bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy of Infliximab for the Treatment of Oral Manifestation of Crohn’s Disease
Authors: Aginbay Aibar , Khamzina Saule , Zhanasbayeva Marzhan , Kaliaskarova Kulpash , Batyrbekov Kanat , Kulkayeva Gulnara
Published: November 2022

Oral manifestations of IBD can be specific or nonspecific, due to intestinal malabsorption or induced by pharmacological treatments. Oral manifestations may precede the diagnosis of IBD or interfere with timely diagnosis and treatment. The paradigm of treatment for oral lesions in patients with IBD is based on treating and controlling the intestinal manifestations of the underlying disease as well as local methods of treatment can be used. Here, we report a case of a patient with the oral manifestation of IBD, who responded to treatment with infliximab. The patient was admitted with complaints of long-term nonhealing ulcers of the lips and oral cavity, odynophagia, and there were no intestinal manifestations at that time. The appearance of the disease in 2008 with lesions of the oral cavity, however, Crohn’s disease was diagnosed in 2016. The patient began therapy with azathioprine and prednisolone, and later developed hormone dependence and osteoporosis. In 2020, against the background of immunosuppressive therapy, the patient has an exacerbation, especially increased symptoms from the lesion of the oral cavity. In 2020 was started therapy with vedolizumab, with slight improvement. Due to the ineffectiveness of the latter’s therapy, therapy with monoclonal antibodies (infliximab) was started in February 2021. Currently, patient is in clinical, laboratory, and endoscopic remission.
Políticas públicas e redução da criminalidade: uma avaliação do Programa Pacto pela Vida do Estado de Pernambuco
Authors: Silveira Neto Raul da Mota , Ratton José Luiz , Menezes Tatiane Almeida de , Monteiro Circe Maria Gama
Published: November 2022

O objetivo do trabalho é avaliar o impacto do programa estadual Pacto pela Vida sobre as taxas de homicídio do Estado de Pernambuco. Implementado pelo governo do estado em 2007, o referido programa visa a redução dos níveis de violência no estado e tem foco específico as taxas de homicídio. A pesquisa utiliza Controles Sintéticos para obter contrafactuais para a taxa de homicídio do Estado e seus resultados indicam que o Pacto pela Vida foi bem sucedido em seu objetivo de redução da taxa de homicídio no período 2007-2014, mas deixa de ser eficaz nesta tarefa a partir de então.
Performance of the HAS‐BLED, ORBIT, and ATRIA Bleeding Risk Scores on a Cohort of 399 344 Hospitalized Patients With Atrial Fibrillation and Cancer: Data From the French National Hospital Discharge Database
Authors: Pastori Daniele , Marang Amélie , Bisson Arnaud , Herbert Julien , Lip Gregory Yoke Hong , Fauchier Laurent
Published: November 2022

Background

The association between cancer types and specific bleeding events in patients with atrial fibrillation has been scarcely investigated. Also, the performance of bleeding risk scores in this high‐risk subgroup of patients is unclear. We investigated the rate of any bleeding, intracranial hemorrhage, major bleeding, and gastrointestinal bleeding according to cancer types in patients with atrial fibrillation. We also tested the predictive value of HAS‐BLED, ATRIA, and ORBIT bleeding risk scores.

Methods and Results

Observational retrospective cohort study including hospitalized patients with atrial fibrillation and cancer from the French National Hospital Discharge Database (Programme de Medicalisation des Systemes d'Information) from January 2010 to December 2019. Major bleeding was defined according to Bleeding Academic Research Consortium definitions. Patients with HAS‐BLED ≥3, ATRIA ≥5, or ORBIT ≥4 were classified as at high bleeding risk. Receiver operating characteristic analysis for each score against any bleeding, major bleeding, gastrointestinal bleeding, and intracranial hemorrhage was performed. Areas under the curve (AUCs) were then compared. We included 399 344 patients. Mean age was 77.9±10.2 years, and 63.2% were men. The highest intracranial hemorrhage rates were found in leukemia (1.89%/year), myeloma (1.52%/year), lymphoma and liver (1.45%/year), and pancreas cancer (1.41%/year). Receiver operating characteristic analysis showed that ORBIT score predicted best for any bleeding. In addition, ORBIT score ≥4 had the highest predictivity for major bleeding (AUC, 0.805), followed by HAS‐BLED ≥3 and ATRIA ≥5 (AUCs, 0.716 and 0.700, respectively). HAS‐BLED and ORBIT performed best for intracranial hemorrhage (AUCs, 0.744 and 0.742 for continuous scores, respectively), better than ATRIA (AUC, 0.635). For gastrointestinal bleeding, ORBIT ≥4 had the highest predictivity (AUC, 0.756), followed by the HAS‐BLED ≥3 (AUC, 0.702) and ATRIA ≥5 (AUC, 0.662).

Conclusions

Some cancer types carry a greater bleeding risk in patients with atrial fibrillation. The identification and management of modifiable bleeding risk factors is crucial in these patients, as well as to flag up high bleeding risk patients for early review and follow‐up.
Impact of Marital Status on Management and Outcomes of Patients With Acute Myocardial Infarction: Insights From the China Acute Myocardial Infarction Registry
Authors: Wei Zhi‐Yao , Yang Jin‐Gang , Qian Hai‐Yan , Yang Yue‐Jin ,   for the China Acute Myocardial Infarction Registry Investigators
Published: November 2022

Background

Acute myocardial infarction (AMI) is one of the leading causes of mortality worldwide, whereas social support is a known predictor of the prognosis after AMI. As a common factor influencing social support, the impact of marital status on care quality, in‐hospital mortality, and long‐term prognosis of patients with AMI remains largely unknown.

Methods and Results

The present study analyzed data from the CAMI (China Acute Myocardial Infarction) registry involving 19 912 patients with AMI admitted at 108 hospitals in China between January 2013 and September 2014 and aimed to evaluate marital status–based differences in acute management, medical therapies, and short‐term and long‐term outcomes. The primary end point was 2‐year all‐cause death. The secondary end points included in‐hospital death and 2‐year major adverse cardiac and cerebrovascular events (a composite of all‐cause death, myocardial infarction, or stroke). After multivariable adjustment, 1210 (6.1%) unmarried patients received less reperfusion treatment in patients with both ST‐segment–elevation myocardial infarction and non–ST‐segment–elevation myocardial infarction (adjusted odds ratio [OR], 0.520 [95% CI, 0.437–0.618];
P
<0.0001; adjusted OR, 0.489 [95% CI, 0.364–0.656];
P
<0.0001). Being unmarried was not associated with poorer in‐hospital outcome but with long‐term all‐cause mortality and major adverse cardiac and cerebrovascular events in both ST‐segment–elevation myocardial infarction (adjusted hazard ratio [HR], 1.225 [95% CI, 1.031–1.456];
P
=0.0209; adjusted HR, 1.277 [95% CI, 1.089–1.498];
P
=0.0027) and non–ST‐segment–elevation myocardial infarction (adjusted HR, 1.302 [95% CI, 1.036–1.638];
P
=0.0239; adjusted HR, 1.368 [95% CI, 1.105–1.694];
P
=0.0040) populations.

Conclusions

The present study suggests that being unmarried is independently related to less reperfusion received, but could not explain the higher in‐hospital mortality rate after covariate adjustment. Being unmarried is associated with a substantially increased risk of adverse events over at least the first 24 months after AMI.

Registration

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT01874691.
Integrin α7 Mutations Are Associated With Adult‐Onset Cardiac Dysfunction in Humans and Mice
Authors: Bugiardini Enrico , Nunes Andreia M. , Oliveira‐Santos Ariany , Dagda Marisela , Fontelonga Tatiana M. , Barraza‐Flores Pamela , Pittman Alan M. , Morrow Jasper M. , Parton Matthew , Houlden Henry , Elliott Perry M. , Syrris Petros , Maas Roderick P. , Akhtar Mohammed M. , Küsters Benno , Raaphorst Joost , Schouten Meyke , Kamsteeg Erik‐Jan , van Engelen Baziel , Hanna Michael G. , Phadke Rahul , Lopes Luis R. , Matthews Emma , Burkin Dean J.
Published: November 2022

Background

Integrin α7β1 is a major laminin receptor in skeletal and cardiac muscle. In skeletal muscle, integrin α7β1 plays an important role during muscle development and has been described as an important modifier of skeletal muscle diseases. The integrin α7β1 is also highly expressed in the heart, but its precise role in cardiac function is unknown. Mutations in the integrin α7 gene (
ITGA7
) have been reported in children with congenital myopathy.

Methods and Results

In this study, we described skeletal and cardiac muscle pathology in
Itga7

−/−

mice and 5 patients from 2 unrelated families with
ITGA7
mutations. Proband in family 1 presented a homozygous c.806_818del [p.S269fs] variant, and proband in family 2 was identified with 2 intron variants in the
ITGA7
gene. The complete absence of the integrin α7 protein in muscle supports the
ITGA7
mutations are pathogenic. We performed electrocardiography, echocardiography, or cardiac magnetic resonance imaging, and histological biopsy analyses in patients with
ITGA7
deficiency and
Itga7

−/−

mice. The patients exhibited cardiac dysrhythmia and dysfunction from the third decade of life and late‐onset respiratory insufficiency, but with relatively mild limb muscle involvement. Mice demonstrated corresponding abnormalities in cardiac conduction and contraction as well as diaphragm muscle fibrosis.

Conclusions

Our data suggest that loss of integrin α7 causes a novel form of adult‐onset cardiac dysfunction indicating a critical role for the integrin α7β1 in normal cardiac function and highlights the need for long‐term cardiac monitoring in patients with
ITGA7
‐related congenital myopathy.
Endoplasmic Reticulum Chemical Chaperone 3‐Hydroxy‐2‐Naphthoic Acid Reduces Angiotensin II‐Induced Vascular Remodeling and Hypertension In Vivo and Protein Synthesis In Vitro
Authors: Cicalese Stephanie , Torimoto Keiichi , Okuno Keisuke , Elliott Katherine J. , Rizzo Victor , Hashimoto Tomoki , Eguchi Satoru
Published: November 2022

Background

Investigations into alternative treatments for hypertension are necessary because current treatments cannot fully reduce the risk for the development of cardiovascular diseases. Chronic activation of unfolded protein response attributable to the endoplasmic reticulum stress has been proposed as a potential therapeutic target for hypertension and associated vascular remodeling. Triggered by the accumulation of misfolded proteins, chronic unfolded protein response leads to downstream signaling of cellular inflammation and dysfunction. Here, we have tested our hypothesis that a novel chemical chaperone, 3‐hydroxy‐2‐naphthoic acid (3HNA) can attenuate angiotensin II (AngII)‐induced vascular remodeling and hypertension.

Methods and Results

Mice were infused with AngII for 2 weeks to induce vascular remodeling and hypertension with or without 3HNA treatment. We found that injections of 3HNA prevented hypertension and increase in heart weight body weight ratio induced by AngII infusion. Histological assessment revealed that 3HNA treatment prevented vascular medial thickening as well as perivascular fibrosis in response to AngII infusion. In cultured vascular smooth muscle cells, 3HNA attenuated enhancement in protein synthesis induced by AngII. In vascular adventitial fibroblasts, 3HNA prevented induction of unfolded protein response markers.

Conclusions

We present evidence that a chemical chaperone 3HNA prevents vascular remodeling and hypertension in mice with AngII infusion, and 3HNA further prevents increase in protein synthesis in AngII‐stimulated vascular smooth muscle cells. Using 3HNA may represent a novel therapy for hypertension with multiple benefits by preserving protein homeostasis under cardiovascular stress.
Sex Differences in Carotid Atherosclerosis: A Systematic Review and Meta-Analysis
Authors: van Dam-Nolen Dianne H.K. , van Egmond Nina C.M. , Koudstaal Peter J. , van der Lugt Aad , Bos Daniel
Published: November 2022

Background:

Over the last decades, several individual studies on sex differences in carotid atherosclerosis have been performed covering a wide range of plaque characteristics and including different populations. This systematic review and meta-analysis aims to summarize previously reported results on sex differences in carotid atherosclerosis and present a roadmap explaining next steps needed for implementing this knowledge in clinical practice.

Methods:

We systematically searched PubMed, Embase, Web of Science, Cochrane Central, and Google Scholar for eligible studies including both male and female participants reporting prevalence of imaging characteristics of carotid atherosclerosis and meta-analyzed these studies. Studies had to report at least the following: (1) calcifications; (2) lipid-rich necrotic core; (3) intraplaque hemorrhage; (4) thin-or-ruptured fibrous cap; (5) plaque ulceration; (6) degree of stenosis; (7) plaque size; or (8) plaque inflammation. We prespecified which imaging modalities had to be used per plaque characteristic and excluded ultrasonography.

Results:

We included 42 articles in our meta-analyses (ranging from 2 through 23 articles per plaque characteristic). Men had more frequently a larger plaque compared to women and, moreover, had more often plaques with calcifications (odds ratio=1.57 [95% CI, 1.23–2.02]), lipid-rich necrotic core (odds ratio=1.87 [95% CI, 1.36–2.57]), and intraplaque hemorrhage (odds ratio=2.52 [95% CI, 1.74–3.66]), or an ulcerated plaque (1.81 [95% CI, 1.30–2.51]). Furthermore, we found more pronounced sex differences for lipid-rich necrotic core in symptomatic opposed to asymptomatic participants.

Conclusions:

In this systematic review and meta-analysis, we demonstrate convincing evidence for sex differences in carotid atherosclerosis. All kinds of plaque features—plaque size, composition, and morphology—were more common or larger in men compared to women. Our results highlight that sex is an important variable to include in both study design and clinical-decision making. Further investigation of sex-specific stroke risks with regard to plaque composition is warranted.
PIERRE BOURDIEU: YAPISAL AKILDA HABITUS
Authors: ALPAY Ahmed Hamza
Published: November 2022

Sosyal fenomenlerin anlaşılmasını kolaylaştıran aktörler arasında meydana gelen günlük mücadeleler, çağın karakteristik kalıbını sürdürmek için konum ve yerleşimde özel olarak tasarlanmıştır. Çok yönlü fenomenlere benzersiz içgörüler oluşturmak için, işleyişi hakkında sayısız ve tekrarlanan sorularla birlikte yapısal akıl; benliği anlamlandırmada kültürel süreçlerdeki habitusa atıfta bulunur. Yapısal akılda, aynı tasarımın ayrılmaz bileşenleri olarak bir failin sosyal uzamda konumlanması, toplumsal dünyanın içkin öğretilerini miras alır. Bourdieu sosyolojisinde, kültürel değerleri tanımlama ve meşrulaştırma yetkisi nesnel bir mesafe ölçüsü elde etmeyi ve yine bu sosyolojide; yaklaşımın araştırma probleminin doğasından kaynaklandığı fikri, akademik deneyim yoluyla bağlamların çeşitlilik ve sıklığını anlamayı gerektirir. Bu makale, Bourdieu sosyolojisinde belirlenen temalar ve alt temaların nedenlerine değil; sosyal bilim metodolojisinde habitus eksenli bazı önemli katkılara odaklanmaktadır. Bu doğrultuda, makalede, Bourdieu sosyolojisinin temel parametrelerinden olan habitus, yapısal akıl ekseninde tartışılacaktır.
Spirituality of Professional Pastoral Caregivers during the COVID-19 Pandemic: Distress, Resources, and Consequences
Authors: Haussmann Annette
Published: November 2022

The COVID-19 pandemic has had an enormous impact on mental health in general and on care professionals in particular. Studies have shown that professional pastoral caregivers are challenged concerning stabilizing their mental health and coping with stress experiences. Spirituality, on the other hand, has been considered as a helpful coping resource. This study examines professional pastoral caregivers in various contexts of hospitals, congregations, old people’s homes or schools during the second lockdown in Germany. Results show the importance of spirituality as a resource, with an overall high centrality of religiosity, high daily spiritual experience and low spiritual dryness, but also reveal various stress factors with which pastoral caregivers have to deal. However, associations between work-related distress, spiritual dryness, centrality of religiosity and spiritual experience are displayed and discussed. Spiritual dryness correlates positively with work-related distress, whereas daily spiritual experience and centrality of religiosity correlates negatively. Possibilities of further support for those offering pastoral care during the pandemic and beyond are presented.
Promoting Inclusivity in Anti-Sectarian Protests: Understanding the Dilemmas of Organizers in Lebanon’s 2019 October Uprising
Authors: Rønn Anne Kirstine
Published: November 2022

This article contributes to explaining limitations to the inclusivity of protest movements against sectarianism through a case study of the 2019 Lebanese October Uprising. The study scrutinizes the challenges key organizers in Beirut faced when seeking to address issues of inclusivity concerning residents from two Shiʿite majority communities in and around the city. Engaging social movement theories on intersectionality and political opportunity structures and drawing on data from twenty-two in-depth interviews, it shows that organizers were attentive to stereotyping and exclusive attitudes concerning young men from the two communities. Yet, while expressing a desire to address these, organizers also found themselves caught in a dilemma, fearing that their efforts to promote inclusivity could trigger accusations of sectarian biases and favoritism. These findings provide important inputs to wider scholarly debates concerning the relationship between protests and other forms of anti-sectarian mobilization as well as the costs and desirability of enhancing inclusivity.
Wood Used in Brussels’ Old Buildings: Origin, Characterisation, and Use (12th–19th Centuries)
Authors: Charruadas Paulo , Cremer Sarah , Hoffsummer Patrick , Modrie Sylvianne , Sosnowska Philippe , Weitz Armelle
Published: November 2022

Since 1990 archaeologists, historians and dendrochronologists have worked on 128 sites in the Brussels-Capital Region. In addition to producing a typo-chronological inventory of wooden roof structures (12th–19th centuries), the studies have now extended to finishings and floor coverings, with an increasing focus being placed on the types of wood used. Although oak was the predominant material, especially before the 17th century, the resources used in Brussels and the surrounding villages were local. They came from three wooded areas, cleared or degraded to varying degrees: the Sonian Forest, state-owned forests, and hedgerows. Oak grows rapidly, with wide rings which make dendrochronological dating difficult, although this can be overcome by utilising more comparative data, employing carbon-14 dating, or knowing the historical context. The use of green wood has been confirmed, with unusual felling periods spread over two years. The sinuous profile of the fast-growing oaks was used to cut the knee braces in roofs over knee walls and porticoed wooden structures of monuments, urban housing, and vernacular architecture. Mediocre oak, or even wood from fruit trees, elm, or ash, was used for this kind of architecture. Moreover, from the 17th century onward, species other than oak began to appear in the roof frames of all buildings, especially after the centre of Brussels was bombarded in 1695. The typology of the reconstructed roof frames is the same as that prior to 1695, but a wider variety of woods were used to meet the high demand at the time of reconstruction. This diversity of species is more evident among floorboards, with poplar, elm, Scots pine, fir, and spruce being used. This may have been due to technical reasons, but, in the local context, it would also have been a question of using the precious oak of the Sonian Forest frugally.
Lysimachia neolongipedicellata, a new name for L. longipedicellata R.Trevis., Funez & Hassemer (Primulaceae)
Authors: IDREES MUHAMMAD , LI MENG , SHAW JULIAN M. H.
Published: November 2022

N/A
A new species of Neoconidiobolus (Entomophthorales, Ancylistaceae) from China based on morphological, molecular and physiological evidences
Authors: NIE YONG , WANG ZI-MIN , ZHOU ZHENG-YU , ZHAO HENG , LIU XIAO-YONG , HUANG BO
Published: November 2022

Neoconidiobolus pseudothromboides is proposed as a species new on the basis of morphological characteristics, physiological feature and molecular phylogeny. This new species is morphologically allied to N. thromboides. However, the maximum growth temperature of this new species is lower than that of N. thromboides and it grows slower than N. thromboides. The phylogenetic analysis of mitochondrial small subunit (mtSSU), nuclear large subunit (nucLSU) and translation elongation-factor-like (EFL) reveals that Neoconidiobolus is divided into three clades, and N. pseudothromboides sp. nov. is closely related to N. lachnodes rather than N. thromboides. Morphological comparisons between N. pseudothromboides sp. nov. and its affinities are provided herein.
Ceriscoides glabra (Gardenieae: Rubiaceae), a new species from Kon Chu Rang Nature Reserve, southern Vietnam
Authors: BINH TRAN DUC , QUANG BUI HONG , CUONG NGUYEN THE , QUYNH HA QUY , HOAN DUONG THI , HAI DO VAN , NGUYEN KHANG SINH , NURALIEV MAXIM S.
Published: November 2022

Ceriscoides glabra, a new species of the tribe Gardenieae (Rubiaceae), is described and illustrated. The species was discovered in 2017–2018 in Kon Chu Rang Nature Reserve (Gia Lai Province, southern Vietnam), in the vicinity of the locally well-known K50 waterfall, also known as Hang En waterfall. The new species differs from its congeners by the following features: plant entirely glabrous, leaf blade mostly less than 6.5 cm long and less than 4 cm wide, with 3–4 pairs of secondary veins and without domatia, calyx in female flowers glabrous with lobes more than 9 mm long, and corolla lobes in female flowers more than 10 mm long and distinctly longer than wide.
Eriocaulon shrirangii (Eriocaulaceae), a new species from the lateritic plateaus of Konkan region of Maharashtra, India
Authors: CHANDORE ARUN NIVRUTTI , BORUDE DEVIDAS BHAUSAHEB , BHALEKAR PARESH PANDHARINATH , MADHAV NILESH APPASO , GOSAVI KUMAR VINOD CHHOTUPURI
Published: November 2022

A new species Eriocaulon shrirangii is described and illustrated here from Konkan region of Maharashtra, India. The new species is allied to E. belgaumensis with rosulate and linear leaves, length of peduncles, c. 2 mm across heads and cells of seed coat transversely elongated, aligned in vertical rows, but differs in its oblanceolate floral bracts; pedicellate male flowers; linear-lanceolate sepals of female flower, hairy at apex; hoary petals of female flower and appendages present on seeds.
Morphology of developing larvae and a dichotomous key for five bubble-nesting Betta species (Teleostei: Osphronemidae)
Authors: POUNGCHAREAN SANTI , LIMPIVADHANA DOMES
Published: November 2022

The morphology of larvae of five bubble-nesting Betta species (B. imbellis, B. mahachaiensis, B. siamorientalis, B. smaragdina, and B. splendens) from Thailand was described from specimens reared in the laboratory from wild-caught parents. For all species, the mean notochord length (NL) of the larvae ranged from 2.37 to 2.58 mm. Larvae reached the flexion stage within 9–15 days (NL = 3.22–5.21 mm) and the juvenile stage within 40–45 days (standard length = 10.45–12.18 mm). The main characteristics of hatched larvae for all species were an oblong and slightly compressed body, a small and rounded head, an oval to rounded eye, and a yolk sac without oil droplets. Pre-flexion larvae for all species have an oblique, terminal mouth, and pectoral buds begin to develop after day 1. During the post-flexion larval stage, rays for the caudal, dorsal, anal, ventral, and pectoral fins begin to develop. Juveniles have a fully developed ventral fin with 2–3 dorsal, central, and ventral stripes, and a caudal spot. The minimal and maximal myomere number and fin rays differed between species. For all species, there were 1–2 dorsal spines, 7–9 dorsal rays, 9–12 pectoral rays, 1 ventral spine, 4–5 ventral rays, 2–4 anal spines, 22–28 anal rays, and 10–12 caudal rays. The different larval stages also differed in pigmentation patterns between species. Pigmentation patterns on the head (pre-orbital, sub-orbital, post-orbital, and sub-opercular bars) and longitudinal stripes on the side of the body could be used to distinguish between different larval stages as well as different species.
Two new species of Triozocera Pierce, 1909 (Insecta: Strepsiptera: Corioxenidae) from the Caribbean Islands
Authors: COOK JERRY L.
Published: November 2022

Triozocera albocciput and Triozocera macrognathus are described from the Caribbean Islands. These new species constitute the only known Triozocera from this region. Triozocera albocciput occurs in the Dominican Republic, Puerto Rico, and Cuba. The specimen from Cuba had previously been misidentified in the literature, as Triozocera mexicana and later Triozocera texana. The new species described here, as well as all other valid species in North America, are known only from male specimens.
Cervico-Mediastinal Extension of Thyroid Cancer
Authors: Torre Gian C. , Ansaldo Gian L. , Borgonovo Giacomo , Varaldo Emanuela , Meola Christiano , Bottaro Paola , Minuto Michele , Mattioli Francesco P.
Published: November 2022

A surgical series of 30 cervico-mediastinal thyroid cancer patients operated on has been retrospectively reviewed. Results were compared with those obtained in patients operated on for benign cervico-mediastinal goiter and thyroid cancer confined to cervical region. Of 4688 thyroidectomies performed, 30 patients were operated on for thyroid carcinoma with cervico-mediastinal extension. There were 15 males and 15 females. The mean age was 67 years (range, 21–86 years). Patients with cervico-mediastinal cancer were significantly older than patients with benign cervico-mediastinal goiter ( P < 0.0001). Time between onset of first symptoms and surgery was significantly longer in patients with cervico-mediastinal cancer than in those with benign cervico-mediastinal goiter ( P < 0.0001) and cervical thyroid cancer. Signs and symptoms at the time of surgery were cervical mass in 28 patients (93%), cervical lymphadenopathy in 20 patients (66%), dyspnea in 21 (70%), dysphagia in 9 (30%), dysphonia in 2 (7%), and venous stasis in 1 (3%). None of the patients was asymptomatic. Total thyroidectomy with functional lymphectomy was performed in 16 cases. Seven of these patients were operated on in 2 stages. In 8 cases the operation was a debulking procedure, and in 6 it was a near-total thyroidectomy. Sternotomy was performed in two cases. A differentiated thyroid cancer was found in 21 patients (70%), medullary in 5 (17%) and undifferentiated in 4 (13%). The incidence of medullary carcinoma was significantly higher compared with cervical cancer ( P < 0.008). Postoperative complications were higher than those occurring in benign cervico-mediastinal goiter and similar to those occurring in cervical cancer. The actuarial survival was similar to that of cervical cancer matched for age and sex. This analysis shows that the longer clinical history of goiter is related to its endothoracic development and its neoplastic transformation. This finding should further encourage surgeons to treat any cervico-mediastinal goiter as promptly as possible.
Retroperitoneal Soft-Tissue Sarcomas: Prognosis and Treatment of Primary and Recurrent Disease
Authors: Bautista Norman , Su Wendy , O'Connell Theodore X.
Published: November 2022

Soft-tissue sarcomas of the retroperitoneum constitute a heterogeneous group of tumors with varying histology, potential for complete resection, and propensity for recurrent disease—making the development of effective treatment difficult and challenging. A retrospective review of 23 patients with retroperitoneal sarcomas from 1985 through 1998 was performed to assess the biological behavior and clinical outcomes and to identify factors that may influence prognosis and optimize treatment strategy. Liposarcomas were the most common pathology (61%); 79 per cent of these were of low grade. Leiomyosarcomas were the next most common pathology (30%); 43 per cent of these were of low grade. Low-grade sarcomas overall accounted for 62 per cent of the total group. Low-grade tumors independent of histologic type exhibited good prognosis for long-term survival with a median survival of 44 months. In contrast, intermediate- or high-grade tumors were associated with a median survival of only 9 months ( P < 0.02). On the other hand, tumor histologic type independent of grade did not have a significant survival difference. Complete tumor resection was possible in 21 of 23 patients, which gives an overall resectability rate of 91 per cent. Eight patients (36%) remain disease-free after initial surgical treatment. However, local recurrence was common; this occurred in 11 of 22 patients (50%). Local recurrence, however, did not preclude long-term survival. Surgical resection of recurrent disease was done in nine patients with a median survival of 91 months (range 24–150 months). Three patients had as many as three operations for recurrent disease. With subsequent recurrences there was a decrease in interval from approximately 4 years to 2 years, and 33 per cent of these patients developed tumor dedifferentiation to high grade. An aggressive surgical approach with reoperation can produce prolonged survival in patients with low-grade retroperitoneal sarcoma.
Traumatic Carotid Artery Dissection: A Significant Incidental Finding
Authors: Hughes K. Michael , Collier Bryan , Greene Karl A. , Kurek Stanley
Published: November 2022

Blunt traumatic carotid artery dissection remains controversial in terms of diagnostic screening, reported incidence, and management. Treatment options include observation, anticoagulation and endovascular stenting, and aggressive surgical repair of the carotid artery injury. Blunt traumatic carotid artery dissections were reviewed through a retrospective study of trauma registry records. Seven patients were identified from 3342 patients over 3 years. Six patients were identified incidentally during magnetic resonance imaging (MRI) cervical spine/brain screening and one patient during angiographic evaluation for possible penetrating neck injury without MRI/magnetic resonance angiography (MRA). A total of 189 patients underwent MRI screening over this 3-year period, demonstrating a relative incidence of 3.7 per cent, contrasting with the reported incidence of 0.08 to 0.4 per cent for all trauma patients. All seven patients suffered severe head injuries (mean Glasgow Coma Score = 4.7) requiring mean intensive care unit and hospital stays of 15.6 and 23.7 days, respectively. None of the patients showed evidence of stroke with CT scanning on presentation. None of the patients demonstrated clinical focal neurologic signs or symptoms indicating carotid injury or stroke. Six patients survived their acute trauma and were discharged to rehabilitation after initiation of observation (one patient) or anticoagulation (five patients). All six patients showed neurological improvement without deterioration clinically or radiographically. In conclusion we propose early aggressive screening through MRI/MRA of severely injured patients to detect occult carotid artery dissections. Conservative medical treatment for this occult injury has been effective in this series of patients.
Meckel's Diverticulum Causing Cecal Volvulus
Authors: Neidlinger Nikole A. , Madan Atul K. , Wright Mary Jo
Published: November 2022

Meckel's diverticulum is present in 2 per cent of the population with bowel obstruction as its most common complication. This case report describes an extremely rare complication of a Meckel's diverticulum, a cecal volvulus. The diagnosis of cecal volvulus was made preoperatively on abdominal X-rays; the diagnosis of a Meckel's diverticulum was made intraoperatively. The cecum was found to be twisted around a vitelline band on a broad-based Meckel's diverticulum extending to the umbilicus. The diverticulum was resected. The patient did well postoperatively and was discharged without any difficulty.
Accuracy of Sentinel Lymph Node Biopsy for Patients with T2 and T3 Breast Cancers
Authors: Wong Sandra L. , Chao Celia , Edwards Michael J. , Tuttle Todd M. , Noyes R. Dirk , Carlson David J. , Laidley Alison L. , Mcglothin Terre Q. , Ley Philip B. , Brown C. Matthew , Glaser Rebecca L. , Pennington Robert E. , Turk Peter S. , Simpson Diana , Mcmasters Kelly M.
Published: November 2022

Although numerous studies have demonstrated that sentinel lymph node (SLN) biopsy can accurately determine the axillary nodal status for early breast cancer some studies have suggested that SLN biopsy may be less reliable for tumors >2 cm in size. This analysis was performed to determine whether tumor size affects the accuracy of SLN biopsy. The University of Louisville Breast Cancer Sentinel Lymph Node Study is a prospective multi-institutional study involving 226 surgeons. The study was approved by the Institutional Review Board of each institution, and informed consent was obtained from all patients. Patients with clinical stage T1–2 N0 breast cancer were eligible for the study. Some patients with T3 tumors were included because they were clinically staged as T2 but on final pathology were found to have tumors >5 cm. This analysis includes 2148 patients who were enrolled from August 1997 through October 2000. All patients underwent SLN biopsy using a combination of radioactive colloid and blue dye injection followed by completion Level I/II axillary dissection. Statistical comparison was performed by chi-square analysis. The SLN identification rate, false negative rate, and overall accuracy of SLN biopsy were not significantly different among tumor stages T1, T2, and T3. We conclude that SLN biopsy is no less accurate for T2–3 breast cancers compared with T1 tumors.
Complication of the Retroperitoneal Approach: Intercostal Abdominal Hernia
Authors: Best Irwin M.
Published: November 2022

The left thoracoabdominal incision with retroperitoneal dissection offers excellent exposure of the abdominal and thoracic aorta. Disadvantages to this approach include inadequate access to the right ileofemoral arterial segments and the right renal artery. Additional difficulties with this approach include flank bulges, hernias, and neuropathy. We present a case of an incisional hernia at the tenth interspace with subsequent herniation of the left colon through this defect. CT defined the extent of this defect and ruled out other significant pathology. The patient underwent an uneventful herniorrhaphy. Abdominal-intercostal hernias have not been previously reported in association with the retroperitoneal aortic repair.
Paraduodenal Hernia: A Report of Two Cases
Authors: Dritsas Eric R. , Ruiz Oscar R. , Kennedy G. Mitchell , Blackford James , Hasl David
Published: November 2022

Paraduodenal hernias are uncommon congenital herniations into the mesentery of the colon that present as small bowel obstruction. The diagnosis is elusive but may be made by CT scan or upper gastrointestinal series. There are three types: left, right, and transverse. The repair involves reduction of the hernia and closure of the mesenteric defect in accordance with the anatomy of the hernia. We present two cases of paraduodenal hernia that are representative of this unusual class of internal herniation.
Operative Acute Small Bowel Obstruction: Admitting Service Impacts Outcome
Authors: Schwab Donald P. , Blackhurst Dawn W. , Sticca Robert P.
Published: November 2022

Early surgical intervention in acute small bowel obstruction (SBO) has long been recognized as an important factor in preventing morbidity and mortality. Factors associated with surgically managed acute SBO were analyzed for delay in intervention and impact on outcome. A retrospective review of all patients evaluated for SBO on the surgical teaching service of the Greenville Hospital System from July 1, 1997 to June 30, 2000 was performed. Data were collected on patient demographics, admission information (date, admitting service, physical examination, and laboratory values), comorbidity, diagnostic studies, surgery date, operative findings, postoperative complications, operative mortality, and discharge date. Analysis of the data revealed 157 cases of presumed SBO of which 61 were managed nonoperatively and 96 required surgery. Acute SBO was diagnosed in 65 patients who constitute the basis for this review. Of these 65 patients 43 (66%) were admitted to the surgical service, 25 (38%) required small bowel resection, and 17 (26%) developed morbidity and/or mortality. When analyzed for morbidity and mortality the only characteristics that were statistically significant were the admitting service ( P = 0.003) and length of stay ( P = 0.003). On further analysis of admitting service and patient outcomes several factors were significant when we compared medical service admissions to surgical service admissions. These included days from admission to surgery ( P = 0.003), length of stay ( P = 0.019), morbidity ( P = 0.004), mortality ( P = 0.005), and combined morbidity and mortality ( P = 0.003). Mortality of patients admitted to the medical service was 27 per cent compared with 2 per cent for the surgical service. There were no differences in morbidity and mortality when analyzed by the need for small bowel resection, patient age, etiology of obstruction, or presence of comorbidities. None of the factors studied were useful in predicting the need for small bowel resection. Our findings agree with those of previous investigators with regard to 1) lack of association between the preoperative evaluation and the need for small bowel resection and 2) the association between delay in diagnosis and increased morbidity and mortality. In addition we have found that one of the primary causes of delay in treatment for SBO was admission to the medical service. This delay led to significantly higher mortality in these patients. We recommend early surgical evaluation for any patient admitted with SBO as a differential diagnosis.
Laparoscopic Ultrasound with Radiofrequency Ablation in Cirrhotic Patients with Hepatocellular Carcinoma: Technique and Technical Considerations
Authors: Podnos Yale D. , Henry Ginard , Ortiz Jorge A. , Ji Ping , Cooke Jonathon , Cao Sean , Imagawa David K.
Published: November 2022

The optimal treatment for hepatocellular carcinoma (HCC) is surgical resection. However, only a small percentage of patients are operative candidates. CT-guided percutaneous radiofrequency ablation (RFA) has been shown to be efficacious in treatment of unresectable HCC. CT-guided RFA, however, may fail to detect small intrahepatic metastases and tumor thrombi, which thus minimizes possible gains from the procedure. Recent advances in laparoscopic ultrasound have greatly improved the accuracy in detecting intrahepatic HCC metastases many of which were missed by CT. Combining intraoperative laparoscopic ultrasound with laparoscopic RFA greatly utilizes advances in both fields and is technically feasible. Our objective is to introduce a novel operative combination of laparoscopic ultrasound with laparoscopic RFA in treatment of HCC. Childs class B patients with unresectable HCC were considered for this study. Twelve patients underwent laparoscopic ultrasound and RFA of 17 lesions. Tumors ranged from 0.27 to 7 cm in diameter. Laparoscopic ultrasound identified tumor not detected preoperatively in one patient (8.3%). A single pneumothorax was the only complication. A single patient (8.3%) had recurrent disease and accounted for the only mortality in the study. We conclude that the use of both laparoscopic ultrasound and RFA is an excellent use of existing technology. The procedure combines improved tumor localization with the means to treat patients with unresectable disease. Because RFA is a relatively recent development long-term results are not yet available. Randomized prospective studies comparing RFA with other modalities will determine the ultimate utility of this procedure.
The Presenting Chest Roentgenogram in Acute Type A Aortic Dissection: A Multidisciplinary Study
Authors: Gregorio M. Consuelo , Baumgartner Fritz J. , Omari Bassam O.
Published: November 2022

Acute type A aortic dissection requires early diagnosis and prompt surgical intervention. It is not entirely clear whether patients with this form of dissection have clear-cut chest roentgenogram (CXR) patterns or whether the CXR can guide the physician in directing further workup for acute aortic dissection. The purpose of this study is to evaluate the impact of the initial CXR in arousing suspicion for acute type A aortic dissection. Twelve physicians from four specialties (emergency medicine, radiology, cardiology, and cardiothoracic surgery) evaluated the presenting CXR of ten patients with acute type A aortic dissection and the CXRs of ten normal individuals in a blinded manner. They were asked whether the CXRs were normal or abnormal (part A) and what the findings were and then were asked whether the CXRs were suspicious for acute aortic dissection (part B) and what the findings were. In part A, of the normal CXRs 81 of 120 (68%) readings were recorded as normal. Of the dissection CXRs 112 of 120 (93%) readings were recorded as abnormal ( P < 0.001). In part B, the physicians were asked specifically about suspicion for aortic dissection. Of the normal CXRs 101 of 120 (84%) readings were listed as not suspicious for dissection (i.e., 16% of the normal CXRs were listed as supsicious for dissection). Of the dissection CXRs 88 of 120 (73%) readings were recorded as suspicious for dissection ( p < 0.001). The most frequent findings on a dissection CXR when physicians were specifically asked about dissection included widened mediastinum in 46 of 120 (38%) followed by not suspicious for dissection in 32 of 120 (27%). Among the physician specialties the only statistically significant finding was that the cardiology group was the most likely group to find an abnormality in a “normal” CXR. This data indicates that the presenting CXR is neither sensitive nor specific for acute type A dissection. In a patient with a suspicious history or physical examination, however, a CXR showing mediastinal widening or other aortic abnormalities should increase the suspicion for dissection and warrant further workup. Furthermore in a patient with a clinical suspicion a normal CXR reading should not delay echocardiography to rule out type A dissection.
Evaluation of Vascular Injury in Penetrating Extremity Trauma: Angiographers Stay Home
Authors: Conrad Mark F. , Patton Joe H. , Parikshak Manesh , Kralovich Kurt A.
Published: November 2022

The debate over the use of diagnostic angiography (DA) to exclude arterial injury in penetrating extremity trauma (PET) continues. This review evaluates our current protocol for PET and identifies indications for DA. Patients presenting to our urban Level I trauma center between January 1997 and September 2000 with PET were included. Demographic data, emergency department (ED) course, and patient follow-up were reviewed. ED evaluation directed by physical examination (PE) included Doppler pressure indices (DPI) and DA if indicated. A total of 538 patients had PET injuries. Twenty (4%) patients with hard signs of vascular injury were taken to the operating room. Ninety-one (17%) patients without vascular compromise underwent operative procedures or were admitted for other injuries. One hundred twenty-three (23%) patients with nonproximity wounds were discharged. Four DAs were performed for abnormal DPI with no change in management. Three hundred patients with a negative PE and normal DPI were discharged from the ED. Follow-up was available on 51 per cent of these patients (range 1–49 months) with no missed injuries identified. We conclude that PE with DPI is an appropriate way to identify significant vascular injuries from PET. Patients with normal PE and DPI can be safely discharged. DA is only indicated for asymptomatic patients with abnormal DPI.
Carotid Artery Restenosis: An Ongoing Disease Process
Authors: Trisal Vijay , Paulson Tammeral , Hans Sachinder S. , Mittal Vijay
Published: November 2022

Recurrence of carotid artery stenosis after primary endarterectomy is a well-known entity. The treatment and optimal management of the disease process, however, is a matter of ongoing debate. We retrospectively reviewed carotid endarterectomies for recurrent disease performed at a community hospital over the past 21 years to evaluate the outcome of surgical intervention. Eighty-two recurrences occurred in 1648 carotid endarterectomies. Females had a slightly higher recurrence rate as compared with males, and the majority of patients had risk factors in the form of hypertension, peripheral vascular disease, or cigarette smoking. All endarterectomies were repaired with a patch angioplasty by either a vein or a prosthetic graft. One patient died secondary to complications of coronary artery disease. None of the patients developed any postoperative neurological event or permanent nerve damage. A subgroup of 11 patients with recurrent carotid artery stenosis with contralateral occlusion underwent 14 endarterectomies with no neurological complications. In conclusion occlusive carotid disease is an ongoing phenomenon, and continued surveillance is recommended. Surgical treatment of recurrent disease is a safe option. Endarterectomies for recurrent carotid disease in the presence of contralateral occlusion can be performed safely.
Pancreatic Resection for Locally Advanced Primary and Metastatic Nonpancreatic Neoplasms
Authors: Pingpank James F. , Hoffman John P. , Sigurdson Elin R. , Ross Eric , Sasson Aaron R. , Eisenberg Burton L.
Published: November 2022

We conducted a retrospective review of our single-institution experience with pancreas resection for locally advanced primary malignancy or metastases from other organs. From January 1989 through April 2001 35 patients underwent pancreatic resection for locally advanced primary (17) and recurrent nonpancreatic (18) tumors. Patient records were examined for recurrence and survival. Seventeen patients with locally advanced primary tumors presented with pancreatic extension either into the head/body (six) or tail (11). Pancreatic resections were completed as en bloc procedures with the primary disease of stomach (five), colon (four), sarcoma (five), adrenal gland (one), or spleen (one). Procedures performed included pancreaticoduodenectomy for proximal lesions and distal pancreatectomy for disease limited to the pancreatic tail. Median overall survival was 56 months. Fourteen of 17 patients remain alive: three with disease and 11 without evidence of recurrence. Eighteen patients presented with recurrent tumor from a previously resected right upper quadrant tumor (nine) or metastases from an intra-abdominal source (nine). The primary source was colon (eight), biliary (three), sarcoma (three), melanoma (two), ovary (one), and unknown primary (one). Patients underwent pancreaticoduodenectomy, distal pancreatectomy, or resection of residual pancreas. Overall median survival was 46 months. In this group of 18 patients there was no increased survival in those patients with a time to recurrence from their primary tumor resection greater than 2 years. We conclude that pancreatic resection for locally advanced nonpancreatic or recurrent intra-abdominal malignancies is possible in properly selected patients. The ability to obtain disease-free margins through en bloc resection is a key component of therapy.