bluuebunny/crossref_metadata_2025 huggingface dataset:
Resistance and Transference in Intensive Short‐Term Dynamic Psychotherapy (IS–TDP) and Classical Psychoanalysis— Similarities and Differences: Part I
Authors: Davis David M.
Published: August 2002

Classical psychoanalysis and Davanloo's system of Intensive Short‐Term Dynamic Psychotherapy (IS–TDP) share similar goals. Their aim is to increase the relative strength of the ego in relation to the superego, id, and external world. While attempting to accomplish this purpose, psychological forces opposing this goal (resistance) are ubiquitous. Both therapies focus in depth upon the therapist/ patient relationship (transference). However, the psychotherapeutic setting and the technical interventions utilized by the two therapies to work with resistance and transference differ dramatically. Part I of this article discusses the evolution of the concepts of resistance and transference from Freud to the present, and how the changes in perspective regarding these clinical phenomena have subtly altered psychoanalysis. The clinical manifestations of resistance and transference in IS–TDP, and how they are managed clinically, are highlighted. The technical interventions utilized to manage the transference resistance in both techniques are compared and contrasted.
SAXS analysis of interface in organo‐modified mesoporous silica
Authors: Li Zhi Hong , Gong Yan Jun , Wu Dong , Sun Yu Han , Wang Jun , Liu Yi , Dong Bao Zhong
Published: August 2002

A small‐angle x‐ray scattering (SAXS) technique using synchrotron radiation as the x‐ray source has been employed to characterize the microstructure of mesoporous silica prepared by one‐pot template‐directed synthesis methodology. The scattering of pure silica agreed with Porod's law. The scattering of organo‐modified mesoporous silica showed a negative deviation from Porod's law, suggesting that an interfacial layer exists between the pores and silica matrix. It was the organic groups comprising the interface, as shown by 29Si cross‐polarization magic‐angle spinning nuclear magnetic resonance imaging (29Si CP MAS/NMR) and Fourier transform infrared spectroscopy (FTIR), that caused this negative deviation of SAXS intensity from Porod's law, and the average thickness of the interfacial layer could be deduced from this negative deviation. Copyright © 2001 John Wiley & Sons, Ltd.
Summary of ISO/TC 201 Standard: V ISO 14975:2000—Surface chemical analysis—Data information formats
Authors: Yoshihara K.
Published: August 2002

This International Standard specifies a format to supplement ISO 14976: Surface chemical analysis—Data transfer format to transfer data for creation, expansion and revision of a surface chemical analysis spectral database. The format is applied to Auger electron spectroscopy(AES) and x‐ray photoelectron spectroscopy (XPS) spectral data. Copyright © 2002 John Wiley & Sons, Ltd.
Non‐parametric analysis of covariance for confirmatory randomized clinical trials to evaluate dose–response relationships
Authors: Tangen Catherine M. , Koch Gary G.
Published: August 2002

In confirmatory randomized clinical trials that are designed to compare multiple doses of a test treatment with a control group and with one another, there are often statistical issues regarding compound hypotheses and multiple comparisons which need to be considered. In most cases the analysis plan needs a clear specification for the proposed order for conducting statistical tests (or for managing the overall significance level), which statistical methods will be used, and whether adjustment for covariates will be performed. There are several benefits of specifying non‐parametric analysis of covariance (ANCOVA) for performing the primary confirmatory analyses. Only minimal assumptions are needed beyond randomization in the study design, whereas regression model based methods have assumptions about model fit for which departures may require modifications that are incompatible with a fully prespecified analysis plan. Non‐parametric methods provide traditionally expected results of ANCOVA; namely, a typically small adjustment to the estimate for a treatment comparison (so as to account for random imbalance of covariates between treatment groups) and variance reduction for this estimate when covariates are strongly correlated with the response of interest. The application of non‐parametric ANCOVA is illustrated for two randomized clinical trials. The first has a (3×4) factorial response surface design for the comparison of 12 treatments (that is, combinations of three doses of one drug and four doses of a second drug) for change in blood pressure; and the second example addresses the comparison of three doses of test treatment and placebo for time‐to‐disease progression. This clinical trial has comparisons among treatments made for a dichotomous criterion, Wilcoxon rank scores and averages of cumulative survival rates. In each example, the non‐parametric covariance method provides variance reduction relative to its unadjusted counterpart. Copyright © 2001 John Wiley & Sons, Ltd.
Computing ripple effect for software maintenance
Authors: Black Sue
Published: August 2002

Recent software maintenance models have included impact analysis and accounting for ripple effect as one of their stages. This paper describes and explains the reformulation of Yau and Collofello's ripple‐effect algorithm and its validity within the software‐maintenance process. Completely automatic computation of ripple effect has until now proved troublesome; we show how our approximation algorithm helps to overcome this. Our Ripple Effect and Stability Tool (REST) which uses our approximated algorithm to compute ripple effect for C programs, is described. Eleven C programs are used in an initial investigation into whether our approximated algorithm can replace Yau and Collofello's original algorithm for the purpose of automatic computation of ripple effect. The Pearson correlation coefficient for the two versions of the algorithm across the eleven programs shows a high correlation. Copyright © 2001 John Wiley & Sons, Ltd.
Supporting human communication in network‐based systems engineering
Authors: Harris David
Published: August 2002

The increased globalization of systems engineering is spawning a range of activities in the support of systems engineering teams who are geographically dispersed. The primary focus is on ways in which these team members can exchange information easily, quickly, and accurately. This paper takes the view that a network agent in a systems engineering design team comprises a computer plus a person, the two combining to form the intelligent network agent. A great deal of current activity is being put into the communication of data between computers. Relatively little is being put into supporting the communication between the people who are the most significant component of the “intelligent agent.” This article investigates the fundamental reasons why the communication is taking place and concludes that its purpose is to transfer from one agent to another sufficient information for the receiving agent to, eventually, supply a satisfactory deliverable to the sending agent. This implies the transfer, in some form, of a set of requirements. In such a transfer, these requirements will always be interface requirements. The paper goes on to discuss the transfer of computer‐based data between dissimilar tools and the issues involved in this transfer. It then compares the domains of “expertise” of the tool and of the human user, and discusses the mutually supportive operation of these together. From this discussion, the paper proposes a first‐cut set of requirements for the data exchange mechanism and its supporting environment. © 2001 John Wiley & Sons, Inc. Syst Eng 4: 213–221, 2001
Integrating global wireless systems with IP
Authors: Lee David J. Y. , Lee William C. Y.
Published: August 2002

We propose several algorithms for a total IP‐based wireless networks. This includes any cellular system from TDMA and GSM to CDMA. Solutions for associated improvements that come with the new architecture are also discussed. One area is the IP inter‐networking among different cellular systems (GSM to GSM, GSM to CDMA, TDMA to GSM). First, an easy and fast means of establishing a total wireless IP network (including backhaul and core) is presented. Our solution is technology independent (TDMA, GSM, CDMA) and has minimal impact on the existing network. With this proposal, the signaling will be carried out through existing PLMN and limited IP‐based standard protocols. This is a pure packet‐based network and can support both data and voice. The mapping of PLMN and IP‐based addressing will be done through HLR to translate phone number‐based address (MIN) to IP‐based address. The PLMN provides services, such as an ISP, to support dynamic IP. For VPN application, the HLR and HLR can do the first‐level authentication. The e2e authentication will be done between the mobile terminal and the server. Second, the wireless vocoding‐based IP vocoder standards are discussed to further integrate the wireless network with the IP network. Third, the solution for wireless IP networks for single technology global markets (European GSM) is presented. Fourth, the solution for wireless IP networks for multiple technologies global markets is presented. Fifth, the one step vocoding conversion for inter systems (GSM to/from CDMA) is discussed. There is no vocoding and IP/PLMN/PSTN conversion needed for pure IP‐based intra‐GSM (or CDMA or TDMA) systems. In the inter‐system scenario (GSM to CDMA), a one‐step vocoding conversion can be performed through the intermobile systems vocoder gateway. This gateway or service bureau will be responsible for converting GSM to CDMA voice in one step. The delay and system resources can be drastically reduced. This definitely will increase the momentum for the wireless IP migration. Copyright © 2001 John Wiley & Sons, Ltd.
A software architecture for GPRS session management
Authors: Haung Yieh‐Ran , Lin Yi‐Bing
Published: August 2002

General packet radio service (GPRS) provides efficient access to the integrated services Internet from wireless networks. When the GPRS‐attached mobile station attempts to send or receive data, a packet data protocol (PDP) context shall be established. The GPRS session management (SM) supports the PDP context handling, which consists of PDP context activation, deactivation, and modification procedures. In this paper, we propose an SM software architecture for the serving GPRS support node. Our design goals are to achieve compatibility, modularity, and flexibility. More importantly, our approach can accommodate the design of the SM software architecture for third‐generation wireless networks. Copyright © 2001 John Wiley & Sons, Ltd.
Critical Analysis of the Treatment of Non‐palpable Breast Cancer:Toward a Less Invasive Future?
Authors: Groenendijk Richard P.R. , ter Horst Han , Tinnemans John G.M. , van der Sluis Rigtje F. , Ruers Theo J.M. , Wobbes Theo
Published: August 2002

Results and experience with the treatmentof non‐palpable breast cancer are reported and related to the future ofless invasive treatment of small breast cancers. The retrospectivestudy included 102 patients treated between 1980 and 1993 at theUniversity Hospital of Nijmegen. Most cancers were screen‐detected.Tumor sizes on pathological examination proved 3 mm (SD 7.7 mm) largerthan on mammography (p = 0.0029). pT1 tumors wereencountered in 77 patients (75%); pT2 tumors in 17 patients (17%).Seventy‐five patients were free of lymph node metastases, 26 patientsshowed stage pN1 (25%). Most patients had invasive ductal cancers.Only two patients died of breast cancer. A 10‐year disease‐freesurvival of 94% was calculated, after excluding four patients withknown systemic disease (M1) at diagnosis. T1a,T1b, and T1c had a 10‐year survival of 100%,96%, and 96%, respectively. Early detection and multimodalitytreatment of breast cancer have significantly improved survival. Inpatients with small breast cancer tumors future developments intreatment must be aimed at the use of less invasive techniques,reducing morbidity while maintaining high levels of disease‐freesurvival.
Early Gastric Cancer: Ten years of Experience
Authors: Nogueira Carlos , Silva António Sérgio , Santos Jorge Nunes , Silva António Gomes , Ferreira Joaquim , Matos Eduarda , Vilaça Hernani
Published: August 2002

Gastric cancer is a disease in which themain treatment is surgical extirpation. The modifications introduced inthe surgical treatment over the last decades were accompanied by aclear increase of survival, which reaches global values of 61% at 5years in Japan. One of the reasons that contribute to this improvementis early diagnosis of the lesions. In the period between January 1,1990 and December 31, 1999 662 patients with gastric adenocarcinomawere treated in the Service of Surgery 1 of our hospital; 110 wererefused surgical treatment. Of the resected patients, 91 (21.4%) wereclassified as early gastric cancer according to the definition of theJapanese Society of Digestive Endoscopy. There were 30 women and 61men, with a median age of 60.2 ± 15 years; 3 patients had apreoperative diagnosis of gastric ulcer; 2 others were operatedwithout recent histology; and 1 patient was urgently resected for ableeding ulcer. In all the remaining patients biopsy confirmed thepresence of cancer (89%) or serious dysplasia (4.6%). The lesions hadbeen distributed essentially in the medium 1/3 (48.3%) anddistal 1/3 of the stomach.%Subtotal gastrectomy was accomplished in 48 patients, total gastrectomyin 40, total desgastrogastrectomy in 3, and in 9 patients thesurgery involved the spleen (8 patients) and the spleen and tail of thepancreas in 1 patient. Lymphadenectomy was not performed in 5 patients,lymph nodes by the first lymph node barrier were removed in 25 patientsand by the second barrier in 61 patients (67%). Median tumor size was26 ± 1.8 mm. The lesion reached the mucosa in 46 patients and themucosa and submucosa in 45. In 6 patients the removed lymph nodes weremicroscopically invaded (6.7%). Five patients died (5.7%). The medianfollow‐up of the patients is 41 ± 26 months; 7 patients died(8.1%) during this period; 4 died unequivocally of diseaseprogression. The median survival of patients was 85% at 5 years and80% at 10 years. In our series, survival was affected by the presenceof invaded lymph nodes, not by the penetration in depth of the lesionor the size of the tumor.
Prospective Evaluation of Laparoscopy‐assisted Colectomy versusLaparotomy with Resection for Management of Complex Polyps of theSigmoid Colon
Authors: Liang Jin‐Tung , Shieh Ming‐Jium , Chen Chiung‐Nien , Cheng Yung‐Ming , Chang King‐Jen , Wang Shih‐Ming
Published: August 2002

Laparoscopy‐assisted colectomy istechnically feasible, but objective evidence of its benefits remainsscarce. This study was done to evaluate the outcomes and operativestress of laparoscopy‐assisted colectomy versus the traditional openmethod in the management of sigmoid complex polyps that cannot besafely or adequately removed by colonofibroscopy. Between January 1997and December 1999, a total of 42 patients were equally randomizedto the laparoscopy group and the laparotomy group by the blockedrandomization method. Three patients randomized to the laparoscopygroup did not complete the trial; therefore 18 patients treated bylaparoscopy‐assisted sigmoidectomy and the other 21 treated by the openmethod were prospectively evaluated. These two groups of patients werewell matched in age, gender, symptoms, tumor location, localizationmethod, tumor size, morphology, histopathology, and the accuracy of theclinical diagnosis. Two standardized surgical strategies, thelateral‐to‐medial and medial‐to‐lateral dissection sequences, wereperformed in 14 and 4 patients of the laparoscopy group, respectively,according to whether their tumors were located above or below 20 cmabove the anal verge. After evaluating the surgical outcomes, we foundthat the laparoscopy group was significantly better than the laparotomygroup in regard to parameters that included severity of postoperativepain, wound size, postoperative complication rate, and the duration ofpostoperative ileus, hospitalization, and disability. There was nosignificant difference in the operating times for these two groups.However, the costs of the laparoscopy group were significantly higher.To evaluate the surgical stress, we measured the serum C‐reactiveprotein (CRP) level, erythrocyte sedimentation rate (ESR), totallymphocyte count, and CD4+/CD8+ ratio 24 hoursbefore and after surgery. We found that the postoperative serum CRPlevel and the ESR were significantly less elevated and the totallymphocyte counts and CD4+/CD8+ ratio weresignificantly less depressed in the laparoscopy group than in thelaparotomy group. We thus concluded that laparoscopy‐assistedsigmoidectomy can be safely performed with shorter convalescence andless operative stress but at a higher cost. We strongly recommended theuse of this technique in the management of sigmoid complex polyps ifthe patient's economic status permits.
Urologic Oncology in the Twenty‐first Century
Authors: Kakizoe Tadao
Published: August 2002

Abstract

The perspective of urologic oncology in the twenty‐first century is presented regarding detection, treatment, and prevention of cancer. There is increasing importance of a cancer information network. Biotechnology and medical engineering based on advances in computer science will be the two key technologies related to such advancement. Ethical, legal, social, and economic issues provoked by the technologic advances will increase in gravity at the same time. Balancing humans in terms of scientific technologic developments and state of mind will be a serious issue.
Minimal Incision Parathyroidectomy: Cure, Cosmesis, and Cost
Authors: Lowney Jennifer K. , Weber Beverly , Johnson Shirley , Doherty Gerard M.
Published: August 2002

The goals of operative treatment of primary hyperparathyroidism are (1) cure; (2) minimal invasion; and (3) cost‐effectiveness. The optimal strategy is controversial. Retrospective review of was undertaken 66 previously unoperated patients having minimal‐incision, full‐neck exploration by one surgeon over 29 months. A group of 51 women and 15 men had open full neck exploration under general anesthesia through a small (25–40 mm) incision using specifically selected instruments; patients remained hospitalized overnight. Preoperative sestamibi scans were obtained before referral for 17 patients: 11 had localized disease, and 6 did not (65% sensitivity). Four parathyroid glands were identified in 98% of patients; intraoperative frozen section was used selectively on a median of one gland per patient. About 76% of patients had single‐gland disease, 6% had two‐gland disease, and 18% had four‐gland hyperplasia. One patient had four normal cervical parathyroid glands and an aortopulmonary window parathyroid adenoma resected at thoracotomy 1 week later; preoperative sestamibi scans failed to localize his disease. There were no nerve injuries and a 98% cure rate after initial cervical exploration. Excluding the cost of the sestamibi scans, there was no difference between those who had preoperative localization and those who did not; 60% of hospital costs were operating room time‐related. Minimal‐incision parathyroidectomy is effective for curing hyperparathyroidism and has excellent cosmetic results with negligible scar. Preoperative sestamibi scanning had no impact on cure or treatment costs. Strategies to improve cost‐effectiveness must address the substantial costs of anesthesia and operating room services.
Lymphatic Mapping and Sentinel Node Biopsy of Operable Breast Cancer
Authors: Rodier Jean‐François , Routiot Thierry , Mignotte Hervé , Janser Jean‐Claude , Bremond Alain , David Eric , Barlier Catherine , Ghnassia Jean‐Pierre , Treilleux Isabelle , Chassagne Catherine , Velten Michel
Published: August 2002

The aim of this study was to evaluate the reliability and accuracy of sentinel node biopsy for invasive breast cancer and the predictability of axillary node status. Between January 1996 and June 1997 a total of 73 patients underwent patent blue dye lymphatic mapping and sentinel node biopsy followed by standard (level I and II) axillary node dissection (one bilateral procedure). The sentinel node was identified in 82.4% (61/74) of the cases and was predictive of axillary status in 96.7% (59/61). The false‐negative rate of the procedure was 8.0% (2/25). The sentinel node was involved in 37.7% (23/61) and was the only one invaded in 30.4% (7/23). The sensitivity of the procedure was 92% (CI95% 74–99%) and its specificity 100%. It is currently considered to be an attractive new procedure undergoing evaluation in prospective controlled trials. This study confirmed the reliability and reproducibility of intraoperative lymphatic mapping and sentinel node biopsy. This is the first step toward a new era of minimally invasive axillary surgery for breast cancer.
Pancreastatin Plasma Levels in Patients with Primary Hyperparathyroidism
Authors: Bergenfelz Anders , Luts Lena , Børglum Jensen Tine , Sundler Frank
Published: August 2002

Pancreastatin, a C‐terminally amidated peptide derived from chromogranin A, is known to inhibit insulin secretion, pancreatic enzyme release, and gastric acid secretion. It also inhibits parathyroid hormone (PTH) secretion in animals. The physiologic and clinical relevance of pancreastatin in humans, however, is not known. Because pancreastatin has been found in parathyroid adenomas, we investigated the plasma levels in patients with primary hyperparathyroidism (pHPT). Thirteen patients operated on for solitary parathyroid adenoma were investigated. Plasma levels of pancreastatin and serum levels of ionized calcium and intact PTH were measured before and 6 weeks after operation. In 10 patients the levels were also monitored before and 60 minutes after adenoma excision. The adenomas were investigated for pancreastatin immunoreactivity by immunocytochemistry. The median weight of the excised parathyroid adenoma was 0.64 g (range 0.07–2.00 g). Cells displaying pancreastatin immunoreactivity were present in all adenomas examined and varied in number and immunostaining intensity among and within the adenomas. Intraoperatively, after adenoma excision the levels of PTH and pancreastatin declined (p < 0.01), whereas the levels of ionized calcium did not change (p= 0.96). At the 6‐week follow‐up the levels of ionized calcium and PTH had decreased compared to the preoperative levels (p < 0.01), and all patients were normocalcemic. In contrast, the pancreastatin levels were not changed (14.5 ± 6.1 pmol/L preoperatively vs. 12.8 ± 11.2 pmol/L 6 weeks postoperatively; p= 0.12). In patients with pHPT, pancreastatin is likely to be produced by the parathyroid adenoma. The changes in pancreastatin levels immediately after surgery warrant further investigation.
PET Scans of Abdominal Malignancy
Authors: Blahd William H. , Brown Charles V. , Khonsary Seyed A. , Farahi Judah B. , Quinones Nayda , Ribe Josephine Y. , Coyle John J. , Glass Edwin C. , Mandelkern Mark A.
Published: August 2002

Positron emission tomography (PET) with fluorine‐18‐2‐d‐deoxyglucose (FDG) currently is being integrated into clinical oncology because it provides unique functional information that can be applied to the management of cancer. In particular, it is useful for assessing tumor activity and growth, evaluating efficacy of therapy, and detecting tumor recurrence. Studies have demonstrated the value of whole‐body PET‐FDG imaging when staging and managing abdominal malignancy.
p53 Hot‐Spot Mutational Analysis in Advanced Western Gallbladder Carcinoma
Authors: Jonas Sven , Springmeier Giovanni , Tauber Rudolf , Wiedenmann Bertram , Gessner Reinhard , Kling Norbert , Lobeck Hartmut , Fieger Claudia , Bechstein Wolf O. , Neuhaus Peter
Published: August 2002

In gallbladder carcinoma, studies on the prime target of genetic alterations and gene therapy in human gallbladder malignancies, the p53 tumor suppressor gene, have been focusing on this gene's immunohistochemical detection. From November 1991 to October 1993, seven patients suffering from gallbladder carcinoma underwent surgical resection. Cancerous and normal liver tissues were obtained immediately after surgery, snap‐frozen in liquid nitrogen, and stored at −80°C for immunohistochemistry and DNA isolation. Exons 5, 6, 7, and 8 of thep53 gene were completely sequenced following polymerase chain reaction (PCR) amplification of a 1574‐bp fragment. Missense mutations were detected in the cancerous tissues of two patients: one transition each on codons 134 (Phe→Leu) and 146 (Trp→Arg). Immunohistochemical p53 staining was positive in the latter patient only. This is the first report on sequence analysis and mutagenesis of the p53 gene in Caucasian patients with gallbladder cancer. Both mutations were transitions and seem to represent a rather rare event. The possible impact of p53mutagenesis on gallbladder tumorigenesis requires evaluation in larger studies.
Adrenalectomy for Primary Aldosteronism: Long‐term Follow‐up Study in 29 Patients
Authors: Sirén Jukka , Välimäki Matti , Huikuri Kauko , Sivula Arto , Voutilainen Petri , Haapiainen Reijo
Published: August 2002

Primary aldosteronism consists of a mixture of subgroups. The operative treatment is successful only in cases of aldosterone‐producing neoplasia (and in rare cases of primary unilateral hyperplasia); all other cases should be treated medically. The aim of this study was to determine if aldosterone‐producing neoplasia had been successfully differentiated from the other subgroups and the outcome of operative treatment. Altogether 29 patients with primary aldosteronism were operated on between January 1, 1979 and December 31, 1993. Patient charts were reviewed retrospectively. The follow‐up data were collected from the patients’ charts, and all patients were contacted to obtain recent blood pressure and serum potassium values. The patients were asked about symptoms related to hyperaldosteronism. If any suspicion of recidive aldosteronism was present, patients were carefully reexamined by hormonal tests and computed tomography (CT). A total of 27 patients had unilateral adenoma, 1 patient had hyperplasia, and 1 patient had an aldosterone‐producing cortical carcinoma. There was no operative mortality or morbidity. The serum potassium level had normalized in all patients. Mean follow‐up time was 76 months. One patient died during the follow‐up from cholangiocarcinoma; 11 patients (41%) were cured by the operation, 10 patients (37%) have a mild but medicated hypertension, and in the remaining 22% the hypertension persisted but was well controlled by the medication. Of the 29 patients, 28 were correctly diagnosed as having an aldosterone‐producing neoplasm. Basic hormonal studies and CT can be used effectively to differentiate aldosterone‐producing neoplasia from hyperplasia in most cases.
Final Reflections: Wellness after Obesity Surgery
Authors: Alvarez‐Cordero Rafael
Published: August 2002

The articles presented in this symposium on treatment of clinically severe obesity cover most of the topics related to obesity surgery, from basic research about genetic causes of obesity to surgical techniques and clinical results on the severely obese patient. The most striking feature of those results observed after bariatric surgery for the clinically severe obese is not the remarkable weight loss and normalization of the body mass index but the amelioration of some of the metabolic and physiologic abnormalities related to obesity. In fact, carbohydrate and lipid metabolism show improvement, as do cardiac and pulmonary function. These observations justify all efforts devoted to the design and improvement of sound bariatric surgical techniques. Moreover, surgeons seek the well‐being of the ex‐obese patient, and in doing so they face special discriminatory attitudes from colleges, patients’ families, and the society, mainly because of negative stereotypes related to the obese individuals and the lack of information on the real benefits of bariatric procedures. Bariatric surgeons will reach their goal only when an informed society, educated physicians, and properly oriented obese patients together give to bariatric surgery its real dimension. The objective of any surgeon is the wellness of his or her patient. This is important in bariatric surgery as well; beyond excess weight loss and normalization of biochemical parameters, the ex‐obese patient should be able to live a normal, productive, happy life. Approaching this goal is a task that takes months or even years. Bariatric surgeons are committed to support and help their patients until they reach wellness after obesity surgery.
Medical Challenges of Internal Conflicts
Authors: Leppäniemi Ari K.
Published: August 2002

The most prevalent menace since the end of the cold war is the occurrence of civil wars and local and regional conflicts. The term “low intensity conflict” describes the new threat environment and covers a multitude of phenomena, such as civil wars, guerrilla warfare, terrorism and counterinsurgency operations occurring between routine, peaceful inter‐ or intrastate competition, and a sustained conventional conflict. There is a great challenge to alert the physicians in general, and the surgical community of the world in particular, to the new threat environment and the medical challenges involved in treating casualties of low intensity conflicts. Specifically, a new international body of surgeons might be required to coordinate the recruitment, training, and creditation for surgeons with special expertise in the management of victims of such conflicts and to facilitate research and general knowledge of the medical challenges of modern conflicts.
Changes in Erythrocyte Deformability after Liver Resection for Hepatocellular Carcinoma Associated with Chronic Liver Disease
Authors: Horii Katsuhiko , Kubo Shoji , Hirohashi Kazuhiro , Kinoshita Hiroaki
Published: August 2002

Erythrocyte deformability is an important factor in the microcirculation. The deformability in patients with chronic liver disease is less than normal. We studied changes in erythrocyte deformability in 32 patients undergoing liver resection for hepatocellular carcinoma with underlying chronic liver disease to investigate whether the measurement of deformability gives information useful for postoperative management. We measured erythrocyte deformability as erythrocyte transit time (ETT) before and after resection, as well as the erythrocyte adenosine triphosphate level, mean corpuscular volume, mean corpuscular hemoglobin concentration, and indices of liver function. The 15‐minute indocyanine green retention rate (ICGR15) was measured before resection. Correlations between the change in deformability and these values were evaluated, as was correlation with the scale of the operation and with the occurrence of postoperative complications. Mean ETT was higher in the patients before resection than in healthy volunteers. ETT was correlated with serum high density lipoprotein‐cholesterol (p <
0.05). The incidence of postoperative complications was higher
(p= 0.001) in the patients (group A) with ETT increased during the first 3 postoperative days by ≥1 SD of the mean of the preoperative value than in patients (group B) with less change. Of the 12 patients whose ICGR15 value was ≥20%, all 9 patients in group A had postoperative complications. The increase in ETT (decrease in erythrocyte deformability) is associated with the development of postoperative complications. The measurement of erythrocyte deformability gives information useful for postoperative management, and special monitoring for postoperative complications is necessary in patients with the increase soon after liver resection.RID="" ID="" Correspondence to: K. Horii, M.D.
Intraarterial Adjuvant Chemotherapy after Pancreaticoduodenectomy for Pancreatic Cancer: Significant Reduction in Occurrence of Liver Metastasis
Authors: Beger Hans G. , Gansauge Frank , Büchler Markus W. , Link Karl Heinz
Published: August 2002

The clinical benefit of adjuvant chemotherapy in pancreatic cancer patients is still questionable. Phase II studies using radiochemotherapy based on 5‐fluorouracil (5‐FU) provided evidence of an increase in median survival times. Because palliative chemotherapy by celiac artery infusion (CAI) led to an increase in survival in pancreatic cancer, we treated 24 patients with adjuvant CAI following resection of the head of the pancreas for pancreatic cancer (21 patients with Union Internationale contre le Cancer (UICC) stage III, 2 with UICC stage II, 1 with UICC stage I). Catheters were placed angiographically into the celiac artery and remained there for 5 consecutive days. One cycle of chemotherapy consisted of mitoxantrone, 5‐FU, folinic acid, and cisplatinum. This treatment was repeated five times at monthly intervals. CAI was well tolerated, and World Health Organization (WHO) grade III toxicities were observed in 8%; WHO grade IV was seen in none of the treatment cycles. Furthermore, we observed pain reduction in nearly all patients under CAI. Median survival times in patients who received CAI were 23 months for all patients, whereas in patients who did not receive adjuvant treatment the median survival was 10.5 months. With Kaplan‐Meier regression analysis of the patients who were curatively resected (R0 resection) and received CAI, the overall 4‐year survival was 54%, whereas in patients without CAI the 4‐year survival was 9.5%. The occurrence of liver metastases in the CAI group went down to 17%. These results demonstrate that CAI is well tolerated, reduces the risk of liver metastasis, and increases the survival time of pancreatic cancer patients.
Treatment Strategy for Mucin‐producing Intrahepatic Cholangiocarcinoma: Value of Percutaneous Transhepatic Biliary Drainage and Cholangioscopy
Authors: Sakamoto Eiji , Hayakawa Naokazu , Kamiya Junichi , Kondo Satoshi , Nagino Masato , Kanai Michio , Miyachi Masahiko , Uesaka Katuhiko , Nimura Yuji
Published: August 2002

Intrahepatic cholangiocarcinomas that secrete macroscopically excessive mucin into the biliary system are rare, and few of the previously reported cases have achieved a curative resection. We defined these tumors as “mucin‐producing intrahepatic cholangiocarcinomas” and clarify the optimal preoperative and surgical management for them. Eleven patients with mucin‐producing intrahepatic cholangiocarcinomas underwent surgical resection in our department. The clinical, radiologic, surgical, and pathologic findings were studied. The clinical presentation of the 11 patients included repeated abdominal pain, jaundice, and fever. Conventional cholangiographies, such as percutaneous transhepatic cholangiography or endoscopic retrograde cholangiography, could not offer precise information about tumor location and extension because of abundant mucin in the biliary system. Using percutaneous transhepatic biliary drainage (PTBD) and percutaneous transhepatic cholangioscopy (PTCS), we were able to drain the mucin and determine precisely the cancer extension into intrahepatic segmental bile ducts. Based on these findings, various types of liver resection with or without extrahepatic bile duct resection were planned, and 10 patients obtained curative resection. The cumulative 5‐year survival rate after curative resection was 78%. In patients with mucin‐producing intrahepatic cholangiocarcinoma, PTBD and PTCS are important for evaluating the cancer extension. Rational surgery based on accurate preoperative diagnosis improved the prognosis of patients with this disease.
Syringe Pressure Irrigation of Subdermic Tissue after Appendectomy to Decrease the Incidence of Postoperative Wound Infection
Authors: Cervantes‐Sánchez Carlos R. , Gutiérrez‐Vega Rafael , Vázquez‐Carpizo Jorge A. , Clark Patricia , Athié‐Gutiérrez Cesar
Published: August 2002

To evaluate syringe pressure irrigation of the surgical wound to decrease its infection after appendectomy, we designed a randomized control trial at the Emergency Department of Mexico City General Hospital, including 350 patients with acute abdomen suggestive of appendicitis, without any other infection clinically evident. The trial was randomized into 2 groups. Group I patients received prophylactic systemic antibiotics before surgery. Group II patients received the same prophylactic systemic antibiotics plus syringe pressure irrigation of the surgical wound with 300 ml of saline solution using a 20‐ml syringe with 19‐gauge intravenous (IV) catheter to measure the incidence of postoperative wound infection. In our results, 283 patients had appendicitis. Of these, 188 were uncomplicated (66.4%) and 95 (33.6%) were complicated. Of the complicated cases, 40 were assigned to group I, and of these, 29 (72.5%) developed wound infection. In group II there were 55 patients and only 9 (16.3%) developed wound infection after syringe pressure irrigation [p= 0.000001; 95% confidence interval (CI) = 0.02–0.22]. We conclude that syringe pressure irrigation of the surgical wound after appendectomy contributes significantly to decrease the incidence of postoperative wound infection in complicated cases. It is a cheap, safe, and accessible method in any surgical room.
Ultrasound of the Hepatobiliary‐pancreatic System
Authors: Benson Mark D. , Gandhi Mitesh R.
Published: August 2002

Ultrasound (US) remains an excellent first line investigation of the gallbladder and for indicating diagnoses and defining levels of extrahepatic biliary obstruction and screening for liver metastases. It is extremely useful in assisting interventional procedures and assessing the status of hepatic vessels. As a nonoperative procedure, endoscopic ultrasound (EUS) can accurately locate and locally stage pathology of the pancreas and periampullary region and even provide reliable biopsy evidence in experienced hands. A limitation, of course, is its field‐of‐view restriction, which prevents identification of distant metastatic disease. This restriction is not present with laparoscopic ultrasound (LUS), which apart from being an operative procedure, has all the other advantages of EUS and in addition can identify nodal, hepatic, and extrahepatic metastatic spread. Greater use of intraoperative biopsy should assist in identifying nodal disease but requires the readily available services of a pathologist. Local disease may be even more definable using the newer technology of intraductal ultrasound (IDUS). Intraoperative ultrasound (IOUS), whether direct or via the laparoscope, is now an indispensable tool for all surgeons who want to perform hepatobiliary‐pancreatic surgery at the highest level.
Surgical Results in Patients with Hepatitis B‐related Hepatocellular Carcinoma and Positive Hepatitis B Early Antigen
Authors: Chen Jen‐Hao , Chau Gar‐Yang , Lui Wing‐Yiu , Tsay Shyh‐Haw , King Kuang‐Liang , Loong Che‐Chuan , Hsia Cheng‐Yuan , Wu Chew‐Wen
Published: August 2002

Hepatitis B virus (HBV) infection is the major risk factor in the pathogenesis of hepatocellular carcinoma (HCC). Patients who are positive for hepatitis B early antigen (HBeAg) have active liver disease. The present study aimed to evaluate the possible role of HBeAg in patients with resectable HCC. A series of 249 HCC patients with complete preoperative hepatitis marker who had undergone potentially curative resection were enrolled. Patients with hepatitis C virus infection were excluded. Of these patients, 27 were positive for hepatitis B surface antigen (HBsAg) and HBeAg (group I), 171 were positive for HBsAg and negative for HBeAg (group II), and 51 were negative for hepatitis B markers (group III). The clinicopathologic features and postoperative survivals were compared among the three groups. The prevalence of HBeAg was 10.8%. Group I patients were significantly younger and had worse liver function, smaller tumors, and a higher incidence of liver cirrhosis and chronic active hepatitis than those in groups II and III. No increase in tumor invasiveness was noted in group I patients. The operative morbidity, mortality, and postresection survival were comparable among the three groups. Our findings indicated that HBeAg positivity is not a negative factor for resection in HCC patients and has no significant influence on postresection survival.
Free Radical Scavenging Activity of Fullerenol on the Ischemia‐reperfusion Intestine in Dogs
Authors: Lai Hong‐Shiee , Chen Wei‐Jao , Chiang Long‐Yong
Published: August 2002

Fullerenol, a water‐soluble C60‐fullerene derivative, has been demonstrated to have the capability to scavenge free radicals in vitro and in vivo. The purpose of this study was to investigate whether fullerenol can scavenge the free radicals that are massively induced during ischemia‐reperfusion (I/R) injury of the small intestine, either preventively or therapeutically. Clamping the superior mesenteric artery and vein for 60 minutes to induce I/R injury was performed on male mongrel dogs. Thirty dogs were divided into three groups (10 in each): The control (C) group received no medication; the preventive (P) group received fullerenol (1 mg/kg) intravenously 30 minutes before ischemia; the therapeutic (T) group received the same dose of fullerenol immediately after reperfusion. This study was an experimental randomized trial. Intestinal segments were obtained 10, 20, 30, and 60 minutes after reperfusion; and blood samples and specimens of major organs were taken 60 minutes after reperfusion. Concentrations of lipid peroxidation products, including conjugated diene (CD) and malondialdehyde (MDA), and the level of glutathione (GSH) in intestinal tissue were determined. Serum indicators of liver and renal function were measured. Histologic examination of the small intestine and major organs were also performed. A significant increase in intestinal MDA and CD contents was detected at 30 and 60 minutes after reperfusion. The tissue GSH content, in contrast, was decreased 60 minutes after reperfusion. Administration of fullerenol diminished these changes both preventively and therapeutically. Liver and renal functions were within normal limits in all groups. Moreover no obvious histopathologic additional damage could be found in either the P or the T group. It is suggested that fullerenol can be considered a powerful scavenger for the free radicals induced by I/R injury of the small intestine.
Early Gastric Cancer: Unrecognized Indicator of Multiple Malignancies
Authors: Bozzetti Federico , Bonfanti Giuliano , Mariani Luigi , Miceli Rosalba , Andreola Salvatore
Published: August 2002

The aim of this study was to evaluate the postoperative outcome and occurrence of second primary malignancies in patients who underwent radical resection for early gastric cancer. Altogether 105 patients with early gastric cancer underwent radical resection and were followed up for a median period of 71 months. Overall lethality was analyzed with regard to mortality due to gastric cancer or other causes. Standardized mortality and morbidity ratios were calculated using data from the Tumor Registry of Lombardy. The 5‐year survival rate was 82.8% (operative mortality excluded), which was not different from that expected from an age‐ and sex‐matched Italian population. Ten second primary malignancies were identified, giving a standardized mortality ratio of 1.12 and a standardized morbidity ratio of 1.50. Patients undergoing surgery for early gastric cancer (especially the intestinal type) may have a circa 50% higher risk of a second tumor and should be periodically checked for other tumors, mainly in the supramesocolic area.
Hepatotoxicity associated with nevirapine or efavirenz-containing antiretroviral therapy: Role of hepatitis C and B infections
Authors: Sulkowski Mark S. , Thomas David L. , Mehta Shruti H. , Chaisson Richard E. , Moore Richard D.
Published: August 2002

Hepatologists are frequently asked to evaluate human immunodeficiency virus (HIV)-infected patients with abnormal liver enzymes and to assess the causal role of medications, such as antiretroviral drugs. Recently, the use of HIV-1 specific non-nucleoside reverse transcriptase inhibitors (NNRTIs), including nevirapine (NVP) and efavirenz (EFV), has been associated with severe hepatic injury. We prospectively studied the incidence of severe hepatotoxicity (grade 3 or 4 change in alanine or aspartate transaminase levels) among 568 patients receiving NNRTI-containing antiretroviral therapy, including 312 and 256 patients prescribed EFV and NVP, respectively. Hepatitis C virus (HCV) and hepatitis B virus (HBV) were detected in 43% and 7.7% of patients, respectively. Severe hepatotoxicity was observed in 15.6% of patients prescribed NVP and 8.0% of those prescribed EFV, but only 32% of NVP and 50% of EFV-associated episodes were detected during the first 12-weeks of therapy. The risk was significantly greater among persons with chronic viral hepatitis (69% of cases) and those prescribed concurrent protease inhibitors (PIs) (82% of cases). Nonetheless, 84% of patients with chronic HCV or HBV did not experience severe hepatotoxicity. Severe hepatotoxicity occurs throughout the course of NNRTI therapy and is more common among patients prescribed nevirapine, those coinfected with HCV or HBV, and those coadministered protease inhibitors.
Hyperdynamic circulation in portal-hypertensive rats is dependent on central c-fos gene expression
Authors: Song Daisheng , Liu Hongqun , Sharkey Keith A. , Lee Samuel S.
Published: August 2002

Portal hypertension is associated with hyperdynamic circulation, but the pathogenesis remains unclear. To clarify the role of central cardiovascular regulatory mechanisms, several protocols were conducted in rats with portal hypertension due to portal vein stenosis (PVS). Neuronal activation was quantified by immunohistochemical staining for Fos, the protein product of the c-fos gene. Fos expression in several brain nuclei with cardiovascular-regulatory roles was examined at 1, 3, 5, and 10 days following PVS surgery. This was correlated with development of cardiovascular changes measured at the same time points. Finally, Fos expression in the nucleus tractus solitarius (NTS) was blocked by local microinjection of c-fos antisense oligonucleotides twice daily for 5 days following PVS. The results showed that Fos-positive neurons were significantly increased in the paraventricular nucleus of hypothalamus, supraoptic nucleus, ventrolateral medulla, and NTS, detectable at day 1 and persistently increased at every day examined in the PVS rats. However, the hyperdynamic circulation developed between days 3 to 5. Administration of c-fos antisense oligonucleotides eliminated the hyperdynamic circulation in PVS rats, but had no effect on sham-operated controls. We conclude that the activation of central cardiovascular-regulatory nuclei, through a c-fos-dependent pathway, is necessary for development of hyperdynamic circulation in portal-hypertensive rats.