bluuebunny/crossref_metadata_2025 huggingface dataset:
A Novel Locus Predicts Spermatogenic Recovery among Childhood Cancer Survivors Exposed to Alkylating Agents
Authors: Sapkota Yadav , Wilson Carmen L. , Zaidi Asifa K. , Moon Wonjong , Fon Tacer Klementina , Lu Lu , Liu Qi , Baedke Jessica , Dhaduk Rikeenkumar , Wang Zhaoming , Chemaitilly Wassim , Krasin Matthew J. , Berry Fred B. , Zhang Jinghui , Hudson Melissa M. , Robison Leslie L. , Green Daniel M. , Yasui Yutaka
Published: June 2020

Exposure to high doses of alkylating agents is associated with increased risk of impaired spermatogenesis among nonirradiated male survivors of childhood cancer, but there is substantial variation in this risk. Here we conducted a genetic study for impaired spermatogenesis utilizing whole-genome sequencing data from 167 nonirradiated male childhood cancer survivors of European ancestry from the St. Jude Lifetime Cohort treated with cyclophosphamide equivalent dose (CED) ≥4,000 mg/m2. Sperm concentration from semen analysis was assessed as the primary outcome. Common variants (MAF > 0.05) were adjusted for age at cancer diagnosis, CED, and top principal components. Rare/low-frequency variants (MAF ≤ 0.05) were evaluated jointly by various functional annotations and 4-kb sliding windows. A novel locus at 7q21.3 containing TAC1/ASNS was associated with decreased sperm concentration (rs7784118: P = 3.5 × 10−8). This association was replicated in two independent samples of SJLIFE survivors of European ancestry, including 34 nonirradiated male survivors treated with 0 < CED < 4,000 mg/m2 (P = 3.1 × 10−4) and 24 male survivors treated with CED ≥4,000 mg/m2 and radiotherapy <40 Gray (P = 0.012). No association was observed among survivors not exposed to alkylating agents included in the CED (P > 0.29). rs7784118 conferred 3.48- and 9.73-fold increases in risk for clinically defined oligospermia and azoospermia and improved prediction of normospermic, oligospermic, and azoospermic states by 13.7%, 5.3%, and 21.7%. rs7784118 was associated with decreased testosterone level, increased levels of follicle stimulating and luteinizing hormones, and 8.52-fold increased risk of Leydig cell failure. Additional research is warranted to determine how this SNP influences spermatogenesis and to assess its clinical utility in characterizing high-risk survivors and guiding intervention strategies.

Significance:

The identified genetic markers harbor potential clinical utility in characterizing high-risk survivors and guiding intervention strategies including pretreatment patient counseling and use of fertility preservation services.
The Role of Der p 23 Sensitization: An Analysis of 474 Patients Sensitized to Mite
Authors: Eder Katharina , Becker Sven , Gellrich Donata , Zieglmayer Petra , Gröger Moritz
Published: June 2020

Introduction: House dust mite contains several allergen components and causes perennial allergy. Lately, a new major allergen, Der p 23, was described with relatively high sensitization rates in different European Countries. In addition, Der p 23 is supposed to cause asthmatic disease. Objective: We would like to question the prevalence and clinical impact of specific immunoglobulin E to Der p 23 in a large patient sample in southern Bavaria, Germany. Methods: 474 patients from southern Bavaria, who visited the allergy department within the Department of Oto-Rhino-Laryngology of a university hospital, with sensitization to Dermatophagoides pteronyssinus were retrospectively compared regarding their sensitization profile to Der p 1, Der p 2, and Der p 23 and their clinical characteristics. Results: Among D. pteronyssinus-sensitized patients, the overall sensitization rate to Der p 23 was 42% in southern Bavaria. Most likely, patients were simultaneously sensitized to Der p 1, Der p 2, and Der p 23. Der p 23-sensitized patients reported more frequently asthma and showed higher prevalence of poly-sensitization towards 3 additional allergen groups and higher prevalence of double-sensitization to Der p 1 and Der p 2 compared to patients with missing sensitization to Der p 23. Considering the results of allergen provocation tests, neither IgE sensitization against Der p 23 nor levels of specific immunoglobulin E to Der p 23 allow a clear prediction of the clinical relevance of the sensitization. Conclusion: With a sensitization rate of 42%, Der p 23 closely misses the criterion of a major allergen in our southern Bavarian patient collective. A higher prevalence of polysensitization and self-reported asthma was the only clinical feature found in Der p 23-sensitized patients.
Horizontes e vagalumes (e o agora)
Authors: Cerqueira Helena Magon Pedreira de
Published: June 2020

Partindo da metáfora dos vagalumes sugerida por Pier Paolo Pasolini, e, dissecada por Georges Didi-Huberman em Sobrevivencia dos vagalumes, este ensaio reflete também questões iluminadas por Walter Benjamin. Em breve diálogo com outros autores,  o estudo lança um olhar para experiências de percepção, apreensão e criação de imagens que irrompam um lampejo na cegueira no mundo contemporâneo.
Lampejo do passado no presente
Authors: Lourenço Maria Cecília França
Published: June 2020

Pesquisam-se ações memoriais, fixadas em formas. Em 2016 surgiu o Memorial Cabeza de Vaca/PR e em 2020, o grafite de Mundano/SP alusivo à tragédia da Cia. Vale, em Brumadinho/MG. Como o ontem raia no hoje e rasga certezas? O que se omitiu? Quais soluções, técnica, material e poética usadas? Contra e a favor de quem se rebelam? Como se dá a reunião de recursos? Por que? Qual a diferença na abordagem da memória?
A Representação da ausência nos vestígios de ação
Authors: Yzumizawa Allan Tanioka
Published: June 2020

Partindo das questões sobre arte e política e da potência das imagens colocadas por Jacques Rancière e Georges Didi-Huberman, o presente artigo propõe a discussão sobre as formas de representação da ausência a partir de trabalhos entendidos como vestígios de ação. Esses trabalhos, ao invés de trazer a imagem representada do corpo, a partir de seus vestígios, denunciam a sua ausência, trazendo à discussão sobre formas de articular o visível.
Cerebral Microbleed Burdens in Specific Brain Regions Are Associated With Disease Severity of Cerebral Autosomal Dominant Arteriopathy With Subcortical Infarcts and Leukoencephalopathy
Authors: Chung Chih‐Ping , Chen Jiun‐Wei , Chang Feng‐Chi , Li Wei‐Chi , Lee Yi‐Chung , Chen Li‐Fen , Liao Yi‐Chu
Published: June 2020

Background

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy, caused by

NOTCH
3

mutations, is characterized by recurrent ischemic strokes and progressive cognitive decline. It remains unclear whether cerebral microbleeds (
CMB
s) can serve as a surrogate marker for disease progression in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy. We aimed to investigate the
CMB
burdens in

NOTCH
3

mutation carriers at different disease stages and test their associations with cognitive performance.

Methods and Results

Forty‐nine individuals carrying

NOTCH
3

cysteine‐altering mutations received brain magnetic resonance imaging with T1‐weighted and susceptibility‐weighted images. Whole brain images were segmented into 14 regions using Statistical Parametric Mapping and FreeSurfer software, and semiautomatic methods were used to locate and quantify the number and volume of
CMB
s. In our study participants, the median of
CMB
counts was 13, with a wide individual variation (range, 0–286).
CMB
s were most frequently present in thalamus, followed by temporal lobe. In the whole brain, the
CMB
counts and
CMB
volume ratios (ie,
CMB
volume divided by the volume of corresponding brain region) gradually increased as the disease advanced.
CMB
counts in the thalamus and temporal and frontal lobes increased more rapidly than other brain regions as disease progressed. There were significant associations between Mini‐Mental State Examination scores and
CMB
counts in the frontal lobe, temporal lobe, and pons.

Conclusions

CMB
s may have an influential role in the clinical manifestations of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy.
CMB
burdens and their distribution in different brain regions may be capable to serve as a disease marker for monitoring the disease severity of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy.
Intravenous Fibrinolysis for Central Retinal Artery Occlusion
Authors: Mac Grory Brian , Nackenoff Alex , Poli Sven , Spitzer Martin S. , Nedelmann Max , Guillon Benoit , Preterre Cécile , Chen Celia S. , Lee Andrew W. , Yaghi Shadi , Stretz Christoph , Azher Idrees , Paddock John , Bakaeva Tatiana , Greer David M. , Shulman Julie G. , Kowalski Robert G. , Lavin Patrick , Mistry Eva , Espaillat Kiersten , Furie Karen , Kirshner Howard , Schrag Matthew
Published: June 2020

Background and Purpose:

Central retinal artery occlusion results in sudden, painless, usually permanent loss of vision in the affected eye. There is no proven, effective treatment to salvage visual acuity and a clear, unmet need for an effective therapy. In this work, we evaluated the efficacy of intravenous tissue-type plasminogen activator (IV alteplase) in a prospective cohort study and an updated systematic review and meta-analysis.

Methods:

We enrolled consecutive patients with acute central retinal artery occlusion within 48 hours of symptoms onset and with a visual acuity of <20/200 from January 2009 until May 2019. The primary outcomes were safety and functional visual acuity recovery. We compared rates of visual recovery between those treated with alteplase within 4.5 hours of symptom onset to those who did not receive alteplase (including an analysis restricted to untreated patients presenting within the window for treatment). We incorporated these results into an updated systematic review and patient-level meta-analysis.

Results:

We enrolled 112 patients, of whom 25 (22.3% of the cohort) were treated with IV alteplase. One patient had an asymptomatic intracerebral hemorrhage after IV alteplase treatment. Forty-four percent of alteplase-treated patients had recovery of visual acuity when treated within 4.5 hours versus 13.1% of those not treated with alteplase (
P
=0.003) and 11.6% of those presenting within 4 hours who did not receive alteplase (
P
=0.03). Our updated patient-level meta-analysis of 238 patients included 67 patients treated with alteplase within 4.5 hours since time last known well with a recovery rate of 37.3%. This favorably compares with a 17.7% recovery rate in those without treatment. In linear regression, earlier treatment correlated with a higher rate of visual recovery (
P
=0.01).

Conclusions:

This study showed that the administration of intravenous alteplase within 4.5 hours of symptom onset is associated with a higher likelihood of a favorable visual outcome for acute central retinal artery occlusion. Our results strongly support proceeding to a randomized, placebo-controlled clinical trial.
Matrix Metalloproteinase-9 and Monocyte Chemoattractant Protein-1 Are Associated With Collateral Status in Acute Ischemic Stroke With Large Vessel Occlusion
Authors: Mechtouff Laura , Bochaton Thomas , Paccalet Alexandre , Crola Da Silva Claire , Buisson Marielle , Amaz Camille , Derex Laurent , Ong Elodie , Berthezene Yves , Eker Omer Faruk , Dufay Nathalie , Mewton Nathan , Ovize Michel , Cho Tae-Hee , Nighoghossian Norbert
Published: June 2020

Background and Purpose:

In ischemic stroke, inflammatory status may condition the development of collateral circulation. Here we assessed the relationship between systemic inflammatory biomarkers and collateral status in large vessel occlusion before mechanical thrombectomy.

Methods:

HIBISCUS-STROKE is a cohort study including acute ischemic stroke patients with large vessel occlusion treated with mechanical thrombectomy following admission magnetic resonance imaging. MMP-9 (matrix metalloproteinase-9) and MCP-1 (monocyte chemoattractant protein-1) were measured on blood sampling collected at admission. Collateral status was assessed on pretreatment Digital subtraction angiography and categorized into poor (Higashida score, 0–2) and good (Higashida score, 3–4). A multiple logistic regression model was performed to detect independent markers of good collateral status.

Results:

One hundred and twenty-two patients were included, of them 71 patients (58.2%) had a good collateral status. In univariate analysis, low MMP-9 levels (
P
=0.01), high MCP-1 levels (
P
<0.01), a low National Institute of Health Stroke Score (
P
=0.046), a high diastolic blood pressure (
P
=0.049), the absence of tandem occlusion (
P
=0.046), a high Alberta Stroke Program Early CT Score (
P
<0.01) and a low volume on the diffusion-weighted imaging (
P
<0.01) were associated with good collateral status. Following multivariate analysis, low MMP-9 levels (
P
=0.02) and high MCP-1 levels (
P
<0.01) remained associated with good collateral status.

Conclusions:

Low MMP-9 and high MCP-1 levels were associated with good pretreatment collateral status in patients with acute ischemic stroke with large vessel occlusion. These results might suggest a relationship between collateral status and inflammation.
CrossWOZ: A Large-Scale Chinese Cross-Domain Task-Oriented Dialogue Dataset
Authors: Zhu Qi , Huang Kaili , Zhang Zheng , Zhu Xiaoyan , Huang Minlie
Published: June 2020

To advance multi-domain (cross-domain) dialogue modeling as well as alleviate the shortage of Chinese task-oriented datasets, we propose CrossWOZ, the first large-scale Chinese Cross-Domain Wizard-of-Oz task-oriented dataset. It contains 6K dialogue sessions and 102K utterances for 5 domains, including hotel, restaurant, attraction, metro, and taxi. Moreover, the corpus contains rich annotation of dialogue states and dialogue acts on both user and system sides. About 60% of the dialogues have cross-domain user goals that favor inter-domain dependency and encourage natural transition across domains in conversation. We also provide a user simulator and several benchmark models for pipelined task-oriented dialogue systems, which will facilitate researchers to compare and evaluate their models on this corpus. The large size and rich annotation of CrossWOZ make it suitable to investigate a variety of tasks in cross-domain dialogue modeling, such as dialogue state tracking, policy learning, user simulation, etc.
A new species of Trigastrotheca Cameron (Hymenoptera: Braconidae: Braconinae) from Thailand
Authors: RAWEEARAMWONG MARISA , QUICKE DONALD L. J. , BUTCHER BUNTIKA A.
Published: June 2020

A new species of Trigastrotheca Cameron, 1906 from Doi Phu Kha National Park, Nan province, Thailand is described and illustrated based on a female specimen collected by light trapping, bringing the total number of Trigastrotheca species known from Thailand to three; T. doiphukhaensis Raweearamwong, Quicke & Butcher, sp. nov., T. pariyanonthae Quicke & Butcher, 2017, and T. sureeratae Quicke & Butcher, 2017. The new species differs markedly in coloration from other Thai species and is most similar to T. tridentata (Enderlein) from which it is differentiated. A checklist to the 14 species known of Trigastrotheca with their distributions is provided.
A new large-bodied, rupicolous Cnemaspis Strauch, 1887 (Squamata: Gekkonidae) allied to Cnemaspis heteropholis Bauer, 2002 from the Central Western Ghats of Karnataka, India
Authors: KHANDEKAR AKSHAY , THACKERAY TEJAS , PAL SAUNAK , AGARWAL ISHAN
Published: June 2020

We describe a new large-bodied, rupicolous Cnemaspis from near Sakleshpur in the Central Western Ghats of Karnataka, India. Cnemaspis magnifica sp. nov. is allied to C. heteropholis and can be diagnosed from all other Indian Cnemaspis by the absence of spine-like scales on flank; heterogeneous dorsal pholidosis, presence of only femoral pores in males, homogenous dorsal pholidosis of tail with small, smooth, regularly arranged, flattened, subimbricate scales, without whorls of enlarged tubercles, median row of sub-caudals enlarged and smooth. The new species differs from its closest congener C. heteropholis in body size, the number of longitudinal ventral scales, number of lamellae under digit I and IV of manus and pes, and subtle colour pattern differences; besides 9.1 % uncorrected ND2 sequence divergence. We provide the first description of topotypic male of C. heteropholis along with data on its distribution and natural history. The discovery of Cnemaspis magnifica sp. nov. with minimal field survey effort indicates the need for further herpetological exploration in the region.
A new genus and species of odiniids (Diptera: Odiniidae) from the canopy of the Brazilian Amazon rainforest
Authors: LIMEIRA-DE-OLIVEIRA FRANCISCO , MARQUES DAYSE WILLKENIA A. , GAIMARI STEPHEN D. , RAFAEL JOSÉ A.
Published: June 2020

Umbodinia bella gen. nov. et sp. nov. is described and illustrated from specimens collected in the canopy of an ombrophilous Amazonian forest, Manaus, Brazil. The genus is characterized by a unique combination of diagnostic features: body predominantly yellow; frons with two shiny dark brown to black lobules in lower corners, between the lunule and eye margins; lunule high-arched with two subtriangular spots covered with black pubescence; parafacial with tufts of long and strong setae, almost as long and stout as the fronto-orbital setae; and anepisternum with setulae dorsally and posteriorly, in addition to posterior setae.
Evaluation of the Clinical Pathway for Laparoscopic Cholecystectomy
Authors: Soria VÍctor , Pellicer Enrique , Flores Benito , Carrasco Milagros , Fe Candel Maria , Aguayo Jose Luis
Published: June 2020

Clinical pathways are comprehensive systematized patient care plans for specific procedures. The clinical pathway for laparoscopic cholecystectomy was implemented in our department in March 2002. The aim of this study is to evaluate the clinical pathway for this procedure 1 year after implementation. A study was conducted on all the patients included in the clinical pathway since its implementation. The assessment criteria include degree of compliance, indicators of clinical care effectiveness, financial impact, and survey-based indicators of satisfaction. The results are compared to a series of patients undergoing surgery the year prior to implementation of the clinical pathway. As our hospital has a system of cost management, we analyzed the mean cost per procedure before and after clinical pathway implementation. Evaluation was made of a series of 160 consecutive patients who underwent surgery during the period 1 year prior to development of the clinical pathway and met the accepted inclusion criteria. The mean length of hospital stay was 3.27 days, and the mean cost per procedure before pathway implementation was 2149 (±768) euros. One year after implementation of the pathway, 140 patients were included (i.e., an inclusion rate of 100%). The mean length of hospital stay of the patients included in the clinical pathway was 2.2 days. The degree of compliance with stays was 66.7 per cent. The most frequent reasons for noncompliance were staff-dependent, followed by patient-dependent causes (oral intolerance, pain, etc.). The mean cost in the series of patients included in the clinical pathway was 1845 (± 618) euros. Laparoscopic cholecystectomy is an ideal procedure for commencing the systemization of clinical pathways. Results show that it has significantly reduced the length of hospital stay and mean cost per procedure with no increased morbidity and with a high degree of patient satisfaction.
Selective Use of Cardiopulmonary Bypass in Trauma Patients
Authors: Dauphine Christine , Mckay Charles , De Virgilio Christian , Omari Bassam
Published: June 2020

The need for cardiopulmonary bypass (CPB) in the treatment of trauma patients is controversial, and not all level I trauma centers have CPB readily available. Our purpose was to review the selective use of CPB in the management of trauma victims at a level I trauma center in Los Angeles County. We reviewed the records of all patients for whom the CPB team was called in from 1994 to 2002. Perfusionists were present for the initial operative management of 24 patients, 22 (92%) of which were male. Twelve patients had penetrating and nine had blunt injuries, two were severely hypothermic, and the last suffered embolization of a bullet to the pulmonary artery. Overall survival was 75 per cent. Sixteen (67%) patients required CPB due to the life-threatening nature of their injuries and/or hemodynamic instability; 11 (69%) survived. The remaining 8 patients were operated on with the CPB team present but on standby; 7 (88%) survived. Cardiopulmonary bypass could be life-saving in select trauma patients with major chest injuries. Hypothermia, acidemia, and shock can be reversed earlier while allowing increased time to gain adequate exposure and perform quality repairs. Level I trauma centers should have CPB capabilities immediately available.
Umbilical Hernia Repair in Cirrhotic Patients: Utility of Temporary Peritoneal Dialysis Catheter
Authors: Slakey Douglas P. , Benz Cynthia C. , Joshi Shobha , Regenstein Fredric G. , Florman Sander S.
Published: June 2020

Umbilical herniorrhaphy in cirrhotic patients with ascites is associated with a significant morbidity, recurrence rate, and mortality and therefore is often managed expectantly. Operative repair is indicated if an ascites leak or infection develops. Surgeons must consider the management of postoperative ascites to reduce recurrence rates and complications. We present a unique method using temporary peritoneal dialysis catheter placement (PD). Eight patients with moderate to massive ascites underwent umbilical herniorrhaphy with concomitant peritoneal dialysis placement. Patients have been followed for 8 to 30 months. All patients had successful repair of their hernia with 1 recurrence at 6 months and 1 late death (14 months). Patients were able to effectively control ascites using the PD catheter at home. There were no postoperative infections. The placement of a temporary PD catheter during umbilical herniorrhaphy provides a method for effective control of ascites in patients with cirrhosis. The technique has several advantages including outpatient management during the postoperative period and for easy removal of the catheter when no longer needed.
Evidence-Based Medicine Applied to Sentinel Lymph Node Biopsy in Patients with Breast Cancer
Authors: Barone James E. , Tucker James B. , Perez Jose M. , Odom Stephen R. , Ghevariya Vishal
Published: June 2020

Sentinel lymph node biopsy (SLNB) has not been examined using the principles of evidence-based medicine (EBM). Specifically, likelihood ratios have not been used to assess the validity of SLNB. The Surveillance, Epidemiology, and End Results (SEER) public database of the National Cancer Institute was used to establish the baseline or pretest probability of finding a positive lymph axillary node for each stage of breast cancer. Rates of false negative results of SLNB for all breast cancer stages were determined from the surgical literature. Positive and negative likelihood ratios (LR) were calculated. For each stage of breast cancer, the Bayesian nomogram was used to find the post-test probability of missing a metastatic axillary node when the SLN was negative. The SEER database of 213,292 female patients with breast cancer yielded the following rates of positivity of axillary lymph nodes for each breast tumor size: T1a, 7.8 per cent; T1b, 13.3 per cent; T1c, 28.5 per cent; T2, 50.2 per cent; T3, 70.1 per cent. The combined data from 13 published studies of SLNB (6444 successful SLNBs) demonstrated a false negative rate of 8.5 per cent. The LR of a negative test is 0.086. According to the nomogram, the chances of missing a positive node for stage of cancer are as follows: T1a, 0.7 per cent; T1b, 1.5 per cent; T1c, 3.0 per cent; T2, 7 per cent; T3, 18 per cent. The risk of missing a positive axillary node can accurately be estimated for each stage of breast cancer using the LR, which is much more useful than the simple false negative rate. Surgeons should use this information when deciding whether to perform SLNB and in their informed consent discussions.
Gallbladder Volvulus: Report of Two Original Cases and Review of the Literature
Authors: Shaikh Almaas A. , Charles Anthony , Domingo Shirley , Schaub George
Published: June 2020

Gallbladder volvulus is defined as the rotation of the gallbladder on its mesentery along the axis of the cystic duct and cystic artery. It is an unusual and rare occurrence with a predilection for women in their seventh or eight decades of life. Only about 300 cases have been reported in the literature ranging from ages 2 to 100 years old. The etiology of gallbladder volvulus remains speculative; however, the presence of a redundant mesentery is a prerequisite for torsion. Gallbladder volvulus leads to occlusive obstruction of biliary drainage and blood flow. With early diagnosis and surgical intervention, the disease maintains a low mortality of approximately 5 per cent. We present two original cases of acute gallbladder volvulus successfully treated with cholecystectomy, as well as a review of the literature.
The Trapezius Port: A Novel Approach for Port Access
Authors: Copper C.M. , Pacanowski J.P. , Bell J.L.
Published: June 2020

Placement of long-term central venous access in breast cancer patients who have undergone bilateral mastectomy presents a unique challenge. The standard anterior chest wall placement of the port may be compromised by factors such as a fresh surgical site, the possibility of postoperative radiation therapy, or the immediate reconstruction field. To avoid the potential for complications that impact the surgical field or subsequent therapy, we have developed a unique new technique for central venous port placement: the trapezius port. By placing the port in a subcutaneous pocket over the trapezius muscle, the risk of infection or cross-contamination of the surgical site is avoided.
Life-Threatening Abdominal Wall Hematoma in a Chronic Renal Failure Patient after a Single Dose of Enoxaparin
Authors: Weinsheimer Robert L. , Libby Edward , Howdieshell Thomas R.
Published: June 2020

We present a patient with chronic renal insufficiency who developed a massive posttraumatic abdominal wall hematoma after a single therapeutic dose of enoxaparin administered during workup of chest pain. Surgical evacuation of the hematoma was required to control life-threatening hemorrhage. Low-molecular-weight heparin use is not without risk and mandates appropriate indication and accurate dosing. Bleeding can occur at any site during heparin therapy, and abdominal wall hematoma should be considered as a source after traumatic injury.
A Laparoscopic Method for Optimal Peritoneal Dialysis Access
Authors: Crabtree John H. , Fishman Arnold
Published: June 2020

Both medical benefits to the patient and financial incentives to the health care system exist to increase the use of peritoneal dialysis as renal replacement therapy. Providing long-term peritoneal access free of mechanical dysfunction continues to represent a major challenge to the success of this modality. Variable outcomes result from the lack of standard implantation methodology and failure to address persistent problems associated with current implantation techniques. This prospective case study compared noninfectious procedural complications of three approaches to establish peritoneal dialysis access. The groups consisted of 63 catheters implanted by traditional open dissection, 78 catheters implanted by basic laparoscopy without associated interventions, and 200 catheters implanted by advanced laparoscopic methods including rectus sheath tunneling, selective prophylactic omentopexy, and selective adhesiolysis. Mechanical flow obstruction, the major outcome indicator, followed only 1 of 200 (0.5%) implantation procedures in the advanced group and was significantly better ( P < 0.0001) than the open dissection (17.5%) and basic laparoscopic (12.5%) groups. A low rate of pericannular leaks (1.3–2%) was not different for the three groups. One pericannular hernia occurred in the open group. Catheter mechanical dysfunction attributable to the surgical technique can nearly be eliminated through adjunctive procedures made possible only by a laparoscopic approach.
Anteriorly Placed Splenic Vein: The First Reported Case
Authors: Shah Omar Javed , Robbani Irfan
Published: June 2020

Surgical treatment of portal hypertension is undertaken to reduce the portal pressure to a level that allows recession of the collateral circulation. For this purpose, surgeons usually carry out anastomosis of the splenic vein with the left renal vein. The splenic vein is a large, nontortuous vessel that runs along the posterior surface of the pancreas but very rarely crosses in front of the gland. It is therefore important that a thorough preoperative study of the anatomical details of the spleno-portal venous axis be made by imaging before attempting surgery. We are presenting herewith the surgical management of a unique case of anteriorly placed splenic vein, which has not yet been described. The embryological basis of such an anomaly is discussed in this article.
Percutaneous Endoscopic Transgastric Jejunostomy: A New Approach
Authors: Melvin Willie , Fernandez Joss D.
Published: June 2020

A percutaneous transgastric jejunostomy allows long-term simultaneous gastric decompression and jejunal feedings. We have developed a safe and effective bedside technique for placement of a large-bore (22 French) feeding tube while providing gastric drainage with no mortalities and minimal morbidities. We have modified the push technique used for percutaneous gastrostomies and introduced a cut-away sheath that is placed using a modified Seldinger technique. The entire procedure is performed under endoscopic visualization. Our experience with more than 100 successful tube placements has made this method common practice at our institute. This technique is ideal for patients with poor gastric emptying of any etiology. We feel that this technique will have an expanding and important role in the future management of this patient population's nutritional problems.
Importance of Identifying the Course of the Recurrent Laryngeal Nerve in Total and Near-Total Thyroid Lobectomies
Authors: Acun Zeki , Cinar Fikret , Cihan Alper , Can Ulukent Suat , Uzun Lokman , Ucan Bulent , Ugur M. Birol
Published: June 2020

In our clinic, near-total thyroidectomy is the principal surgical procedure performed for benign thyroid diseases. We conducted a single-institution study on 176 consecutive patients who underwent near-total thyroidectomy due to various thyroid diseases. We compared the incidence of recurrent laryngeal nerve injury between total and near-total thyroid lobectomy sides in each patient. Our hypothesis was that the incidence of recurrent laryngeal nerve injury after total thyroid lobectomy would be similar to that of near-total thyroid lobectomy when the course of the recurrent laryngeal nerve was identified during surgery. The temporary recurrent laryngeal nerve palsy rates on the total and near-total thyroid lobectomy sides were 3.9 per cent (7 of 176 nerves) and 2.2 per cent (4 of 176 nerves), respectively. The difference was not statistically significant. Permanent recurrent laryngeal nerve palsy did not occur in any of our patients. In conclusion, the incidence of recurrent laryngeal nerve injury in total versus near-total thyroid lobectomy is not different when the course of the recurrent laryngeal nerve is identified during surgery.
Significance of the Effective Remnant Liver Volume in Major Hepatectomies
Authors: Gruttadauria Salvatore , Vasta Fabio , Minervini Marta Ida , Piazza Tommaso , Arcadipane Antonio , Marcos Amadeo , Gridelli Bruno
Published: June 2020

The aim of this study is to identify the minimum safe amount of effective remnant liver volume (ERLV) in patients undergoing a major hepatectomy. Thirty-eight consecutive major hepatectomies (resection of ≥3 Couinaud segments) performed between July 1999 and March 2004 in which a frozen section liver biopsy was obtained were included. No patient had chronic viral hepatitis, cirrhosis, or cholestasis. The total liver volume (TLV) was calculated using the Vauthey formula, and the postsurgical liver volume (PSLV) was derived by subtracting the estimated volume of liver resected from the TLV. The PSLV minus the percentage of macrovesicular steatosis as nonfunctional liver was defined as the effective remnant liver volume (ERLV). Three groups of ERLV/TLV ratios (<30%, between 30% and 60%, and >60%) were correlated with liver resection type, mortality, complications, intraoperative blood transfusions, operative time, length of hospitalization, and mean value of liver function tests in the first 5 postoperative days. Comparisons between clinical parameters were performed by Pearson χ2 test. There was significant correlation between ERLV/TLV ratios and surgical resection type ( P < 0.001), early postoperative mortality ( P < 0.01), and complications ( P < 0.003). The ERLV/TLV ratio may be a useful predictor of surgical outcome after major hepatectomy.
Occult Fifth Gland Intrathyroid Parathyroid Adenoma Identified by Gamma Probe
Authors: Berland Todd , Smith Stephen L. , Huguet Kevin L.
Published: June 2020

We report the case of a 54-year-old woman undergoing radioguided parathyroidectomy in whom four normal glands were identified on cervical exploration. The gamma probe was instrumental in guiding us to the adenoma in a fifth gland that was not visible and was localized to the parenchyma of the left lobe of the thyroid gland. Many surgeons do not advocate use of the gamma probe in minimally invasive parathyroidectomy and rely solely on focused exploration on the basis of a preoperative sestamibi scan and intraoperative rapid parathyroid hormone assays. This case, however, illustrates the utility of the gamma probe in parathyroid adenoma localization.
Falciform Ligament Hernia after Laparoscopic Cholecystectomy: A Rare Case and Review of the Literature
Authors: Charles Anthony , Shaikh Almaas A. , Domingo Shirley , Kreske Edward
Published: June 2020

The occurrence of an internal hernia through a congenital or iatrogenic defect in the falciform ligament is extremely rare. In the era of minimally invasive surgery, we present an unusual case of small bowel obstruction after laparoscopic cholecystectomy. An 85-year-old white male presented to the emergency room 2 weeks after an uneventful cholecystectomy and complaining of a colicky, nonradiating right upper quadrant abdominal pain. Hydroxyiminodiacetic acid (HIDA) scan and endoscopic retrograde cholangiopancreatography (ERCP) performed revealed an open ductal system. Abdominal computed tomography (CT) scan was suggestive of a high-grade small bowel obstruction. Exploratory laparotomy revealed a herniated loop of distal ileum, passing from right to left through a defect in the falciform ligament created by the subxyphoid trochar. The surgeon should consider dividing the inferior leaf of the free edge of the falciform ligament, including the round ligament, should an aperture be created during laparoscopic port placement.
Comparison of Results in Endovascular Interventions for Infrainguinal Lesions: Claudication versus Critical Limb Ischemia
Authors: Trocciola Susan M. , Chaer Rabih , Dayal Rajeev , Lin Stephanie C. , Kumar Naveen , Rhee Jason , Pierce Matthew , Ryer Evan J. , Mckinsey James , Morrissey Nicholas J. , Bush Harry L. , Kent K. Craig , Faries Peter L.
Published: June 2020

This study analyzed clinical success, patency, and limb salvage after endovascular repair in patients treated for chronic limb ischemia presenting with claudication versus critical limb ischemia. Between October 2001 and August 2004, 115 patients (mean age 71) underwent endovascular treatment for infrainguinal arterial disease. Techniques included subintimal angioplasty and transluminal angioplasty with or without stents. Lesions were classified according to Transatlantic InterSociety Consensus. Follow-up (mean 11 months) included physical exam, ankle-brachial index, and duplex ultrasound. Patency rates were determined using Kaplan-Meier and compared by log-rank analysis. One hundred ninety-nine lesions were treated in 121 limbs using percutaneous techniques. Comorbidities were similar except higher rates of diabetes mellitus (67% vs 41%, P < 0.001) and chronic renal insufficiency (22% vs 7%, P < 0.05) were found in critical limb ischemia patients. Primary patency for claudicants was 100 per cent, 98 per cent, and 85 per cent at 3, 6, and 12 months and 89 per cent, 80 per cent, and 72 per cent for critical limb ischemia, respectively ( P = 0.06). Limb salvage was 91 per cent at 12 months for critical limb ischemia patients. Morbidity was similar between groups, and there was no perioperative mortality. Percutaneous intervention for both claudication and critical limb ischemia provides acceptable 12-month patency with limited morbidity.
Prevalence of Delayed Hemothorax in Blunt Thoracic Trauma
Authors: Sharma Om P. , Hagler Sara , Oswanski Michael F.
Published: June 2020

Delayed hemothorax (DHTX) is rarely seen. On an 8-year retrospective analysis of blunt thoracic trauma (BTT), hemothorax (HTX) was diagnosed in 167 patients: 18 children, 113 adults, and 36 elderly. No statistical differences were seen in any age groups regarding Injury Severity Score (mean ISS, 30.54), critical care length of stay (CLOS, 9.0), and hospital LOS (HLOS, 11.21). Mortality rate was 18 per cent in adults and 28 per cent in elderly ( P value < 0.0001). HTX was acute in 160 and delayed in 7 patients. Two-thirds of HTX patients were males and 75 per cent had rib fractures. All of our DHTX patients were males (5 adults and 2 elderly) and had rib fractures. Acute HTX was seen in younger patients (43.3 vs 56.1 years, P value 0.46), with higher ISS (31.44 vs 14.43, P value < 0.001), CLOS (7.19 vs 3.0 days, P value 0.511) and HLOS (11.9 vs 11.6, P value 0.468). Mortality was 22.5 per cent in AHTX and none in DHTX. Eighty-six per cent of DHTX and 49 per cent of AHTX patients went home on discharge. DHTX was rare (5%) in the current report with lower ISS, HLOS, and no mortality. Patients with rib fractures should be watched for development of DHTX as timely diagnosis and treatment is essential for favorable outcome.
Neoadjuvant Chemotherapy in Stage III Breast Cancer
Authors: Alassas Mohamed , Chu Quyen , Burton Gary , Ampil Fred , Mizell Jason , Li Benjamin D.
Published: June 2020

Neoadjuvant chemotherapy in advanced breast cancer can potentially downstage disease prior to definitive surgery. In this study, a doxorubicin-based neoadjuvant regimen was administered to stage III breast cancer patients to assess 1) primary tumor response, 2) tumor involvement of resection margins, and 3) predictive value in cancer outcome. Eighty-two patients with stage IIIA and IIIB breast cancer diagnosed between 1990 and 2003 were studied. All patients received similar chemotherapy regimens, consisting of doxorubicin, cisplatin, and 5-fluorouracil, plus surgery and radiation therapy. End points measured include primary tumor response [complete response (CR) = 100%, partial response (PR) >50%, or no response (NR) ≤50%], resection margins for tumor, disease-free, and overall survival. Kaplan-Meier and log-rank tests were performed. Of the 82 patients studied, 34 received neoadjuvant therapy, 48 received conventional postoperative treatment. Seventy-two per cent of the stage IIIB and 22 per cent of the stage IIIA patients received neoadjuvant therapy. In the neoadjuvant group, 29 (85%) patients demonstrated tumor response, 9 (26%) of which were CR. Tumor-free resection margins were achieved in 94 per cent of the neoadjuvant group. Survival analysis demonstrated no benefit comparing neoadjuvant versus postoperative adjuvant therapy but hints at improved disease-free survival in neoadjuvant CR patients (log-rank test, P = 0.07). Eighty-five per cent of patients with stage III breast cancer treated with neoadjuvant chemotherapy experienced clinical response, with 26 per cent CR, and 97 per cent tumor-free resection margins. CR may portend a better cancer outcome.
Absence of the Retrohepatic Inferior Vena Cava: What the Surgeon Should Know
Authors: Sneed Darrel , Hamdallah Isam , Sardi Armando
Published: June 2020

Anomalies of the inferior vena cava are rare and can easily be misdiagnosed if one is not aware of such variants. We report a case of a 57-year-old patient that had a percutaneous CT-guided biopsy of what was considered to be enlarged pericaval lymph nodes. This occurred because of the poor technique of the CT scan and the unawareness of such a condition. These changes were related to a proximal varicele of an absent, retrohepatic inferior vena cava. There was an extensive collateral network with filling of large azygos and hemiazygos veins draining through the posterior mediastinum into the superior vena cava. This case emphasizes the importance of correctly identifying vascular anomalies before the initiation of biopsy attempts in order to prevent the risk of major complications that could arise during such biopsy.
Monetary Lessons from Litigation Involving Laparoscopic Cholecystectomy
Authors: Mclean Thomas R.
Published: June 2020

Limited information exists on the relationship between adverse events associated with laparoscopic cholecystectomy (LC) and subsequent litigation. Out of 104 suits concerning LC, 18 cases were settled for $628,138; 48 cases resulted in a plaintiff's verdict with the plaintiff receiving $2,891,421; and 18 cases resulted in a surgeon's verdict. However, when multiple defendant cases were excluded, there was <$20,000 difference between a negotiated settlement and plaintiff's verdict. Given the minimal monetary differences between a settlement and a plaintiff's verdict, when a surgeon is the sole defendant in a malpractice case concerning LC, the surgeon should encourage their carriers not to settle before trial; as only a trial will exonerate the surgeon. However, this encouragement should be tempered when there are “red flags” that favor the plaintiff, including multiple defendants (especially a hospital), male plaintiffs, bile duct injuries, knowledgeable and well-financed plaintiff's attorneys, and certain plaintiff's venues.
A Preliminary Study of Imiquimod Treatment in Variants of Basal Cell Carcinoma
Authors: McCutcheon Brion , White Kenneth , Kotwall Cyrus , Germolic Dori , Rebolloso Yvette , Hamann Mary Sue , Stiles Anquonette
Published: June 2020

Imiquimod is a topical immune response modifier that has proved efficacious in the treatment of the superficial variant of basal cell carcinoma. The nodular variant of basal cell carcinoma has shown moderate response to imiquimod; other variants have not been tested. The mechanism of action is largely unknown; however, studies indicate the mechanism involves alteration of local cytokine production. The objective of this study is to evaluate the cytokine response of imiquimod in all variants of basal cell carcinoma. Ten patients were selected who had clinically and histologically proven basal cell carcinoma. All lesions were treated with imiquimod once a day, 5 days a week, for 3 weeks. After a 3-week rest period, the lesions were rebiopsied. All biopsy specimens were analyzed via polymerase chain reaction (PCR) for various cytokines. Nine of 10 lesions resolved clinically, which included nodular, superficial, infiltrative, adenoid, and micro-nodular variants. The cytokine with the greatest change pre- and post-treatment was IL-8, which decreased an average of 44 per cent ( P = 0.06). We concluded that topical 5 per cent imiquimod is an effective treatment of various subtypes of basal cell carcinoma. IL-8, which plays an important role in the development and metastasis of melanoma, may be involved in the mechanism of action of imiquimod on cutaneous malignancies. Larger studies are needed to prove the efficacy of imiquimod on nonsuperficial variants of basal cell carcinoma and cutaneous melanoma metastasis.
An Unusual Rectosigmoid Mass: Endometrioid Adenocarcinoma Arising in Colonic Endometriosis: Case Report and Literature Review
Authors: Hoang Chuong D. , Boettcher Adam K. , Jessurun Jose , Pambuccian Stefan E. , Bullard Kelli M.
Published: June 2020

Malignant transformation is an infrequent complication of endometriosis. The ovary is the primary site in 79 per cent of cases, and extragonadal sites are identified in 21 per cent. Primary involvement of these types of tumors with the colon and/or rectum is a rare clinical entity. Endometrioid carcinoma is a common histologic type that remains a diagnostic challenge–the main differential diagnosis includes colorectal carcinomas. We report a case of malignant transformation arising in colonic endometriosis. The patient had a total abdominal hysterectomy and bilateral salpingo-oophorectomy 10 years before she presented with hematochezia. The patient was ultimately treated by surgical resection. Immunohistochemical staining in addition to the usual histopathology was critical for accurate diagnosis of this endometriosis-associated intestinal tumor.
The Implication of Lymph Node Metastasis on Survival in Patients with Well-Differentiated Thyroid Cancer
Authors: Podnos Yale D. , Smith David , Wagman Lawrence D. , Ellenhorn Joshua D.I.
Published: June 2020

Though survival for well-differentiated thyroid cancer is very good, specific populations suffer greater recurrence and mortality. Defining these cohorts can significantly influence prognosis and extent of treatment. This study, using a large, multi-institutional database, seeks to determine how the presence of lymph node disease in patients with well-differentiated thyroid cancer affects outcome. The Surveillance, Epidemiology, and End Results (SEER) database is a large-scale sample of 14 per cent of the U.S. population. It was used to identify patients with papillary and follicular thyroid carcinomas and identify the prognostic implications of lymph node metastasis. Additional factors, including presence of metastasis, age, and tumor size, were compared using multivariate and χ2 analyses. Of 19,918 patients identified, lymph node status was known for 9,904 (49.7%). On multivariate analysis, age >45 years, presence of distant metastasis, large tumor size, and lymph node involvement significantly predicted poor outcome. Overall survival at 14 years was 82 per cent for node negative and 79 per cent for node positive patients ( P < 0.05). This study shows that the survival of patients with well-differentiated thyroid cancer is adversely affected by lymph node metastases. The optimum treatment for this cohort needs further delineation, as particular populations are at greater risk of recurrence and death.
Laparoscopic Distal Pancreatic Resection
Authors: Root Jeff , Nguyen Ninh , Jones Blanding , Mccloud Scott , Lee John , Nguyen Phuong , Chang Ken , Lin Peter , Imagawa David
Published: June 2020

Laparoscopic resection is not an established treatment for pancreatic tumors. Previous reports, mainly in Europe and Japan, have demonstrated the potential utility of laparoscopic distal pancreatectomy (LDP). However, few reports have been published from the United States. We instituted a pilot program to assess LDP. A total of 11 patients were included from December 2003 to December 2004. All patients were staged with preoperative endoscopic ultrasound and received vaccinations for possible splenectomy. The indications for surgery were as follows: neuroendocrine tumor (n = 7), unspecified tumor (n = 1), and cystic neoplasm (n = 3). All procedures began with diagnostic laparoscopy and intraoperative ultrasound. Three patients underwent laparoscopic enucleation of a discrete pancreatic nodule. In eight patients, LDP was attempted. One patient required conversion to an open procedure. In the other seven patients, the procedure was completed laparoscopically, two with hand-assist. The average operative time was 5 hours and 3 minutes; average length of stay was 5 days; and the splenectomy rate was 57 per cent (n = 4). There was one complication of an infected hematoma. There were no pancreatic leaks, deaths, nor readmissions. LDP with or without splenectomy is feasible and can be performed with minimum morbidity and only slightly increased operative time.