bluuebunny/crossref_metadata_2025 huggingface dataset:
Autopoiesis, agency and accident: criteria for the attribution of life
Authors: Cameron W.
Published: August 2002

‘Life’ is manifest in autonomous being in a contingent world and ‘natural life’ is life that has developed autonomously in that its becoming has not depended on prior agency. Autonomous being requires the capacity of autopoiesis and the maintenance of autonomous being in a contingent world requires the capacity of intentional agency. Also, autonomous and diverse becoming requires the capacities of accidental creation and reproductive evolution in an environment of contingent events. These capacities may be explained in theories of functional organization, each of which may be variously realized in the physical domain. Copyright © 2001 John Wiley & Sons, Ltd.
Role of endorectal ultrasound in the conservative management of rectal cancers
Authors: Kim Hong Jin , Wong W. Douglas
Published: August 2002

Endorectal ultrasonography (ERUS) extends the ability of the clinician to define the clinical features assessed on routine physical examination, and remains the best modality for accurately staging depth of penetration and presumptive nodal status in rectal cancers. The success of conservative management of rectal cancers is predicated on proper patient selection. The preoperative selection of the ideal patient for local therapies can be difficult, and the decision‐making process takes into account many critical factors. Careful assessment of the T and N stages is critical in determining the success of conservative therapies, and directing treatment algorithms. Local resections with curative intent are limited to patients with T1N0 rectal cancers, and select patients with T2N0 tumors with favorable pathological criteria. Conservative management may also be extended to patients identified with significant underlying comorbid conditions staged preoperatively with unfavorable T2/T3 lesions, often combined with adjuvant therapies in a palliative setting. In addition, ERUS may have a role in the selection of those patients with more advanced lesions to neoadjuvant chemoradiation, followed by radical resection. Though not clearly defined, ERUS is evolving in its role in the postoperative follow‐up of patients treated conservatively for rectal cancers, and can lead to the early detection of local recurrences. The widespread use of ERUS remains limited due to high operator variability and errors in interpretation; however, the role of ERUS in the postoperative management of rectal cancers is evolving and requires further evaluation. Semin. Surg. Oncol. 19:358–366, 2000. © 2000 Wiley‐Liss, Inc.
Unit and integration testing strategies for C programs using mutation
Authors: Vincenzi A. M. R. , Maldonado J. C. , Barbosa E. F. , Delamaro M. E.
Published: August 2002

Mutation testing, originally proposed for unit testing, has been extended to integration testing with the proposition of the Interface Mutation criterion. This paper presents the results of an experiment using two mutation‐based testing criteria for unit and integration testing phases: the Mutation Analysis and the Interface Mutation adequacy criteria, respectively. The aim is to investigate how they can be used in a complementary way during the testing activity, establishing an incremental testing strategy comprising the unit and integration testing phases and guidelines on how to obtain a high mutation score with respect to mutation testing with a low cost, in terms of the number of mutants generated. Copyright © 2001 John Wiley & Sons, Ltd.
In vivo microdialysis and conditioned place preference studies in rats are consistent with abuse potential of tramadol
Authors: Sprague Jon E. , Leifheit Michael , Selken Jennifer , Milks Michael M. , Kinder David H. , Nichols David E.
Published: August 2002

The abuse potential of tramadol was investigated using both in vivo microdialysis measures of dopamine (DA) release within the nucleus accumbens (NAc) shell and the conditioned place preference (CPP) paradigm in rats. Tramadol (75 mg/kg, i.p.) induced a statistically significant increase (starting 80 min posttreatment) in DA release within the NAc shell, which was maintained for at least 120 min posttreatment. Tramadol (18.75, 37.5, and 75 mg/kg i.p.) produced a statistically significant CPP, with the effects of the two highest doses comparable to those induced by morphine (5 mg/kg, s.c.). The release of DA within the NAc shell may be responsible for the rewarding properties of tramadol and, together with the CPP results, provide evidence that tramadol may possess greater abuse potential than originally believed. Synapse 43:118–121, 2002. © 2001 Wiley‐Liss, Inc.
Learning to teach science in urban schools
Authors: Tobin Kenneth , Roth Wolff‐Michael , Zimmermann Andrea
Published: August 2002

Teaching in urban schools, with their problems of violence, lack of resources, and inadequate funding, is difficult. It is even more difficult to learn to teach in urban schools. Yet learning in those locations where one will subsequently be working has been shown to be the best preparation for teaching. In this article we propose coteaching as a viable model for teacher preparation and the professional development of urban science teachers. Coteaching—working at the elbow of someone else—allows new teachers to experience appropriate and timely action by providing them with shared experiences that become the topic of their professional conversations with other coteachers (including peers, the cooperating teacher, university supervisors, and high school students). This article also includes an ethnography describing the experiences of a new teacher who had been assigned to an urban high school as field experience, during which she enacted a curriculum that was culturally relevant to her African American students, acknowledged their minority status with respect to science, and enabled them to pursue the school district standards. Even though coteaching enables learning to teach and curricula reform, we raise doubts about whether our approaches to teacher education and enacting science curricula are hegemonic and oppressive to the students we seek to emancipate through education. © 2001 John Wiley & Sons, Inc. J Res Sci Teach 38: 941–964, 2001
Recurrent cleft lip and palate in siblings of a patient with malabsorption syndrome, probably caused by hypovitaminosis a associated with folic acid and vitamin B2 deficiencies
Authors: Faron Gilles , Drouin Régen , Pedneault Lyne , Poulin Louis‐Denis , Laframboise Rachel , Garrido‐Russo Maria , Fraser William Donald
Published: August 2002

We present a woman with metabolic disorders secondary to malabsorption and renal disease who gave birth to a stillborn male fetus with left unilateral cleft lip and palate and a live born infant with left unilateral cleft lip and palate. We discuss potential cofactors that could be implicated in the abnormal embryonic process. Teratology 63:161–163, 2001. © 2001 Wiley‐Liss, Inc.
Increased cell death in the developing vestibulocochlear ganglion complex of the mouse after prenatal ethanol exposure
Authors: Du Xiaoping , Hamre Kristin M.
Published: August 2002

Background

Previous studies have demonstrated that excessive prenatal alcohol exposure can damage the auditory and vestibular systems, in particular, cochlear hair cells. However, the direct effect of ethanol on the peripheral neurons in these pathways has not been examined. To study the effects of prenatal ethanol exposure on the developing vestibulocochlear ganglion (VCG) complex and the peripheral sensory organs, we exposed pregnant mice to ethanol and examined the levels of cell death in the inner ear.

Methods

Pregnant C57BL/6J mice were administered one of three doses of either ethanol (3.0, 4.5, and 5.5 g/kg) or isocaloric maltose/dextrin via intragastric intubation on gestational day (GD) 12.5. Embryos were dissected out of the uterus 8 hr after the intubation. Dying cells in the inner ear were stained with Nissl stain and labeled by in situ terminal dUTP nick‐end labeling (TUNEL), and the percentage of dying cells was quantified.

Results

Ethanol exposure produced region‐specific effects, with ethanol‐exposed embryos exhibiting enhanced cell death only in the VCG complex, and not in the primitive saccule, cochlea, semicircular canal, or endolymphatic sac. The effects of ethanol on cell death in the VCG are dose dependent, with a significant increase in the level of cell death found only at the higher doses.

Conclusions

Ethanol has a selective cytotoxic dose‐dependent effect on the VCG at GD 12.5 suggesting that loss of VCG neurons may contribute to hearing and /or vestibular abnormalities in FAS children. Furthermore, the presence of TUNEL‐positive cells and DNA laddering is consistent with the cells undergoing apoptotic cell death. Teratology 64:301–310, 2001. © 2001 Wiley‐Liss, Inc.
Reproductive potential of crimson‐spotted rainbowfish (Melanotaenia fluviatilis) following short‐term exposure to bass strait crude oil and dispersed crude oil
Authors: Pollino Carmel A. , Holdway Douglas A.
Published: August 2002

An examination of the potential of crude oil and mixtures of dispersants and crude oil to act as reproductive toxicants is reported in this article. The short‐term effects of a water‐accommodated fraction of crude oil (WAF) and a dispersed crude oil water‐accommodated fraction (DCWAF) on selected reproductive end points were measured by conducting 3‐day exposures to the crimson‐spotted rainbowfish (Melanotaenia fluviatilis). Exposures were followed by 14‐day depuration periods to determine the ability of fish to recover from the exposure. There were no changes to egg production, hatchability, or larval lengths for the WAF and DCWAF test periods. There were no changes to plasma estradiol or testosterone concentrations, gonadosomatic indices, or histopathological organization of gonad tissues after the exposure and depuration periods for both WAF and DCWAF. As reproductive parameters were not altered after 3 days of exposure and 14 days of depuration, crimson‐spotted rainbowfish were able to endure short‐term exposures to crude oil and dispersed crude oil. © 2002 Wiley Periodicals, Inc. Environ Toxicol 17: 138–145, 2002; Published online in Wiley InterScience (www.interscience.wiley.com). DOI 10.1002/tox.10043
A colorimetric protein phosphatase inhibition assay for the determination of cyanobacterial peptide hepatotoxins based on the dephosphorylation of phosvitin by recombinant protein phosphatase 1
Authors: Heresztyn Tamila , Nicholson Brenton C.
Published: August 2002

A colorimetric protein phosphatase inhibition assay based on the dephosphorylation of phosvitin by recombinant protein phosphatase 1 was developed for analysis of waters for cyanobacterial hepatotoxins. The phosphate released in the assay was determined using a malachite green reagent. Good agreement with toxin concentrations determined by HPLC was obtained. The assay was capable of determining these toxins at concentrations around 1 μg/L with high precision and without sample concentration. This is of considerable benefit as the World Health Organisation specifies a provisional guideline of 1 μg/L for microcystin‐LR. There was evidence, however, that the sample matrix might affect quantification, leading to false positive results. Thus the assay should be viewed as a screening procedure, and confirmatory analyses by an alternative procedure should be carried out for positive results. Further work is required to resolve the question of matrix interferences if phosphatase inhibition assays are used directly for measuring toxin levels in water, especially if this information is used to check compliance with water quality guidelines. © 2001 John Wiley & Sons, Inc. Environ Toxicol 16: 242–252, 2001
Graded mode of transcriptional induction in yeast pheromone signalling revealed by single‐cell analysis
Authors: Poritz Mark A. , Malmstrom Sharon , Kim Marianne K.‐H. , Rossmeissl Peter J. , Kamb Alexander
Published: August 2002

Signalling pathways typically convert a graded, analogue signal into a binary cellular output. In the several eukaryotic systems that have been investigated to date, including MAP kinase cascade activation in Xenopus oocytes, analogue‐to‐digital conversion occurs at points in the pathway between receptor activation and the effector mechanism. We used flow cytometry combined with an intracellular fluorescent reporter to examine the characteristics of the yeast pheromone‐response pathway. Surprisingly, pheromone response in yeast, which relies on the MAP kinase cascade, behaved in a fundamentally graded manner. Expression of certain exogenous dominant inhibitors of the pathway converted the response to graded‐or‐none behaviour. These results have implications for the dissection of biological response mechanisms in cells and illustrate how signalling pathways, even homologous ones, may have strikingly different signal propagation/amplification characteristics. Copyright © 2001 John Wiley & Sons, Ltd.
Functional analysis of structural genes for NAD+‐dependent formate dehydrogenase in Saccharomyces cerevisiae
Authors: Overkamp Karin M. , Kötter Peter , van der Hoek Richard , Schoondermark‐Stolk Sung , Luttik Marijke A. H. , van Dijken Johannes P. , Pronk Jack T.
Published: August 2002

Co‐consumption of formate by aerobic, glucose‐limited chemostat cultures of Saccharomyces cerevisiae CEN.PK 113‐7D led to an increased biomass yield relative to cultures grown on glucose as the sole carbon and energy substrate. In this respect, this strain differed from two previously investigated S. cerevisiae strains, in which formate oxidation did not lead to an increased biomass yield on glucose. Enzyme assays confirmed the presence of a formate‐inducible, cytosolic and NAD+‐dependent formate dehydrogenase. To investigate whether this enzyme activity was entirely encoded by the previously reported FDH1 gene, an fdh1Δ null mutant was constructed. This mutant strain still contained formate dehydrogenase activity and remained capable of co‐consumption of formate. The formate dehydrogenase activity in the mutant was demonstrated to be encoded by a second structural gene for formate dehydrogenase (FDH2) in S. cerevisiae CEN.PK 113‐7D. FDH2 was highly homologous to FDH1 and consisted of a fusion of two open reading frames (ORFs) (YPL275w and YPL276w) reported in the S. cerevisiae genome databases. Sequence analysis confirmed that, in the database genetic background, the presence of two single‐nucleotide differences led to two truncated ORFs rather than the full‐length FDH2 gene present in strain CEN.PK 113‐7D. In the latter strain background an fdh1Δfdh2Δ double mutant lacked formate dehydrogenase activity and was unable to co‐consume formate. Absence of formate dehydrogenase activity did not affect growth on glucose as sole carbon source, but led to a reduced biomass yield on glucose–formate mixtures. These findings are consistent with a role of formate dehydrogenase in the detoxification of exogenous formate. Copyright © 2002 John Wiley & Sons, Ltd.
Use of local North Carolina browse species to supplement the diet of a captive colony of folivorous primates (Propithecus sp.)
Authors: Campbell Jennifer L. , Glenn Kelly M. , Grossi Brian , Eisemann Joan H.
Published: August 2002

The nutrient content and intake of locally available North Carolina browse was evaluated for use as a supplement to a herbivorous primate diet of commercial biscuit and produce. Twice weekly from May to October 1997, total dietary intakes were determined for two groups of folivorous lemurs. Group I consisted of Propithecus diadema diadema (n = 1) and P. tattersalli (n = 1) and group II consisted of P. verreauxi coquereli (n = 3). Six pooled samples of the diet and weekly samples of three browse species, Rhus copallina, Albizia julibrissin, and Liquidamber styrachiflua were analyzed for dry matter, energy, fiber, and nitrogen content. Browse species were also analyzed for nonprotein nitrogen and acid‐insoluble nitrogen. Group average dry matter intakes were 37.1 ± 2.2% (mean ± SEM) and 49.7 ± 3.0% of amount offered for groups I and II, respectively. Browse contributed 40.7 ± 2.9% and 29.6 ± 2.4% of the total daily intake for groups I and II, respectively. Browse species differed (P < 0.05) for dry matter, energy, neutral detergent fiber, acid detergent fiber, cellulose, lignin, total nitrogen, nonprotein nitrogen, available nitrogen, and available protein. R. copallina and L. styrachiflua were similar in total nitrogen, available nitrogen, and nonprotein nitrogen; A. julibrissin was higher. L. styrachiflua was highest in lignin. Dry matter, acid detergent fiber, and lignin in browse samples increased seasonally (P < 0.05), whereas available protein decreased (P < 0.01). Animals were offered and consumed R. copallina most often, followed by A. julibrisson and L. styrachiflua. With the exception of R. copallina, animals generally consumed only the immature leaves, flowers, or seeds of species offered. Daily dry matter intake varied because of both browse offered and consumed and biscuit and produce diet consumed. Thus, increased fiber density can be a major benefit of browse use only when incorporated into the total diet with respect to species use, quantity of other diet ingredients offered, and targeted nutrient intakes. Zoo Biol 20:447–461, 2001. © 2002 Wiley‐Liss, Inc.
The optimal constant in Wente's $L^∞$ estimate
Authors: Topping Peter
Published: August 2002

We explore some geometric aspects of compensation compactness associated to Jacobian determinants. We provide the optimal constant in Wente's inequality - the original motivation of this work - and go on to give various extensions to geometric situations. In fact we improve Wente's inequality somewhat, making it more appropriate for applications in which optimal results are required. This is demonstrated when we prove an optimal inequality for immersed surfaces of constant mean curvature in

\Bbb {R}^3

, contolling their diameter in terms of their area and curvature.
Sur les feuilletages algébriques de Rolle
Authors: Chazal F.
Published: August 2002

L'objet de ce travail est l'étude des feuilletages algébriques de Rolle dans

\Bbb {R}^n

. On montre que leur restriction au complémentaire d'un nombre fini de feuilles possède une structure de produit. On précise aussi la topologie de certaines de leurs feuilles.
Moduli of quadrilaterals and extremal quasiconformal extensions of quasisymmetric functions
Authors: Wu S.
Published: August 2002

We establish a relationship between Strebel boundary dilatation of a quasisymmetric function of the unit circle and indicated by the change in the module of the quadrilaterals with vertices on the circle. By using general theory of universal Teichmüller space, we show that there are many quasisymmetric functions of the circle have the property that the smallest dilatation for a quasiconformal extension of a quasisymmetric function of the unit circle is larger than indicated by the change in the module of quadrilaterals with vertices on the circle.
A classification of solutions of a conformally invariant fourth order equation in $\mathbf{R}^n$
Authors: Lin C.-S.
Published: August 2002

In this paper, we consider the following conformally invariant equations of fourth order

\begin{cases} \Delta^2 u = 6 e^{4u} & \text{in } \mathbf {R}^4, \cr e^{4u} \in L^1(\mathbf {R}^4), \end{cases} \qquad (1)

and

\begin{cases} \Delta^2 u = u^{n+4 \over n-4}, \cr u>0 \quad \text{in } {\mathbf R}^n \quad \text{for } n \ge5 , \cr \end{cases} \quad (2)

where

\Delta^2

denotes the biharmonic operator in

\mathbf{R}^n

. By employing the method of moving planes, we are able to prove that all positive solutions of (2) are arised from the smooth conformal metrics on

S^n

by the stereograph projection. For equation (1), we prove a necessary and sufficient condition for solutions obtained from the smooth conformal metrics on

S^4

.
The structure of branching in Anosov flows of 3-manifolds
Authors: Fenley S. R.
Published: August 2002

In this article we study the topology of Anosov flows in 3-manifolds. Specifically we consider the lifts to the universal cover of the stable and unstable foliations and analyze the leaf spaces of these foliations. We completely determine the structure of the non Hausdorff points in these leaf spaces. There are many consequences: (1) when the leaf spaces are non Hausdorff, there are closed orbits in the manifold which are freely homotopic, (2) suspension Anosov flows are, up to topological conjugacy, the only Anosov flows without free homotopies between closed orbits, (3) when there are infinitely many stable leaves (in the universal cover) which are non separated from each other, then we produce a torus in the manifold which is transverse to the Anosov flow and therefore is incompressible, (4) we produce non Hausdorff examples in hyperbolic manifolds and derive important properties of the limit sets of the stable/unstable leaves in the universal cover.
p-universal spaces and rational homotopy types
Authors: Body R. , Mimura M. , Shiga Hiroo , Sullivan Dennis
Published: August 2002

We prove that the p-universality of a space does not depend on a prime p but only on its rational homotopy type. The minimal model of such a rational homotopy type is characterized by the existence of the trivial endomorphism in the closure of its automorphism group.
Geodesic foliations in Lorentz 3-manifolds
Authors: Zeghib A.
Published: August 2002

We study geodesic foliations on manifolds endowed with Lorentz metrics. The (local) theory works formally exactly as in the Riemannian case, if the induced metric on the leaves is non-degenerate. We consider here some local and global properties in the degenerate case
Covering degrees are determined by graph manifolds involved
Authors: Wang Shicheng , Yu F.
Published: August 2002

W.Thurston raised the following question in 1976: Suppose that a compact 3-manifold M is not covered by (surface)

\times S^1

or a torus bundle over

S^1

. If

M_1

and

M_2

are two homeomorphic finite covering spaces of M, do they have the same covering degree? For so called geometric 3-manifolds (a famous conjecture is that all compact orientable 3-manifolds are geometric), it is known that the answer is affirmative if M is not a non-trivial graph manifold. In this paper, we prove that the answer for non-trivial graph manifolds is also affirmative. Hence the answer for the Thurston's question is complete for geometric 3-manifolds. Some properties of 3-manifold groups are also derived.
Open manifolds with nonnegative Ricci curvature and large volume growth
Authors: Xia Changyu
Published: August 2002

In this paper, we study complete open n-dimensional Riemannian manifolds with nonnegative Ricci curvature and large volume growth. We prove among other things that such a manifold is diffeomorphic to a Euclidean n-space

R^n

if its sectional curvature is bounded from below and the volume growth of geodesic balls around some point is not too far from that of the balls in

R^n

.
On the equivariant structure of ideals in abelian extensions of local fields (with an appendix by W. Bley)
Authors: Burns David
Published: August 2002

Let p be an odd rational prime and K a finite extension of

{\Bbb Q}_p

. We give a complete classification of those finite abelian extensions

L/K

in which any ideal of the valuation ring of L is free over its associated order in

{\Bbb Q}_p[Gal(L/K)]

. In an appendix W. Bley describes an algorithm which can be used to determine the structure of Galois stable ideals in abelian extensions of number fields. The algorithm is applied to give several new and interesting examples.
Asymptotic degeneration of representations of quivers
Authors: Strassen V.
Published: August 2002

We define asymptotic degeneration of nilpotent representations of an arbitrary finite quiver, using large tensor powers and small direct sums, and characterize this notion by a simple and effective criterion.
Testing Algebraic Data Types and Processes: A Unifying Theory
Authors: Gaudel Marie-Claude , James Perry R.
Published: August 2002

There is now a lot of interest in program testing based on formal specifications. However, most the works in this area focus on one formalized aspect of the software under test. For instance, some previous works of the first author consider abstract data type specifications. Other works are based on behavioural descriptions, such as finite state machines or finite labelled transition systems. This paper begins by brie y recalling the principles of test data selection from algebraic data types specifications. Then, it transposes them to basic and full LOTOS. Finally it exploits this uniform framework and suggests a new integrated approach to test derivation from full LOTOS specifications, where both behavioural properties and data types properties are taken into account when dealing with processes.
A clinical and radiographic comparison of absorbable and non‐absorbable suture anchors in open shoulder stabilisation
Authors: Ejerhed Lars , Kartus Jüri , Funck Eduard , Köhler Kristina , Sernert Ninni , Karlsson Jon
Published: August 2002

The aim of this study was to compare the clinical and radiographic results using either absorbable or non‐absorbable suture anchors in patients with recurrent unidirectional, post‐traumatic shoulder dislocations. All patients had a Bankart lesion. One surgeon operated on 33 consecutive patients, 27 males and six females. Group A comprised 15 shoulders and group B 18 shoulders, all of which underwent a standardised open Bankart reconstruction using 3.7‐mm TAG suture anchors. In group A, absorbable anchors were used, while in group B, non‐absorbable ones were used. There was one re‐dislocation in each group. In group A, the Rowe and Constant scores were 89 (69–98) and 89 (76–99) points, respectively. The corresponding values in group B were 87 (44–98) (not significant; NS) and 90 (71–100) points (NS). The strength measurements revealed 8.1 (3.8–12.3) kg in 90° abduction in group A and 10.0 (6.7–12.0) kg in group B. Healthy control shoulders revealed 10.2 (4.5–13.2) kg (NS A and B versus controls). The external rotation in abduction was 70° (40–90) in group A and 80° (40–100) in group B. The value for the controls was 90° (80–120) [P<0.001 (A versus controls),P<0.05 (A versus B) andP<0.001 (B versus controls)]. The radiographs revealed that 9/15 (60%) in group A and 10/15 (66%) in group B had visible drill holes or cystic formations in conjunction with the drill holes (NS). Furthermore, 11/15 (73%) in group A and 10/15 (66%) in group B had signs of minor degeneration (NS). We conclude that, in terms of stability and clinical results, no differences were found between the study groups. Both groups demonstrated a restriction in external rotation as compared with the healthy shoulders in the same cohort. On the radiographs, visible drill holes or cystic formations in conjunction with the drill holes were seen with equal frequency, regardless of whether absorbable or non‐absorbable suture anchors were used.
Abnormal bone scans of the tibial tunnel 2 years after patella ligament anterior cruciate ligament reconstruction: correlation with tunnel enlargement and tibial graft length
Authors: Hogervorst T. , van der Hart C.P. , Pels Rijcken T.H. , Taconis W.K.
Published: August 2002

Tibial bone tunnels were examined with bone scans 2 years after patella ligament ACL reconstruction in 68 patients. At 2 years, scan uptake at the tibial tunnel was increased in 29% of patients. Marked increase of scintigraphic uptake was associated with tibial tunnel enlargement of more than 35% and a graft length in the tibial tunnel over 14 mm. Scan uptake was correlated to tunnel enlargement (r=0,64, P<0.01) and tunnel enlargement was correlated to graft length inside the tibial tunnel (r=0,59P<0,001). No correlation was found between scan uptake or tunnel enlargement and anterior laxity, sagittal tunnel position and subjective outcome. Scintigraphy indicates the enlarged tibial tunnels are filled with remodelling bone. Tibial fixation location influences ligament healing inside the tunnel: Return of osseous homeostasis at the tibial tunnel can take more than 2 years when fixation is more than 14 mm below the joint.
One‐stage Surgical Management of Concomitant Abdominal Aortic Aneurysm and Gastric or Colorectal Cancer
Authors: Matsumoto Kenji , Murayama Takaya , Nagasaki Kazuhito , Osumi Koji , Tanaka Katsunori , Nakamaru Makoto , Kitajima Masaki
Published: August 2002

One‐stage surgical management of concomitant abdominal aortic aneurysm (AAA) and gastric or colorectal cancer should provide certain benefits. We reviewed the records of 21
patients with both AAA and gastric or colorectal cancer who underwent one‐stage surgical management. Four had distal gastrectomy, 2 had total gastrectomy, and 5 had abdominoperineal rectal resection transperitoneally; 3 had total gastrectomy transperitoneally and AAA repair extraperitoneally. Two underwent right hemicolectomy and thromboexclusion of the AAA. Two had creation of a temporary ileostomy and implantation of an interposition graft. Two underwent left hemicolectomy, creation of a temporary transversostomy, and implantation of an interposition graft. One had a Hartmann’s procedure and implantation of a bifurcated prosthetic interposition graft for AAA. There were no operative deaths or serious postoperative complications. One patient had colorectal ischemia that resolved with conservative treatment. Eighteen of the 21 patients (85.7%) were alive
10 months to 14 years postoperatively. In conclusion, one‐stage surgical treatment of concomitant AAA and gastric or colorectal cancer is well tolerated and can avoid the time, financial costs, and patient anxiety involved in a second operation.
Double Role of HLA in Organ Transplantation
Authors: van Rood Jon J.
Published: August 2002

Although HLA matching can improve organ graft survival, well matched grafts fail and poorly matched ones survive. Recently evidence has been found that perinatal exposure to noninherited antigens (NIMAs) has a lifelong impact on the immune repertoire of the individual. The state of the art of the influence of NIMAs on graft survival is summarized. These findings could lead to a better understanding of the allograft reaction.
Endoscopic Management of Polypoid Early Colon Cancer
Authors: Williams Christopher B. , Saunders Brian P. , Talbot Ian C.
Published: August 2002

Endoscopic management of polypoid early colonic cancer (malignant polyps and polypoid carcinomas) is no longer controversial. When the endoscopist is satisfied that excision is complete and histology is "favorable" (a resection margin of 2 mm and well or moderately well differentiated tumor), surgery is unnecessary. When histology shows "unfavorable" characteristics (which a few histologists still take to include invasion into lymphatics), surgical or laparoscopic resection may be indicated, providing the patient is considered at suitable risk. Surgery kills some patients without finding residual cancer and cannot save others with metastases, so it should be recommended only with due clinical consideration. Sessile or broad‐based polyps, especially those in the rectum, are more likely to be "high risk" and merit specialist management if local removal is to be attempted and to allow proper histologic assessment. Endoscopic approaches such as saline injection polypectomy, india‐ink tattooing, and use of the argon beam coagulator are applicable in some cases. New approaches that still require trials include ultrasonographic probes, which occasionally clarify the degree of invasion, and prototype stapling devices to allow full‐thickness histologic specimens to be obtained.
Multivariate Analysis of Risk Factors for Postoperative Complications in Benign Goiter Surgery: Prospective Multicenter Study in Germany
Authors: Thomusch Oliver , Machens Andreas , Sekulla Carsten , Ukkat Jörg , Lippert Hans , Gastinger Ingo , Dralle Henning
Published: August 2002

Risk factors for postoperative complications of benign goiter surgery have not been investigated systematically. To this end, a prospective multicenter study (January 1 through December 31, 1998) was conducted involving 7266 patients with surgery for benign goiter from 45 East German hospitals. High‐volume providers (>150 operations per year) performed 69% (5042/7266), intermediate‐volume providers 27% (50–150), and low‐volume providers 4% (258/7266) of operations. Among the hospital groups, the pattern of thyroid disease did not vary significantly, but there was a trend that small‐volume providers tended to perform more operations for uninodular goiter and high‐volume providers treated more patients with Graves' disease and recurrent goiter. Extent of resection (p < 0.0001) and remnant size (multinodular goiter and recurrent goiter, p < 0.001), differed significantly, with total thyroidectomy being performed more often in hospitals with more than 150 operations compared to hospitals with an operative volume of less than 150 procedures per year. Despite the larger extent of resection and smaller remnant size, rates of recurrent laryngeal nerve (RLN) palsy or hypoparathyroidism were not increased. When the logistic regression analyses were fitted to evaluate the impact of risk factors on transient and permanent RLN palsy and hypoparathyroidism, larger extent of resection [relative risk (RR) 1.5–2.1] and recurrent goiter (RR 1.8–3.4) consistently evolved as independent risk factors. With hypoparathyroidism, additional significant factors included patient gender (RR 2.1–2.4), hospital operative volume (RR 0.8–1.5), and Graves' disease (RR 2.8). Unlike parathyroid gland identification during hypoparathyroidism, RLN identification (RR 1.6) significantly (p= 0.01) reduced permanent RLN palsy rates. The multivariate analyses clearly confirmed the pivotal role of routine RLN identification, independent of the extent of the thyroid resection. These findings might help hospitals with lower operative volumes to identify patients at increased risk whom they might consider for specialist care.
Catabolic Response to Stress and Injury: Implications for Regulation
Authors: Hasselgren Per‐Olof
Published: August 2002

Muscle catabolism is an important component of the metabolic response to stress and injury, including sepsis and burn injury. Muscle wasting and weakness in catabolic patients may adversely affect the outcome in these patients owing to delayed ambulation and involvement of respiratory muscles. An understanding of the regulation of muscle protein breakdown during sepsis and following injury therefore is of great importance from a clinical standpoint and is essential for the development of new therapeutic modalities to prevent protein loss from muscle tissue. Studies in experimental animals and in patients have provided evidence that the myofibrillar proteins actin and myosin are particularly sensitive to the effects of sepsis and injury. Glucocorticoids, interleukin‐1, and tumor necrosis factor participate in the regulation of muscle protein breakdown. Most muscle proteins are degraded by the ubiquitin—proteasome‐dependent proteolytic pathway. Because the proteasome does not degrade intact myofibrils, a calcium‐dependent Z‐band disintegration and release of myofilaments from the myofibrils may be an important initial step of muscle breakdown during sepsis and other catabolic conditions. Continued studies to define mechanisms of the catabolic response to stress and injury are important for improving the metabolic care of patients with muscle catabolism.
Place of Video‐thoracoscopy in Thoracic Surgical Practice
Authors: Yim Anthony P.C. , Lee Tak Wai , Izzat Mohammad Bashar , Wan Song
Published: August 2002

The advent of video‐endoscopy revolutionizes the practice of surgery. Within a short span of time, video‐assisted thoracic surgery (VATS) has become an acceptable approach to a wide range of thoracic procedures. The use of VATS as a diagnostic modality is now well established. For therapeutic procedures, VATS has also been generally accepted for the treatment of such conditions as primary spontaneous pneumothorax, loculated effusions, thoracodorsal sympathectomy, and resection of simple mediastinal cysts. Its roles in more complex procedures such as thymectomy and anatomic lung resections, however, remain poorly defined at present, even though the existing intermediate‐term results are encouraging. VATS is still in evolution. Miniaturization of instruments promises to reduce access‐induced trauma even further. On the other hand, attention to cost‐containment is essential if VATS is to be applicable to patients in developing countries. Technology will continue to change. Carefully conducted clinical trials should precede the general acceptance of any new technology, no matter how attractive it may appear initially.
Pulmonary and Thymic Carcinoid Tumors
Authors: Dusmet Michael E. , McKneally Martin F.
Published: August 2002

Carcinoid tumors of the lung and bronchi are usually benign lesions with no influence on life expectancy, although occasionally, they are malignant with a poor prognosis. Between these two extremes are atypical carcinoids, which can be slow‐growing tumors with an average 5‐year survival of 60% and an average 10‐year survival of 40%. The myriad names used to describe these lesions complicates the understanding of their behavior, especially as the term carcinoid is used to describe the complete spectrum of disease or exclusively the benign well differentiated lesions with an excellent prognosis. Thymic carcinoids are uncommon lesions. Their prognosis is poor, even in cases that appear favorable in terms of resectability and histology. Pulmonary carcinoids present uncommonly with a paraneoplasic syndrome. Both carcinoid and Cushing syndromes are seen with approximately 2% of these lesions. Cushing syndrome can be present in as many as one‐third of patients with thymic carcinoids but an association with the carcinoid syndrome has never been described.
Primary Hyperparathyroidism in Multiple Endocrine Neoplasia Type IIa: Retrospective French Multicentric Study
Authors: Kraimps Jean‐Louis , Denizot Anne , Carnaille Bruno , Henry Jean‐François , Proye Charles , Bacourt François , Sarfati Emile , Dupond Jean‐Louis , Maes Brigitte , Travagli Jean‐Paul , Boneu Andrée , Roger Patrick , Houdent Chantal , Barbier Jacques , Modigliani Elisabeth ,   Groupe d’Etude des Tumeurs á Calcitonine (GETCroup) Surgeons
Published: August 2002

Primary hyperparathyroidism (PHPT) in multiple endocrine neoplasia (MEN) type IIa is rare, occurring in 20% to 30% of the patients. The aim of this study was to evaluate clinical findings, surgical therapy, and outcome for 56 patients affected by PHPT among 249 MEN‐IIa patients collected from 84 families assembled by the Groupe d’Etude des Tumeurs á Calcitonine (GETC, French Calcitonin Tumors Study Group). This retrospective study was based on cases registered by the GETC (20 participating centers) from 1969 to 1994. Characteristics of PHPT in 56 patients (31 women, 25 men) with MEN‐IIa were reviewed. All but two underwent cervicotomy. The median age at diagnosis was 37.6 years. PHPT was found concomitantly with medullary thyroid carcinoma (MTC) or pheochromocytoma in 43 patients (77%). PHPT was asymptomatic in 68% of the patients. Serum calcium levels ranged from 2.20 to 3.70 mmol/L (median 2.82 mmol/L; normal 2.10–2.60 mmol/L). The number of parathyroid glands removed at surgery was 0 (n= 2), 1 (n= 24), 2 (n= 5), > 2 (n= 12), 4 (n= 11). Pathology (initial surgery) consisted of 24 adenomas, 4 double adenomas, and 25 hyperplasia. Cure after initial surgery was obtained in 89%, including a 22% incidence of hypoparathyroidism. There were 6 cases (11%) with persistent PHPT. With a mean follow‐up of 6.4 years, five patients (9%) had recurrent PHPT. The results indicate that MEN‐IIa‐related PHPT is generally associated with mild, often asymptomatic hypercalcemia. Despite recurrences encountered 5 to 15 years after the first cervicotomy, resection of only macroscopically enlarged glands generally appears sufficient. Subtotal or total parathyroidectomy with autotransplantation is associated with a high rate of hypoparathyroidism.
Clinical and Financial Aspects of Cholecystectomy: Laparoscopic Versus Open Technique
Authors: Stevens Hieronymus P.J.D. , van de Berg Marjan , Ruseler Coert H. , Wereldsma Jack C.J.
Published: August 2002

Clinical and financial aspects of laparoscopic (LC) (n= 119) and open (OC) (n= 117) cholecystectomy are compared in a retrospective study. The number and nature of perioperative complications do not differ importantly between these techniques. In favor of LC, significant differences are observed regarding the numbers of days severe pain was suffered (mean 1.7 days versus 5.4 days), the total number of days pain was suffered (mean 7.0 days versus 12.2 days), the number of postoperative days in hospital (mean 3.1 days versus 8.8 days), the extent of perioperative monitoring performed, and the number of days before patients could return to (every day) work (mean 12.8 days versus 34.8 days). In this study total charges for LC (hospital and professional charges) are significantly lower than the total charges for OC [means, in dutch guilders (DG) were 4425 for LC versus 9215 for OC; $1 US = 1.93 DG]. The difference is the result of fewer days of postoperative hospitalization and reduced perioperative screening for LC. Furthermore, hospital charges for LC in The Netherlands (DG 3655) are less expensive than average hospital charges reported so far (US $1894 compared to $4948). For the hospital itself, however, on an annual base LC might well be more expensive than OC because of a maximum quota‐annex‐budgetizing system installed by the government to keep national health care costs controllable and low. In conclusion, LC has clear advantages over OC in clinical, social, and financial respects. Unjustly, the hospital does not seem to gain financial benefit from this fact.
Acute pancreatitis: Nonsurgical management
Authors: Tenner Scott , Banks Peter A.
Published: August 2002

The care of patients with severe acute pancreatitis is complex. Although numerous medical therapies have been proposed, few interventions have been shown to be of benefit in patients with severe disease. This review summarizes the nonoperative management of patients with acute pancreatitis, including therapies shown to be of little value, the role of antibiotics in patients with acute pancreatitis, the importance of monitoring and supportive care, and the rationale of endoscopic and surgical intervention.
New Approach to Surgical Management of Early Esophageal Thoracic Perforation: Primary Suture Repair Reinforced with Absorbable Mesh and Fibrin Glue
Authors: Bardaxoglou E. , Manganas D. , Meunier B. , Landen S. , Maddern G.J. , Campion J.P. , Launois B.
Published: August 2002

Esophageal perforation is a life‐threatening situation and represents a major therapeutic challenge. Results have improved in recent years particularly as a result of progress in antibiotic therapy and the use of total parenteral nutrition. Surgical management retains a predominant role, involving early primary closure and thoracic drainage. We have made an addition to the surgical management by applying an absorbable mesh and fibrin glue to the repaired site. Seven patients (ages 38–79 years)
were treated as described. The mean interval from leak to surgery was
28 hours. Six patients had an uneventful postoperative course with a mean hospital stay of 34 days (range 26–45 days). In one case the technique failed and the patient required an exclusion‐diversion procedure. All 7 patients recovered without mortality. We believe that this technique provides a real improvement for this precarious esophageal repair.
Antibiotic Prophylaxis and Open Groin Hernia Repair
Authors: Taylor Eric W. , Byrne Derek J. , Leaper David J. , Karran Stephan J. , Browne M. Kennedy , Mitchell Kenneth J.
Published: August 2002

Antibiotic prophylaxis is not routinely given for nonimplant, clean operations, although this view has recently been challenged. We have conducted a randomized multicenter, double‐blind prospective trial to compare co‐amoxiclav with placebo in 619 patients undergoing open groin hernia repair. Altogether 563 (91%) patients fulfilled the protocol; 283 received co‐amoxiclav and 280 placebo. There was no difference between the groups in the number of patients receiving local or general anesthetic, the type of repair performed, the use of a subcutaneous fat suture, the type of skin closure used, the use of wound analgesia, or the use of a wound drain. Patients were given a card to return to the hospital in the event of their wound discharging or their needing to see their general practitioner. All patients were reviewed at approximately 6 weeks after operation. Fifty (8.9%) patients sustained a wound infection, 25 in the co‐amoxiclav group and 25 in the placebo group. We conclude that antibiotic prophylaxis is of no benefit to patients undergoing open groin hernia repair.
Portal Vein Thrombosis following Splenectomy for Hematologic Disease: Prospective Study with Doppler Color Flow Imaging
Authors: Chaffanjon Philippe C.J. , Brichon Pierre‐Yves , Ranchoup Yves , Gressin Remy , Sotto Jean Jacques
Published: August 2002

We report the results of a prospective series of 60 consecutive splenectomies for hematologic disorders performed between February 1995 and May 1996. The portal venous flow of all the patients (34 men and 26 women with a mean age of 54.1 years) was systematically studied before and after intervention with Doppler color imaging (on the day before the intervention and on the 7th and 30th postoperative days). The objective of this study were to determine the real frequency of asymptomatic portal or splenic venous thrombosis (PSVT) after hematologic splenectomy. The intervention began with exteriorization of the spleen and the tail of the pancreas; ligation of the splenic vein was performed close to its junction with the inferior mesenteric vein. Twenty‐three complications (38.3%) were noted with three deaths (5%). One symptomatic PSVT (1.6%) and three asymptomatic PSVTs (6.7%) were diagnosed and treated with no deaths. Three risk factors of PSVT, recognized by all the authors, were present in these four cases: large splenomegaly, thrombocytosis, or myeloproliferative disorder. The systematic ultrasonographic (US) examinations increased the frequency of diagnosis of PSVT sevenfold during the perioperative period. Patients with marked splenomegaly associated with lymphoma, chronic lymphocytic leukemia, or myeloid metaplasia probably require systematic US monitoring during follow‐up, but this must be determined by further study.
Altered Bile Composition in the Gallbladder and Common Bile Duct of Patients with Anomalous Pancreaticobiliary Ductal Junction
Authors: Sugiyama Yuzuru , Kobori Hiroyasu , Hakamada Kenichi , Seito Dai , Sasaki Mutsuo
Published: August 2002

The high incidence of biliary tract carcinoma in patients with anomalous pancreaticobiliary ductal junction (APBDJ) has been well documented. Elevation of the secondary and free bile acid (FBA) concentrations is considered a risk factor for biliary carcinogenesis in these patients. Bile from the gallbladder and common bile duct in 12 patients with APBDJ was analyzed and compared with gallbladder bile from 19 patients with gastric cancer and a normal hepatobiliary tract. The concentrations of secondary bile acids were significantly lower in the APBDJ group than in the control group, and FBA concentrations were not detected in the gallbladder in either group. The lysolecithin (LL) in the phospholipid, which is produced from lecithin by activated phospholipase A2 in refluxing pancreatic juice, was significantly elevated in the APBDJ group. Elevation of the LL concentration in the bile is one of the factors for the development of biliary tract carcinoma in patients with APBDJ.