bluuebunny/crossref_metadata_2025 huggingface dataset:
Survival of Patients with Disseminated Midgut Carcinoid Tumors after Aggressive Tumor Reduction
Authors: Wängberg B. , Westberg G. , Tylén U. , Tisell L.‐E. , Jansson S. , Nilsson O. , Johansson V. , Scherstén T. , Ahlman H.
Published: August 2002

Sixty‐four consecutive patients with disseminated midgut carcinoids were treated during an 8‐year period according to a single clinical protocol aimed at aggressive tumor reduction by surgery alone or with subsequent hepatic artery embolization. All patients had markedly elevated urinary 5‐hydroxyindoleacetic acid (5‐HIAA) levels (581 ± 79 μmol/24 h) and hormonal symptoms. Fourteen patients (22%) reached anatomic and biochemical cure by surgery alone. At follow‐up, the mean 5‐HIAA levels were still normal after 69.0 ± 6.2 months; two patients had died from unrelated causes. With the introduction of somatostatin receptor scintigraphy, subclinical disease was diagnosed in 7 of these 14 patients. Forty patients with bilobar hepatic disease underwent embolization in combination with octreotide. In this group, 5‐HIAA levels were still reduced by 55% after 71 ± 11 months of follow‐up, and the 5‐year survival was 56%, estimated from the total death hazard function. After embolization, two subgroups could be identified with marked differences in their long‐term response to treatment. Ten patients were not embolized owing to complicating diseases. The 5‐year survival for the entire series was 58%. A significantly increased risk of cardiovascular deaths was seen, which underlines the importance of total survival analysis in a disease with multiple hormonal effects. It is concluded that an active surgical approach must be recommended to patients with the midgut carcinoid syndrome. In patients with bilobar hepatic disease, embolization combined with octreotide treatment markedly reduced the 5‐HIAA excretion and suggested a prolonged 5‐year survival.
Family history as a marker of risk for colorectal cancer: Austrian experience
Authors: Karner‐Hanusch Judith , Mittlböck Martina , Fillipitsch Thomas , Herbst Friedrich
Published: August 2002

A family history of colorectal cancer is a known risk factor for the disease. As a result of different study designs from different populations, the strength of this association varies in the literature. We intended to define the incidence and the risk predictors in first‐degree relatives of patients with colorectal cancer in the Austrian population. A family history was obtained from first‐degree relatives of 100 consecutive patients with sporadic colorectal cancer. Life‐table methods were used to compare the observed and expected incidence of colorectal cancer and the influence of differences in risk for first‐degree family members. The calculated lifetime risk for colorectal cancer in Austria is 1:16. Individuals with a positive family history had a 4.6‐fold risk (p ≤ 0.0001), particularly in the case of a young index patient (p ≤ 0.011) or if two or more family members were affected (p ≤ 0.001). In addition, the risk for gastric cancer in relatives was increased almost fourfold (p ≤ 0.0001). We have confirmed for Austria that a positive family history of colorectal cancer is a strong risk factor, and that this risk is comparable to that in other Western countries. We have shown that relatives are also at increased risk for gastric cancer.
Relations among Plasma Prolactin, Testosterone, and Injury Severity in War Casualties
Authors: Cernak Ibolja , Savic Jovan , Lazarov Angel
Published: August 2002

Tissue trauma leads to a complex hormonal response of pituitary end‐organ axis. This response can be recorded by determining parameters that represent the functional integrity of these systems. The concentrations of serum prolactin (PRL), serum testosterone, and plasma adrenocorticotropin (ACTH) were measured in 62 adult male casualties from the recent war in former Yugoslavia. Patients with brain injury were not included. Venous blood samples were taken as soon as possible (2–18 hours) after admission and at 1, 2, 5, and 14 days after injury. The severity of gunshot/missile wounds was assessed by the Injury Severity Score (ISS). The control group consisted of healthy blood donors. Uninjured subjects who had undergone great stress on the battlefield (explosion in the vicinity without injury) served as the sham‐control group. Tissue trauma leads to a severity‐dependent decrease in serum testosterone concentrations during the first 5 days following injury. Significant correlations were observed between ACTH, prolactin, and ISS during the first 18 hours after injury. A strong negative correlation between testosterone and prolactin serum concentrations was found during the first 18 hours. In patients with additional complications or unsatisfactory outcome, the prolactin concentrations remained elevated, whereas testosterone concentrations were reduced. Our results support the usefulness of recording hormonal changes for determining trauma severity and monitoring the clinical course. Such monitoring also helps assess the efficacy of therapeutic strategies. The relation between testosterone and prolactin might be helpful for predicting the clinical course and trauma outcome.
Repeat Hepatic Resection for Recurrent Colorectal Cancer
Authors: Chu Quyen D. , Vezeridis Michael P. , Avradopoulos Konstantine A. , Wanebo Harold J.
Published: August 2002

Recurrence in the liver following hepatic resection for metastatic colorectal carcinoma is a predictable phenomenon, occurring in about two‐thirds of patients who develop recurrence. There are few data, however, about the value of repeated hepatic resection in patients who have a recurrence in the liver following initial resection of their hepatic metastases. We have reviewed our experience with 10 patients (of whom 9 were evaluable), culled from a series of 74 patients who had an initial hepatic resection for metastastic colorectal carcinoma. There were seven men and two women, mean age 52 (range 34–75 years). Duke's stages of the primary cancer were B1 in two patients, B2 in one patient, and C2 in six patients. Most of the patients had elevated carcinoembryonic antigen (CEA) and constitutional symptoms as indications for the second‐look procedure. There was one surgical death due to hepatic failure in a patient who required a trisegmentectomy. The average interval between the first and second hepatic resections was 21 months. The estimated 1‐ and 5‐year actuarial survivals from the second liver resection were 78% and 23%, respectively. The median survival was 41 months from the first resection (range 14–100 months) and 16 months from the second resection (range 0–92 months). In conclusion, repeat hepatectomy for recurrent liver metastases is a viable option for the well selected patient. It is a low risk surgical procedure and may augment survival in the patient with well documented metastases limited to the liver.
Perioperative Radiation Therapy
Authors: Påhlman Lars , Dahlberg Michael , Glimelius Bengt
Published: August 2002

The use of radiotherapy, as a complementary procedure prior to surgery for immobile, nonresectable, rectal cancers or as an adjuvant treatment in patients with mobile rectal cancer is discussed. Locally nonresectable rectal cancer can be resected after prolonged preoperative radiotherapy. The proportion of patients possible to cure after this prolonged treatment is not precisely known, mainly due to differences in the criteria for nonresectability. Literature data show that between 35% and 80% can undergo resection for cure, and 25% to 40% can be long‐term disease‐free survivors. Moreover, the role of chemotherapy in combination with radiotherapy in this group is not yet settled owing to the lack of convincing data from randomized trials. Data from the literature clearly indicate that preoperative radiotherapy in patients with mobile rectal cancer is superior to postoperative irradiation. Provided the dose is sufficiently high, a relative reduction in the local recurrence rate of 60% in combination with “standard surgery” is to be expected, and this reduction increases long‐term survival. An important question is the role of adjuvant radiotherapy together with “more optimized surgery.” It is likely that the local recurrence rate will decrease with the same magnitude, indicating that local recurrent rectal cancer in patients with mobile rectal cancer can be more or less eradicated if optimized surgery is combined with preoperative radiotherapy. With proper timing and treatment technique, the adverse effects on surrounding tissues, both immediate and late, can be kept acceptably low.
Heterologous Desensitization in Neoplastic Thyroid Cells: Influence of the Phospholipase C Signal Transduction System on the Thyrotropin–adenylate Cyclase Signal Transduction System
Authors: Tezelman S. , Hoelting T. , Jossart G.H. , Wong M.G. , Siperstein A.E. , Duh Q.‐Y. , Clark O.H.
Published: August 2002

Desensitization is defined as a decreased functional response after continuous or repetitive stimulation of a receptor with its agonist. Thyrotropin (TSH) increases cAMP levels in normal and neoplastic thyroid tissue. The tumor promoter 12‐O‐tetradecanoyl‐phorbol‐13‐acetate (TPA) activates protein kinase C (PKC). The aim was to determine whether TPA induces heterologous desensitization of the TSH–adenylate cyclase (AC) signal transduction system. Three human thyroid neoplasms in culture for 6 months or longer (one papillary carcinoma, one Hurthle cell carcinoma, one follicular adenoma) were incubated with TSH (10 mU/ml) and TPA (1.6 × 10\‐8 M) separately and together for various time periods (from 10 minutes to 24 hours). The mixture was subsequently incubated for 30 minutes with TSH. TPA alone had no effect on cAMP levels, but co‐incubation of TPA and TSH caused a significant reduction in cAMP response when compared to the cAMP response that resulted after stimulation with only TSH (p < 0.001). cAMP levels in response to TSH decreased by 31%, 44%, and 57% after preincubation with TSH for 10 minutes, 4 hours, and 24 hours, respectively. cAMP levels in response to TSH decreased by 44%, 33%, and 29% after preincubation with TPA for 10 minutes, 4 hours, and 24 hours, respectively (p < 0.01; ANOVA). Co‐incubation of cells with TPA and staurosporine (10 ng/ml), a PKC inhibitor, prevented the effect of TPA on desensitization at 10 minutes and blunted the effect at 4 hours. This is the first demonstration in human neoplastic thyroid cells that TPA induced heterologous desensitization of the cAMP response to TSH. This TPA‐induced effect appears to involve PKC activation, as it can be blocked by staurosporine.
Desensitization in Normal and Neoplastic Human Thyroid Cell Lines
Authors: Al‐Sobhi Saif S. , Soh Euy Y. , Wong Mariwil G. , Siperstein Allan E. , Duh Quan‐Yang , Clark Orlo H.
Published: August 2002

Because some papillary thyroid cancers continue to grow when thyroid‐stimulating hormone (TSH) levels are suppressed, we questioned whether desensitization (i.e., a decreased cAMP response to repeat stimulation with TSH) occurs in normal and neoplastic thyroid tissue. If desensitization does occur, is it similar or different in these human thyroid cells? Normal and papillary thyroid cancer cells from the same patient were cultured as we have previously described. Normal and neoplastic thyroid tissues responded to TSH (0.01–10.0 mU/ml) by increasing cAMP production and growth in a dose‐dependent manner. In normal cells there was an 11‐fold mean increase in cAMP production at 4 hours, and all thyroid cultures responded. In neoplastic cells cAMP production increased from 1.5‐fold to 3.0‐fold with a mean 2.0‐fold increase at 4 hours. In normal thyroid cells the cAMP response to a second TSH stimulus (desensitization) decreased up to 75% (range 25–75%), and desensitization occurred in all normal thyroid cell cultures. In neoplastic thyroid cells, however, the cAMP response to a second TSH stimulus decreased up to 17% (range 0–17%); and desensitization occurred in only two of the five neoplastic thyroid cell cultures. Thus when normal thyroid and neoplastic cells from the same patients were studied, greater desensitization occurred in the normal cells (75% vs. 17%). These studies document that there is greater desensitization in normal tissue than in neoplastic thyroid tissue, which may account for the increased growth of thyroid neoplasms in the presence of ever‐changing low levels of TSH.
Prospective Study of Calcium Homeostasis after Renal Transplantation
Authors: Claesson Kerstin , Hellman Per , Frödin Lars , Rastad Jonas
Published: August 2002

Nineteen consecutive patients receiving renal transplants underwent prospective evaluation of their calcium homeostasis for 1 year after transplantation to characterize indices of hyperparathyroidism (HPT) amelioration. All but one underwent dialysis, and six had vitamin D supplementation before grafting. The rapid falls in serum creatinine concentrations and increased creatinine clearances the first weeks after grafting were accompanied by rapidly reversed hypercalcemia and hypermagnesemia, induced hypophosphatemia, maintained parathyroid hormone (PTH) excess and calcitriol deficiency, and decreased alkaline phosphatases. At 3 months when the serum calcitriol had started to rise, serum PTH levels were the lowest and parathyroid responses to induced hypocalcemia the least abnormal. This was coupled to peaks in serum calcium, 24‐hour urine calcium excretions, and serum alkaline phosphatase levels. All patients had subnormal creatinine clearances at the study end, and normal serum PTH occurred in only seven of them. Arbitrary subgrouping of the material was performed according to posttransplant creatinine clearance and serum PTH levels. More satisfactory graft function related to lower serum PTH values and less abnormal parathyroid responses to induced hypocalcemia, earlier and higher rises in serum calcitriol, and higher urine calcium excretion. Patients with mild HPT at the study end generally had higher creatinine clearance, lower serum PTH, calcium, and alkaline phosphatase values, and lower urine calcium excretion. Moreover, they had fewer prevalent signs of radiologic bone involvement before grafting. These temporal diversities in conjunction with the variable graft function and intensity of immunosuppression provide a complex interaction in renal transplant recipients, which should be considered in the light of improved function of the PTH/PTHrP receptor in bone and kidney and cation receptors in the parathyroid and kidney.
Tumor Recurrence following Resection for Early Gastric Carcinoma and Its Implications for a Policy of Limited Resection
Authors: Namieno Tsutomu , Koito Kazumitsu , Higashi Tsunemi , Shimamura Tsuyoshi , Yamashita Kenichiro , Kondo Yukifumi
Published: August 2002

Some patients suffer postoperative recurrence after curative resection of early gastric carcinoma. This study reviewed consecutive patients with a single primary lesion and analyzed the relation between the pathologic findings and recurrence of early gastric carcinomas for determining indications for limited surgery. Among the 1585 consecutive patients with a solitary primary lesion of an early gastric carcinoma who had undergone curative surgery between 1963 and 1989 at one general hospital, pathologic findings relating to recurrence were analyzed according to Japan's General Rules for Gastric Cancer Study in Surgery and Pathology. Of these carcinomas, mucosal carcinomas comprised 701 (44.2%) and submucosal ones 884 (55.8%). The total recurrence rate in this series was 1.0%. Submucosal carcinomas (1.6%) were significantly (p < 0.02) more recurrent than mucosal ones (0.29%). Of the 16 patients with recurrence, 10 (62.5%) died within 5 years after surgery, frequently because of blood‐borne metastasis. Macroscopically elevated components, the degree of histologic differentiation, and lymph node metastasis significantly contributed to the postoperative recurrence. After detailed analysis of submucosal carcinomas, it is strongly suspected that carcinomas with a macroscopically elevated component were significantly associated with nodal involvement and microvessel invasion, and that these abnormalities lead to recurrence. Among the early gastric carcinomas, differentiated submucosal carcinomas with a macroscopically elevated component, lymph node metastasis, or both have the most potential of recurrence after surgery. Mucosal carcinomas must be restricted to limited surgery, but, blood‐borne metastasis should be carefully avoided.
Regional Dermolipectomy as Treatment for Sequelae of Massive Weight Loss
Authors: del Campo Antonio Fuente , Allegretti Eustacio Rojas , Filho Jose Amandio Fernandes , Gordon Christopher Burnside
Published: August 2002

Dermolipectomy is the most important procedure for treatment of the deformities engendered by massive weight loss. It remains the only treatment for excising redundant skin. Although liposuction is useful for removing fatty deposits without traditional surgical incisions, its application is limited by the ability of the skin to contract and conform to the newly sculpted figure. Thus liposuction may serve as an adjunct when treating the sequelae of weight loss but not as a primary procedure. In response to changing expectations, reconstructive surgeons have developed increasingly ingenious and specific dermolipectomy procedures to minimize or hide scars, lessen morbidity, and enhance function. Liposuction in combination with dermolipectomy has expanded the applicability of traditional procedures to a wider variety of patients. Surgical history, patient selection, surgical planning, a spectrum of regional dermolipectomy procedures, and potential complications are discussed herein.
Perforation Due to Metastatic Tumors of the Ileocecal Region
Authors: Shiraishi Masayuki , Hiroyasu Shungo , Nosato Eiji , Shimoji Hideaki , Kusano Toshiomi , Muto Yoshihiro
Published: August 2002

We reviewed our department's medical records between April 1986 and April 1994 to identify patients who showed acute abdominal symptoms requiring surgical treatment due to metastatic tumors of the small intestine. In group A, seven patients (30%) were treated for acute peritonitis, and all were found to have an intestinal perforation due to hematogenous metastases (group A). In group B, 16 patients (70%) were treated for an intestinal obstruction, and all were found to have disseminated tumors of the small intestine (group B). In group A all tumors were isolated and located exclusively in the ileocecal region, whereas all tumors in group B showed peritoneal dissemination, with no predominant anatomic localization. In general, the intestinal tumors in group A originated from cancers of the upper aerodigestive tract, whereas those in group B originated from advanced cancers in the abdominal cavity. The tumors were significantly smaller and the period between the onset of symptoms from the original malignancy and the onset of abdominal symptoms (perforation or obstruction) was significantly shorter in group A. In conclusion, intestinal metastases located in the ileocecal region have unique clinicopathologic features and so should be recognized as a distinct disease entity. Therefore when patients with a known upper aerodigestive malignancy exhibit acute abdominal symptoms, intestinal metastasis to the ileocecal region, necrotic changes, and perforation should be considered in the differential diagnosis.
Wound Healing of Intestinal Anastomosis after Digestive Surgery under Septic Conditions: Participation of Local Interleukin‐6 Expression
Authors: Ishimura Ken , Tsubouchi Taijiro , Okano Keiichi , Maeba Takashi , Maeta Hajime
Published: August 2002

This study aimed to evaluate the integrity of anastomotic wound healing after digestive surgery under septic conditions and to observe local interleukin‐6 (IL‐6) expression around the anastomotic segment. Experimental animals were separated into lipopolysaccharide (LPS) and control groups. Each was injected with LPS or normal saline solution into the peritoneal cavity 24 hours before transection and anastomosis of the colon. The anastomotic bursting pressure (ABP) and tissue hydroxyproline concentration (HP) were measured as indicators of wound healing. Immunohistochemical staining for IL‐6 was performed on tissue samples obtained from the anastomotic segment, lung, liver, and kidney. The reactive cells were counted by light microscopy. The ABP and HP were significantly lower in the LPS group than the control group 7 days after the surgery. In the LPS group, IL‐6 expression around the anastomotic segment was enhanced 1 and 6 hours after surgery but suppressed 24 hours afterward. In contrast, IL‐6 expression in lung, liver, and kidney was enhanced in the LPS group 24 hours after surgery but not in the control group. It is suggested that anastomotic wound healing is impaired after digestive tract surgery under septic conditions, and local IL‐6 expression participates in wound healing.
Genetic and Biochemical Screening for Endocrine Disease: III. Costs and Logistics
Authors: Delbridge Leigh , Robinson Bruce
Published: August 2002

The cost of screening tests in endocrine disease can be determined in a number of ways, including the charge or billed cost, the production cost, or most appropriately the cost to achieve the intended aim of the test (cost‐effectiveness). Cost‐effectiveness analysis allows clinicians to determine whether an added benefit of a test comes at an acceptable cost. For example, analysis of the cost‐effectiveness of routine thyroid function tests prior to surgery in elderly patients with nodular thyroid disease shows that the cost per life saved is only US $405, making the tests clearly cost‐effective. Cost‐effectiveness does not always equate with affordability, however, especially in developing countries. Thyroid function testing prior to surgery represents only 0.8% of the average household income in Australia and is therefore both cost‐effective and affordable, whereas in Sri Lanka the same screening test represents up to 50% of the average monthly income. A survey of membership of the International Association of Endocrine Surgeons worldwide showed that molecular genetic screening for endocrine disease is readily available in 67% of institutions, with all of those having facilities for the rearrangement during transfection (
RET) proto‐oncogene testing, and lesser numbers having access to the Meningene, the von Hippel‐Lindau syndrome (VHL) gene, or linkage analysis for familial pheochromocytoma. The median cost of screening for the RET proto‐oncogene was $290 (range $100–3000). Cost‐effectiveness analysis of molecular genetic screening for MEN‐II syndrome demonstrates that the cost per life saved is only $5175. This compares favorably with reliance on screening based on annual pentagastrin testing, where the cost per life saved is as high as $76,315. Molecular genetic screening for endocrine disease (e.g., the MEN‐II syndrome) is not only cost‐effective but the therapy required (total thyroidectomy) is both acceptable and well tolerated.
Significance of Biologic Aggressiveness and Proliferating Activity in Papillary Thyroid Carcinoma
Authors: Kurozumi Kazushi , Nakao Kazuyasu , Nishida Toshirou , Nakahara Masaaki , Ogino Nobuo , Tsujimoto Masahiko
Published: August 2002

Papillary thyroid carcinoma is a frequent thyroid cancer. Many factors have been reported to be of prognostic importance, but the significance of biologic factors suggesting aggressiveness and proliferating activity has not been sufficiently documented. Conventional prognostic factors such as age, extrathyroidal invasion, lymph node and distant metastasis, and biologic factors including histologic differentiation, DNA ploidy, S‐phase and G2M‐phase fractions, and expression of CD44 variant 6 (CD44‐v6) obtained from 131 patients who underwent surgery for papillary thyroid carcinoma at Osaka Police Hospital were analyzed retrospectively. Age was closely related to extrathyroidal invasion, G2M‐phase fraction, and CD44‐v6 expression. Extrathyroidal invasion was independently related to age, gender, and lymph node metastasis. The grade of lymph node metastasis was related to extrathyroidal invasion, gender, distant metastasis, and CD44‐v6 expression. Distant metastasis was associated with aneuploid tumors. Cause‐specific survival was independently related to biologic factors including extrathyroidal invasion, distant metastasis, DNA ploidy and S‐phase fraction. These results suggest that biologic factors indicating aggressiveness and proliferating activity are important for papillary thyroid carcinoma.
Surgical Repair of Postinfarction Ventricular Septal Defect: 10‐Year Experience
Authors: Athanassiadi Kalliopi , Apostolakis Efstratios , Kalavrouziotis Georgios , Charitos Christos , Karamichali Evangelia , Kakavos Dimitrios , Lolas Christos
Published: August 2002

Postinfarction ventricular septal defect
(PIVSD) remains a surgical challenge resulting in devastating mortality rates. We present our 10‐year experience in surgical management of this catastrophic complication of acute myocardial infarction. During a decade (1987–1996) 14 patients with PIVSD were treated surgically in our department. There were 10 men and 4 women, ranging in age from 51 to 78 years. The rupture occurred within the first 4 days after the infarction in most cases (n= 10). Eight patients were supported perioperatively by intraaortic balloon counterpulsation
(IABP). In all cases the surgical technique included infarctectomy and ventricular septum reconstruction with synthetic patches. Coronary artery bypass grafting was synchronously performed in four patients. Seven patients died perioperatively (mortality rate 50%) due to heart failure and to multiple organ failure. The most frequent complications were low cardiac output syndrome, hemorrhage, and respiratory and renal insufficiency. The PIVSD needs urgent surgical intervention with the patient hemodynamically stable after cardiac catheterization. Long‐term results are favorable for survivors.RID="" ID="" Correspondence to: K. Athanassiadi, M.D., Ph.D., 34A Konstantinoupoleos Str., 15562 Holargos, Athens, Greece
The Luminati of Leiden: From Bontius to Boerhaave
Authors: Kidd Mark , Modlin Irvin M.
Published: August 2002

In the glittering canopy of the history of great medical centers of Europe, none was more viviscent than Leiden. Although wealthy nations nurtured great medical establishments in Padua, Salerno, Montpellier, and Paris, it was from a diminutive market town in The Netherlands that a group of medical cognoscenti arose whose intellectual prowess blazed across the intellectual firmament of seventeenth and eighteenth century Europe. The tradition of medical excellence established by Bontius was amplified by the surgeon Peter Paaw, whose stewardship of the Anatomical Theater guided it to heights comparable to those achieved at Padua. At the same time, Clusius established a botanical garden that would have no rival for two centuries. The multitalented Sylvius educated some of the greatest minds of the generation, accepted the Harveian theories of circulation, and succeeded in fostering an intellectual environment characterized by novel ideas and tolerance of thought. van Horne defined and chartered the existence of lymphatic circulation, and Bartholin destroyed the myth of the liver as a source of blood. Exalting in the freedom of thought, the cabal of Ruysch, Steensen, de Graaf, and Swammerdam banded together under Sylvius and van Horne and made significant advances in pancreatic, lymphatic, reproductive, and respiratory physiology. There is little doubt, however, that of all the great names linked with Leiden, it is Boerhaave's that is universally held to be synonymous with that of the city. As a clinician, scientist, and teacher, the aura of his knowledge and fame spread to the farthest corners of Europe. Without doubt, the great medical schools of Edinburgh, Vienna, and Gottingen owe their subsequent potency to him. Thus the legacy of Leiden provides the richest of all earthly concepts—an appreciation of the unique spiritual power and intellectual wealth that devolves from the pursuit of the life of the mind.
Ultrasound of the Prostate and Testicles
Authors: Lavoipierre Alain M.
Published: August 2002

Considerable advances have occurred in the sonographic imaging of small parts over recent years, including improved transducer technology and Doppler imaging. After reviewing briefly prostatic anatomy, including McNeal's concept of zonal anatomy, the techniques used for examining the prostate gland sonographically and for performing biopsy are discussed. Ultrasound (US) findings in the normal gland, in benign prostatic hyperplasia, and in prostatic cancer are described, with an emphasis on cancer. The role of targeted and random biopsy is assessed, as is the role of color Doppler in detecting prostatic cancer. An overview of the findings in inflammation and infertility also is provided. The technique used for examining the scrotum and testicles is discussed after a short review of scrotal anatomy. The sonographic appearances of the normal scrotal contents are described, followed by a discussion of findings in tumors, inflammatory conditions, and testicular torsion. A synopsis of the appearances of cysts and microlithiasis also is provided. Both the increased use and expectations by surgeons of US in the assessment of the prostate and testicles make it imperative to understand the techniques, range of findings, new developments, and limitations involved in using this modality.
Endosonography of the Anal Canal and Rectum
Authors: Kumar Adarsh , Scholefield John Howard
Published: August 2002

Endosonography has evolved into an effective tool for the accurate preoperative assessment of anorectal pathology, from idiopathic anal pain to malignancy. The published data suggest that endosonography is currently the best method for assessing the structural integrity of the anal sphincter and for staging rectal cancer. The development of new treatment modalities for rectal cancer, including local excision, preoperative radiotherapy, and total mesorectal excision, has increased the importance of accurate preoperative staging to allow the optimum treatment planning. However, there is little information about the impact of endosonographic findings on clinical decision making. Education, training, and quality control in the use of endosonography also require further work. This article aims to evaluate the usefulness and limitations of this technique in clinical practice.
Trends in Peptic Ulcer Bleeding and Surgical Treatment
Authors: Ohmann Christian , Imhof Michael , Röher Hans‐Dietrich
Published: August 2002

An evidence‐based approach is followed, with grading of evidence by study design, to evaluate surgical treatment of a bleeding peptic ulcer. In contrast to endoscopic treatment, reports of surgical treatment are rare, with only five randomized trials having been identified. Epidemiologic studies have demonstrated that the incidence of emergency surgery has not changed despite major improvements with endoscopic treatment. There are no proven alternatives to emergency operation for massive bleeding uncontrollable by endoscopic procedures. There is some debate about surgery for rebleeding, but no randomized trial has assessed whether a second endoscopic treatment alone is preferable to surgery with or without repeated endoscopic treatment. Concerning the type of operative procedure, the existing body of evidence, including two randomized studies, indicates that patients are best served by a relatively aggressive surgical approach. Today the value of these studies is limited owing to prevention of ulcer recurrence by eradication and technical improvements of local procedures (e.g., arterial ligation). Early elective surgery was tested in two randomized studies and several uncontrolled series, which demonstrated that it may be beneficial in high risk groups and harmful in others. Indications for early elective surgery should be refined taking into account updated prognostic information and more effective endoscopic treatment. Because of a new understanding of ulcer disease the role of surgery has changed markedly within the last years, no longer aiming to cure the disease but primarily to stop the hemorrhage. Evidence, however, is not derived from properly randomized controlled trials but is based on theoretic arguments and knowledge from studies not primarily dealing with operative treatment.
Ultrastructural Alterations of Polytetrafluoroethylene Prostheses Implanted in Abdominal Wall Provoked by Infection: Clinical and Experimental Study
Authors: Bellón Juan M. , Contreras Luis A. , Buján Julia
Published: August 2002

Infection of an expanded polytetrafluoroethylene (ePTFE) prosthesis after implant is a major drawback of its use in current clinical practice. The aim of the present study was to compare the behavior of such prostheses implanted into New Zealand rabbits with that of prostheses infected after clinical implant. Experimental implants of ePTFE Soft Tissue Patch were performed to repair defects (7 × 5 cm) created in the abdominal wall of 10 rabbits. Prior to implant the prostheses were contaminated with Staphylococcus aureus. Five animals implanted with noncontaminated ePTFE prostheses served as controls. All the animals were sacrificed at 30 days after implant. For the clinical study, specimens were taken from three ePTFE implants that had been found to be infected after intervention. The clinical and experimental implant specimens were processed for light microscopy and scanning electron microscopy. Macroscopic and microscopic examination of experimental and clinical implants revealed alterations to the ePTFE structure, such as areas of fragmentation, fracture lines, and detachment of fine layers of ePTFE that harbored numerous Staphylococcus colonies. Neoformed tissue around contaminated implants was arranged more loosely, and on occasion large spaces between fibers gave rise to an “unknitted” appearance with respect to the control implants. It may be concluded that microporous ePTFE prostheses show similar behavior following experimental or clinical implant in the presence of infection. Irreversible changes to the structure of the prosthesis are produced owing to colonization of the biomaterial by microorganisms, which in most cases necessitates total replacement of the prosthesis.
Palpatory Method Used to Identify the Recurrent Laryngeal Nerve during Thyroidectomy
Authors: Procacciante Fabio , Picozzi Pietro , Pacifici Massimo , Picconi Stefania , Ruggeri Sandro , Fantini Aldo , Basso Nicola
Published: August 2002

The major complication of thyroid surgery, occurring in 1% to 6% of cases, is injury to the recurrent laryngeal nerve (RLN). A simple method to identify the RLN during thyroid surgery is described by the authors. It consists in palpation of the nerve caudally to the inferior pole of the thyroid, after the nerve has been made taut by the upward and medial traction of the thyroid gland. This method was used on 47 human cadavers and 45 patients with benign thyroid diseases. It made it possible to identify the RLN in all of the cadavers and 52 of the 55 identifications during 45 thyroidectomies (in 10 total thyroidectomies the identification was bilateral). Laryngeal motility was normal in all patients at postoperative laryngoscopy. Using the palpation before dissection in the region of the inferior thyroid artery, the traditional viewing method became easier and safer, reducing the risk of injury where it is most likely to occur to the nerve.
Behavioral processes and egg‐laying decisions of the bean weevil, Callosobruchus maculatus
Authors: Horng S. ‐B. , Lin H. ‐C. , Wu W. ‐J. , Godfray H. C. J.
Published: August 2002

Empirical studies of behavioral processes were designed in a seed beetle, Callosobruchus maculatus, to distinguish between two alternative tactical models, namely, comparison tactics and threshold tactics of seed choice, and also to deduce the behavioral rule of its oviposition decisions. Search sequences and the oviposition process of the female bruchid beetle were observed and recorded. Analyzing data of the search sequence showed that the female bruchid beetle repeatedly encountered seeds randomly and tended to oviposit on a newly encountered seed in an ovposition bout. These results contradict the usual comparison models, which predict that the female will return to choose any one of the previously encountered seeds after sampling. In addition, the oviposition decision (rejection or acceptance of an encountered seed to oviposit) was analyzed with a generalized linear modeling (GLIM) technique. Modeling showed that the probability of accepting a seed with different numbers of eggs on it changed during her egg‐laying process. This evidence supports the idea that the female is using a threshold tactic and that her acceptance threshold is being adjusted by experience gained during the egg‐laying process. The analysis of statistical modeling also showed that both the time since the last oviposition and the number of eggs which had been laid by the female had a significant effect on the probability of accepting seeds with different numbers of eggs. Therefore, a time measuring system and the physiological state variable, e.g., eggload of the female, should be included in the behavioral rule to explore how the female makes her decision in the egg‐laying process and to examine the importance of choice behavior as a component of selection and adaptation.
Search for Signature Inversion in the πi13/2⊗νi13/2Band in Odd-Odd178Ir
Authors: Zhang Yu-Hu  , T. Hayakawa  , M. Oshima  , Y. Toh  , J. Katakura  , Y. Hatsukawa  , M. Matsuda  , N. Shinohara  , T. Ishii  , H. Kusakari  , M. Sugawara  , T. Komatsubara  , K. Furuno
Published: August 2002

The search for the πi13/2⊗νi13/2band in178Ir has been conducted through the152Sm(31P,5nγ) 178Ir reaction and the excitation functions,x-γ and γ-γ-tcoincidence measurements. Five rotational bands have been newly identified. The low-spin signature inversion in the πi13/2⊗νi13/2band has been confirmed by the observations of linking transitions and signature crossing atI= 25.5 ℏ. The inversion phenomenon in πh11/2⊗νi13/2, πh9/2⊗νi13/2and πi13/2⊗νi13/2structures in178Ir provides a unique testing ground for different theoretical interpretations.
Triple differential cross section measurements in H2and D2
Authors: N Scherer  , H Lörch  , V Schmidt
Published: August 2002

Triple differential cross sections (TDCS) for double photoionization in H2and D2(for comparison also in helium) have been measured for equal energy sharing,E1 = E2 = 10 eV. In agreement with previous observations by the Reddish group and in comparison to the equivalent helium case, our D2data confirm a `narrowing' effect in the correlation factor which influences the observed TDCS lobes, as well as a `filling-in' effect at relative angles θ1,2 = 180°. However, we do not confirm the previous differences in the magnitude of D2and H2TDCS values. Instead, we get equal TDCS strengths and, in comparison to helium, reasonable agreement with the corresponding total cross section ratio for double photoionization in He and D2.
Neutron powder diffraction study ( T = 4.2-300 K) and polarization analysis of YBaCuFeO5+δ
Authors: Mombrú A W , Prassides K , Christides C , Erwin R , Pissas M , Mitros C , Niarchos D
Published: August 2002

The crystal and magnetic structures of the perovskite YBaCuFeO5+δ have been studied in the temperature range T = 4.2-300 K by powder neutron diffraction. In addition to the antiferromagnetic ordering transition at TN
 = 442 K, a commensurate–incommensurate magnetic transition is detected at TN
′ = 190 K. Below this temperature, two sets of satellite peaks surround the (1/2,1/2,1/2) magnetic peak at d ∼ Å, collapsing into a single set of satellites below 155 K. Polarization analysis has been performed to confirm the magnetic nature of the (1/2,1/2,1/2)± satellites.
Novel Biphasic Synthesis of Porphyrin
Authors: ELLIS PAUL E. , LANGDALE WAYNE A.
Published: August 2002

An unusual synthesis of porphyrin has been developed using a novel biphasic solvent system. Under optimized conditions reproducible yields of pure porphyrin of over 15% can be easily obtained in about two hours from the acid-catalysed condensation of 2-hydroxymethylpyrrole in a solvent consisting of water and an immiscible ketone. Important variables of the reaction have been studied to improve the yield and characterize the limitations of the reaction.
Dinuclear RhII-Phthalocyaninates with a Rh-Rh Single Bond: X-ray Crystal Structure of Di(pyridinephthalocyaninato(2-)rhodium(II))
Authors: HÜCKSTÄDT HEINER , BRUHN CLEMENS , HOMBORG HEINER
Published: August 2002

Red, diamagnetic di(phthalocyaninato(2-)rhodium(II)), [( Rhpc 2−)2] is prepared by thermal decomposition of acidophthalocyaninatorhodium(III) or di(acido)phthalocyaninatorhodates(III) in inert, high boiling solvents or under reduced pressure at T < 350° C . It is insoluble in most common solvents except pyridine ( py ), yielding red, diamagnetic di(pyridinephthalocyaninato(2-)rhodium(II)), [{ Rh ( py ) pc 2−}2]. This crystallizes as benzene solvate in the cubic space group Ia-3 (no. 206) (a = 35.960(7) Å) with Z = 24. The Rh - Rh distance (d( Rh - Rh ) = 2.741(2) Å) indicates a strong unsupported Rh - Rh single bond. Due to the axial coordination of py the Rh atoms are virtually bonded in the centre ( ct ) of the pc 2− core (d( Rh - ct ) = 0.08(1) Å). The pc 2− ligands are staggered with the skew angle φ( N iso - Rh - Rh '- N iso ') = 42(1)°. Asymmetrical doming of the pc 2− ligands is caused by a short interplanar distance (d( ct - ct ) = 2.89(1) Å) and axial coordination of pyridine. Due to the labilizing trans influence of the Rh - Rh bond the d( Rh - N py ) = 2.309(8) Å is rather long. Two quasi-reversible anodic and four cathodic electron transfer processes are observed in the differential pulse voltammogram of [{ Rh ( py ) pc 2−}2] at 0.81, 0.55, −0.33, −0.50, −0.75 and −1.33 V. The UV/vis NIR spectrum of [{ Rh ( py ) pc 2−}2] shows the typical π-π* transitions of the pc 2− ligand. The B region is split into two bands at 15 440 ( B −) and 16 890 cm−1( B +) of equal intensity due to strong excitonic coupling. The totally symmetric Rh - Rh stretching vibration is selectively enhanced in the Fourier Transform–Raman spectrum at 176 cm−1.
Diphthalocyanine metal complexes and their analogues
Authors: ERCOLANI CLAUDIO
Published: August 2002

The present overview deals with ditetrapyrrolic macrocycles, mainly diphthalocyanine systems, of the following three classes: (a) sandwich-type molecules (I); (b) metal-metal bonded systems (II); (c) single-atom bridged dimers (III). The available information focuses on the structural and electronic features, redox properties and partial oxidation. Practical applications, e.g. electrochromic devices, molecular metals, liquid crystals, non-linear optics, etc., make these classes of complexes particularly attractive and promising materials. The bonding mechanism and the structural, magnetic, conductive and optical properties of these systems are elucidated by density functional calculations.
Social self‐esteem and self‐reported bullying behaviour among adult prisoners
Authors: Ireland Jane L.
Published: August 2002

This paper addresses how social self‐esteem relates to self‐reported bullying behaviour among adult prisoners. It explores both level of self‐esteem and participants’ certainty of their self‐esteem. A total of 502 adult prisoners (285 men and 217 women) completed a self‐report behavioural checklist (Direct and Indirect Prisoner Behaviour Checklist) [Ireland JL. 1999. Aggres Behav 25:162–178] that addressed the level of bullying behaviour at their present institution. Prisoners also completed a questionnaire that measured social self‐esteem (Texas Social Behaviour Inventory) [Helmreich R, Stapp J. 1974. Bull Psychonomic Soc 4:473–475]. Four categories of prisoners were compared: bullies, victims, those who reported both bullying others and being victimised themselves (bully/victims), and those who were not involved in bullying behaviour. There were no significant differences among bully categories in total self‐esteem scores. Men reported significantly higher levels of self‐esteem than did women. There were no significant sex or bully category differences in certainty of self‐esteem. Self‐esteem was found to include a number of individual components that differed between the sexes. The findings are discussed, and directions for future research are suggested. Aggr. Behav. 28:184–197, 2002. © 2002 Wiley‐Liss, Inc.
On‐line robust parameter identification for parabolic systems
Authors: Demetriou M. A. , Rosen I. G.
Published: August 2002

In this paper a robust scheme for the adaptive parameter identification of parabolic distributed parameter systems is developed. Results from the finite‐dimensional treatment of the parameter projection method and σ (sigma) modifications to the standard adaptation rules are extended to infinite‐dimensional systems. For the class of systems under study, modifications to these standard parameter adaptation rules were deemed necessary in order to account for the additional mathematical subtleties that arise when dealing with infinite‐dimensional systems. Copyright © 2001 John Wiley & Sons, Ltd.
Free radical copolymerization of styrene with vinyl acetate using p‐acetylbenzylidene triphenylarsonium ylide as an initiator
Authors: Daniel Neeta , Srivastava A. K.
Published: August 2002

p‐Acetylbenzylidene triphenylarsonium ylide (p‐ABTAY) initiated free radical copolymerization of styrene (Sty) with vinyl acetate (VA) in dioxane, at 65 ± 0.1°C, under the inert atmosphere of nitrogen has been studied. The system follows ideal radical kinetics and the kinetic equation for the system is Rp ∝ [p‐ABTAY]0.5[Sty][VA]. The rate of copolymerization (Rp) is proportional to the square root of [p‐ABTAY] indicating biomolecular termination. The values of kp2/kt and energy of activation have been computed as 5.0 × 10−3 mol l−1 s−1 and 34.0 kJ mol−1 respectively. The reactivity ratios calculated by using Kelen–Tudos method are r1(Sty) = 42.8, r2(VA) = 1.0. SEM analysis shows that arsenic is not incorporated in the polymer and the copolymerization reaction is initiated by phenyl free radicals. The formation of phenyl radicals may be attributed to the pπ–dπ overlap between the hybridized sp2 orbital and more diffused 4d orbital of arsenic. © 2002 Wiley Periodicals, Inc. Adv Polym Techn 21: 108–115, 2002; Published online in Wiley Interscience (www.interscience.wiley.com). DOI 10.1002/adv.2000
The consolidation wave in U.S. food retailing: A European perspective
Authors: Wrigley Neil
Published: August 2002

This article assesses, from the perspective of a European academic, the intense wave of acquisition and merger driven consolidation that swept through the U.S. food retail industry during the late 1990s. It reviews the characteristics and causes of that consolidation wave, placing emphasis on the regulatory history of the industry, the consequences of its financial reengineering during the 1980s, and the link between Wal‐Mart's entry into the industry and the consolidation wave. The article then assesses the extent to which a shift in regulatory policy and practice by the Federal Trade Commission at the very end of the decade may have altered the pattern and scale of consolidation in the industry. Finally, it considers the future landscape of U.S. food retail consolidation, debating the consequences for the consolidation process of the period of FTC regulatory tightening during 1999/2000 and the likely implications of a Bush administration appointee heading the FTC [EconLit Classifications: L810, L190, G340, L400]. © 2001 John Wiley & Sons, Inc.