bluuebunny/crossref_metadata_2025 huggingface dataset:
Gender‐based perceptions of equity in China's state‐owned enterprises
Authors: Nie Winter , Hopkins Willie E. , Hopkins Shirley A.
Published: August 2002

Despite the emphasis on equality in China's state‐owned enterprises, analysis of data collected
from 900 Chinese in 10 state‐owned enterprises indicated that statistically significant pay differences
exist between male and female employees. However, differences between male and female employees'
perceptions of equity in these enterprises were found to be statistically significant only among those
employees with fewer years of work experience and those with lower levels of technical skills. Perceptions of
equity were also found to be related to the job satisfaction of both male and female employees. These results
are discussed within the context of the Maoist ideology of egalitarianism and the post‐Tiananmen
movement toward the forging of links between employee compensation and performance. © 2002 Wiley
Periodicals, Inc.
NTT DoCoMo and m‐commerce: A case study in market expansion and global strategy
Authors: Anwar Syed Tariq
Published: August 2002

This case discusses and evaluates NTT DoCoMo's overseas expansion and global strategies in the wireless
and mobile phone industry. The primary objective of this work is to examine NTT DoCoMo's recent acquisitions
within the concept of internationalization and global expansion issues. Analysts believe that in the next five
years, NTT DoCoMo will become one of the leading players in the global wireless industry because of increasing
consumer demand and growth potential. On the other hand, NTT DoCoMo may also face a heightened competition and
will be challenged by other competitors in Japan and other markets. © 2002 John Wiley & Sons, Inc.
Preliminary evidence for in vivo tumour initiation by oral administration of extracts of the blue‐green alga Cylindrospermopsis raciborskii containing the toxin cylindrospermopsin
Authors: Falconer I. R. , Humpage A. R.
Published: August 2002

New reports indicate that the toxic alkaloid cylindrospermopsin occurs in cyanobacteria in Israel, Florida, South America, and Australia in drinking water sources. This toxin is now recognised as a potential threat to human health. Furthermore, we have recently demonstrated the mutagenicity of cylindrospermopsin in vitro in a human lymphoblastoid cell‐line. Therefore it is essential to determine whether cylindrospermopsin is also carcinogenic in vivo. In this preliminary study, 53 mice were treated up to three times orally with Cylindrospermopsis raciborskii extract containing cylindrospermopsin, while 27 control mice were treated with saline. A proportion of each group were then given O‐tetradecanoylphorbol 13‐acetate (10 μg/mouse, twice weekly in liquid food) for the duration of the experiment; the remainder were given a control diet. After 30 weeks, the mice were euthanased and the major organs were examined histologically. Five tumours were found in 53 cylindrospermopsin‐treated mice while none were found in the 27 controls. Although the number of animals used was too low to provide statistical significance (p=0.16), the calculated relative risk (RR=6.2; 95% CI: 0.33–117) indicates a potential biological and public health significance requiring further investigation. Estimates are given of the size of experiment required to provide statistical proof of cylindrospermopsin carcinogenicity. © 2001 John Wiley & Sons, Inc. Environ Toxicol 16: 192–195, 2001
A Method for Determination of Damping for Edgewise Blade Vibrations
Authors: Thomsen K. , Petersen J. T. , Nim E. , Øye S. , Petersen B.
Published: August 2002

Violent edgewise blade vibrations have in recent years been a large problem for some stall‐regulated wind turbines. Owing to the complexity of the phenomenon, it has been difficult to predict the risk of these vibrations with aeroelastic load prediction tools. One problem is the choice of parameters in the aeroelastic model, e.g. structural damping and aerodynamic aerofoil characteristics. In many cases a high degree of uncertainty in the predicted response exists and the need for experimental verification methods is obvious. In this work a new method to identify the effective damping for the edgewise blade mode shape for wind turbines has been developed. The method consists of an exciter mechanism which makes it possible to excite the edgewise blade mode shapes from the wind turbine nacelle. Furthermore, the method consists of an analysis method which enables a straightforward determination of the damping. The analysis method is based on a local blade whirl description of the edgewise blade vibrations. The method is verified on a Bonus wind turbine, and for this specific turbine the effective damping for edgewise blade vibrations has been determined. The results support the further development of aeroelastic models and show potential for fine‐tuning of parameters of importance for the edgewise blade vibration problem. Furthermore, the method can be used for experimental investigation of the risk of edgewise blade vibrations for a specific turbine. Copyright © 2000 John Wiley & Sons, Ltd.
Construction of a focusing high‐resolution crystal analyser for x‐rays
Authors: Tirao G. , Cusatis C. , Stutz G.
Published: August 2002

We present the construction of a focusing x‐ray analyser designed to operate in back‐diffraction geometry. A spherical crystal surface was achieved by positioning about 2000 small Si crystals on a concave glass substrate. The analyser was mounted at the XRD beamline of the LNLS (Laboratório Nacional de Luz Síncrotron) for testing the energy resolution of a spectrometer consisting of both a sagitally focusing monochromator and the analyser. Controlling the vertical angular divergence of the primary beam, resolving powers of ΔE/E≈2 × 10−4 could be achieved with good intensity. Copyright © 2002 John Wiley & Sons, Ltd.
Isolation of a gene encoding a putative polyamine transporter from Candida albicans, GPT1
Authors: McNemar Mark D. , Gorman Jessica A. , Buckley Helen R.
Published: August 2002

A gene encoding a transport protein from the pathogenic yeast, Candida albicans, has been isolated during a complementation experiment utilizing an ornithine decarboxylase‐negative (spe1Δ) strain of Saccharomyces cerevisiae. This gene restores γ‐aminobutyric acid (GABA) transport to a GABA transport‐negative mutant of S. cerevisiae and encodes a protein which putatively allows transport of one or more of the polyamines. We have assigned the name GPT1 (GABA/polyamine transporter) to this gene. The GenBank Accession No. for this gene is AF080132. Copyright © 2001 John Wiley & Sons, Ltd.
Mutations in Fks1p affect the cell wall content of β‐1,3‐ and β‐1,6‐glucan in Saccharomyces cerevisiae
Authors: Dijkgraaf Gerrit J. P. , Abe Mitsuhiro , Ohya Yoshikazu , Bussey Howard
Published: August 2002

Fks1p and Fks2p are related proteins thought to be catalytic subunits of the β‐1,3‐glucan synthase. Analysis of fks1Δ mutants showed a partial K1 killer toxin‐resistant phenotype and a 30% reduction in alkali‐soluble β‐1,3‐glucan that was accompanied by a modest reduction in β‐1,6‐glucan. The gas1Δ mutant lacking a 1,3‐β‐glucanosyltransferase displayed a similar reduction in alkali‐soluble β‐1,3‐glucan but did not share the β‐1,6‐glucan defect, indicating that β‐1,6‐glucan reduction is not a general phenotype among β‐1,3‐glucan biosynthetic mutants. Overexpression of FKS2 suppressed the killer toxin phenotype of fks1Δ mutants, implicating Fks2p in the biosynthesis of the residual β‐1,6‐glucan present in fks1Δ cells. In addition, eight out of 12 fks1ts fks2Δ mutants had altered β‐glucan levels at the permissive temperature: the partial killer resistant FKS1F1258Y N1520D allele was severely affected in both polymers and displayed a 55% reduction in β‐1,6‐glucan, while the in vitro hyperactive allele FKS1T605I M761T increased both β‐glucan levels. These β‐1,6‐glucan phenotypes may be due to altered availability of, and structural changes in, the β‐1,3‐glucan polymer, which might serve as a β‐1,6‐glucan acceptor at the cell surface. Alternatively, Fks1p and Fks2p could actively participate in the biosynthesis of both polymers as β‐glucan transporters. We analysed Fks1p and Fks2p in β‐1,6‐glucan deficient mutants and found that they were mislocalized and that the mutants had reduced in vitro glucan synthase activity, possibly contributing to the observed β‐1,6‐glucan defects. Copyright © 2002 John Wiley & Sons, Ltd.
Optimal conditions for breeding of captive humboldt penguins (Spheniscus humboldti): A survey of British zoos
Authors: Blay Nicola , Côté Isabelle M.
Published: August 2002

We surveyed 16 British zoos and bird gardens to assess the optimal conditions for breeding of captive Humboldt penguins (Spheniscus humboldti). We obtained information on population, enclosure, and husbandry characteristics and related these variables to three measures of per capita breeding success, namely, per capita egg productivity, chick productivity, and hatching success (measured as the proportion of eggs laid that hatched). All three fitness measures increased with an increasing number of breeding pairs and total population size but were not related to population density. Once the effect of number of breeding pairs was removed statistically, chick productivity was found to be highest when nesting boxes were lined with sand and gravel instead of alternative substrata such as twigs or vegetation. Hatching success increased with increasing pool size and was highest in enclosures with concrete floors. Adult mortality in zoos was generally low and appeared related to the use of chlorine in freshwater pools and to the presence of other penguin species in Humboldt penguin displays. Several enclosure and husbandry parameters were not variable enough to assess their impact on reproduction of captive Humboldt penguins. Recommendations for optimising conditions for captive breeding of Humboldt penguins include keeping as large a population as possible in a concrete enclosure with a large pool area, while providing sand and gravel as nesting material. Bird density may be important but we did not detect detrimental effects on breeding for densities up to 0.25 birds m–2. Adult mortality can be minimised by exhibiting Humboldt penguins in single‐species display and avoiding chlorination of pool water. An experimental approach is recommended to confirm the results of this correlational study. Zoo Biol 20:545–555, 2001. © 2002 Wiley‐Liss, Inc.
Birth of a chimpanzee (Pan troglodytes) after artificial insemination with cryopreserved epididymal spermatozoa collected postmortem
Authors: Kusunoki Hiroshi , Daimaru Hideshi , Minami Shinji , Nishimoto Shosaku , Yamane Ken‐Ichi , Fukumoto Yukio
Published: August 2002

A male chimpanzee (Pan troglodytes) suddenly died of acute hemorrhagic enteritis at the age of 18 years. Within 24 hours after its death, a large quantity of spermatozoa of excellent quality was recovered from the distal cauda epididymides and was subsequently cryopreserved. After storage for 67 days, the frozen spermatozoa were thawed and inseminated in an adult, normal cycling, nulliparous female. The optimal day for insemination was estimated by monitoring the swelling of the female’s sex skin and urinary luteinizing hormone concentrations. Pregnancy was confirmed by a urinary chorionic gonadotropin test, and a normal female infant was born after 214 days of gestation. This birth demonstrates that distal cauda epididymal spermatozoa recovered from a dead male can be cryopreserved and successfully inseminated in a female chimpanzee. Zoo Biol 20:135–143, 2001. © 2001 Wiley‐Liss, Inc.
Partial-order Reduction Techniques for Real-time Model Checking
Authors: Dams Dennis , Gerth Rob , Knaack Bart , Kuiper Ruurd
Published: August 2002

A new notion, covering, generalising independence is introduced. It enables improved effects of partial-order reduction techniques when applied to real-time systems. Furthermore, we formulate a number of locally checkable conditions for covering that can be used as the basis for a practical algorithm. Correctness is proven with respect to a chosen discretisation method.
Achilles tendon rupture: experimental results on spontaneous repair in a sheep‐model
Authors: Bruns J. , Kampen J. , Kahrs J. , Plitz W.
Published: August 2002

We studied the course of spontaneous healing of Achilles tendons in a sheep model after transection and partial resection of the tendon by means of histological and biomechanical analyses. In 18 sheep used for another animal study the operated knee had to be excluded from weight‐bearing; therefore the Achilles tendons were transected and for 1.5 cm partially resected in the middle substance of the tendon. For evaluation these spontaneously healed tendons (n=18) were compared with the contralateral noninvolved tendons (n=18). Specimens were analyzed 3, 6, and 12 months postoperatively by means of histology, polarized light, angiography, and mechanically analyzing the specific tensile strength and absolute tensile strength. We found that in all animals the resected tendon healed spontaneously. All animals exhibited a normal gait pattern at least 6 weeks postoperatively. Histologically, the tendinous area of healing demonstrated after 3 months a fibrous collagenous tissue with a loose fiber orientation. The cross‐sectional area had at 3 months increased to maximum but decreased later. Concomitantly the fiber orientation improved with time and 12 months after transection the specimens showed a nearly normal histological structure of the healed tendon. Biomechanically the specimens exhibited a rather low specific rupture force after 3 months (28.8% of normal tendons) and 6 months (30.2%) but increased after 12 months (56.7%). In regard to the resulting total rupture force the decrease in the spontaneously healed tendons was less (75.6% after 3 months, 56.1% after 6 months, 81.18% after 12 months), because the cross‐sectional area of the healing tendon had significantly (P<0.05) increased to maximum after 3 and 6 months. Sheep Achilles tendons thus healed spontaneously without any immobilization. The initial healing mechanism is thickening of the scar tissue with improvement of the fiber orientation towards a tendonlike structure within 1 year. Parallel to this, the specific rupture force increased and the thickness of the newly tendonlike area decreased.
Influence of Postoperative Epidural Analgesia with Bupivacaine onIntestinal Motility, Transit Time, and Anastomotic Healing
Authors: Jansen Marc , Fass Jürgen , Tittel Andreas , Mumme Thorsten , Anurov Michael , Titkova Svetlana , Polivoda Michael , Öttinger Alexander , Schumpelick Volker
Published: August 2002

Epidural application of bupivacaine hasbeen suggested to have a sympatholytic effect on spinal reflexmechanisms that shortens postoperative paralysis and leads to animproved transit time. The influence on anastomitic healing remainscontroversial. Laparotomy was performed in eight dogs. A short segmentof the distal colon was resected and five electrodes were fixed on theserosa to measure the myoelectric activity (e.g., Migrating MyoelectricComplex—MMC). After operation a peridural catheter was placed betweenL7 and the sacral crest. One milliliter of bupivacaine 0.25% for each3 kg of body weight was injected every 4 hours. Barium pellets coatedin wax were placed into the stomach to allow radiographicrepresentation of transit time. After 5 days the colon anastomosis wasresected to measure the bursting pressure. In the peridural analgesiagroup (PDA) we found one small bowel intussusception and one coveredanastomotic leakage. Postoperative PDA led to early and severemyoelectric activity but did not influence the time until the first MMCoccurred (44 ± 0.8 h, PDA; 44.6 ± 1.5 h,control). Neither the transit time to the colon (50.2 ± 1.9h, PDA; 51.7 ± 5.5 h, control) nor the anastomotic healingwas influenced (bursting pressure: 176 ± 21.1 mmHg, PDA; 152± 27.7 mmHg, control). Postoperative epidural analgesia withbupivacaine shortens intestinal paralysis. Early myoelectric activitywith a lack of propulsive activity can cause complications like smallbowel intussusception. Hence early postoperative enteral nutritionafter epidural analgesia is risky. Because the influence of epiduralanalgesia on propulsive motility remains unclear, it seems reasonableto recommend its limited use in colon surgery.
Small Nonpolypoid Colorectal Carcinoma
Authors: Weil Ruben , Ohana Gil , Halpern Marisa , Estlein Dov , Avni Arieh , Wolloch Yaakov
Published: August 2002

The objective of this study was to characterize and assess the presence and frequency of small nonpolypoid colorectal adenocarcinomas among patients with colorectal cancer referred for surgery. The medical, endoscopic, and surgical reports and the histopathologic slides of all patients operated on for colorectal cancer were retrospectively reviewed. Small nonpolypoid colorectal cancer (SNPCC) was defined as a malignant, nonpolypoid lesion smaller than 15 mm. SNPCC was classified according to the Japanese macroscopic classification of colorectal carcinoma. The frequency of SNPCC among patients referred for operation was 1.8%. Most of these patients were asymptomatic and were diagnosed by the same endoscopist using a high‐resolution video‐endoscope without the assistance of enhancement techniques. These lesions had a mean size of 10.8 mm, were mainly of the flat or flat elevated type, and were located in the distal colon.
Among patients with colorectal cancer referred for surgery, 1.8% had SNPCC. These lesions can be detected using high‐resolution video‐endoscopy equipment without the need for enhancement techniques,
as reported in Japanese series. Increased awareness of the existence of such SNPCC lesions may help the average endoscopist detect such lesions. As SNPCC represents colorectal cancer, all the cases in our series were treated by typical oncologic surgical resection.
Prope Tolerance: A Step in the Search for Tolerance in the Clinic
Authors: Calne Roy Y.
Published: August 2002

Following the demonstration by Knechtle and colleagues that profound T cell depletion in rhesus monkeys treated with a CD3 diphtheria immunotoxin resulted in tolerance to renal allografting, we have used a similarly depleting protocol that, in addition, depletes B cells in recipients of a cadaveric renal transplant. The humanized antiCD52 monoclonal antibody had a rapid depleting effect when given intravenously, 20 mg on days 0 and 1 after‐renal transplantation, to 31 patients. At 48 hours after the second dose of low dose monotherapy cyclosporine (Neoral) was given to maintain blood levels averaging 100 ng/ml. Initially no other immunosuppression was given. With an average follow‐up of 24 months all but one of the patients are alive, 29 with intact functioning grafts. There have been five rejection episodes, which responded to pulsed steroid treatment. One patient had a recurrence of her original disease. Two patients developed opportunistic infections, which responded to therapy; and one patient with severe heart failure at the time of surgery died from this condition after 11 months. Currently 29 patients are still on the original low dose cyclosporine monotherapy. The outcome in this cohort of patients has been encouraging, with efficacy that compares favorably to our conventional triple therapy but in most cases allows the patients to be steroid‐free on low dose immunosuppressive monotherapy. The maintenance treatment is inexpensive and should be beneficial in the context of tight budgetary constraints worldwide. The patients who avoided steroids are pleased with this aspect of the protocol. A randomized trial comparing this treatment with standard therapy is planned.
Metabolic Assessment
Authors: Jacobs Danny O. , Wong Michael
Published: August 2002

Although no techniques are currently available that meet the needs of nutrition‐support professionals, the future is promising. This article reviews various methods and techniques used to assess the metabolic and nutritional status of surgical patients. Technologic advances in bioengineering, molecular biology, and physiology are providing exciting new tools that may eventually replace or supplement traditional static indices of metabolic assessment. At the very least, an increased understanding of the cellular abnormalities associated with various diseases will likely change our view of illness and our approaches to nutritional and metabolic intervention.
Perioperative Nutrition and Metabolism in Pediatric Patients
Authors: Imura Kenji , Okada Akira
Published: August 2002

A developing child, with a high metabolic rate and low body stores of nutrients, is susceptible to metabolic disturbances due to surgical stress. For perioperative nutritional care of infants, the distinct physiologic features of their body fluids must be carefully considered. The postoperative metabolic response is the same as that in adults, but in children this response is more rapid. Based on the urinary excretion of 3‐methylhistidine in infants, the postoperative degradation of muscle protein is thought to be twice the preoperative level. This transient increase during the early postoperative period was not suppressed by increased amino acid intake, and energy intake was sufficient. To prevent postoperative metabolic complications, the energy intake of glucose or fat should correspond to the patient—s requirements, and excess carbohydrate should be avoided. The quantity and quality of the amino acid formula used must be carefully evaluated.
Enhanced Expression of Matrix Metalloproteinase‐9 in Abdominal Aortic Aneurysms
Authors: Yamashita Akimasa , Noma Takafumi , Nakazawa Atsushi , Saito Satoshi , Fujioka Kentaro , Zempo Nobuya , Esato Kensuke
Published: August 2002

Abdominal aortic aneurysms (AAAs) are characterized by structural alterations of the aortic wall resulting from degradation of collagen and elastin. Matrix metalloproteinases (MMPs), particularly MMP‐2 and MMP‐9, show strong elastinolytic activity. We examined the levels of mRNA for MMP‐2, MMP‐9, membrane type (MT)‐MMP‐1, tissue inhibitor of metalloproteinase‐1 (TIMP‐1), and TIMP‐2 in AAAs (n= 8), atherosclerotic occlusive diseases (AOD) (n= 8), and normal subjects (n= 8) using the reverse transcription‐polymerase chain reaction (RT‐PCR). We also analyzed the gelatinolytic activity of these metalloproteinases using gelatin zymography. The levels of MMP‐2 and MMP‐9 mRNA were increased in the AAA group compared with those in the AOD group and normal subjects. The levels for TIMP‐1 and TIMP‐2 mRNA in the AAA group were also higher than those in the AOD and normal groups. Only in the case of MT‐MMP‐1 was the difference between AAA and AOD not statistically significant. By gelatin zymography with the same samples used for RT‐PCR, gelatinolytic activity of MMP‐9 was elevated in all AAA tissues. The 62‐kDa form of MMP‐2 was elevated in both the AAA and AOD groups and did not differ significantly between them. Linear regression analysis demonstrated a significant positive correlation between mRNA levels of MMPs and those of TIMPs. These observations suggest that aneurysm formation in patients with atherosclerosis is related to the degree of MMP‐9 expression.
Intraoperative Esophageal Manometry and Fundoplications: Prospective Study
Authors: Slim Karem , Boulant James , Pezet Denis , Lechner Christian , Pelissier Eric , Delasalle Patrick , Bommelaer Gilles , Chipponi Jacques
Published: August 2002

The purpose of this study was to validate the use of intraoperative manometry for assessing fundoplication and to search for predictive manometric criteria. This prospective study concerned 48 patients operated for gastroesophageal reflux. The manometry was carried out pre‐ and intraoperatively for all patients and postoperatively as well for 30 patients. The operative procedures were total fundoplication (n= 25) and posterior (partial) fundoplication (n= 5). The lower esophageal sphincter (LES) pressures and lengths were similar in the preoperative and intraoperative measurements before any esophageal mobilization, whereas the intraoperative LES pressure was significantly higher after fundoplication. The mean postoperative LES pressure decreased by 50 ± 19% compared with the intraoperative pressure after fundoplication. The final intraoperative pressures of two dysphagic patients were not the highest of the study. More importantly, their final intraoperative pressures were 7.5 and 8.2 times the initial pressure, respectively, which was significantly greater than the intraoperative pressure increase of the nondysphagic patients (4.6 ± 2.0 times). The final intraoperative pressure of the only patient with recurrence (18.2 mmHg) was the lowest of the study. In conclusion, intraoperative manometry is an effective method for evaluating the LES, and it could have predictive value for the surgical management of gastroesophageal reflux disease.
Animal Models as the Basis of Pharmacologic Intervention in Trauma and Sepsis Patients
Authors: Redl H. , Schlag G. , Bahrami S. , Yao Y.M.
Published: August 2002

With limited resources and the current concerns about using animals for research purposes, the needs must be clear when setting up trauma and sepsis experiments for pharmacologic interventions. Such interventions are performed typically for four reasons: (1) to study the pathophysiologic role of certain mediators (which can be influenced by pharmacologic agents); (2) to study the therapeutic efficacy of treatment strategies; (3) to study the overall safety of new drugs under trauma/sepsis conditions, which are adjunct studies to standard toxicology; (4) to test new diagnostic procedures in a defined trauma or sepsis setting. Intervention in the inflammatory response may be performed at several levels: (1) at the primary induction site (e.g., by antilipopolysaccharide or by preventing complement activation); (2) at the intermediate mediator level (e.g., by antitumor necrosis factor); (3) at the final mediator level (e.g., by block of polymorphonuclear neutrophil elastase, and (4) at the target (e.g., by membrane stabilization or enhanced antioxidant defense).
Improved Survival of Patients with Papillary Thyroid Cancer after Surgical Microdissection
Authors: Tisell Lars‐Erik , Nilsson Bengt , Mölne Johan , Hansson Göran , Fjälling Martha , Jansson Svante , Wingren Urban
Published: August 2002

A total of 195 patients had surgery for papillary thyroid cancer. The mean age at operation was 50 years. A microdissection technique was used for total thyroidectomy and lymph node clearance. Postoperative radioiodine tests showed no uptake or an uptake close to the background activity in 77% of the examined patients. By counting the lymph nodes removed at surgery we were able to check on the quality of the lymph node dissection. Men had a higher incidence (70%) of lymph node metastases than women (45%). Only 4% of the patients had radioiodine ablation of the thyroid remnant. The median follow‐up time was 13 years. None of the patients below 45 years of age at surgery died of thyroid cancer. In the older age group eight patients died of thyroid cancer at a mean age of 75 years. Five of those who died of a thyroid carcinoma had distant metastases at diagnosis. Among patients with resectable disease, three (1.6%) died of thyroid cancer, all of whom had lived for more than 17 years after surgery. Hence longer follow‐up is needed before we know the final mortality in our series. The results suggest that surgical technique and strategy can positively influence the survival of patients with papillary thyroid cancer.
Clinicopathologic Study of Angiogenesis in Japanese Patients with Breast Cancer
Authors: Kato Takao , Kimura Tsunehito , Miyakawa Ryuhei , Tanaka Shinichi , Fujii Akiho , Yamamoto Kazuko , Kameoka Shingo , Hamano Kyoichi , Kawakami Makio , Aiba Motohiko
Published: August 2002

To evaluate the clinicopathologic significance of angiogenesis as a prognostic factor and the objective methods for evaluating angiogenesis, we immunohistochemically stained a representative section of breast tumors with factor VIII‐related antigen staining. There were 109 patients with primary breast cancer from 1971 to 1979. The two methods of identifying angiogenesis were the average microvessel count per square millimeter (AMC) and the highest microvessel count per square millimeter (HMC). There was no relation between microvessel count (AMC or HMC) or age, menopausal status, clinical tumor size (T), histologic classification, nuclear grade, node status, histologic grade (HG), mitosis index, or lymphatic invasion (LI). There was a relation between microvessel count and blood vessel invasion (BVI) (HMC:p= 0.0007) and tumor necrosis (TN) (HMC:p= 0.0050). Univariate analysis showed that AMC or HMC was a statistically significant predictor of overall survival in all patients (p= 0.0086 andp= 0.0307, respectively). Multivariate analysis showed that AMC was an independent predictor of node status when we fitted a model with node status, BVI, and either AMC or HMC; but HMC was not independent. However, when we fitted a model including all 11 of the other indicators and AMC or HMC, the node status, HG, and LI were independent predictors, but AMC and HMC were not. Although AMC was a better method than HMC for evaluating angiogenesis, we cannot confirm angiogenesis as a significant independent prognostic factor associated with long‐term survival in Japanese breast cancer patients.
High Stroke Volume Para‐aortic Counterpulsation Device versus Centrifugal Pump in Cardiogenic Shock: Experimental Study
Authors: Nanas Serafim N. , Nanas John N. , Charitos Christos E. , Gougoulakis Alexandros , Makaritsis Konstantinos , Chatzigeorgiou John , Moussoutzani Kiriaki , Anastasiou‐Nana Maria I. , Moulopoulos Spyridon D.
Published: August 2002

During the last decades a number of left ventricular assist devices has been used especially for patients resistant to pharmacologic treatment and to intraaortic balloon pump (IABP) support for left ventricular failure. A high stroke volume para‐aortic counterpulsation device (PACD) has been developed utilizing the principle of the diastolic counterpulsation technique. In this study the hemodynamic effects of the valveless PACD were compared to those of the centrifugal blood pump (CBP) in nine dogs in acute experimental cardiogenic shock. Hemodynamic measurements were obtained at baseline with both devices off, PACD on and CBP off, or PACD off and CBP on. There was no difference in mean aortic pressure between PACD on (60.0 ± 11.5 mmHg) and CBP on (69.0 ± 26.8 mmHg). Similarly, there was no difference in left ventricular end‐diastolic pressure with the PACD on (11.9 ± 5.4 mmHg) versus the CBP on (9.9 ± 5.2 mmHg) or the cardiac index with the PACD on (84 ± 36 ml/kg/min) versus the CBP on (77 ± 36 ml/kg/min). However, the left ventricular systolic pressure (55.0 ± 19.0 with PACD versus 73.0 ± 26.0 with CBP,p< 0.001), the tension time index (712 ± 381 versus 1333 ± 694,p< 0.01), and the double product (5629 ± 2574 versus 7440 ± 3294,p< 0.01) were significantly lower during assistance with the PACD than with the CBP. It was concluded that PACD is at least as effective as CBP for restoring hemodynamic status during acute experimental cardiogenic shock. Moreover, the PACD unloads the left ventricle more effectively than CBP, making it suitable for left ventricular mechanical support in cases with reversible myocardial damage.
Comparative Study of the Early Postoperative Course and Complications in Patients Undergoing Billroth I and Billroth II Gastrectomy
Authors: Kyzer S. , Binyamini Y. , Melki Y. , Ohana G. , Koren R. , Chaimoff C. , Wolloch Y.
Published: August 2002

Distal gastric resection can be followed by reconstruction according to the Billroth I (BI) or Billroth II (BII)
techniques. The aim of this study was to compare the early postoperative results and complications of patients undergoing BI and those undergoing BII resection. Eighty‐eight patients operated during the years 1991 to 1994 underwent distal gastric resection (41 had BI, and 43 had BII resections). The indications for BI resections were gastric tumors in 39 patients (95%) and duodenal ulcer in 2 (5%). The indications for BII resection were malignancy in 28 patients (65%) and duodenal ulcer disease in 15 (35%). The average duration of the procedure was 147 ± 28 minutes for the BI resection and 175
± 38 minutes for the BII resection (p < 0.05). No patient in the BI group developed anastomic leakage. Two patients who underwent BII resection developed duodenal stump leakage (4.7%). Relaparotomy was indicated in five patients, two from the BI group
(malignant cells in the resection margins) and three from the BII group
(one due to duodenal stump leakage and two for bleeding). There was no postoperative mortality in the BI group. The postoperative mortality in the BII group was 7.1% (p < 0.05). The average proximal gastric resection margins were significantly smaller in the BI group than in the BII group (3.65 ± 2.83 cm and 5.18 ± 2.57 cm, respectively; p < 0.05). The number of lymph nodes found in the resected specimen did not differ significantly between the two groups. Recurrent tumor at the gastric remnant developed in two patients in the BI group but not in the BII group. The results of our study revealed that the BI procedure is accompanied by significantly lower postoperative complication and mortality rates than the BII procedure in cases of gastric malignancy. BI resection performed for malignancy seems to achieve smaller proximal gastric resection margins, which may influence the recurrence rate.
Sentinel Node Biopsy in Melanoma Patients: Dynamic Lymphoscintigraphy Followed by Intraoperative Gamma Probe and Vital Dye Guidance
Authors: Pijpers Rik , Borgstein Paul J. , Meijer Sybren , Hoekstra Otto S. , van Hattum Lex H. , Teule Gerrit J.J.
Published: August 2002

Biopsy of the first tumor‐draining lymph node (sentinel node, SN) is bound to become the procedure of choice in regional staging of melanoma patients. A tumor‐negative SN virtually excludes lymphatic metastases and obviates the need for lymph node dissection. The aim of this study was to combine the advantages of three known techniques to improve the yield of successful SN biopsies. A total of 150 drainage areas in 135 patients was evaluated. First, preoperative dynamic and static lymphoscintigraphy was performed after injection of technetium 99m colloidal albumin. In all patients one to three focal accumulations, concordant with SNs, were seen in the lymphatic drainage areas, in 97% within 20 minutes from injection of the tracer. Peroperative identification of the SN, 2 to 24 hours after injection of the tracer, was done with a handheld gamma probe to estimate the optimal site for the small incision and to guide preparation. Vital dye was injected just preoperatively and served to facilitate the final identification and biopsy of the SN. A total of 216 SNs were biopsied. Micrometastases were found in 39 SNs in 30 drainage areas, and in 22 of the 30 the SN was the only node harboring tumor. In 5 of 30 drainage areas, the SN did not contain blue dye and would not have been found without the gamma probe. Up to now (follow‐up 233–691 days) no recurrence has developed in the lymphatic drainage areas where the SN was tumor‐free. It was concluded that by combining these three techniques the SN could be detected and excised in all patients. The procedure combines a steep learning curve with high sensitivity.
Role of Helicobacter pylori in Residual Gastritis after Distal Partial Gastrectomy
Authors: Yamamoto Shigetaka , Yamasaki Yoshio , Kuwata Keiji , Yamasaki Hajime , Nishida Yukihiro , Kobayashi Yasushi
Published: August 2002

We studied the relation between Helicobacter pylori and residual gastritis in 28 patients with gastric cancer on whom distal partial gastrectomy with Billroth I reconstruction was performed over a 13‐month period. They were subjected to serologic testing along with endoscopic and histologic examinations before operation and at 3, 6, and 12 months after operation. Anti‐H. pylori immunoglobulin G (IgG) and serum gastrin levels were measured by serologic tests. The presence or absence of gastritis was determined endoscopically, and gastric mucosal hexosamine levels were determined. Gastritis was measured quantitatively by histologic examination in specimens taken from the gastric mucosa using Rauws’ score. After the initial histologic evaluation we divided the H. pylori‐positive patients into two groups: those with a Rauws’ score of 0 to 3 (“weak” gastritis group), and those with a Rauws’ score of 4 to 10 (“strong” gastritis group), allowing us to compare the results of our three postoperative histologic examinations of the two groups for possible significant differences. Our endoscopic examinations showed gastric mucosal inflammatory changes in both H. pylori‐positive andH. pylori‐negative patients at 3, 6, and 12 months after operation, but there was no significant difference between these two groups at any point. During the histologic examinations, however, anti‐H. pylori IgG assay had become negative in several patients in the “weak” gastritis group at 3 months after operation and was found to have become negative in 78% of all patients in that group 12 months after operation. In contrast, in the “strong” gastritis group H. pylori infection was still evident in the patients 12 months after operation, suggesting that “strong” histologic gastritis may have some connection to H. pyloriinfection, whereas “weak” histologic gastritis has no such connection. The gastric mucosal hexosamine level was higher in the “weak” gastritis group than in the “strong” gastritis group both before operation and at 6 and 12 months, indicating some relation between gastric inflammatory changes and hexosamine levels in gastric mucosa. It further suggested the possibility that H. pyloriplays a role in destroying gastric mucosa by depleting mucin, thus acting as one (though not the only) cause of residual gastritis after distal partial gastrectomy. In conclusion, we found evidence that there is a relation between residual gastritis and H. pyloriinfection, but H. pylori is not the sole cause of residual gastritis after gastric surgery. A causal relation is difficult to detect by simple analysis of histologic findings or by endoscopic observation or clinical symptoms alone.
Role of Nitric Oxide in the Colon of Patients with Ulcerative Colitis
Authors: Tomita Ryouichi , Tanjoh Katsuhisa
Published: August 2002

The cause of impaired motility, such as diarrhea and toxic megacolon, in patients with ulcerative colitis (UC) is unknown. Nitric oxide (NO) has been shown to be a neurotransmitter in the nonadrenergic noncholinergic (NANC) inhibitory nerves in the human gut. To assess the physiologic significance of NO in the colon of patients with UC, we investigated enteric nerve responses on lesional and normal bowel segments derived from patients with ulcerative colitis (n= 6) and patients who underwent colon resection for colonic cancers (n= 10). A mechanographic technique was used to evaluate in vitro muscle responses to electrical field stimulation (EFS) of adrenergic and cholinergic nerves before and after treatment with various autonomic nerve blockers, includingNG‐nitro‐l‐arginine (l‐NNA) and l‐arginine. The results showed that (1) NANC inhibitory nerves were found to act on both normal colon and UC colon; (2) the colon with UC was more strongly innervated by NANC inhibitory nerves than the normal colon; (3) l‐NNA concentration‐dependently inhibited the relaxation in response to EFS in the colon of both normal and UC colon; and (4) this inhibitory effect in the colon of both normal and UC patients was reversed by l‐arginine; (5) NO acts more strongly in the UC colon than the normal colon. These findings suggest that NANC inhibitory nerves play an important role in the impaired motility observed in patients with UC and that NO plays an important role as a neurotransmitter in NANC inhibitory nerves of human colon.
Single‐stage, Bilateral, Video‐assisted Thoracoscopic Lung Volume Reduction Surgery for End‐stage Emphysema
Authors: Vigneswaran Wickii T. , Podbielski Francis J. , Halldorsson Ari , Kong Lawrence , Schwab Toni , Janulaitis Cynthia M. , Khurshid Abid
Published: August 2002

The reintroduction of lung volume reduction surgery has provided functional improvement for selected patients afflicted with end‐stage emphysema. Evolution of the operation from a median sternotomy approach to the two‐stage video‐assisted thoracoscopic surgical technique in our experience has resulted in a faster return to full activity. Nineteen patients underwent video‐assisted thoracoscopic lung volume reduction surgery between July 1995 and August 1997. The 12 men and 7 women in the study had an average age of 63.7 years. All patients were evaluated preoperatively with computed tomography of the chest, radionuclide lung perfusion scan, left ventricular stress test, right heart catheterization, and a monitored rehabilitation program. In 15 patients the operation was performed as a bilateral single‐stage procedure. The operation involved resection of wedges from the upper lobes and in 10 of these patients from the lower lobes as well. In all patients the estimated operative blood loss was less than 150 ml. The mean operative time was 177 minutes (range 115–235 minutes). The mean length of hospital stay was 10.8 days (median 11 days, range 5–24 days). At 2 to 3 months’ follow‐up increases were noted in the FEV1 (51%), PaO2 (27%), and 6‐minute walk distance (18%); and there was a decrease in total lung capacity and respiratory volume. No significant change was observed in carbon monoxide diffusion in the lung. Morbidity included persistent air leaks in three patients and refractory supraventricular tachyarrhythmia in one. There were no perioperative deaths. We therefore recommend this technical modification to reduce operating time and blood loss without compromising surgical exposure or outcome.
Medical Management of Common Bile Duct Stones
Authors: González‐Koch Alvaro , Nervi Flavio
Published: August 2002

Common bile duct stones are a common cause of morbidity and mortality in adults. An increasing number of surgical and medical therapies are available to manage them, with different success rates reported. The various medical treatment strategies were developed during the last decade, but these medical modalities should not be contemplated as a first‐line alternative of treatment. A consensus from experts is that there is no primary indication to use solvents on common bile duct stones because they have a relatively high rate of adverse effects and their success is limited compared with lithotripsy. However, there is a subgroup of patients in whom invasive or surgical treatment is risky or may fail. In these patients stone dissolution by solvent may constitute a plausible therapeutic alternative or may help reduce the size of the stones sufficiently to facilitate subsequent endoscopic extraction. Solvents may also be indicated in settings where endoscopic techniques or lithotripsy are not available and the patient has a T‐tube in the common bile duct. Even in this condition, however, it is probably quicker and more effective to refer the patient to a center with expertise and technologic support to practice stone removal.
Charles B.G. de Nancrede: Academic Surgeon at the Fin de Siècle
Authors: Bloom David A. , Uznis Gretchen , Campbell Darrell A.
Published: August 2002

At the last turn of the century American surgery was in the midst of a number of paradigm shifts, involving transitions in technology, surgical practice, surgical specialization, patient care, surgical training, and medical economics. Charles B. G. de Nancrede was a leader during this formative period. A key figure in the transition from antiseptic to sterile technique in American medicine, he was also a prolific writer, a bold surgeon, and a great surgical educator. De Nancrede created one of the earliest prototypes of the modern multispecialty surgical departments. The coming turn of the century promises new transitions comparable to those of the past.
Genetic and Biochemical Screening for Endocrine Disease: II. Ethical Issues
Authors: Kinder Barbara K.
Published: August 2002

The ability to test for specific genes conferring susceptibility to a variety of diseases has profound ethical implications for the way in which we care for patients. Legislators and health care insurers are scrambling to address the aspects of genetic screening that they believe fall within their purview. Critical to the development of appropriate societal regulations regarding genetic screening is a fundamental understanding of the ethical issues involved. A review of those concerns and the areas in which they interface with legal and insurance issues is the topic of this paper.
Who Benefits from Portal Vein Resection during Pancreaticoduodenectomy for Pancreatic Cancer?
Authors: Launois Bernard , Stasik Christian , Bardaxoglou Eustathios , Meunier Bernard , Campion Jean Pierre , Greco Luigi , Sutherland Francis
Published: August 2002

Portal vein resection during pancreaticoduodenectomy has recently experienced renewed interest. We describe our results with this procedure over a 20‐year period. Among 88 consecutive pancreatectomies for cancer of head of the pancreas, 14 included en bloc removal of the portal vein. There was no hospital mortality. Only 21% were found to have histologically confirmed cancer invasion, and the remainder had inflammatory adherence. Two‐year survival was 15% compared to 34% for patients who did not have portal vein resection. There were no 5‐year survivors. We discuss our results in light of other recent reports.
Management of Peptic Ulcers: Emerging Issues
Authors: Freston James W.
Published: August 2002

Most peptic ulcers are caused by Helicobacter pylori infection. The infection is best diagnosed by a radiolabeled carbon urea breath test, which also can prove that eradication therapy was successful. Serologic testing is useful for establishing prior or present infection but not to determine if the infection has been eradicated. Endoscopic tests usually are not needed to establish a diagnosis. Modern ulcer treatment consists of H. pylori eradication in infected patients. A combination of a proton pump inhibitor plus clarithromycin and amoxicillin or a proton pump inhibitor plus bismuth, metronidazole, and tetracycline are the most effective regimens. Reinfection is less than 2% per year in developed countries. Evidence suggests that H. pylori eradication may foster the development of erosive esophagitis, but confirmatory studies are needed. Studies also suggest an interaction between H. pylori infection and peptic ulcers related to the use of nonsteroidal antiinflammatory drugs (NSAIDs). However, the studies are conflicting: One shows that H. pylori eradication protects against NSAID‐related ulcers; another suggests protection afforded by the infection. Non‐H. pylori peptic ulcers remain a challenge, especially in the United States, where one study showed that 42% of peptic ulcers were not due to the infection. Some non‐H. pylori ulcers are refractory to usual doses of antisecretory drugs.