing features. On the basis of available histoloigical evidence, the term inflammatory pseudotumour perhaps remains the term best suited to designate this entity, since it sums up its two most distinctive features. However, the possibility that this lesion is in fact a neoplastic process with reactive inflammation (inflammatory myofibroblastic tumour) cannot be ruled out on the basis of the histology, and remains a serious consideration in view of the proven neoplastic nature of lesions with very similar histology arising elsewhere in the body. Importantly, none of the pancreatic lesions reported here recurred or progressed (five informative cases, median follow-up time 70 months).〈section xml:id="abs1-3"〉〈title type="main"〉Conclusions:Inflammatory pseudotumour (inflammatory myofibroblastic tumour) of the pancreas may closely mimic pancreatic adenocarcinoma clinically and radiologically.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1573-8280
    Keywords: kidney transplantation ; OKT3 ; rejection prophylaxis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Sixteen kidney transplant recipients received the IgG2a anti-CD3 monoclonal antibody OKT3 and azathioprine as rejection prophylaxis during the first two postoperative weeks. Concomitant immunosuppression consisted of low dose steroids while cyclosporine A therapy was instituted on day 12. Side effects included fever, bronchospasm, hypotension and diarrhoea. OKT3 caused T cell modulation resulting in CD3 dim +, CD4+ or CD8+, CD5+, WT31− and 11F2−cells. Anti-OKT3 antibodies were found in approximately 50% of the patients. The protocol induced a 100% patient and graft survival and a 81% actuarial freedom of rejection at 18 months. It prevented CsA associated nephrotoxicity in the direct postoperative phase. These beneficial effects outweighed the side effects of OKT3.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1432-0851
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Studies from several centers have shown an immunosuppressive effect of surgical procedures, whilst others have shown blood transfusion in association with cancer surgery to have an adverse effect on ultimate prognosis. We have previously demonstrated enhanced growth of tumor metastases, in rats following allogeneic blood transfusion and surgery. Polyadenylic-polyuridylic acid (poly A-poly U) has been reported to stimulate immune responses. In this report, we have investigated the effectiveness of poly A-poly U as an adjuvant to blood transfusion and surgical procedures in BN rats bearing artificial lung metastases. Significantly reduced tumor growth was observed, following poly A-poly U adjuvant treatment. These results lead to serious contemplation of the use of this drug as adjuvant therapy in blood transfused and surgically treated patients.
    Type of Medium: Electronic Resource
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  • 4
    Electronic Resource
    Electronic Resource
    Springer
    Journal of cancer research and clinical oncology 109 (1985), S. 156-158 
    ISSN: 1432-1335
    Keywords: Experimental liver metastases ; Colon tumor ; 5-Fu ; Interferon
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The combined effect of 5-Fluorouracil (5-Fu) and partially purified rat interferon (RIFN) was assessed on experimental liver metastases of a transplantable colon tumor in rats. Treatment was given for 8 weeks and started 1 week after inoculation into the portal vein of 5×105 tumor cells. Administration of 105 units RIFN/kg/day for 7 days, in alternate weeks, had no effect on the number or size of liver metastases as judged by laparotomy on days 30 and 50, whereas treatment with 5-Fu at a dose of 15 mg/kg once a week had a moderate but significant inhibitory influence. The combined administration of RIFN and 5-Fu led to earlier development of liver metastases than in the control group. There was no difference in survival time between the control group and the RIFN-treated group; all animals died within 20 weeks after tumor cell injection. However, three of eight animals in the 5-Fu group and, surprisingly, four of ten animals in the RIFN+ 5-Fu group survived for more than 20 weeks and were found to be free of tumor when inspected after 175 days. The data indicate that 5-Fu, given either alone or combined with RIFN, is effective in about 40% of cases, and further suggest that RIFN has tumor-enhancing properties in those animals in which treatment with 5-Fu has no antitumor effect.
    Type of Medium: Electronic Resource
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  • 5
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé Les effets bénéfiques des transfusions de sang sur la survie des organes greffés ont été établis par de nombreuses études chez l'animal et chez l'homme. La suppression de ces effets par la splénectomie fait l'objet de cette étude expérimentale menée chez les chiens de race beagle. Ces chiens reçurent 3 fois une transfusion de 100 ml de sang provenant de chiens bâtards, 4, 3, et 2 semaines avant la transplantation d'un rein de chien bâtard ou avant une splénectomie. Sept des chiens transfusés furent splénectomisés une semaine avant la transplantation, neuf ne furent pas splénectomisés et un groupe de contrôle de neuf chiens qui avaient reçu une allogreffe ne furent ni transfusés ni splénectomisés. Tous les chiens greffés reçurent un traitement immuno-suppresseur postopératoire par azathioprine et prednisolone. Comme cela a déjà été démontré, l'étude entreprise a permis de constater que les 3 transfusions préopératoires chez les chiens qui ne furent pas splénectomisés se sont soldées par un prolongement significatif de la durée de survie du rein greffé; en effet les chiens transfusés ont survécu plus de 3 semaines, période au cours de laquelle 50% des reins greffés furent rejetés dans le groupe de contrôle; 4 des 9 chiens qui avaient été transfusés avant l'intervention sont d'ailleurs entrés dans le groupe des survivants à long terme. En ce qui concerne le groupe des chiens transfusés puis splénectomisés, 70% des beagles greffés présentèrent une réaction de rejet au cours des 3 semaines suivant la greffe et un seul animal a survécu à long terme. L'absence des effets bénéfiques de la transfusion chez la majorité des chiens splénectomisés conduit à penser que, dans les conditions expérimentales suivies, la rate joue un rôle crucial dans l'induction et l'expression de ces effets.
    Abstract: Resumen El efecto benéfico de las transfusiones de sangre sobre la supervivencia de órganos transplantados ha sido confirmado en numerosos estudios en animales y en el hombre. Poco se conoce sobre el mecanismo involucrado en el fenómeno transfusional. El papel del bazo en la manifestación del fenómeno transicional fue estudiado en perros. Los perros fueron transfundidos tres veces con 100 ml de sangre canina 4, 3 y 2 semanas antes del transplante de riñón o la esplenectomía. Siete perros transfundidos fueron esplenectomizados una semana antes del transplante, nueve animales transfundidos no fueron esplenectomizados y un grupo control de nueve alotransplantes no fue transfundido ni esplenectomizado. Todos los recipientes recibieron inmunosupresión con azatioprina y prednisolona. Al igual que lo demostrado previamente, se encontró que la administración de 3 transfusiones pretransplante en el grupo no esplenectomizado resultó en una prolongación significativa de la supervivencia del transplante renal. Todos los animales transfundidos sobrevivieron por más de 3 semanas, periodo durante el cual más del 50% de los riñones en el grupo de control fue rechazado. Cuatro de 9 perros transfundidos se convirtieron en sobrevivientes a largo plazo. En el grupo transfundidoesplenectomizado, el 70% de los recipientes rechazaron el riñón en forma aguda en las primeras 3 semanas, y sólo un animal se convirtió en su perviviente a largo plazo. La ausencia del efecto transfusional en la mayoría de los animales esplenectomizados sugiere que, bajo las condiciones experimentales utilizadas, el bazo juega un papel crucial en la inducción y manifestación del fenómeno transfusional.
    Notes: Abstract The role of the spleen in the manifestation of the transfusion phenomenon was studied in beagle dogs. Beagles were transfused 3 times with 100 ml blood from different mismatched mongrel dogs, at 4, 3, and 2 weeks before mongrel kidney transplantation or splenectomy. Seven transfused dogs were splenectomized 1 week before transplantation, 9 transfused animals were not splenectomized, and a group of 9 kidney allografted controls was neither transfused nor splenectomized. All recipients were given postoperative immunosuppression, which consisted of azathioprine and prednisolone. As with earlier demonstrations it was found that 3 pretransplant blood transfusions in the nonsplenectomized group led to a significant prolongation of kidney graft survival. All transfused animals survived for more than 3 weeks, a period in which more than 50% of the kidneys in the control group were rejected. Four out of 9 transfused dogs became long-term survivors. In the transfused-splenectomized group, 70% of the recipients rejected their kidney acutely within 3 weeks, and only one animal became a long-term survivor. The absence of a transfusion effect in most of the splenectomized dogs suggests that, under the experimental conditions employed, the spleen plays a crucial role for the induction and manifestation of the transfusion phenomenon.
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  • 6
    Electronic Resource
    Electronic Resource
    Springer
    Journal of cancer research and clinical oncology 111 (1986), S. 50-53 
    ISSN: 1432-1335
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The effect of a single blood transfusion on the formation and outgrowth of experimental lung metastases was assessed in two tumor models in rats. The transfusions were given either 1 week before (day-7) or 1 week after (day +7) tumor cell inoculation. The first approach was performed to investigate the effect of transfusions on the formation of lung colonies, the second approach to study the effect on the outgrowth of established metastases. The first tumor model used was a transplantable, nonimmunogenic sarcoma (LS175) in BN rats. Animals were injected i.v. with 105 tumor cells and the number of metastases developing in the lungs was counted after 18 days. Experimental animals received 1 ml of allogeneic WAG blood, controls were given 1 ml of syngeneic BN blood. A single allogeneic transfusion given on day-7 had no effect on the formation of LS175 lung colonies but, when given day +7, stimulated the outgrowth of established metastases. The second tumor model was a highly immunogenic transplantable basal cell carcinoma (BC 1618) in inbred WAG rats. Rats were injected i.v. with 106 tumor cells and the numbers of lung colonies were counted after 21 days. Experimental animals were transfused with 1 ml of BN blood, controls received 1 ml of WAG blood. An allogeneic transfusion on day-7 led to a significant inhibition of lung metastases, whereas a transfusion on day +7 had no effect. The results clearly indicate that allogeneic blood transfusions can modulate tumor growth and metastasis. Although immunological factors seem to play a crucial role in this transfusion phenomenon, there was no clear-cut correlation between the observed effects (accelerated tumor growth vs inhibition of metastasis) and the type of immunomodulation evoked.
    Type of Medium: Electronic Resource
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  • 7
    Electronic Resource
    Electronic Resource
    Springer
    Journal of cancer research and clinical oncology 115 (1989), S. 200-202 
    ISSN: 1432-1335
    Keywords: Adjuvant chemotherapy ; Pancreatic cancer ; Periampullary cancer
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary From 1980 till 1984 16 patients were entered into a non-randomized pilot study, to investigate the feasibility of five courses of adjuvant 5-fluorouracil, Adriamycin and mitomycin C 9FAM) after a curative resection of pancreatic or periampullary cancer. The survival of this group of patients was compared with that of 36 patients who underwent a curative resection alone between 1977 and 1984. Four patients received less than 20%, 4 patients 50%–60% and 7 patients≧80% of the calcuated dose of adjuvant chemotherapy. The chemotherapy was badly tolerated. Only 1 patient resumed some of his normal activity during chemotherapy. The 3-year actuarial survival after curative resection with and without FAM was similar, i.e. 24% and 28% respectively. These data suggest that adjuvant FAM after a Whipple's operation or total pancreatectomy is not feasible because of additive postoperative and chemotherapy-induced morbidity.
    Type of Medium: Electronic Resource
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  • 8
    Electronic Resource
    Electronic Resource
    Springer
    Surgical endoscopy and other interventional techniques 14 (2000), S. 960 -963 
    ISSN: 1432-2218
    Keywords: Key words: Adhesions — Prosthetic materials — Mesh — Rat — Incisional hernia — Hernia repair
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: In many cases, incisional hernia repair requires the use of prosthetic materials. The aim of this experimental study in a rat model was to assess the role of polyglactin 910 mesh and fluoropassivated polyester mesh in preventing the formation of adhesions. Methods: In the first experiment, the formation of peritoneal adhesions was assessed after insertion of polypropylene, polypropylene combined with polyglactin 910, or no mesh. In the second experiment, adhesion formations were compared after insertion of fluoropassivated polyester, polypropylene, and no mesh. Results: The first experiment showed no significant difference in adhesion formations between the polypropylene mesh and the combined mesh; however, when no mesh was used, there were significantly fewer adhesions in both experiments (p 〈 0.01). The second experiment showed a significantly lower degree of adhesions and a lower Adhesion Index after insertion of fluoropassivated polyester mesh than when polypropylene mesh was used (p= 0.04). Conclusions: Adding polyglactin 910 mesh to polypropylene mesh to prevent the formation of adhesions is not an effective measure. Fluoropassivated polyester meshes appear to provide a better alternative to the use of polypropylene meshes for incisional hernia repair in humans in terms of the formation of adhesions.
    Type of Medium: Electronic Resource
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  • 9
    Electronic Resource
    Electronic Resource
    Springer
    World journal of surgery 11 (1987), S. 412-417 
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé Des essais prospectifs randomisés pour étudier la meilleure opération susceptible de prévenir les métastases locales et distales en cas de cancer colo-rectal n'ont pas été entrepris. La prévention de la récidive locale doit être l'objectif à atteindre. Pour ce faire il convient de procéder à la résection radicale de la zone tumorale, de réduire au minimum la possibilité d'une récidive au niveau de la suture, d'éviter de laisser en place des éléments tumoraux dans les ganglions mésentériques et les tissus voisins, et de s'abstenir de tout essaimage des cellules tumorales. La résection étendue des ganglions mésentériques ou la lymphadenectomie pelvienne ne semble pas d'un grand bénéfice d'après les études rétrospectives. Lorsque les organes adjacents sont envahis, la résection en bloc est indiquée si l'on veut obtenir une bonne survie. Elle peut être entreprise avec un taux faible de mortalité même si le pancréas ou le duodénum est envahi ainsi que le montre notre série de 34 opérés dont le taux de mortalité a été de 3%. L'examen histologique extemporané de la zone réséquée lors de l'intervention fait partie intégrante de celle-ci. En ce qui concerne la prévention des métastases à distance, la technique “no touch” de Turnbull doit être appliquée. Dans un essai prospectif randomisé concernant 236 malades opérés de cancer du colon, les métastases hépatiques sont apparues plus tardivement et à un taux plus faible chez les sujets opérés en suivant ce principe. Ce fait a été observé particulièrement lorsqu'il s'agissait d'un processus tumoral à envahissement vasculaire.
    Abstract: Resumen Aún no se han realizado ensayos clínicos prospectivos y aleatorizados con el fin de estudiar la mejor técnica quirúrgica para prevenir metástasis locales y distales en cáncer colorectal. La prevención de la recurrencia local debe ser un propósito mayor mediante la resectión radical del área tumoral, minimizando las posibilidades de recurrencia en la línea de sutura, eliminando remanentes del tumor en los ganglios linfáticos intramesentéricos o en los tejidos vecinos, y evitando la contaminación con células tumorales. Las resecciones extensas de los ganglios mesentéricos o las linfadenectomías pélvicas no han demostrado beneficio de significación en la mayoría de los estudios prospectivos. En casos de invasión de órganos adyacentes, la resección en bloque tiene justificación porque se pueden lograr supervivencias prolongadas. Esta operación puede ser realizada con una baja mortalidad operatoria aún en casos de invasión de páncreas o de duodeno, como se ve en nuestra serie de 34 pacientes con 3% de mortalidad operatoria. Cortes por congelación del área de resección deben ser incluidos en el procedimiento operatorio. Con el objeto de prevenir el desarrollo de metástasis distales debe realizarse la técnica de aislamiento (“no touch”) de Turnbull. En un ensayo clínico prospectivo con 236 pacientes operados por cáncer de colon, las metaśtasis hepáticas hicieron su aparicón mas tardíamente y en menor grado en los pacientes operados con la técnica de aislamiento, especialmente cuando hay crecimiento angioinvasivo del tumor.
    Notes: Abstract Prospective, randomized trials that study the best surgical technique to prevent local and distal metastases in colorectal cancer have not yet been performed. Prevention of local recurrence must be a major effort achieved by radical resection of the tumor area, by minimizing the possibility of suture line recurrence and of tumor remnants in intramesenteric lymph nodes or surrounding tissue, and by avoiding spillage of tumor cells. Extended resections of mesenteric lymph nodes or pelvic lymphadenectomy did not prove to be of significant benefit in most retrospective studies. In the case of adjacent organ involvement, en bloc resection is indicated since long-term survival can be obtained. This operation can be performed with low operative mortality rates even in the case of pancreas or duodenum involvement as is shown in our series of 34 patients (3% operative mortality). Frozen sections of the resection area have to be included in the operative procedure. For prevention of distant metastases, the no-touch technique of Turnbull should be performed. In a prospective, randomized trial of 236 patients operated on for colon cancer, liver metastases appeared later and to a lesser degree in patients operated on with the no-touch isolation technique, particularly in the case of angioinvasive growth of the tumor.
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  • 10
    Electronic Resource
    Electronic Resource
    Springer
    Der Chirurg 71 (2000), S. 676-681 
    ISSN: 1433-0385
    Keywords: Keywords: Surgical research ; Netherlands ; Scientific index ; Multicenter studies. ; Schlüsselwörter: Chirurgische Forschung ; Niederlande ; wissenschaftlicher Index ; Multizenter-Studien.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung. Die Schlußfolgerung der hier gezeigten Daten könnte sein, daß die Niederlande eine große Anzahl guter chirurgischer Studien publiziert und damit in der Spitze der westlichen Welt rangiert. Es ist auffallend, daß die höchste Produktivität in kleinen Ländern und in Ländern mit niedriger Einwohnerzahl gefunden wurde. Die meisten großen europäischen Länder haben einen geringen wissenschaftlichen „output“ nach der in der hier vorliegenden Arbeit benutzten Methode. Die skandinavischen Länder, Holland und die Schweiz haben den besten wissenschaftlichen Index nach der hier benutzten Methodik. Es könnte sein, daß die großen europäischen Länder wie Deutschland, Italien, Frankreich und Spanien dazu tendieren, in lokalen Zeitschriften zu publizieren. In manchen Ländern oder Landesteilen gehört es vielleicht auch nicht zur Gewohnheit, Daten in der englischsprachigen Literatur zu publizieren, was sicherlich den wissenschafltichen Index dieses Landes negativ beeinflußt. Die hohe Produktivität holländischer Chirurgen könnte dadurch erklärt werden, daß die 700 Chirurgen in einem kleinen Land mit einer relativ großen Anzahl an Einwohnern gut organisiert sind. Die holländischen Chirurgen sind in einer nationalen Chirurgengesellschaft organisiert, in welcher fast jeder Chirurg aktives Mitglied ist. Alle sprechen und schreiben Englisch sehr gut. Die von der nationalen Chirurgengesellschaft organisierten Aktivitäten sind sehr gut besucht und beinhalten 2mal im Jahr wissenschaftliche Treffen, bei dem Assistenten und Chirurgen für einen oder 2 Tage zusammenkommen. Zusätzlich werden in allen Ausbildungs- und nicht Ausbildungskliniken Qualitätskontrollen durchgeführt. Durch all diese Maßnahmen kennen sich die Chirurgen in diesem relativ kleinen Land untereinander sehr gut, welches die Kooperation bei der Durchführung von Studien fördert. Die Größe der Niederlande ist gerade ausreichend, um relevante klinische Studien durchzuführen und es mag sein, daß wir relativ viele solcher Studien kreieren. Holland ist ein demokratisches Land, welches dem Chirurgen und Forscher die freie Gelegenheit bietet, Forschung und Publikationen nach eigenem Gusto durchzuführen ohne von hierachischen Strukturen behindert zu werden. Alle diese Faktoren zusammen schaffen ein wissenschaftliches Klima in den Niederlanden, das zur Organisation von Multizenter-Studien und klinischen Studien anregt.
    Notes: Abstract. A large number of good surgical studies have been published in The Netherlands, putting the country at the top of the list in the Western world. It is remarkable that the highest productivity was found in small countries and in countries with a low population. Most of the large European countries have a low scientific output according to the method used in the present study. The Scandanavian countries, Holland, and Switzerland have the best scientific index according to these results. It could be that the larger countries, such as Germany, Italy, France, and Spain, tend more to publish in national journals. Perhaps it is not common in some some countries and regions to publish data in English – which certainly has a negative effect on the scientific index of such a country. The high productivity found among Dutch surgeons could be explained by the fact that the 700 surgeons in a small country with a relatively high population are well organized: Almost all Dutch surgeons are members of the national surgical society. All of them can speak and write English very well. Participation in the activities organized by the national society is high. Scientific meetings where surgeons and assistants get together for a day or two are held twice a year. In addition quality controls are carried out at all teaching and non-teaching hospitals. Through this the surgeons in this relatively small country know each other quite well, which promotes cooperation when studies are undertaken. The Netherlands is just large enough for relevant clinical studies to be conducted and it may be that we initiate a relatively large number of such studies. It is a democratic country in which surgeons and researchers are offered the freedom and opportunity to conduct research and publish their results as they like without being hindered by hierarchic structures. Together, these factors create a scientific climate in The Netherlands which stimulates the organization of multicenter and clinical studies.
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