bluuebunny/crossref_metadata_2025 huggingface dataset:
Laserlicht aus photonischem Kristall
Authors: Drach Volker
Published: March 2004

Fortschrittliche Prozesstechniken zur Herstellung und Strukturierung von Halbleitermaterialien ermöglichten neuartige Konzepte für elektronische und optoelektronische Bauteile. So genannte Quanten‐Kaskaden‐Laser und photonische Kristalle sind Beispiele hierfür. Diese beiden Konzepte zu kombinieren und dabei eine neuartige, miniaturisierte Laserquelle für Infrarotlicht mit senkrechter Emission herzustellen, gelang nun einer Forschergruppe an den Bell Laboratories (Lucent Technologies, Murray Hill, USA) um Raffaele Colombelli [1].
Ulm und München
Authors: Hoffmann Dieter
Published: March 2004

Einstein hatte ein bewegtes Leben. In den ersten 35 Lebensjahren wechselte er über zehnmal seinen Wohnort. In unserer neuen Reihe schildern wir die wichtigsten Stationen.
Physikportale im Test
Authors: Radons Gunnar
Published: March 2004

Zwei Internetportale befassen sich in Deutschland mit Inhalten der Physik: Welt der Physik (www.weltderphysik.de), verfasst von der Deutschen Physikalischen Gesellschaft und vom Bundesministerium für Bildung und Forschung, und Pro‐Physik.de (www.pro‐physik.de), ebenfalls von der DPG in Zusammenarbeit mit Wiley‐VCH herausgegeben. Wir vergleichen die beiden Portale.
Changing patterns of gallstone disease in Korea
Authors: Park Yong ‐Hyun , Park Sang ‐Jae , Jang Jin ‐Young , Ann Young Joon , Park Youn ‐Chan , Yoon Yong Bum , Kim Sun ‐Whe
Published: March 2004

The aim of this study was to investigate the epidemiologic characteristics and changing patterns of gallstone disease in Korea over a recent 20‐year period. A total of 4020 gallstone patients who had undergone surgery at Seoul National University Hospital during 1981–2000 were analyzed according to periods: period I (1981–1985: 831 cases); period II (1986–1990: 888 cases); period III (1991–1995: 1040 cases); period IV (1996–2000:1261 cases). The literature from 13 institutes in Korea reporting a total of 13,101 gallstone cases were reviewed to elucidate the nation‐wide trend. The number of gallstone cases gradually increased. A female predominance was not noted (F/M = 1.17–1.37) as is seen in Western countries. The patients with common bile duct (CBD) stones were older than those with gallbladder (GB) stones or intrahepatic duct (IHD) stones. Over time, the relative proportion of those with a GB stone increased, plateauing (80–85%) during the 1990s; that of patients with CBD stones decreased (34% → 19%); and that of those with IHD stones remained unchanged (11–15%). Over the entire period, the rural pattern of gallstone formation (low number of GB stones, high numbers of CBD and IHD stones) has become similar to the urban pattern. The body mass index (BMI) of the GB stone group was above average, as were the BMIs of the CBD stone and IHD stone groups. Throughout the literature review, this same changing pattern of the relative proportion of gallstone disease was confirmed. Thus the pattern of gallstone disease in Korea has become similar to that seen in Western countries except for a high prevalence of hepatolithiasis.
Treatment of uncomplicated hydatid cyst of the liver by closed marsupialization and fibrin glue obliteration
Authors: Hofstetter Christian , Segovia Eduardo , Vara‐Thorbeck Rafael
Published: March 2004

Treatment of hepatic echinococcosis remains a surgical problem not only in endemic countries. Between January 1983 and December 1999 a total of 29 patients underwent surgical treatment for hepatic hydatidosis at the Department of General Surgery at the University Hospital of Granada. The diagnosis was based on clinical criteria, serology, and imaging techniques. There were 16 male and 12 female patients (ages 7–67 and 30–74 years, respectively). Concomitant extrahepatic complications were found in seven patients. Among them, five had secondary parasitic cysts in the peritoneal cavity. In one case an intrathoracic rupture was found, and one patient suffered an intraabdominal rupture with anaphylactic shock. The right lobe was affected in 62% (18 patients). Hepatic cysts were multiple in 4 cases and calcified in 13. Conservative surgical procedures were performed in 23 patients (closed marsupialization with fibrin glue obliteration in 17 and drainage‐marsupialization in 6), and radical surgical procedures were undertaken in 6 (pericystectomy in 5 and hemihepatectomy in 1). One patient underwent an explorative laparotomy with intraabdominal lavage followed by pericystectomy after primary resuscitation due to anaphylactic shock. The mean period of hospitalization was 15.9 days, and there were no serious postoperative complications or fatal outcomes. The perioperative morbidity rate was 2.5%. One patient suffered a recurrence of the disease following drainage marsupialization after an interval of 5 years. Our results indicate that the closed marsupialization technique is a safe, sparing method for treating uncomplicated hepatic hydatidosis. The results were also compared to those of a former study reported by our group in which the experience of another 19 years was presented.
Rectus abdominis muscle flap for high‐output duodenal fistula: Novel technique
Authors: Chander Jagdish , Lal Pawan , Ramteke Vinod K.
Published: March 2004

Duodenal fistula after closure of peptic ulcer perforation, though rare, is difficult to manage and carries a high mortality. The high mortality is associated with the poor nutritional status of the patient, high output from the fistula, and late development of peritonitis and septicemia. The various techniques described in the literature for the closure of the postsurgical external duodenal fistulas range from conservative management with total parenteral nutrition (TPN), serosal patch repair, and Roux‐en‐y procedures to radical surgery like Billroth II gastrectomy. Total parenteral nutrition achieves spontaneous closure in 70% to 80% of cases, but it is very expensive and requires prolonged hospitalization. In addition, some surgical procedures have yielded poor results in our setting, so we sought a new modality of treatment. We describe a novel technique for repair of postsurgical external fistula of the duodenum with a rectus abdominis muscle flap. The rectus abdominis muscle is detached from its superior attachment and mobilized from the rectus sheath. The flap, based on the deep inferior epigastric artery, is raised and sutured to the duodenal fistula with thick silk sutures. We treated six patients with post‐surgical duodenal fistulas with this technique between 1995 and 2002. The leak was completely sealed in all patients. One patient died of septicemia. We recommend this technique for the management of postsurgical external duodenal fistula as an alternative to other surgical techniques.
Quantitative evaluation of the utero‐ovarian venous pattern in the adult human female cadaver with plastination
Authors: Pavkov Mircea L. , Koebke Jürgen , Notermans Hans ‐P. , Brökelmann Jost
Published: March 2004

We described the anatomy of the utero‐ovarian venous system in the adult postmenopausal female cadaver using casts and the von Hagen’s plastination technique. To qualitatively and quantitatively evaluate the uterine vein, the utero‐ovarian arcade, the ovarian vein and the ramus communicans between left and right parametrium, we injected epoxy resin into the internal iliac vein and artery and the ovarian vein and artery in six cadavers. In two cases the internal genital organs were excised before injection and in the other four after the injection and polymerization of the resin. All specimens were macroscopically examined and venous diameters were digitally measured, the average values of the measured diameters being 3.38 mm for the uterine vein, 3.71 mm for the utero‐ovarian arcade, 3.49 mm for the ovarian vein, and 3.71 mm for the ramus communicans. The veins were completely filled out and could be best examined in the four cases where in situ injection was performed. We could observe that the utero‐ovarian arcade is an important vein with a caliber similar to that of the ovarian and uterine veins, that there is an impressive network of venous anastomoses between the left and right parametrium and that the fallopian tubes are drained by three separate veins: internal, median, and external tubal veins. Pelvic venous congestion was present in two specimens; in one of them it was located in the region of the left uterine vein and in the other one in the region of the left ovarian vein. Given the similar average diameters of the uterine vein, ovarian vein, and utero‐ovarian arcade, we assume that there is no preferential uterine or ovarian venous drainage and that the veins of the internal genital organs are behaving like a venous pool. Nevertheless, congestion can affect limited sites, which can and should be treated locally.
Barrett’s esophagus: Histopathologic definitions and diagnostic criteria
Authors: Mueller James , Werner Martin , Stolte Manfred
Published: March 2004

Adenocarcinoma of the distal esophagus is rising more rapidly in incidence than any other visceral malignancy in the Western world. It is well established that most, if not all, of these tumors develop in Barrett’s esophagus via the metaplasia‐dysplasia‐carcinoma sequence and could theoretically be detected at an early stage, but despite this, the majority of these tumors are still detected late in their course. This highlights the fact that the goal of effective surveillance for patients at risk for developing an adenocarcinoma of the distal esophagus is still far off. In addition, adenocarcinomas of the esophagogastric junction and gastric cardia are also rising in incidence, but their carcinogenesis and their relation to Barrett’s esophagus are still being defined, as are the meaning and significance of the relatively new entities “short‐segment Barrett’s” and “ultra‐short‐segment Barrett’s”. This review attempts to clarify the main histopathologic issues concerned with the definition of Barrett’s esophagus, its distinction from intestinal metaplasia of the gastric cardia, as well as the criteria for the histologic diagnosis of dysplasia and carcinoma in Barrett’s esophagus.
Special wound healing methods used in ancient Egypt and the mythological background
Authors: Sipos Péter , Gyõry Hedvig , Hagymási Krisztina , Ondrejka Pál , Blázovics Anna
Published: March 2004

The Egyptian civilisation is one of the oldest in history and was renowned for its scientific and artistic achievements, and medicine was no exception. The ancient Egyptians were masters in applying and arranging bandages, and they recognized the cardinal signs of infection and inflammation. Egyptian drug therapy can be regarded as having evolved from a system rooted in magic and empirical observation. To illustrate how the Egyptian wound healing methods provided a major stimulus for the development of surgery, we conducted a literature search.
Appraisal of surgical treatment for pT2 gallbladder carcinomas
Authors: Suzuki Shohachi , Yokoi Yoshihiro , Kurachi Kiyotaka , Inaba Keisuke , Ota Shigeyasu , Azuma Masaki , Konno Hiroyuki , Baba Satoshi , Nakamura Satoshi
Published: March 2004

This retrospective study was designed to appraise the surgical procedures for pT2 gallbladder (GB) carcinomas. Twenty patients with pT2 GB carcinomas underwent surgical resection. Hepatectomy of segments 4b and 5 was performed in 19 patients, and an extended right hepatic lobectomy was performed in 1. The extrahepatic bile duct was preserved in 8 patients in whom the disease was limited to the GB fundus and/or body. Regional lymphadenectomy was performed in 18 patients. A separate radical second operation was performed in 8 patients after cholecystectomy. Final pathological staging was stage IB in 15 patients, IIB in 4, and IV in 1. Overall 5‐year survival rate in those 20 patients was 77% without operative deaths. The 5‐year survival rate in 5 patients with nodal metastasis and in 8 patients without extrahepatic biliary resection was 80% and 100%, respectively. A separate radical second operation in 8 patients yielded 75% survival after 5 years. Perineural invasion as a prognostic determinant was closely associated with tumor extending to the neck or the cystic duct. Partial hepatectomy, usually with extrahepatic biliary resection and regional lymphadenectomy, was appropriate as a standard radical operation for pT2 GB carcinoma, but preservation of extrahepatic bile duct is advocated for disease limited to the GB fundus and/or body. Radical second operation enhanced the chance for cure in patients with pT2 GB carcinoma.
Presentation and prognosis of gastric cancer in patients aged 80 years and older
Authors: Rabunal Ramón R. , Pita Salvador F. , Rigueiro M. Teresa V. , Casariego Emilio V. , Pértega Sonia D. , García‐Rodeja Eugenia , Abraira Victor
Published: March 2004

The aim of this study was to analyze the characteristics of the presentation and prognosis of patients aged ≥ 80 who were diagnosed with gastric adenocarcinoma. We have used a retrospective cohort study of 2334 patients diagnosed between 1975 and 1993 in northwestern Spain, 263 (11.3%)of whom were ≥ 80 years of age. No differences were observed with respect to patients of a younger age at diagnosis regarding the site of the tumor, extension of the disease, or Laurén’s histologic type. However, fewer resections with curative intent were performed in the older group (49.1% vs. 30.1%; p < 0.0001). Among those operated on with curative or palliative intent, at the end of the first month the survival probability was 0.9 and the 0.95% confidence interval (CI 95%) was 0.93–0.97 for patients < 80 years of age and 0.93 (CI 95% 0.89–0.98) for the older group (p = 0.19). At the end of 5 years of follow‐up these probabilities were 0.29 (CI 95% 0.27–0.31) and 0.18 (CI 95% 0.14–0.23), respectively (p < 0.0001). If we consider only those patients undergoing curative resection, the survival probability for the two groups (p = 0.4) was not statistically different. In conclusion, although the two groups showed similar characteristics at presentation, patients ≥ 80 years of age underwent surgery with curative intent less frequently and their general prognosis was worse. Our data support the idea that curative surgery should not be ruled out exclusively for reasons of age.
Serum monocyte chemoattractant protein‐1 in patients with postoperative infectious complications from gastrointestinal surgery for cancer
Authors: Tonouchi Hitoshi , Miki Chikao , Ohmori Yukinari , Kobayashi Minako , Mohri Yasuhiko , Tanaka Kouji , Konishi Naomi , Kusunoki Masato
Published: March 2004

We examined the kinetics of serum monocyte chemoattractant protein‐1 (MCP‐1) perioperatively and clarified its significance regarding the development of infectious complications. We studied 94 patients who underwent gastrointestinal surgery for gastric or colorectal cancer at Mie University Hospital from 1996 to 2000. Serum concentrations of MCP‐1 and interleukin‐6 (IL‐6) were measured perioperatively. The number of circulating lymphocytes and neutrophils were counted to assess the apoptotic rate of neutrophils. Patients were divided into two groups at the median preoperative MCP‐1 level obtained from 40 gender‐and agematched healthy volunteers. The rate of developing infectious complications was significantly higher and tumor size was significantly larger in the low MCP‐1 group than in the high MCP‐1 group. The increasing IL‐6 ratio (postoperative/preoperative IL‐6 level) in the low MCP‐1 group was about twofold greater than that in the high MCP‐1 group. The neutrophil level calculated for the low MCP‐1 group was significantly higher than that in the high MCP‐1 group on postoperative day 3. We concluded that a decreased level of serum MCP‐1 reflected tumorrelated immunosuppression. Low MCP‐1 levels were associated with an exaggerated postoperative IL‐6 response and delayed neutrophil apoptosis, which affected the incidence of postoperative infectious complications developing in patients with gastrointestinal malignancies.
Damage control laparotomy for generalized necrotizing enterocolitis
Authors: Banieghbal Behrouz , Davies Michael R.
Published: March 2004

Macroscopic generalized necrotizing enterocolitis (G‐NEC) is associated with a very high mortality in neonates. In some instances, however, multiple bowel segments are necrotic, with most of the remaining small bowel damaged but viable. In these selected patients morbidity can be reduced and survival increased with an aggressive and early surgical approach. We have termed this approach damage control laparotomy (DCL). Over a 5 1/2‐year period, all neonates with G‐NEC with adequate length of viable small bowel were subjected to DCL. The procedure is characterized by a resuscitative period of a few hours followed by laparotomy and resection of dead/perforated bowel. The bowel ends are either anastomosed or tied, and the bowel is returned to the abdomen to allow full tissue demarcation. Re‐look laparotomy is performed 3–4 days later, at which time any new necrotic bowel is excised and re‐joined, to achieve small bowel continuity. In this prospective study, 104 neonates with G‐NEC underwent operation; 27 neonates (26%) were considered to have an adequate potential length of viable bowel and were selected for DCL. Nineteen neonates survived in the follow‐up period. Early mortality was due to sepsis syndrome in 6 patients, and late mortality in 2 neonates was secondary to the short bowel syndrome. The DCL procedure is another step toward improving survival in surgical G‐NEC; this technique avoids proximal stomas and their complications, and at the same time it preserves the best possible bowel length.
Bloodless liver resection using the Monopolar Floating Ball plus Ligasure diathermy: Preliminary results of 16 liver resections
Authors: Sakamoto Yoshihiro , Yamamoto Junji , Kokudo Norihiro , Seki Makoto , Kosuge Tomoo , Yamaguchi Toshiharu , Muto Tetsuichiro , Makuuchi Masatoshi
Published: March 2004

Blood loss during liver transection and ischemia‐reperfusion injury associated with hepatic inflow occlusion are significant drawbacks during liver surgery. Sixteen patients underwent liver resection using the Monopolar Floating Ball (FB) plus LigaSure (LS) diathermy without occlusion of the hepatoduodenal ligament (group FB‐LS). The liver parenchyma was precoagulated using the FB, and the uncovered tiny vessels were sealed using LS. Surgical outcomes were retrospectively compared with 16 well matched patients who underwent liver resection using the conventional clamp crushing method with Pringle’s maneuver (group CC). The amount of blood loss during liver transection was significantly less in group FB‐LS than in group CC [200 ml (0–990 ml) vs. 480 ml (120–1800 ml);p = 0.006]. The median time it took to complete the liver transection was significantly longer in group FB‐LS than in group CC [144 minutes (43–335 minutes) vs. 58 minutes (18–94 minutes); p < 0.0001]. Hepatic inflow occlusion was temporally used in five patients in group FB‐LS to achieve hemostasis in hepatic venous tributaries for 6,10, 19, 26, and 61 minutes, respectively. Using these two electronic devices allows liver resection to be safely performed, with the advantage of minimal blood loss and a reduced inflow occlusion period compared to the conventional method. The major disadvantage may be a slower transection speed. A prospective randomized trial is needed to clarify the clinical benefits of liver resections performed using this novel technique.
Impact of intraoperative parathyroid hormone monitoring on the prediction of multiglandular parathyroid disease
Authors: Clerici Thomas , Brandie Michael , Lange Jochen , Doherty Gerard M. , Gauger Paul G.
Published: March 2004

Optimal interpretation of the results of intraoperative parathyroid hormone (IOPTH) monitoring during neck exploration for primary hyperparathyroidism (pHPT) is still controversial. The reliability of the “50% rule” in multiglandular disease (MGD) is often disputed, mostly because of competing pathophysiologic paradigms. The aim of this study was to ascertain and corroborate the ability of IOPTH monitoring to detect MGD in a practice, combining conventional and alternative parathyroid‐ectomy techniques. This is a retrospective single institution analysis of 69 consecutive patients undergoing cervical exploration for pHPT by various approaches. The IOPTH measurements were performed after induction of anesthesia but prior to skin incision and 10 minutes after excision of the first visualized enlarged parathyroid gland. In this series, 55 patients (80%) had single adenomas, and 14 patients (20%) had MGD. In 8 of the 14 patients with MGD, IOPTH levels were obtained sequentially after removal of every enlarged gland. Of these 8 patients, 6 (75%) had a false‐positive decrease (decrease below 50% of baseline value in presence of another enlarged gland) failing to predict the presence of a second enlarged gland. In 2 cases IOPTH monitoring provided a true‐negative result, correctly predicting MGD. If MGD is defined by gross morphologic criteria, IOPTH monitoring fails to predict the presence of MGD reliably. However, if MGD is defined by functional criteria, the course of these patients does not seem significantly affected. The importance of these findings must be further investigated, especially with regard to the outcome of minimally invasive parathyroid procedures.
Clinical and molecular biologic characteristics of early‐onset versus late‐onset colorectal carcinoma in Filipinos
Authors: Uy Gemma B. , Kaw Leoncio L. , Punzalan Corazon K. , Querol R Ireneo Luis C. , Koustova Elena V. , Bowyer Mark W. , Hobbs Christine M. , Sobin Leslie H. , Wherry David C.
Published: March 2004

A case‐control study of Filipino patients who underwent surgical resection for colorectal cancer (CRC) during a 1‐year period was undertaken. Thirty‐five patients under age 40 years were identified. Paraffin blocks of these and 35 randomly selected patients over age 40 underwent histologic and immunohistochemical evaluation. Markers chosen for evaluation included the apoptosis‐associated gene products (p53 and bcl‐2), a tumor proliferation activity‐related factor (Ki‐67), and the markers (MLH1 and MSH2) of DNA microsatellite instability (MSI). Results were correlated with age and the stage and location of the tumor. The average age of the early‐onset group was 30.7 years compared to the late‐onset group at 67.0 years; and the male/female ratio was equivalent. The younger patients had a significantly higher Dukes’ stage, the tumors were more poorly differentiated, and they were more frequently of the mucinous and signet ring cell histopathologic type. Expression of p53 was higher in the younger patients (p < 0.001) and was independent of the degree of differentiation or the stage of the tumor. No differences of expression were noted for the other markers measured. The increased frequency of CRC in Filipino patients less than 40 years of age offers a unique opportunity to gain a better understanding of carcinogenesis, which might be exploited during diagnosis and management. The differences noted between the early‐ and late‐onset CRC are provocative and provide an impetus for increased screening in Filipinos.
Total mesorectal excision for rectal cancer: The truth lies underneath
Authors: Fernández‐Represa Jesús A. , Mayol Julio M. , Garcia‐Aguilar Julio
Published: March 2004

The surgical technique itself has emerged as a crucial factor for local recurrence since the popularization of total mesorectal excision for the treatment of rectal cancer. This procedure is associated with lower local recurrence rates after “curative” surgery compared to traditional dissection of the rectum. The aim is to remove an intact mesorectal envelope from the promontorium down to the pelvic floor by sharp dissection with tumorfree margins and without causing injury to the pelvic nerves. However, the description of total mesorectal excision has been confusing. Moreover, the implication that total excision of all the perirectal fat contained within the perirectal fascia en bloc in all patients with rectal cancer can minimize local recurrence remains contentious. Therefore a critical appraisal of the procedure is required. Nonrandomized clinical studies have shown that total mesorectal excision reduces the local recurrence rate and increases disease‐free survival in patients with adenocarcinoma of the middle and distal third of the rectum. Circumferential resection margins of 2 mm or more are associated with a lower local recurrence rate. Additional benefits in local control can be obtained with neoadjuvant treatment. Thus the modern treatment of rectal cancer combining total mesorectal excision with neoadjuvant chemoradiation results in excellent local tumor control. However, it is achieved at the cost of significant functional sequelae and impaired quality of life. The development of therapeutic alternatives that can achieve similar rates of local and distant tumor control without the mortality, morbidity, and functional consequences of radical surgery is a major challenge for colorectal surgeons.
Adverse effects of direct current cardioversion on cardiac pacemakers and electrodes
Authors: Waller Christiane , Callies Frank , Langenfeld Heiner
Published: March 2004

Use of pacing in sick sinus syndrome and recent developments in pacemaker therapy for intermittent atrial fibrillation raise the question of whether external electrical cardioversion should be used for termination of atrial fibrillation. This paper analyzes three cases of pacemaker and/or electrode dysfunction appearing after direct current (DC) cardioversion for termination of atrial fibrillation. Despite similar conditions during cardioversion in all cases, different dysfunctions reflecting damage to the pulse generator and/or a rise of the stimulation threshold in both, atrial and ventricular leads, have been observed. The possible mechanisms for these effects are discussed and recommendations for the management of cardioversion in patients with permanent pacemaker systems are given.
Radiofrequency catheter ablation of an accessory pathway through an anomalous inferior vena cava with azygos continuation
Authors: Guerra Ramos Jose Maria , Font Enrique Rodriguez , Moya i Mitjans Angel
Published: March 2004

A 59-year-old man with Wolff–Parkinson–White syndrome and an infrahepatic interruption of his inferior vena cava with an azygos continuation underwent a successful ablation of a right anteroseptal accessory pathway with a femoral approach through the azygos vein and superior vena cava.
Ice mapping during cryothermal ablation of accessory pathways in WPW: the role of the temperature time constant
Authors: Theuns Dominic A.M.J. , Kimman Geert P. , Szili-Torok Tamas , Res Jan C.J. , Jordaens Luc J.
Published: March 2004

Aim

Cryothermal energy has the ability reversibly to demonstrate loss of function with cooling, ice mapping, at less deep temperatures. The purpose of this study was to investigate the time course of the temperature during ice mapping of accessory pathways.

Methods and results

Thirteen patients with the Wolff–Parkinson–White (WPW) syndrome underwent cryoablation. After identification of a prospective ablation site, ice mapping was performed by cooling the tip to a minimum of −30 °C. Successful ice mapping was defined by loss of accessory pathway (AP) conduction. A total of 104 ice maps were analyzed. Successful ice mapping was demonstrated in 17 attempts. There was no significant difference in mapping temperature between successful and unsuccessful ice mapping (−29.4±3.2 °C vs −30.4±1.7 °C). The temperature time constant τ during successful ice mapping was significantly shorter compared with unsuccessful ice mapping (7.0±1.1 s vs 10.1±1.3 s; P<0.0001). The response time (RT) to mapping temperature of −30 °C was significantly prolonged in unsuccessful ice mapping attempts (35.8±4.5 s vs 53.5±11.0 s; P<0.0001). Significant correlations were found between successful ice mapping and the temperature time constant, and between RT and the temperature time constant (P<0.001).

Conclusion

The ability to identify prospective ablation sites by ice mapping was demonstrated. Successful ice mapping attempts were characterized by a short temperature time constant and a short response time to mapping temperature with a sudden disappearance of pathway conduction.
Clinical value of routine predischarge testing after ICD-implantation
Authors: Buob Axel , Siaplaouras Stephanos , Tscholl Dietmar , Schäfers Hans-Joachim , Böhm Michael , Jung Jens
Published: March 2004

Aims

After implantation of a cardioverter/defibrillator (ICD) predischarge testing is often performed to ensure appropriate therapy function. Nevertheless there is no proven evidence for the necessity of this examination. In this retrospective single-centre analysis we investigated the clinical value of routine predischarge testing.

Methods and results

Predischarge testing was performed in 161 patients 6±2 days after primary implantation of an ICD. There were no complications related to ICD-testing. In 17 of 161 patients (11%) there was at least one pathological finding. In 4 of 17 patients we observed a defibrillation energy requirement (DER) with a safety margin of less than 10 J. In two of these patients an early lead repositioning was undertaken and in two patients reversal of the shock polarity was used to achieve an adequate DER. In 13 of 17 patients we detected a distinct deviation of pacing thresholds or R-wave sensing amplitudes. In two of these patients an early electrode repositioning was performed because of lead displacement. In the remaining 11 patients we found an adequate DER at first, whereas in two patients a further lead repositioning was still necessary during follow-up. In 144 of 161 patients (89%) predischarge testing was without pathological findings. None of these patients needed revision of the ICD-lead during a mean follow-up of 24±13 months.

Conclusions

Abnormal measurements during predischarge testing are not rare findings in ICD-recipients. Noninvasive methods cannot rule out inadequate defibrillation function. A normal predischarge test seems to be a reliable predictor for a stable electrode function during the first years of follow-up.
Mortality of patients with implanted cardioverter/defibrillators in relation to episodes of atrial fibrillation
Authors: Deneke Thomas , Lawo Thomas , Gerritse Bart , Lemke Bernd ,   for the European GEM DR™ Investigators
Published: March 2004

Aims

This study was undertaken to evaluate if a history of episodes of atrial fibrillation (AF) has an effect on survival in patients (pts) with implanted cardioverter defibrillators (ICD).

Methods and results

Retrospective analysis of baseline characteristics, medication and endpoints in pts receiving a dual-chamber ICD comparing pts without (group 1: n=291) and with a history of AF (group 2: n=68).

Pts in groups 1 and 2 did not differ with regard to baseline characteristics. Forty-one pts (8.7%) experienced a detected episode of AF.

During the study period (mean follow-up 9.5 months) 25 pts died (5.8% of group 1 vs 11.8% of group 2). Patient survival was found to be 97.9% vs 91.2% (n=279 vs 63) at 3 months after implantation, 97.5% vs 89.7% (n=244 vs 54) at 6 months, and 93.7% vs 86.5% (n=96 vs 28) at 12 months in group 1 vs group 2 (p=0.005).

The risk of death increased after a first episode of AF was experienced during follow-up (RR=5.0, p=0.0007). Independent predictors of mortality are NYHA class (p=0.002), history of AF (p=0.009 for predicting early mortality), and detected episodes of AF during follow-up (p=0.001).

Conclusion

ICD-patients with a history of AF had a higher than average risk of death early after implantation and after device-detected episodes of AF.
Electrical storm in Brugada syndrome successfully treated using isoprenaline
Authors: Maury P. , Couderc P. , Delay M. , Boveda S. , Brugada J.
Published: March 2004

A case of an electrical storm occurring in a patient implanted with a cardioverter-defibrillator for Brugada syndrome is reported. Recurrent ventricular fibrillation was initiated by short-coupled isolated monomorphic ventricular premature beats probably originating from the right ventricular outflow tract, associated with a manifest electrocardiographic pattern of Brugada syndrome. Infusion of atropine accelerated the heart rate but did not prevent ventricular fibrillation, however, low doses of isoprenaline quickly obviated any recurrence of ventricular fibrillation. This was associated with the disappearance of the short-coupled premature beats together with a normalization of the electrocardiographic pattern. Possible mechanisms are discussed according to the accepted pathophysiological hypothesis.
Prognostic significance of right ventricular extrasystoles
Authors: Zweytick B. , Pignoni-Mory P. , Zweytick G. , Steinbach K.
Published: March 2004

Extrasystoles (RVES) from the right ventricular outflow tract (RVOT) are a common arrhythmia in routine ECGs.

Methods

In this prospective study 56 consecutive patients with RVES (22 males, 34 females) were examined for morphological and/or functional right ventricular (RV) abnormalities by 12-lead, Holter, exercise ECGs, transthoracic echocardiography and signal averaging. The follow-up time was 3.1–15.8 years (arithmetic mean±SD=7.2±1.6 years; median, 6.9 years). Patients with hyperthyroidism, structural cardiovascular and/or lung diseases were excluded.

Results

A total of 57.1% of the patients with RVES presented with echomorphologic abnormalities of the right ventricle (RV). In 26.8% the echomorphologic right ventricular abnormalities progressed in 33.3% of patients with normal RVs at baseline (group I) and in 21.9% of those with abnormal RVs at baseline (group II).

No significant differences were found between the 2 patient groups in terms of age at onset, family history, ECG changes, late potentials and malignant right ventricular outflow tract arrhythmias on 24-h and exercise ECGs. While females predominated in group I, males were numerous in group II (p=0.006). Sustained ventricular tachycardia, syncope or sudden death were absent throughout the follow-up.

Conclusion

Patients with RVES carry a good prognosis in terms of morbidity and mortality no matter whether echomorphologic abnormalities are present or not.
The DATAS rationale and design: a controlled, randomized trial to assess the clinical benefit of dual chamber (DDED) defibrillator
Authors: Quesada Aurelio , Almendral Jesús , Arribas Fernando , Ricci Renato , Wolpert Christian , Adragao Pedro , Cobo Eric , Navarro Xavier
Published: March 2004

Single chamber (SC) implantable cardioverter defibrillators (ICDs) have several limitations that might be relevant during follow-up, like atrial pacing requirements, inadequate therapies, sustained atrial tachyarrhythmias and difficulties to achieve an accurate diagnosis of the arrhythmia. Dual chamber (DC) ICDs offer an attractive and rational solution, although controversy remains if the costs and complexity of these devices offer a real clinical advantage. The Dual Chamber & Atrial Tachyarrhythmias Adverse Events Study (DATAS) was designed to analyze the ability of DC ICD, DDED, to reduce clinically significant adverse events compared with SC ICD in a non-selected population with conventional indications for ICD implantation. This is a prospective, multicentre, randomized, open labelled study, with three arms: two of them (simulated SC ICD and true DC ICD) cross-over, and the third (true SC ICD) parallels the other two. The composite primary end point comprises four Clinically Significant Adverse Events (CSAE): (1) all-cause mortality, (2) invasive intervention, hospitalization or prolongation of hospitalization due to cardiovascular cause, (3) inappropriate shocks, and (4) sustained symptomatic atrial tachyarrhythmias that (a) require urgent termination or (b) last more than 48 h leading to therapeutic intervention. Secondary end points constitute each of the individual components of CSAE, cardiovascular status, quality of life and a detailed analysis of atrial and ventricular arrhythmias. To date (June 2003) there have been 343 patients enroled from 947 screened patients. The projected enrolment includes 360 patients and the conclusion of the study is expected at the beginning of 2005.
ECG signs mimicking acute inferior wall myocardial infarction are associated with elevated myocardial enzymes during isolation of pulmonary vein for focal atrial fibrillation
Authors: Schwab Joerg Otto , Burkhardt Dietmar , Yang Alexander , Schrickel Jan , Lüderitz Berndt , Lewalter Thorsten
Published: March 2004

In this study, we report an intraprocedural incident in patients undergoing ablation for atrial fibrillation. During left atrial manipulation our patients suffered from acute chest pain, showed ECG signs of an acute inferior wall myocardial infarction, and increased levels of cardiac Troponin I (cTnI). We strongly recommend being aware of unexpected reactions during isolating pulmonary veins for focal atrial fibrillation, especially when passing the dorsal part of the left atrium. If pericardial effusion is ruled out and ECG signs as well as symptoms disappear, the ablation procedure should proceed. We think patients undergoing pulmonary vein ablation for atrial fibrillation should be informed of this threatening complication.
High viral loads despite absence of clinical and pathological findings in cats experimentally infected with feline coronavirus (FCoV) type I and in naturally FCoV-infected cats
Authors: Meli M , Kipar A , Müller C , Jenal K , Gönczi E , Borel N , Gunn-Moore D , Chalmers S , Lin F , Reinacher M , Lutz H
Published: February 2004

Specified pathogen-free cats were naturally infected with FCoV or experimentally infected with FCoV type I. Seroconversion was determined and the course of infection was monitored by measuring the FCoV loads in faeces, whole blood, plasma and/or monocytes. Tissue samples collected at necropsy were examined for viral load and histopathological changes. Experimentally infected animals started shedding virus as soon as 2 days after infection. They generally displayed the highest viral loads in colon, ileum and mesenteric lymph nodes. Seroconversion occurred 3–4 weeks post infection.

Naturally infected cats were positive for FCoV antibodies and monocyte-associated FCoV viraemia prior to death. At necropsy, most animals tested positive for viral shedding and FCoV RNA was found in spleen, mesenteric lymph nodes and bone marrow. Both experimentally and naturally infected cats remained clinically healthy. Pathological findings were restricted to generalized lymphatic hyperplasia. These findings demonstrate the presence of systemic FCoV infection with high viral loads in the absence of clinical and pathological signs.
FIP: A novel approach to vaccination
Authors: German A.C. , Helps C.R. , Harbour D.A.
Published: February 2004

Feline infectious peritonitis (FIP) is a fatal disease of cats. Early attempts at vaccination have been unsuccessful, some even serving to exacerbate the disease through antibody-dependent enhancement. Replication-incompetent feline foamy virus (FFV) transducing vectors are being developed as potential vaccine agents, into which immunogenic fragments of feline coronavirus (FCoV) proteins will be inserted. To use a recombinant viral vector to express FCoV proteins, the agent chosen should be apathogenic and replication incompetent within the host following gene delivery. Spumaviruses confer several advantages over the more traditionally explored retroviral vectors. Stable helper cell line clones have been established by transfection of CRFK cells with FFV tas and assessed using β-galactosidase assays, PCR, immunofluorescence and western blotting. The generation of infectious virions using these cell lines has been investigated using tas-deleted FFV vectors containing the enhanced green fluorescent protein (eGFP) cassette.
Use of recombinant feline interferon and glucocorticoid in the treatment of feline infectious peritonitis
Authors: Ishida T , Shibanai A , Tanaka S , Uchida K , Mochizuki M
Published: February 2004

A total of 12 clinically ill cats previously diagnosed as feline infectious peritonitis (FIP) were treated with a combination of recombinant feline interferon and glucocorticoid. A complete remission (over 2 years) and a partial remission (2 to 5 months) were observed in four (33.3%) and four (33.3%) cases, respectively. Those that survived for more than 2 years were all older cats (6 to 16 years old) with the effusive form of FIP.
Evaluation of an in-practice test for feline coronavirus antibodies
Authors: Addie Diane D. , McLachlan Shona A. , Golder Matthew , Ramsey Ian , Jarrett Oswald
Published: February 2004

A commercially available in-practice test for feline coronavirus (FCoV) antibodies (FCoV Immunocomb, Biogal Galed Laboratories) was evaluated by comparison with the gold standard FCoV immunofluorescent antibody (IFA) test. One hundred and three serum or plasma samples were selected and tested: 70 were positive by both tests, 24 were negative by both tests. The in-practice test produced five false positive and four false negative results. The sensitivity of the in-practice test was 95% and the specificity was 83%. When the titres were compared it was found that the in-practice test results were significantly correlated with IFA titres but the degree of correlation was not likely to be clinically useful. The IFA titres of the four false negative samples were found to be low (less than 40) which suggests that even a cat with a false negative result is still unlikely to be excreting FCoV.

A negative result with the in-practice assay is likely to be reliable for screening cats prior to entry into an FCoV-free cattery or stud. It would also be useful in the investigation of suspected FIP as most cats with this condition have high IFA titres of antibodies. A strong positive result would be useful in the diagnosis of FIP (in conjunction with other biochemical and cytological testing), but positive results would be of limited value in monitoring FCoV infection in healthy cats as the antibody titre could not be reliably compared with those obtained with IFA. All positive results obtained using the in-practice kit should be confirmed and titrated by IFA. The kit also appeared to work efficiently with ascites samples ( n=6) but too few samples were analysed to draw firm conclusions.
Comparison of kinematic analysis by mapping tibiofemoral contact with movement of the femoral condylar centres in healthy and anterior cruciate ligament injured knees
Authors: Scarvell Jennifer M. , Smith Paul N. , Refshauge Kathryn M. , Galloway Howard R. , Woods Kevin R.
Published: February 2004

Two methods of analysis of knee kinematics from magnetic resonance images (MRI) in vivo have been developed independently: mapping the tibiofemoral contact, and tracking the femoral condylar centre. These two methods are compared for the assessment of kinematics in the healthy and the anterior cruciate ligament injured knee.

Sagittal images of both knees of 20 subjects with unilateral anterior cruciate ligament injury were analysed. The subjects had performed a supine leg press against a 150 N load. Images were generated at 15° intervals from 0° to 90° knee flexion. The tibiofemoral contact, and the centre of the femoral condyle (defined by the flexion facet centre (FFC)), were measured from the posterior tibial cortex.

The pattern of contact in the healthy knee showed the femoral roll back from 0° to 30°, then from 30° to 90° the medial condyle rolled back little, while the lateral condyle continued to roll back on the tibial plateau. The contact pattern was more posterior in the injured knee (p = 0.012), particularly in the lateral compartment. The medial FFC moved back very little during knee flexion, while the lateral FFC moved back throughout the flexion arc. The FFC was not significantly different in the injured knee (p = 0.17).

The contact and movement of the FFC both demonstrated kinematic events at the knee, such as longitudinal rotation. Both methods are relevant to design of total knee arthroplasty: movement of the FFC for consideration of axis alignment, and contact pattern for issues of interface wear and arthritic change in ligament injury. © 2004 Orthopaedic Research Society. Published by Elsevier Ltd. All rights reserved.
The heavens of the sky and the heavens of the heart: the Ottoman cultural context for the introduction of post-Copernican astronomy
Authors: BEN-ZAKEN AVNER
Published: March 2004

In 1637 a Frenchman named Noël Duret (Durret) published a book in Paris that referred to the heliocentric Copernican system. In 1660 an Ottoman scholar named Ibrāhīm Efendi al-Zigetvari Tezkireci translated the book into Arabic. For more than three centuries this manuscript was buried in an Ottoman archive in Istanbul until it resurfaced at the beginning of the 1990s. The discovery of the Arabic text has necessitated a re-evaluation of the history of early modern Arabic natural philosophy, one that takes into account the intellectual context of Ibrāhīm Efendi and the overarching trends in the world of Sufi mysticism. These trends were reflected in art, literature, philosophy and natural philosophy. Using philological and cultural clues, as well as Ibrāhīm Efendi's own words, we can attempt deductions about why, how and for what purposes Ibrāhīm Efendi chose Duret's book for his project.
Fallible or inerrant? A belated review of the ‘constructivist's bible’ Jan Golinski, Making Natural Knowledge: Constructivism and the History of Science. Cambridge History of Science. Cambridge: Cambridge University Press, 1999. Pp. xiv+236. ISBN 0-521-44913-8. £15.95 (paperback).
Authors: Eddy M. D.
Published: March 2004

When Jan Golinski's Making Natural Knowledge was published in 1998 it was generally applauded for its ecumenical stance between the empirical ‘art’ of historians and the theoretical focus of the social sciences. Indeed, such a middling position was a unique approach to be taken in wake of the ‘science wars’ and this, in combination with the book's clear organization and (for the most part) forthright prose, quickly earned it a place upon HPS, STS and SSK postgraduate reading lists. Now, five years since its first edition was published (hardback, 1998), the work has become a standard introduction to historically minded scholars interested in the constructivist programme. In fact, it has been called the ‘constructivist's bible’ in many a conference corridor. Since the book has attained such a status (and since it has not been reviewed in the BJHS), it is perhaps worth reflecting on whether or not such canonical text (to use a biblical analogy) is fallible or inerrant – especially in relation to its content and pedagogical efficacy.
Candidate Positioning in US Congressional Elections
Authors: BURDEN BARRY C.
Published: March 2004

Theory suggests that three factors – the importance of ideology to primary voters, costly movement due to candidate reputations and lack of competition – all contribute to candidate divergence in US congressional elections. These predictions are analysed with new data from a 2000 mail survey that asked congressional candidates to place themselves on a left–right ideological scale. The data reveal that candidates often diverge, but that the degree of candidate polarization is variable and may be explained by factors in the theory. Candidates with firm public reputations, those who face weak general election competition, and those who experience stiff primary competition are all more likely to deviate from the median voter's position. Perhaps more importantly, the locations that candidates adopt have clear effects on their vote shares.