bluuebunny/crossref_metadata_2025 huggingface dataset:
Fabrication of a ring nanoelectrode in an AFM tip: novel approach towards simultaneous electrochemical and topographical imaging
Authors: Lugstein Alois , Bertagnolli Emmerich , Kranz Christine , Mizaikoff Boris
Published: August 2002

We present a novel approach for the fabrication of a ring nanoelectrode integrated in a standard atomic force microscopy (AFM) tip. The discussed procedure enables the integration of an electroactive area in an exactly defined distance above the apex of a scanning probe tip and the subsequent remodelling and sharpening of the original AFM tip using a focused ion beam technique. This approach is a novel concept towards enhancing the functionality of AFM in order to obtain laterally resolved electrochemical information. Hence, entirely separated topographical and electrochemical information can be obtained simultaneously. The presented technique also demonstrates an alternative approach towards electrochemical imaging using nanometer electrodes with a well‐defined geometry, as shown with the development of the first integrated ring nanoelectrode in an AFM cantilever. Copyright © 2002 John Wiley & Sons, Ltd.
Inter‐diffusion between PMMA and PVDF during lamination studied by time‐of‐flight secondary ion mass spectrometry chemical imaging
Authors: Feng Jiyun , Li Lin , Chan Chi‐Ming , Weng Lu‐Tao
Published: August 2002

A laminate was prepared by laminating a poly(vinylidene fluoride) (PVDF) disc and a poly(methyl methacrylate) (PMMA) disc using compression moulding. Both PVDF and PMMA are miscible polymers. Time‐of‐flight secondary ion mass spectrometry (ToF‐SIMS) chemical images were used to investigate inter‐diffusion between the PVDF and PMMA during lamination at 200 °C and 16 MPa. Negative ToF‐SIMS chemical images clearly revealed the presence of inter‐diffusion between the PVDF and PMMA. Both the lamination time and the PMMA molecular weight could significantly influence the inter‐diffusion distance. As the lamination time increased, the inter‐diffusion distance increased significantly. In addition, as the PMMA molecular weight decreased, the inter‐diffusion distances also increased markedly due to the decrease in viscosity of the PMMA. Copyright © 2002 John Wiley & Sons, Ltd.
Backscattering correction for AES spectra measured at oblique (>45°) incidence of primary electron beam
Authors: Shimotsuma Y. , Ichimura S.
Published: August 2002

The validity of matrix corrections on an AES analysis for incident angles θ (measured from the surface normal) of >45° was examined. The correction factors to take into account were the atomic density correction factor (N), the electron backscattering correction factor (R) and the inelastic mean free path (λ). The backscattering correction factor at large incidence angles was estimated by extrapolation from the factors for θ < 45°, which have been reported based on Monte‐Carlo simulations. The validity of the extrapolation was checked using pure Au and Cu samples used in the measurements of AES intensity dependence on the angle of incidence. This present approach then was applied to the quantitative analysis of Si3N4 samples for a large incident angles. It was confirmed that the proposed matrix correction method is more accurate than the conventional one based on the use of sensitivity factors. Copyright © 2001 John Wiley & Sons, Ltd.
Inference of object‐oriented design patterns
Authors: Tonella Paolo , Antoniol Giulio
Published: August 2002

When designing a new application, experienced software engineers usually adopt solutions that have proven successful in previous projects. Such reuse of code organizations is seldom made explicit. Nevertheless, it represents important information, which can be extremely valuable in the maintenance phase by documenting the design choices underlying the implementation. In addition it can be reused whenever a similar problem is encountered. In this paper an approach for the inference of recurrent design patterns directly from the code is proposed. No assumption is made on the availability of any pattern library, and the concept analysis algorithm—adapted for this purpose—is able to infer the presence of class groups which instantiate a common, repeated pattern. In fact, concept analysis provides sets of objects sharing attributes, which—in the case of object‐oriented design patterns—become class members or inter‐class relations. The approach was applied to three C++ applications for which the structural relations among classes led to the extraction of a set of design patterns, which could be enriched with non‐structural information about class members and method invocations. The resulting patterns could be interpreted as meaningful organizations aimed at solving general problems which have several instances in the applications analyzed. Copyright © 2001 John Wiley & Sons, Ltd.
Appreciative designa
Authors: Norum Karen E.
Published: August 2002

Appreciative Inquiry (AI) is an inquiry into the ‘best of’ what already exists in a system. It is a search to discover the life‐giving forces of the system. Organizations grow in the direction of what they study and, in this sense, invent themselves. AI asserts if good and bad exist in any system, we can choose to study the ‘good’ instead of the ‘bad’. Unfortunately, we are well trained through problem‐solving to study the ‘bad’ instead of the ‘good’. However, by changing what is ‘studied’ in the organization, the system can ‘reinvent’ itself. When using an appreciative inquiry (AI) approach, the questions we ask will determine what we find. Thus, shaping the inquiry is critical. The questions asked will reveal the life‐giving forces of the system. Once those are discovered, the next stage in the process is to dream of what could be. Then comes the design phase: creating the infrastructure that will bridge the best of what is with what could be. The system can then live its destiny by strengthening its affirmative capability. Appreciative Design differs from traditional approaches to organizational design in that it is not a method of problem‐solving; rather it is a way to design a system around identified life‐giving forces. In this paper, the author will present a model for ‘Appreciative Design’. Examples from consulting work and an instructional design class will be used for illustrative purposes. How ‘Appreciative Design’ could be used to reinvent educational systems will also be discussed. Copyright © 2001 John Wiley & Sons, Ltd.
Managing viable knowledge
Authors: Achterbergh Jan , Vriens Dirk
Published: August 2002

In this paper, Beer's Viable System Model (VSM) is applied to knowledge management. Based on the VSM, domains of knowledge are identified that an organization should possess to maintain its viability. The logic of the VSM is also used to support the diagnosis, design and implementation of the knowledge processes that should make and keep organizationally viable knowledge available. Copyright © 2002 John Wiley & Sons, Ltd.
Electron microscopic immunocytochemical detection of PSD‐95, PSD‐93, SAP‐102, and SAP‐97 at postsynaptic, presynaptic, and nonsynaptic sites of adult and neonatal rat visual cortex
Authors: Aoki Chiye , Miko Ilona , Oviedo Hysell , Mikeladze‐Dvali Tamara , Alexandre Lucien , Sweeney Neal , Bredt David S.
Published: August 2002

Membrane‐associated guanylate kinases (MAGUKs) assemble protein complexes at sites of cell–cell contact. At excitatory synapses in brain, MAGUKs localize to the postsynaptic density (PSD) and interact with N‐methyl‐D‐aspartate (NMDA) glutamate receptors and downstream signaling proteins. However, NMDA receptors are not restricted to the PSDs, as electron microscopic immunocytochemical (EM‐ICC) results indicate that NMDA receptors also occur at nonsynaptic portions of dendrites, perhaps functioning as reserves for rapid insertion into synaptic membranes in response to appropriate synaptic activity. NMDA receptors also occur in axons, at least in part to support glutamate‐dependent enhancement of transmitter release. In this study, a systematic EM‐ICC survey was performed to determine whether the distributions of four neuronal MAGUKs—PSD‐95, PSD‐93, SAP‐102, and SAP‐97—resemble that of NMDA receptors. Quantitative analysis revealed that the density of PSD‐95 over thick PSDs of asymmetric axo‐spinous synaptic junctions is 2–3‐fold the level in the immediately adjacent cytoplasm of spines and terminals, while symmetric synapses show no association with PSD‐95. Similarly, all four MAGUKs occur over PSDs of spines. However, we also detected MAGUK immunoreactivity, albeit more diffusely, along presynaptic membranes and in the cytoplasm of axons and dendritic shafts. In fact, the overall distribution of PSD‐95 within the neuropil is equally prevalent along plasma membranes (including synaptic portions) as in the cytoplasm, away from plasma membranes. These results suggest that MAGUKs have dual roles: to maintain receptors at synapses and to regulate shuttling of receptors between nonsynaptic and synaptic sites. Synapse 40:239–257, 2001. © 2001 Wiley‐Liss, Inc.
2,3,7,8‐tetrachlorodibenzo‐p‐dioxin (TCDD) inhibition of coronary development is preceded by a decrease in myocyte proliferation and an increase in cardiac apoptosis
Authors: Ivnitski I. , Elmaoued R. , Walker M.K.
Published: August 2002

Background

2,3,7,8‐Tetrachlorodibenzo‐p‐dioxin (TCDD) causes cardiovascular toxicity, culminating in edema, hemorrhage, and mortality in piscine, avian, and mammalian embryos. To elucidate the mechanism of the cardiovascular teratogenicity of TCDD, we used a chick embryo model to determine whether TCDD alters coronary artery development and whether this alteration was associated with apoptosis and/or changes in myocyte proliferation.

Methods

Fertile chicken eggs were injected with corn oil (control), 0.24, or 0.40 pmol TCDD/g in corn oil before incubation. To evaluate effects of TCDD on differentiation of coronary arteries, chick embryo hearts from incubation days 8 (D8), D10, and D12 were stained with anti‐α‐smooth muscle actin. Myocyte proliferation was measured by BrdU incorporation on D6, 8, 10, and 12 after TCDD treatment. In addition, temporal and spatial patterns of apoptosis were detected by TUNEL on D3, D5, D6, D8, and D10, and immunohistochemistry was used to identify the origin of apoptotic cells on D6.

Results

TCDD increased apoptosis in structures where cell death normally occurs, including the outflow tract, endocardial cushion of the atrioventricular canal, and dorsal mesocardium, peaking in intensity on D6. Immunohistochemistry revealed that cells undergoing TCDD‐induced apoptosis in the dorsal mesocardium were not neural or epicardial in origin. On D8 and D10 TCDD reduced myocyte proliferation. On D10, TCDD reduced coronary artery size and on D10 and D12 TCDD induced a dose‐dependent decrease in coronary artery number.

Conclusions

The reduction of myocyte proliferation by TCDD preceded the reduction in coronary artery number and size, suggesting that changes in coronary development may be a consequence of reduced myocyte proliferation and a thinner ventricle wall. The peak of TCDD‐induced increase in apoptosis occurred even earlier in embryo development and thus may contribute to changes in myocyte proliferation, coronary development, and cardiac structural malformations; however, a cause‐and‐effect relationship between apoptosis and these other events has yet to be established. Teratology 64:201–212, 2001. © 2001 Wiley‐Liss, Inc.
New conceptions of scholarship for a new generation of faculty members
Authors: Deane Sorcinelli Mary
Published: August 2002

Scholarship Reconsidered gave us an amplified vision of scholarly work, yet this process of tenure has inhibited the full realization of that vision. This chapter argues that we need to make the tenure process work more effectively and flexibly in order to validate and encourage the multiple types of scholarship Boyer proposes.
Extraction and purification of the zwitterions cylindrospermopsin and deoxycylindrospermopsin from Cylindrospermopsis raciborskii
Authors: Norris R. L. G. , Eaglesham G. K. , Shaw G. R. , Senogles P. , Chiswell R. K. , Smith M. J. , Davis B. C. , Seawright A. A. , Moore M. R.
Published: August 2002

The hepatotoxin cylindrospermopsin (CYN) has been isolated from the cyanobacterium Cylindrospermopsis raciborskii (C. raci.). Efforts to study this toxin have been hampered by the time‐consuming requirement to extract it from cultures of the organism. It is usually extracted from lyophilized cells collected from a laboratory culture. Our preliminary work suggested far more of the toxin is available in solution in the culture media than in the cells collected. We have therefore investigated the use of commercially available solid phase extraction sorbents to extract CYN from culture media in which C. raci. has been grown. A range of reverse phase and ion‐exchange sorbents were tested across a range of pHs for their ability to retain CYN without success. Subsequently, graphitized carbon cartridges were found to retain CYN strongly. Elution with 5% formic acid in methanol allowed the CYN to be regained for final purification by HPLC. Deoxy‐CYN, an analog of CYN can also be extracted using this procedure. © 2001 John Wiley & Sons, Inc. Environ Toxicol 16: 391–396, 2001
Comparison of potential power production at on‐ and offshore sites
Authors: Pryor S. C. , Barthelmie R. J.
Published: August 2002

This article presents analyses of the potential power production from turbines located in the near‐shore and offshore environment relative to an onshore location, using half‐hourly average wind speed data from four sites in the Danish wind monitoring network. These measurement sites are located in a relatively high wind speed environment, and data from these sites indicate a high degree of spatial coherence. For these sites and representative turbine specifications (rated power 1·3–2 W) the fraction of time with power output in excess of 500 kW is twice as high for the offshore location as for the land site. Also, the fraction of time with negligible power production (defined as <100 kW output from the turbines described herein) is less than 20% for the offshore site and twice as high at the land‐based location. Capacity factors are higher for coastal sites than for the land site, and the annual capacity factor for the offshore location is twice that of the land site. Potential power output at the offshore site exhibits approximately the same seasonal variation as at the land site but little diurnal variation. Copyright © 2001 John Wiley & Sons, Ltd.
Atmospheric particulate analysis by synchrotron radiation total reflection (SR‐TXRF)
Authors: Matsumoto Edson , Simabuco Silvana M. , Pérez Carlos A. , Nascimento Filho Virgílio F.
Published: August 2002

X‐ray fluorescence with synchrotron radiation total reflection was used to analyze the atmospheric particulate collected in Campinas, SP, Brazil, in fine and coarse fractions, using a stacked filter unit. After treatment with acid solution and pipetting on to Perspex disks, the samples were measured at the x‐ray fluorescence beamline at the National Synchrotron Light Laboratory (LNLS), Campinas, using a polychromatic beam for sample excitation. The detection limits obtained ranged from 0.3 to 8.9 ng m−3 for the majority of the elements. The data obtained were treated using analysis receptor models of the principal components, then absolute principal component analysis was applied to obtain the contribution of each source to the total of both particulate fractions. Four sources were identified for the fine fraction for autumn/winter and summer periods: (1) soil dust (22 and 29%); (2) industry (26 and 23%); (3) sulfate (23 and 20%); (4) motor vehicle (22 and 20%); and 7% and 8% non‐explained, in the autumn/winter and summer periods, respectively. In coarse fraction analysis, two sources were identified for the autumn/winter and summer periods and with similar rates for source contribution. The obtained sources were: (1) soil dust (77 and 78%); (2) industry (18 and 16%); and non‐explained rates of 5 and 6%, in the autumn/winter and summer periods, respectively. Copyright © 2002 John Wiley & Sons, Ltd.
Combining XRF analysis and chemometric tools for a preliminary classification of argentine soils
Authors: Custo G. , Boeykens S. , Cicerone D. , Vázquez C.
Published: August 2002

A procedure for the non‐destructive elemental analysis of soils using wavelength‐dispersive x‐ray fluorescence spectrometry (WDXRF) is proposed. The determination of minor and trace elements is considered. It does not require any sophisticated treatment of the sample. The method was validated using certified soil standard reference materials, obtaining satisfactory agreement between the WDXRF results and the certified values. The multielemental information provided by the proposed method was used to model a classification of Argentine soils by chemometric analysis. Copyright © 2002 John Wiley & Sons, Ltd.
Sequencing of a 4.3 kbp region of chromosome 2 of Candida albicans reveals the presence of homologues of SHE9 from Saccharomyces cerevisiae and of bacterial phosphatidylinositol‐phospholipase C
Authors: Andaluz Encarnación , Coque Juan‐José R. , Cueva Rosario , Larriba Germán
Published: August 2002

The nucleotide sequence of a 4.3 kb fragment downstream of the LIG4 gene of Candida albicans has been determined. This fragment contains two entire ORFs (ORF1 and ORF2) and a truncated one (ORF3). ORF1 (1029 bp; EMBL databank, Accession No. AJ277539) encodes a putative protein of 343 amino acids with a high degree of similarity to phosphatidylinositol‐specific phospholipases C (PI‐PLC) of bacterial origin and, to a lesser degree, to similar proteins from trypanosome, fly and human. Isolated ORF1 confers PI‐PLC activity to Escherichia coli transformants. ORF2 (1572 bp; EMBL databank, Accession No. AJ277538) predicts a protein of 524 amino acids with high similarity along most of the entire length to Ydr393w from Saccharomyces cerevisiae. This protein carries a domain with significant similarity to several cytoskeleton proteins of different origins. YDR393w (SHE9) is an orphan gene whose overexpression compromises cell growth. ORF3 appears to encode the homologue of the well‐conserved proteasomal 26S regulatory subunit. Copyright © 2001 John Wiley & Sons, Ltd.
Ynl038wp (Gpi15p) is the Saccharomyces cerevisiae homologue of human Pig‐Hp and participates in the first step in glycosylphosphatidylinositol assembly
Authors: Yan Benjamin C. , Westfall Barbara A. , Orlean Peter
Published: August 2002

Glycosylphosphatidylinositols (GPIs) are found in all eukaryotes and are synthesized in a pathway that starts with the transfer of N‐acetylglucosamine (GlcNAc) from UDP‐GlcNAc to phosphatidylinositol (PI). This reaction is carried out by a protein complex, three of whose subunits in humans, hGpi1p, Pig‐Cp and Pig‐Ap, have sequence and functional homologues in the Saccharomyces cerevisiae Gpi1, Gpi2 and Gpi3 proteins, respectively. Human GlcNAc‐PI synthase contains two further subunits, Pig‐Hp and PigPp. We report that the essential YNL038w gene encodes the S. cerevisiae homologue of Pig‐Hp. Haploid YNL038w‐deletion strains were created, in which Ynl038wp could be depleted by repressing YNL038w expression using the GAL10 promoter. Depletion of Ynl038wp from membranes virtually abolished in vitro GlcNAc‐PI synthetic activity, indicating that Ynl038wp is necessary for GlcNAc‐PI synthesis in vitro. Further, depletion of Ynl038wp in an smp3 mutant background prevented the formation of the trimannosylated GPI intermediates that normally accumulate in this late‐stage GPI assembly mutant. Ynl038wp is therefore required for GPI synthesis in vivo. Because YNL038w encodes a protein involved in GPI biosynthesis, we designate the gene GPI15. Potential Pig‐Hp/Gpi15p counterparts are also encoded in the genomes of Schizosacchomyces pombe and Candida albicans. Copyright © 2001 John Wiley & Sons, Ltd.
Insertional mutagenesis in yeasts using T‐DNA from Agrobacterium tumefaciens
Authors: Bundock Paul , van Attikum Haico , den Dulk‐Ras Amke , Hooykaas Paul J. J.
Published: August 2002

Insertional mutagenesis is a powerful tool for the isolation of novel mutations. The gene delivery system of the bacterium Agrobacterium tumefaciens, which mediates transfer not only to plants but also to yeasts and fungi, could be exploited to generate collections of yeasts containing insertional mutations if there were no bias towards particular integration sites, as is the case in plants. To test this, we have analysed a small collection of Saccharomyces cerevisiae strains with T‐DNA copies integrated in the S. cerevisiae genome. The position of 54 of these T‐DNAs was determined. The T‐DNA showed no clear preference for certain DNA sequences or genomic regions. We have isolated insertions in the coding regions of the genes YGR125w, YDR250c, YGR141w, YGR045c, YPL017c, YGR040w, YDL052c, YJL148w, YCL033c, YFL061w, YJR033c, YDR175c and YLR309c confirming that these genes are non‐essential for S. cerevisiae haploid growth on minimal medium. Given the advantages of T‐DNA, we propose its use as an ideal mobile DNA element for insertional mutagenesis in yeasts. Copyright © 2002 John Wiley & Sons, Ltd.
Towards a Formal Treatment of Implicit Invocation Using Rely/Guarantee Reasoning
Authors: Dingel J. , Garlan D. , Jha S. , Notkin D.
Published: August 2002

Implicit invocation [SuN92, GaN91] has become an important architectural style for large-scale system design and evolution. This paper addresses the lack of specification and verification formalisms for such systems. A formal computational model for implicit invocation is presented. We develop a verification framework for implicit invocation that is based on Jones' rely/guarantee reasoning for concurrent systems [Jon83, Stø91]. The application of the framework is illustrated with several examples. The merits and limitations of the rely/guarantee paradigm in the context of implicit invocation systems are also discussed.
Quality of Life after Gastrectomy: Longmire’s ReconstructionAlone Compared with Additional Pouch Reconstruction
Authors: Hoksch Beatrix , Ablassmaier Bernhard , Zieren Juergen , Müller Joachim M.
Published: August 2002

The optimal reconstruction protocol aftertotal gastrectomy is still a matter of debate. Pouch reconstructionsare developed to create a larger reservoir for food, to provide abarrier against intestinoesophageal reflux, and to lengthen the foodtransit time. Preservation of the duodenal passage should result inbetter physiologic regulation of the ingested food. Controlledrandomized clinical studies must be conducted to assess the quality oflife after gastrectomy and various types of reconstruction. In thepresent trial, which compared Longmire’s reconstruction without apouch and Longmire’s reconstruction with a pouch of varying sizes, weevaluated the quality of life for 41 patients during the firstpostoperative year. The quality of life was examined by an EORTCquestionnaire and an organ‐specific module. There were no statisticallyproven benefits for pouch reconstruction in comparison with Longmire’sreconstruction alone. Some benefits are shown for the large pouch butit was only a trend. This is especially so with regard to diarrhea andfood consumption. A definitive answer to the question about the valueof a pouch reconstruction after gastrectomy has not yet been attained.It is possible that there will be significant differences betweenreconstruction groups during the long‐term follow‐up.
Management of Hyperthyroidism Due to Graves' and Nodular Diseases
Authors: Okamoto Takahiro , Iihara Masatoshi , Obara Takao
Published: August 2002

Endocrine surgeons have had an important role in the management of hyperthyroidism due to either Graves' disease or toxic nodule(s). Since alternative treatments such as antithyroid drugs or radioiodine are also available, the decision‐making for management should be based on clear assessment of advantages and limitations of each of the treatment options. Surgery provides rapid resolution of these conditions, and cure rates are high, although it may be associated with perioperative complications and postoperative thyroid dysfunction. The authors' experience in the surgical treatment of hyperthyroidism and a review of the recent literature are outlined in this report.
Management of Nonfunctioning Islet Cell Carcinomas
Authors: Bartsch Detlef K. , Schilling Thomas , Ramaswamy Annette , Gerdes Berthold , Celik Ilhan , Wagner Hans‐Joachim , Simon Babette , Rothmund Matthias
Published: August 2002

Tumors arising from the pancreatic islet cells are rare and represent a heterogeneous group of benign or malignant lesions. Most tumors present with well characterized syndromes, whereas others appear to be nonfunctioning. The clinical features of 11 men and 7 women with nonfunctioning islet cell carcinomas operated on between 1983 and 1998 were reviewed. The median patient age was 53.5 years (range 26–74 years). The most frequent presenting symptoms were abdominal pain (13 patients), weight loss (7 patients), and obstructive jaundice (4 patients). Gut hormone profiles were normal in all patients. Abdominal sonography and computed tomography localized the tumor in 17 patients, and correct prediction of an endocrine tumor was achieved in 12 patients. Six of seven patients showed a hypervascular tumor upon angiograpy, and seven of eight patients preoperatively had positive somatostatin receptor scintigraphy. At operation, regional or distant metastases were present in 15 (83%) and 6 (33%) patients, respectively. Eleven patients underwent potentially curative resections, and the remaining seven patients were managed palliatively by resection (four patients) or bypass procedures (three patients). Three patients had up to three more resection for metastases. Eight patients received postoperative octreotide, interferon α therapy, or both. The overall cumulative 5‐ and 10‐year survival rates were 65.4% and 49.1%, respectively. Of the 11 patients who underwent curative resection, 10 were alive after a median follow‐up of 63 months (range 7–180 months), but only 5 are free from disease. Although surgical cure is rare in nonfunctioning islet cell carcinomas, significant long‐term palliation can be achieved in a large proportion of patients with an aggressive surgical approach and, when indicated, additional medical therapy.
Effect of Fecal Diversion Alone on Perianal Crohn's Disease
Authors: Yamamoto Takayuki , Allan Robert N. , Keighley Michael R.B.
Published: August 2002

The role of fecal diversion alone for perianal Crohn's disease remains unclear. This study was undertaken to assess its role in perianal Crohn's disease and to examine predictive factors for outcome. Thirty‐one patients who underwent fecal diversion alone for perianal Crohn's disease between 1970 and 1997 were reviewed. The principal indications for fecal diversion were severe perianal sepsis in 13 patients, recurrent deep anal ulcer in 3, complex anorectal fistula in 9, and rectovaginal fistula in 6. Twenty‐five patients (81%) went into early remission, and six (19%) failed to respond. Of the 25 early responders, 17 relapsed at a median duration of 23 months after fecal diversion. By contrast, 8 patients (26%) went into complete remission and required no further surgery at a median duration of 81 months after the diversion. Altogether, 22 patients required surgery at a median duration of 20 months after fecal diversion: proctectomy in 21 and repeated drainage of anal sepsis in 1. At present, intestinal continuity has been restored in only three patients (10%). The following parameters were compared in patients with and without complete remission after fecal diversion: age, gender, duration of disease, steroid use, smoking, coexisting Crohn's disease, preoperative blood indices, and Crohn's disease activity index. None of these parameters affected the outcome. In conclusion, fecal diversion alone is effective in selected patients with perianal disease, but the prospect of restoring intestinal continuity is low. There were no parameters to identify those in whom a successful outcome is likely.
Effect of Sucrose on Collagen Metabolism in Keloid, Hypertrophic Scar, and Granulation Tissue Fibroblast Cultures
Authors: Kössi Jyrki , Vähä‐Kreula Marko , Peltonen Juha , Risteli Juha , Laato Matti
Published: August 2002

Sucrose has been used to treat wounds with excellent results and with minimal abnormal scarring. In this study the effects of sucrose on collagen metabolism in fibroblast culture was evaluated. Sucrose (5.5, 15, or 25 mM) was added to granulation tissue, hypertrophic scar, and keloid fibroblast cultures. mRNA levels and procollagen aminopropeptides for type I and III collagens in cell culture medium were studied. Sucrose decreased mRNA levels for proα1(I) and proα1(III) collagens in fibroblast cultures derived from hypertrophic scar and keloid. In normal granulation tissue fibroblast cultures, 5.5 mM sucrose increased mRNA levels for proα1(I) and proα1(III) collagen, and higher concentrations decreased them. The synthesis of type I collagen decreased dose‐dependently in all cell strains, whereas the synthesis of type III collagen decreased only in granulation tissue fibroblasts. To conclude, in vitro high concentrations of sucrose down‐regulate both collagen gene expression and synthesis in normal granulation tissue fibroblasts, whereas in fibroblasts derived from abnormal scar sucrose down‐regulates only type I collagen gene expression and synthesis, changing the pattern of collagen metabolism toward normal.
Prospective Randomized Comparison of Two Preoperative Skin Preparation Techniques in a Developing World Country
Authors: Meier Donald E. , Nkor Sunday K. , Aasa David , OlaOlorun David A. , Tarpley John L.
Published: August 2002

Povidone‐iodine (PI) is a scarce and expensive item for some hospitals in developing countries. This prospective, randomized study was performed at Baptist Medical Centre (BMCO) in Ogbomoso, Nigeria to determine if the use of PI for preoperative skin preparation would result in a lower postoperative wound infection rate and to identify other factors influencing the infection rate. Two hundred patients undergoing inguinal hernia repair were randomized to receive skin preparation with either: (1) locally available, inexpensive market soap and methylated spirit or (2) imported PI. The two groups were equally stratified. The overall postoperative wound infection rate was 5.5%, and there was no significant difference between the groups (5.1% vs. 5.9%). Factors that did not affect the infection rate included gender, age, type of anesthesia, type or duration of the operative procedure, and number of breaks in optimal technique. There were eight abscesses and three cases of cellulitis without suppuration diagnosed an average of 10 days postoperatively. Staphylococcus was the only bacterium identified on Gram stain or culture. The expense of procuring PI is not justified at BMCO. Available funds may better be used for preoperative antibiotics or for improvement in hospital infrastructure, which should result in fewer breaks in optimal operating room technique.
New Therapy Complementary to Transcatheter Arterial Embolization for Hepatocellular Carcinoma
Authors: Yamada Ryusaku , Nakamura Kenji , Nishida Norifumi , Matsuoka Toshiyuki , Yamada Katsuyuki , Tanaka Kayo , Terada Masaki , Sato Morio
Published: August 2002

A new therapy complementary to transcatheter arterial embolization (TAE) in which anticancer agents are percutaneously injected into the tumor under ultrasound guidance (percutaneous injection chemotherapy combined with TAE; TAE‐PICT) has been developed and found to be effective. A total of 68 hepatocellular carcinoma (HCC) nodules in 50 patients were treated with TAE‐PICT, and the complications were evaluated. Among those with solitary HCC nodules 5 cm in diameter, 17 were treated with TAE‐PICT and 24 with only TAE in a prospective comparative study. No major complications were seen, and the anticancer drugs could still be found in the tumor 3 months after injection. A significantly higher cumulative survival rate (p = 0.03961) and significantly higher cumulative recurrence‐free survival rate (p = 0.00647) were achieved in patients treated with TAE‐PICT than in those treated with TAE alone.
Familial Hyperparathyroidism without Multiple Endocrine Neoplasia
Authors: Huang Shih‐Ming , Duh Quan‐Yang , Shaver John , Siperstein Allan E. , Kraimps Jean‐Louis , Clark Orlo H.
Published: August 2002

Hyperparathyroidism occurs sporadically, in association with multiple endocrine neoplasia (MEN) types I and II, or rarely as familial hyperparathyroidism (FHPT) without other manifestations. We analyzed our experience in 16 FHPT patients from 14 families treated between 1934 and 1991 and reviewed 51 other FHPT patients reported in the literature to determine the clinical course of these patients. Among our 16 patients, 7 (44%) had a serum calcium level ≥ 3.75 mmol/L, 5 (31%) presented with hypercalcemic crisis, 3 (19%) had osteitis fibrosa cystica, 5 (31%) had nephrolithiasis, 1 had pancreatitis, 12 (75%) had multiple abnormal parathyroid glands, 3 (19%) had supernumerary glands, and 7 (44%) required reoperation for persistent (n= 4) or recurrent (n= 3) hyperparathyroidism. Three patients (19%) also had papillary thyroid cancer, and 7 (44%) had other coexistent thyroid disorders. Among 51 patients with FHPT reported in the literature, 23 (45%) had serum calcium ≥ 3.75 mmol/L, and 23 (45%) had multiple abnormal parathyroid glands; 10 (20%) had recurrent hyperparathyroidism. FHPT without other endocrinopathies is a distinct entity. Patients with FHPT have multiple abnormal parathyroid glands and are prone to both recurrent and persistent hyperparathyroidism. They frequently present with profound hypercalcemia or hypercalcemic crisis, in contrast to patients with MEN‐associated hyperparathyroidism or sporadic hyperparathyroidism.
Myomammary Flap of Pectoralis Major Muscle for Breast Reconstruction: New Technique
Authors: Denewer Adel Taha
Published: August 2002

Simple mastectomy and modified radical mastectomy is still the preferred surgical technique for management of breast cancer, as it is always in the second stage (II). Breast reconstruction in Egypt is always accompanied by reduction mammoplasty of the other breast. The new method utilizes a myomammary flap from the other side. This flap depends on the other breast being of moderate or large size. The flap being transferred depends on the pedicle of the pectoralis major tunneled under the skin. The new technique utilizes the nipple on the healthy side to reconstruct the nipple of the new breast at the same time. A reduction mammoplasty was achieved in healthy contralateral huge breasts. A total of 23 female patients were submitted for breast reconstruction using a pectoralis major myomammary flap from the other relatively large breast. The flap depended on a blood supply from the pectoral branch of the thoracoacromial artery. Good cosmetic results were achieved in 60% of cases, fair results in 25%, and unsatisfactory results in 15%. In conclusion, this new technique of breast reconstruction is suitable especially for patients with large, healthy breasts and for relatively poor patients.
Lack of Survival Benefit of Extended Lymph Node Dissection for Ductal Adenocarcinoma of the Head of the Pancreas: Retrospective Multi‐institutional Analysis in Japan
Authors: Mukaiya Mitsuhiro , Hirata Koichi , Satoh Takashi , Kimura Masami , Yamashiro Kazuhiro , Ura Hideki , Oikawa Ikuo , Denno Ryuichi
Published: August 2002

It has not been established that extended lymph node resection is necessary for ductal adenocarcinoma of the head of the pancreas. According to the general rules for the study of pancreatic cancer, a multiinstitutional, retrospective clinical study was undertaken to investigate the efficiency of extended lymph node dissection for this malignancy. Altogether 501 patients underwent resection of the pancreas between 1991 and 1994 at 77 medical facilities; the surgical procedures, staging, lymph node dissection, curability, and survival rate were analyzed retrospectively. Eighteen of the patients died within 30 postoperative days, leaving 483 patients to be studied. The resection was curative microscopically in 94 patients, resulting in a 3‐year survival of 29%. Macroscopically curative resection resulted in a 3‐year survival of 14%; noncurative resection produced a 3‐year survival of 6%. Although extended lymph node dissection was performed on 38 patients in stage I, 42 patients in stage II, 206 patients in stage III, and 1 patient in stage IV, there was no improvement in survival when the results were compared to those seen after standard or palliative lymph node dissection. The extent of lymph node dissection has not affected the prognosis for ductal adenocarcinoma of the head of the pancreas at any stage of the course of the disease. Excessive lymph node dissection in advanced cases does not necessarily lead to a favorable prognosis. The patients who undergo a radical operation with an adequate lymph node dissection have longer survivals.
Stage‐dependent Therapy of Rectal Carcinoid Tumors
Authors: Schindl Martin , Niederle Bruno , Häfner Michael , Teleky Bela , Längle Friedrich , Kaserer Klaus , Schöfl Rainer
Published: August 2002

Although malignant behavior of rectal carcinoid tumors is rare, the risk of metastases and death does exist. Adaptation of therapy according to the estimated malignancy seems necessary. To develop a stage‐dependent therapy, 31 patients with rectal carcinoid tumors measuring 5 to 50 mm in diameter were analyzed retrospectively. Malignancy was estimated according to tumor size, infiltration depth, and histopathology. There were 18 tumors within the mucosa and submucosa (T1), 7 tumors with muscularis propria invasion (T2), and carcinoid tumor penetrating the full rectal wall (T3) or spreading to surrounding tissue (T4) in 6 patients. Altogether 20 patients (65%) were treated with a minimally invasive intervention: endoscopic polypectomy (EP) in 12 and transanal excision (TE) in 8 patients. In 11 patients (35%) aggressive surgical procedures—anterior resection (AR) in 4 and abdominoperineal resection (APR) in 7—were performed. After a mean ± SD follow‐up of 86.0 ± 61.3 months, tumor recurrence was not seen in any of the 20 patients with minimally invasive treatment, and all were still alive. No severe complications associated with surgical procedures were detected. In contrast, 5 of the 10 patients with advanced tumor stage died from their disease despite aggressive surgery (AR, APR). In conclusion, depending on tumor stage, treatment of rectal carcinoids includes EP, TE, or extended resection. Minimally invasive techniques are safe treatments for small to medium‐size T1/T2 rectal carcinoids. Extended surgery cannot improve the overall survival of those with advanced tumors (T3/T4, N1, M1) but can be beneficial for preventing local complications.
Intraoperative Gastrin Measurements during Surgical Management of Patients with Gastrinomas: Experience with 20 Cases
Authors: Proye Charles , Pattou François , Carnaille Bruno , Paris Jean‐Claude , d’Herbomez Michèle , Marchandise Xavier
Published: August 2002

Despite recent advances in imaging techniques for endocrine tumors of the duodenum and the pancreas, preoperative localization of gastrinomas is inconsistent. Successful surgical management of patients with Zollinger‐Ellison syndrome (ZES) and removal of all gastrin‐secreting tumors remains a difficult task. The aim of the study was to evaluate the predictive value of intraoperative gastrin measurements for successful surgical treatment in patients with gastrinomas. Intraoperative gastrin measurements were performed in 20 patients with ZES who underwent resection of gastrin‐secreting tumors. Gastrin was measured with a radioimmunologic assay in blood samples obtained from a peripheral vein and from the portal vein at the beginning of the operation (T0) and 20 minutes after removal of the lesion(s) (T1). In 16 patients gastrin was also measured 4 minutes after injection of secretin 3 U/kg (T2). Thirteen patients (65%) were cured by surgery. In two of them, peripheral and portal gastrin levels were normal at T0, precluding any further interpretation of the test. Completeness of surgery was confirmed by normalization of gastrin levels at T1 or the absence of stimulation at T2 (or both) in 10 patients. In only one case did the gastrin levels remain elevated at T1 despite a favorable outcome after surgery. In each of the seven patients (35%) who had persisting disease at 1 year, failure of the surgical procedure was predicted by persistence of high levels of gastrin at T1. In patients with hypergastrinemia, the positive predictive value of intraoperative gastrin measurement for completeness of surgery and the specificity were 100%. The negative predictive value was 88% and the sensitivity 91%. The overall accuracy of the test was 94%. In patients with ZES the normalization of systemic hypergastrinemia during surgery affirms the successful removal of all gastrin‐secreting tumors. We conclude that intraoperative gastrin measurement is a valuable addendum for optimizing the surgical management of gastrinoma.
Somatostatin Receptor Subtypes, Octreotide Scintigraphy, and Clinical Response to Octreotide Treatment in Patients with Neuroendocrine Tumors
Authors: Kölby Lars , Wängberg Bo , Ahlman Håkan , Tisell Lars‐Erik , Fjälling Martha , Forssell‐Aronsson Eva , Nilsson Ola
Published: August 2002

Several types of neuroendocrine tumor express high numbers of somatostatin receptors (sstr). We have compared the expression of sstr subtypes with the outcome of octreotide scintigraphy in patients with carcinoids and medullary thyroid carcinoma (MTC) in comparison with Hürthle cell tumors. The effect of sstr activation (octreotide treatment) on tumor markers was also studied in patients with disseminated carcinoid tumors. Six patients with carcinoid tumors (four midgut and two foregut), and three patients with thyroid tumors (one MTC, one Hürthle cell carcinoma, and one Hürthle cell adenoma) were studied. Octreotide scintigraphy visualized tumor sites in all nine patients. Macroscopic tumor was verified at these sites at subsequent surgical exploration. Using Northern blotting and subtype‐specific riboprobes, sstr could be detected in all tumors examined. All five sstr subtypes were detected in most of the carcinoid tumors. All six carcinoids expressed sstr2. This was in contrast to the findings for the thyroid tumors analyzed, which also expressed several sstr subtypes but in some cases lacked expression of sstr2. This was also the case for normal thyroid tissue. Clinically, octreotide treatment of the patients with midgut carcinoid tumors resulted in palliation of hormonal symptoms accompanied by a significant reduction of urinary 5‐HIAA levels (28–71%). These results indicate that carcinoid tumors frequently express all five sstr subtypes. The thyroid tumors also expressed multiple sstr but could lack expression of sstr2. Nevertheless, these tumors were visualized by octreotide scintigraphy, indicating that sstr2 expression is not a prerequisite for tumor imaging.
Latent Subclinical Medullary Thyroid Carcinoma: Diagnosis and Treatment
Authors: Henry Jean‐François , Denizot Anne , Puccini Marco , Gramatica Luis , Kvachenyuk Andrey , Conte Devolx Bernard , De Micco Cathérine
Published: August 2002

Sporadic medullary thyroid carcinoma (SMTC) is usually diagnosed at a clinical stage often associated with lymph node involvement. Hence surgical treatment does not result in definitive cure in many patients. Studies have demonstrated that routine measurement of serum basal calcitonin (CT) in patients with nodular thyroid disease allows preoperative, early diagnosis of unsuspected SMTC. The aim of this work was to assess the results of surgery in patients operated on for subclinical SMTC detected preoperatively by measurement of serum CT. Results were compared with those obtained in patients with SMTCs diagnosed at a clinical stage and operated on during the same period. During a 4‐year period (1993–1996) 24 SMTCs were diagnosed and treated in our department. They were diagnosed at a clinical stage in 13 patients (group 1): palpable thyroid tumor (n= 11), palpable metastatic lymph node (n= 6), distant metastases (n= 4). In nine cases the diagnosis was made by both fine‐needle aspiration cytology and serum CT measurement. In the four other cases the initial cytology was incorrect, but the diagnosis was revised on the basis of elevated basal CT values. In 11 patients (group 2) presenting with nodular thyroid disease, SMTC was not clinically detectable. SMTC was preoperatively suspected by elevated CT levels: basal CT > 10 pg/ml and pentagastrin‐stimulated CT peak > 100 pg/ml. One patient in group 1 with distant metastases was not operated on. All of the other 12 patients underwent total thyroidectomy and extensive lymph node dissection. The mean size of the tumors was 27 mm. Lymph node involvement was found in nine patients. After surgery, CT levels returned to normal in five patients but remained elevated in five others; the two remaining patients died of distant metastases. All 11 patients in group 2 underwent total thyroidectomy and central neck dissection. None of the 11 patients had nodal extension. All 11 patients are biochemically cured. It was concluded that routine measurement of basal serum CT in those with nodular thyroid disease allows early, preoperative diagnosis of subclinical SMTC and improves the results of surgery.
Efficacy of PdB in Preventing Intraoperative Risk of Infectious Diseases
Authors: Botet Xavier , Serra Javier , Padrós Rafael , López Santos , Boldó Enric , Llauradó Josep M. , Trias Ramon , Rius Xavier
Published: August 2002

The objectives of this study were to (1) determine the number of punctures surgeons and assistants suffer during operations involving a laparotomy during the intraabdominal and closure phases; and (2) determine if the number of puncture injuries during wound closure can be reduced using a new surgical instrument (PdB) that protects the surgeon's hands and the patient's viscera against needlesticks. For the first objective, all laparotomies performed during 1 month (n= 52) were controlled, collecting the gloves used and determining the number of perforations. For the second objective, a randomized prospective controlled study, involving two series of 100 medial laparotomies, was carried out. The incidence of perforations was 29% during the intraabdominal phase and 16% during the wound closure phase. The glove perforation rate while closing medial laparotomies was 31.5% if the PdB was not used and 3% if the PdB was used (p < 0.0001). The glove perforation rate during laparotomy is significant, but with the use of the PdB this incidence can be significantly reduced.