bluuebunny/crossref_metadata_2025 huggingface dataset:
Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Statement for Health Professionals From the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association
Authors: Newburger Jane W. , Takahashi Masato , Gerber Michael A. , Gewitz Michael H. , Tani Lloyd Y. , Burns Jane C. , Shulman Stanford T. , Bolger Ann F. , Ferrieri Patricia , Baltimore Robert S. , Wilson Walter R. , Baddour Larry M. , Levison Matthew E. , Pallasch Thomas J. , Falace Donald A. , Taubert Kathryn A.
Published: December 2004

Background. Kawasaki disease is an acute self-limited vasculitis of childhood that is characterized by fever, bilateral nonexudative conjunctivitis, erythema of the lips and oral mucosa, changes in the extremities, rash, and cervical lymphadenopathy. Coronary artery aneurysms or ectasia develop in ∼15% to 25% of untreated children and may lead to ischemic heart disease or sudden death.

Methods and Results. A multidisciplinary committee of experts was convened to revise the American Heart Association recommendations for diagnosis, treatment, and long-term management of Kawasaki disease. The writing group proposes a new algorithm to aid clinicians in deciding which children with fever for ≥5 days and ≤4 classic criteria should undergo electrocardiography, receive intravenous gamma globulin (IVIG) treatment, or both for Kawasaki disease. The writing group reviews the available data regarding the initial treatment for children with acute Kawasaki disease, as well for those who have persistent or recrudescent fever despite initial therapy with IVIG, including IVIG retreatment and treatment with corticosteroids, tumor necrosis factor-α antagonists, and abciximab. Long-term management of patients with Kawasaki disease is tailored to the degree of coronary involvement; recommendations regarding antiplatelet and anticoagulant therapy, physical activity, follow-up assessment, and the appropriate diagnostic procedures to evaluate cardiac disease are classified according to risk strata.

Conclusions. Recommendations for the initial evaluation, treatment in the acute phase, and long-term management of patients with Kawasaki disease are intended to assist physicians in understanding the range of acceptable approaches for caring for patients with Kawasaki disease. The ultimate decisions for case management must be made by physicians in light of the particular conditions presented by individual patients.
Elimination of Organic Compounds of Sewage or Sewage Fractions in Sandy Soil below Leaking Sewers
Authors: Hua Jianmin , An Pinglin , Winter Josef , Gallert Claudia
Published: December 2004

To determine the purification effect of a sandy underground for pollutants from leaky sewers, raw sewage, clarified sewage and the resuspended solids fraction of sewage were trickled through sand columns of 1.25 m length.

On average 79 % of the chemical oxygen demand (COD) of raw sewage from dry weather seasons and 62 % of the COD of raw sewage from wet seasons were eliminated during trickling through the sand. During trickling of the soluble sewage fraction 61 % of the COD were eliminated, whereas the COD of the hydrolysed portion of the particulate fraction was eliminated to an extent of 85 %. The non‐hydrolysed residues (26 % of the COD of sewage) remained as a discrete sludge layer on top and in the first 5 cm of the sand, not causing colmation during one year.

The mean hydraulic residence time (HRT) of sewage in the sand columns was determined by spiking with potassium chloride and conductivity measurement. It was 24 h initially and after a trickling time of more than 8 months 32 h for the soluble fraction of sewage or 35 h for raw sewage. The increasing HRT of the soluble sewage fraction in the sand columns with trickling time indicated the formation of a water‐retaining biofilm on the sand particles in the columns, which was more pronounced when a greater portion of degradable COD was supplied with the raw sewage as compared to clarified sewage. The HRT of all columns was drastically shorter at flow rates of more than 6.4 L d—1, presumably by preferential, non‐restricted wastewater flow through large pores.
Conformation of peptides constructed from achiral amino acid residues Aib and ΔZPhe: Computational study of the effect of L/D‐ Leu at terminal positions
Authors: Nandel Fateh Singh , Khare Baldeep
Published: December 2004

Conformational studies of the peptides constructed from achiral amino acid residues Aib and ΔZPhe (I) Ac‐Aib‐ΔZPhe‐NHMe (II), and Ac‐(Aib‐ΔZPhe)3‐NHMe; peptides III–VI having L‐Leu or D‐Leu at either the N‐ or the C‐terminal position and of peptides VII–X having Leu residues in different enantiomeric combinations at both the N‐ and the C‐terminal positions in peptide II have been studied to design the peptide with the required helical sense. Peptide II, as expected, adopts degenerate left‐ and right‐handed helical structures. It has been shown that the peptides IV and VI having D‐Leu at either the N or the C terminus can be realized in the right‐handed helical structure with the ϕ,ψ values of −20° and −60° for the Aib/ΔZPhe residues. L‐Leu and D‐ Leu at both the terminals in peptides VII and VIII, respectively, have hardly any effect as both the left‐ and the right‐handed structures are found to be degenerate. Peptides III and IX can be realized in right‐ and left‐handed helical structures, respectively, in solvents of low polarity whereas peptides V and X are predicted to be in the right‐handed helical structures stabilized by carbonyl–carbonyl interactions without the formation of hydrogen bonds. The conformational states with the ϕ,ψ values of 0° and −85° in peptide V are characterized by rise per residue of 2.03 Å, rotation per residue of 117.5°, and 3.06 residues per turn. In all peptides having Leu residue at the N terminus, the methyl moiety of the acetyl group is involved in the CH/π interactions with the CϵCδ edge of the aromatic ring of ΔZPhe (3) and the amino group NH of ΔZPhe is involved in the NH/π interactions with its own aromatic ring. The CH3 groups of the Aib residues are also involved in CH/π interactions with the i + 1th and i + 3th ΔZPhe's aromatic side chains. © 2004 Wiley Periodicals, Inc. Biopolymers, 2005
HLA‐B27 typing: Evaluation of an allele‐specific PCR melting assay and two flow cytometric antigen assays
Authors: Seipp Michael T. , Erali Maria , Wies Rae Lynn , Wittwer Carl
Published: December 2004

Background

Human leukocyte antigen B27 (HLA‐B27) is a major histocompatibility complex class 1 molecule that is strongly associated with the disease ankylosing spondylitis. Testing for HLA‐B27 is of diagnostic value because 90% of patients with ankylosing spondylitis have the B27 antigen. Two commonly used HLA‐B27 flow cytometric assays are commercially available.

Methods

An allele‐specific polymerase chain reaction (PCR) melting assay for HLA‐B27 was compared with two available antigen assays on 371 clinical samples. The accuracy of the assays was measured by receiver operating characteristic analysis using the PCR method and sequencing as the reference standard.

Results

When PCR results were compared with those of the antigen assays, complete concordance was observed except for five discrepant results that were resolved by sequence analysis. Using DNA sequencing as the gold standard, the sensitivity and specificity of PCR were 99.6 and 100.0, those of the best single antigen assay were 98.2 and 97.6, and those of a reflex combination of both antigen assays were 98.8 and 97.6.

Conclusions

The allele‐specific PCR melting assay for HLA‐B27 genotyping is easy to perform and has better sensitivity and specificity than antigen assays. The performance of the two flow cytometric antigen assays depends on the antibody used and the positive cutoff values assigned. © 2004 Wiley‐Liss, Inc.
Respiratory syncytial virus‐induced exaggeration of allergic airway disease is dependent upon CCR1‐associated immune responses
Authors: John Alison E. , Gerard Craig J. , Schaller Matthew , Miller Allison L. , Berlin Aaron A. , Humbles Allison A. , Lukacs Nicholas W.
Published: December 2004

Severe respiratory syncytial virus (RSV) infection has a significant impact on airway function, and may alter subsequent development of asthma. CCR1 mRNA was significantly up‐regulated during primary RSV infection in BALB/c mice, and was also up‐regulated during allergen exposure in sensitized mice. Although CCR1–/– mice exhibited similar levels of airway hyperresponsiveness (AHR) as wild‐type mice in response to cockroach allergen alone, in animals treated with RSV prior to cockroach antigen (CRA) sensitization and challenge, a significant decrease in exacerbated AHR was observed in the CCR1–/– mice. The reduction in AHR after RSV and allergen challenge in CCR1–/– mice was not associated with changes in peribronchial eosinophilia, but was accompanied by significantly decreased IL‐13 levels in the lungs, as well as an absence of mucus cell staining within the airways. When T lymphocyte numbers were compared in animals receiving CRA to animals receiving a combination of RSV and allergen an increase in both CD4 and CD8 T lymphocytes could be detected in wild‐type but not CCR1–/– animals. Thus, these data suggest that CCR1‐mediated responses have a primary role for inducing severe disease during RSV infection, and may be responsible for altering the lung pathophysiological responses to subsequent allergen challenges via IL‐13‐mediated mechanisms.
High responsiveness of HLA‐B57‐restricted Gag‐specific CD8+ T cells in vitro may contribute to the protective effect of HLA‐B57 in HIV‐infection
Authors: Jansen Christine A. , Kostense Stefan , Vandenberghe Kristin , Nanlohy Nening M. , Cuyper Iris M. De , Piriou Erwan , Manting Erik H. , Miedema Frank , van Baarle Debbie
Published: December 2004

HLA‐B57 has been shown to be associated with long‐term asymptomatic HIV‐1 infection. To investigate the biological mechanism by which the HLA‐B57 allele could protect from HIV‐1 disease, we studied both the number of CD8+ T cells as well as CD8+ T cell responsiveness directed to different HIV‐1 Gag peptides presented by HLA‐A2, ‐B8 or ‐B57. T cells specific for the HLA‐B57 peptide KAFSPEVIPMF responded more readily and to a higher extend to antigenic stimulation in vitro than T cells specific for the HLA‐A2 peptide SLYNTVATL or the HLA‐B8 peptide EIYKRWII. This phenomenon was reproducible with T cells from individuals expressing HLA‐B57 in combination with one or both of the other alleles and was persistent during long‐term follow‐up. Lower reactivity of A2‐ and B8‐restricted T cells was not explained by mutations in the B8‐ or A2‐restricted Gag‐peptides. Moreover, no correlation between peptide mutation frequency and IFN‐γ production by the corresponding Gag‐specific T cells was observed. In conclusion, functional differences were observed between T cells specific for HIV epitopes derived from the same protein presented by different HLA molecules. B57‐restricted KAFSPEVIPMF‐specific CD8+ T cells have relatively high responsiveness, which could contribute to the protective effect of HLA‐B57 in HIV infection.
Cover Picture: Bis(trimethylsilyl)acetylene Complexes of Titanocenes and Zirconocenes: Their Recent Chemistry and Reactions with Lewis Acids (Eur. J. Inorg. Chem. 24/2004)
Authors: Rosenthal Uwe , Burlakov Vladimir V. , Arndt Perdita , Baumann Wolfgang , Spannenberg Anke , Shur Vladimir B.
Published: December 2004

The cover picture shows the stable and well‐defined metallocene bis(trimethylsilyl)acetylene complexes Cp2M(L)(η2‐Me3SiC2SiMe3) (M = Ti, without L; M = Zr, L = THF, pyridine), of the pentamethylcyclopentadienyl complexes Cp*2M(η2‐Me3SiC2SiMe3) (M = Ti, Zr) and the ethylenebis(tetrahydroindenyl) complexes rac‐(ebthi)M(η2‐Me3SiC2SiMe3) (M = Ti, Zr). These form an essential basis for recent applications in chemistry. By using different Cp ligands (Cp, Cp*, ebthi), additional ligands (THF, pyridine), and metals (Ti, Zr), a fine‐tuning of several stoichiometric and catalytic reactions was feasible. The latter complexes offer a number of compelling advantages over the widely used other similar metallocene reagents. As a metaphor, this piece of basic research stands “solid as a rock in heavy seas” (in the photo the Baltic Sea nearby Rostock‐Warnemünde), alluding to the fact that fundamental preparative organometallic chemistry provides a solid foundation for attractive applications. Details of this chemistry are described in the Microreview by U. Rosenthal et al. on p. 4739ff.
Hierarchical thermodynamic metrics for evaluating the environmental sustainability of industrial processes
Authors: Yi Heui‐seok , Hau Jorge L. , Ukidwe Nandan U. , Bakshi Bhavik R.
Published: December 2004

Industrial progress toward sustainability requires meaningful, practical, and scientifically sound metrics. Most existing metrics rely on information about material and energy inputs and emissions from the main process and selected processes in its life cycle. Such metrics often result in multiple conflicting variables, making it difficult to use them for decision making. Furthermore, sustainability metrics need to be scientifically rigorous and capable of evaluating the broader economy and ecosystem scale impacts of selected processes and products. This paper proposes a framework for evaluating the environmental sustainability of industrial processes that satisfies these needs. This framework uses exergy analysis to combine different types of material and energy streams in a thermodynamically sound manner. Exergy analysis is also combined with end‐point life‐cycle impact assessment methods for evaluating the impact of emissions. This results in metrics for a selected system with different levels of aggregation ranging from multiple to single dimensions. The challenge of analyzing a process at life cycle and coarser spatial scales is met by combining exergy analysis, life cycle assessment, input–output analysis, and both economic and ecological aspects. The result is a doubly nested hierarchy, which analyzes processes at multiple spatial scales of process, life cycle, economy, and ecosystem. Each scale contains another hierarchy based on the degree of aggregation of the metrics. A case study of the ammonia process illustrates the characteristics of the proposed approach. © 2004 American Institute of Chemical Engineers Environ Prog, 2004
Strategic planning in higher education
Authors: Dooris Michael J. , Kelley John M. , Trainer James F.
Published: December 2004

The authors present an overview of strategic planning, examine its history and mystique, and conclude that planning, if properly implemented, can have a powerful impact on advancing and transforming colleges and universities.
Linking planning, quality improvement and IR: Los Angeles City College
Authors: Seymour Daniel
Published: December 2004

Stung by a negative accreditation review, Los Angeles City College established an administrative position and a planning process that is successfully creating a culture of continuous improvement. At the core of this success is a “plan‐act‐check” reinforcing systems loop that links planning, budgeting, and institutional research.
Future‐search conferences at Cornell University
Authors: Warzynski Chester C.
Published: December 2004

A future‐search conference is a participatory planning and decision‐making process in which a group of individuals with diverse perspectives come together; engage in a process of data collection, discussion, and learning; and decide on an appropriate course of action. The competencies, skills, and intellectual capital developed as part of this search conference had a significant impact on the faculty.
Comparison of plastic films with different optical properties for soil covering in horticulture: test under simulated environmental conditions
Authors: Heißner Adolf , Schmidt Stefanie , von Elsner Burkhardt
Published: December 2004

Covering the soil with plastic film is an important method to modify soil temperature and improve the conditions for plant growth. For the optimal use of films in horticulture, it is necessary to quantify this effect, which depends particularly on the optical properties of the film. Five films, used mainly for soil covering in asparagus cultivation, were tested by measuring the soil temperature as well as the transmittance and reflectance in the short‐ and long‐wavelength bands: ‘Taschenfolie schwarz/weiß’, a film with black and white surfaces and pockets for fastening; ‘Antitaufolie’, a film with anti‐condensation coating, ‘Solartherm plus Folie’, a film with black top and transparent sides; ‘MaterBi Folie’, a biodegradable film; and ‘Thermoplus Folie’, a black polyethylene with transparent sides. All films were produced in Germany. The temperature measurements were carried out under controlled irradiation (short‐wavelength band) and ambient temperature conditions in the laboratory: first, 182 W m−2 and 11 °C at a depth of 0.4 m, and second, 340 W m−2 at 20 °C. A significant relationship between the temperature increase or decrease by covering the soil with the film and the calculated apparent quantities of the reflectance in the short and long‐wavelength band was derived (r2 = 0.85, n = 12). Furthermore, first tests with a physical model were carried out to obtain basic information, which should be used in the development of strategies for film management in the field. Copyright © 2004 Society of Chemical Industry
Genetic analysis of developmental behavior for amylose content in filling process of rice
Authors: Shi Chunhai , Wu Jianguo , Wu Ping
Published: December 2004

Dynamic genetic effects for amylose content (AC) of indica rice were analyzed at four different filling times/stages using the genetic models for quantitative traits. The expression of triploid endosperm, cytoplasmic and diploid maternal plant genes were important for AC at different developmental stages of rice, especially at the early and middle filling stages. AC of rice was mainly controlled by the cumulative or net endosperm effects and their genotype × environment interaction effects, except at late filling stage which the net maternal effects were larger. The expression of genes at day 7, 14 or 21 after flowering was more easily influenced by the environmental conditions, while the genes' expression at mature stage of rice was stable. Breeding improvement could be achieved by selection for a better variety with a suitable AC because of the larger additive and cytoplasmic effects. The total narrow‐sense heritabilities for AC on days 7, 14, 21 and 28 after flowering were 78.9, 85.6, 80.1 and 70.2%, respectively. The interaction heritability was more important than the general heritability, except at the maturing time of rice. Significant genotypic correlations for AC were observed among developmental times of rice. Copyright © 2004 Society of Chemical Industry
BMP‐7 (OP‐1) in human orthopaedic surgery: Local and systemic effects of application
Authors: Benke G. , Górecki A.
Published: December 2004

Six patients with nonunion of long bones, one with delayed bone formation during distraction osteogenesis, and one with nonunion of the neck of the femur were enrolled in a clinical trial. Duration of nonunion was from 8 to 94 months (mean 29,4 months). Recombinant human OP‐1 (BMP‐7) was purchased from the manufacturer. One unit (3,5 mg of active substance mixed with 1 gram of type I bovine bone‐derived collagen) was used in each patient. In four patients OP‐1 implant was delivered by standard open operative procedure, in 3 percutaneously. In one patient with femoral neck nonunion OP‐1 implant was placed intramedullary. No patient had serious adverse reactions related to the implant. At 5 to 8 weeks following the operative procedure five out of 6 patients with nonunion of long bones and one patient with delayed bone formation in distraction osteogenesis were judged by clinical and radiological criteria to have been treated successfully. In one patient with femoral neck nonunion bone union was achieved after 22 weeks. To determine whether the local stimulation with OP‐1 might induce prolonged changes in systemic levels of growth and angiogenic factors, the serum levels of the angiogenin (ANG), interleukin‐8 (IL‐8), vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF) and insulin‐like growth factor‐1 (IGF‐1) were assessed prior, and 1, 2, 6 and 12 weeks after operative treatment with OP‐1 device. There is no evidence for a potentially harmful systemic rise in growth and angiogenesis factors after local administration of the amount of BMP‐7 used in our study.
Force control and disease severity in Parkinson's disease
Authors: Robichaud Julie A. , Pfann Kerstin D. , Vaillancourt David E. , Comella Cynthia L. , Corcos Daniel M.
Published: December 2004

Several measures of isometric contractions reflect motor impairments in subjects with Parkinson's disease (PD), including long relaxation times and greater power in the 5 to 15 Hz electromyographic (EMG) bandwidth during the holding phase of contractions compared to those measures in healthy subjects. We sought to determine whether the impairments observed in subjects with PD in the performance of isometric contractions reflect disease severity. Twenty‐eight subjects with PD performed isometric contractions at a torque level equal to 50% of the torque generated during a maximum voluntary contraction while off medication. Subjects were instructed to reach the target torque as fast as possible upon hearing the auditory “go” signal and to relax their muscles when a second auditory cue signaled the end of the hold phase. There was a significant positive correlation between torque relaxation time and Unified Parkinson's Disease Rating Scale (UPDRS)‐Motor score. A significant positive correlation was also observed between the proportion of power in the 5 to 15 Hz frequency bin of the agonist EMG signal and UPDRS‐Motor score, and a significant negative correlation between the proportion of power in the 15 to 30 Hz frequency bin and UPDRS‐Motor score. These measures provide objective quantification of the severity of motor impairment that can be used to investigate the efficacy of different interventions in individuals with PD. © 2004 Movement Disorder Society
Crystallization regime characteristics of exfoliated polyethylene/vermiculite nanocomposites
Authors: Tjong S. C. , Bao S. P.
Published: December 2004

Polyethylene (PE)–vermiculite (VMT) nanocomposites containing 0.5, 2, 4, 6, and 8 wt % clay loadings were fabricated via direct melt compounding in a twin‐screw extruder. Crystallization kinetics was investigated by means of polarized optical microscopy and differential scanning calorimetry. Moreover, the kinetics of the spherulitic growth of PE–VMT nanocomposites was evaluated with the Lauritzen–Hoffman (LH) secondary nucleation theory. The results showed that the PE–VMT nanocomposite exhibits crystallization regime characteristics. The nucleation constants for regimes I and II were determined from the slope of the LH plots. The fold surface energies (σe) of the PE–VMT nanocomposites were estimated from these slopes. The σe values were found to decrease with an increasing VMT content, up to 2%, in regime I. Further increasing the VMT content resulted in a slight increase of the σe values. In regime II, the σe values of the nanocomposites were generally lower than that of pure PE. These results demonstrated that the exfoliated silicate layers acted as effective nucleation sites for the secondary nucleus of the nanocomposites. © 2004 Wiley Periodicals, Inc. J Polym Sci Part B: Polym Phys 43: 253–263, 2005
Cytoreduction and sequential resection for surgically verified unresectable hepatocellular carcinoma: Evaluation with analysis of 72 patients
Authors: Tang Zhao‐You , Yu Ye‐Qin , Zhou Xin‐Da , MA Zeng‐Chen , Lu Ji‐Zheu , Lin Zhi‐Ying , Liu Kang‐Da , Ye Sheng‐Long , Yang Bing‐Hui , Wang Hong‐Wei , Sun Hui‐Chuan
Published: December 2004

The poor prognosis of hepatocellular carcinoma (HCC) was partly a result of the majority of unresectable HCCs in clinical patients. Fortunately, with the progress of regional cancer therapies and multimodality treatment, some of the localized unresectable HCCs were converted to resectable ones. During the period 1960–1994, 72 of the 663 patients with surgically verified unresectable HCCs have been converted to resectable. Successful cytoreduction with median diameter reduced from 10 cm to 5 cm was mainly a result of the triple or double combination treatment with hepatic artery ligation, hepatic artery cannulation with infusion, radioimmunotherapy, and fractionated regional radiotherapy. The interval between the first operation and the sequential resection was 5 months. The operative mortality was 1.4% for sequential resection, and the 5‐year survival was 62.1%. Analysis of factors influencing sequential rescction rate revealed HCCs that were single nodule, well encapsulated, situated at right lobe or hepatic hilum, associated with micronodular cirrhosis, and treated with triple or double combination modalities had higher sequential resection rate as compared to their counterparts. Analysis of factors influencing survival after sequential resection revealed that HCCs with a solitary tumor confined in one lobe, without tumor embolus, and without residual cancer in specimen of sequential resection, had longer survival. It is suggested that localized unresectable, solitary, well encapsulated, right lobe or hilar HCC, associated with micronodular cirrhosis, will be good candidates for cytoreduction and sequential resection; and HCCs with unilateral involvement, without tumor embolus, and with complete necrosis of tumor after multimodality treatment favored better prognosis.
Transcatheter arterial chemoembolization (TACE) in the treatment of unresectable liver cancer
Authors: Yamada Ryusaku , Kishi Kazushi , Sato Morio , Sonomura Tesuo , Nishida Norifumi , Tanaka Kayo , Shioyama Yasukazu , Terada Masaki , Kimura Masashi
Published: December 2004

Basis, techniques, and recent strategies and results of interventional treatments for hepatoma were reviewed. The basic experimental researches indispensable to justify clinical technique and dosage have been accomplished. A total of 1310 unresectable cases underwent transcatheter arterial chemoembolization (TACE) and/or related therapies. The related therapies are several modified or strengthened TACE such as Lipiodol‐TACE and subsegmental TACE. The therapies for unembolizable cases are balloon occluded arterial infusion, Lipiodol‐SMANCS infusion and percutaneous direct injection chemotherapy, that reinforces the effect of TACE. As for the resectable cases, postoperative TACE was proved to be beneficial because it increased survival rates; however, preoperative TACE was not beneficial. The TACE and related interventional radiologic therapies for the hepatoma can be an equal or superior therapy by virtue of targeting chemotherapy.
Intralesional ethanol in the treatment of unresectable liver cancer
Authors: Livraghi Tito , Lazzaroni Sergio , Meloni Franca , Torzilli Guido , Vettori Claudio
Published: December 2004

Percutaneous ethanol injection (PEI) under ultrasonography guidance has been widely tried in not advanced hepatocellular carcinoma (HCC). Ten years after the introduction of PEI, some conclusions of its indications can be drawn. In our series, 210 cirrhotic patients were treated; 141 with multisession PEI in an outpatient clinic, 57 with “single session” PEI under general anesthesia, and 12 with both. The 1‐, 3‐, and 5‐year survival rates (by Kaplan‐Meier method) were 93%, 65%, and 41% for Child class A patients with single HCC ≤ 5 cm, and 88%, 47%, and 33% for patients with multiple HCC up to five lesions ≤ 5 cm. In these patients the local recurrence rate was 15% and the new lesion rate at the 5‐year follow‐up was 74%. One death due to hemorrhage from esophageal varices in a Child class C patient treated by single session PEI occurred. The large number of cirrhotic patients enrolled in ultrasonography screening programs has created a large demand for effective, safe, repeatable, low‐cost treatment that can be offered at many centers. PEI meets all these requirements. PEI is proposed as the treatment of choice for the mentioned patients, excluding candidates for liver transplantation and surgical resection according to the predictive adverse factors currently in use. “Single session” technique widened the indications of traditional PEI to larger lesions.
Leukocyte activation by isolated hyperthermic liver and limb perfusion due to malignancy
Authors: Arnestad Jan Petter , Bengtsson Anders , Bengtson Jan‐Peter , Hafstrom Larsolof , Redl Heinz , Schlag Günther
Published: December 2004

Fourteen patients with liver tumor malignancy and sixteen patients with malignant melanoma localized to one limb were studied regarding leukocyte activation with the release of polymorphonuclear neutrophilic (PMN) elastase and of neopterin and formation of cytokines (TNF‐α and Il‐6) during the surgical treatment. Patients undergoing liver resection (n=10), abdominal hysterectomy (n=10), or hip replacement surgery (n=10) served as control groups. Isolated hyperthermic liver perfusion was performed with cytostatic‐containing perfusate (melphalan and cisplatinum). Patients with recurrent malignant melanoma confined to one limb underwent isolated hyperthermic limb perfusion with cytostatic‐containing perfusate (melphalan). Blood samples for determination of PMN elastase, neopterin, TNF‐α, and IL‐6 were drawn from the patients preoperatively, 1 minute before the start of the perfusion, 60 and 120 minutes after the start of the perfusion, and 24 hours postoperatively. Samples from the perfusate were drawn 60 minutes after the start of the perfusion. High concentrations of plasma PMN clastase were found both in patients undergoing liver and limb perfusion and in patients undergoing liver resection surgery. Elevated concentrations of Il‐6 were found in the patients undergoing liver perfusion and in patients undergoing liver resection. In none of the patients were there increased concentrations of neopterin or TNF‐α. The perfusate contained high concentrations of PMN elastase, neopterin, and IL‐6. This study also demonstrated that major surgery leads to elevated concentrations of PMN elastase and IL‐6. An increase of PMN elastase and IL‐6 was seen in response to perfusion and to surgical trauma.
Benign hepatic tumors: Focal nodular hyperplasia and hepatocellular adenoma
Authors: Nagorney David M.
Published: December 2004

Focal nodular hyperplasia (FNH) and hepatocellular adenoma (HA) are uncommon benign hepatic tumors that continue to pose diagnostic and therapeutic challenges. An update of a recent Mayo Clinic experience is presented to highlight the management of patients harboring these neoplasms. A marked female predominance was seen. Incidental diagnosis was more prevalent with FNH, whereas symptomatic presentation was typical of HA. The frequency of oral contraceptive steroid use was similar regardless of tumor histology. Preoperative diagnosis remains difficult. Scintigraphy proved most specific, and ultrasonography and computed tomography were equally sensitive. Resection was employed in most patients. There was no mortality and minimal morbidity. Selective observation of FNH was uneventful, but resolution of HA after abstinence of oral contraceptive steroids was uncommon. These findings and data from the literature support selective management of benign liver tumors.
Results of hepatic resection for hepatocellular carcinoma
Authors: Kawasaki Seiji , Makuuchi Masatoshi , Miyagawa Shinichi , Kakazu Tohru , Hayashi Ken , Kasai Hide , Miwa Shiro , Hui Al‐Min , Nishimaki Keiji
Published: December 2004

The results of 122 hepatic resections in 112 patients with hepatocellular carcinoma are described. The type of liver resection performed was selected according to the patient's liver function. Forty‐nine patients underwent anatomic resections, including 1 trisegmentectomy, 5 lobectomies, 11 segmentectomies, and 32 subsegmentectomies; the remaining 63 patients had nonanatomic resections. The 1‐, 2‐, and 3‐year survivals after liver resection for all patients, taking into account one operative and one hospital death (0.9% each), were 92.4%, 85.0%, and 78.9%, and disease‐free survivals at 1, 2, and 3 years were 68.6%, 46.2%, and 32.6%, respectively. Twenty‐one repeat hepatic resections (17.2% of the total of 122 resections) were performed with no hospital mortality. Cumulative survival from the time of repeat hepatectomy in these 21 patients was 84.2% and 56.3% at 1 and 2 years, respectively. Among the factors that may affect survival or disease‐free survival, the absence of vascular invasion (p<0.05) and intrahepatic metastases (p<0.01) were significantly related to the disease‐free survival time. A good outcome was obtained after liver resection in 112 patients with hepatocellular carcinoma through appropriate choice of the type of resection, careful follow‐up, and a vigorous surgical approach for recurrence.
Hepatic resection for noncolorectal nonneuroendocrine metastases
Authors: Schwartz Seymour I.
Published: December 2004

The experience with hepatic resection for metastatic lesions, exclusive of colorectal and neuroendocrine tumors, is anecdotal. The reduction in operative mortality leads to a reconsideration of the subject. A review of the literature suggests a selective approach. These is little improvement to be anticipated for resection of metastases from tumors of the esophagus, stomach, small intestine, or pancreas. Resection of metastases from primary renal cell carcinoma, Wilms' tumor, and adrenocortical carcinoma is indicated. There is little to recommend resection of metastases from gynecologic or breast primary carcinomas. Resection as palliation is to be considered for all lesions, particularly bulky metastases from ocular melanomas.
Impact of therapeutic endoscopy on the treatment of bleeding duodenal ulcers: 1980–1990
Authors: Miller Alexander R. , Farnell Michael B. , Kelly Keith A. , Gostout Christopher J. , Benson Joanne T.
Published: December 2004

Therapeutic endoscopy (TE) has provided a new means for treating peptic ulcer disease, prompting a reevaluation of surgery's role. The aim of this study was to determine if surgical therapy of bleeding duodenal ulcers has changed since the advent of TE. This retrospective review involved consecutive time periods during which TE was (1985–1990) and was not (1980–1984) widely available. Exclusion criteria were prior gastric surgery, nonpeptic conditions, and untreated ulcers. Inclusion standards were met by 252 patients (180 men, 72 women) whose mean age was 67 years. Patients were grouped by the initial therapeutic intervention. Groups were similar in age, medical condition (mean APACHE II score 16), and morbidity. Seventy‐five patients had surgery alone during 1980–1984 and 38 during 1985–1990. TE was initially performed on 134 patients during 1985–1990. Bleeding (n=30) and perforation (n=1) prompted emergent operation in 23% of cases following TE. Thus 69 (38+31) patients underwent surgery between 1985 and 1990. Preprocedure transfusions averaged 4.1 units in the endoscopic group and 8.2 units in the operative groups (p<0.0001). Disagreement existed between the endoscopic and surgical descriptions of ulcer location in 53% of cases. Emergent surgery was required in 45% of hemodynamically unstable patients versus 14% of stable patients who initially underwent TE (p<0.0001). Sixty‐one percent of incompletely visualized TE‐treated lesions required operation, and 18% of well visualized ulcers underwent operation (p<0.0001). Hospital mortality was similar (8% versus 16%) in the endoscopic and operated groups (p=0.7). Mean follow‐up was 540 days. The number of operations performed for bleeding duodenal ulcer did not change significantly during the TE era, and a significant subset (23%) of endoscopically treated patients required surgical therapy. TE failure was portended by hemodynamic instability or incomplete endoscopic visualization.
Carcinoma of the ampulla of vater: Histopathologic analysis of tumor spread in Whipple pancreatoduodenectomy specimens
Authors: Shirai Yoshio , Tsukada Kazuhiro , Ohtani Tetsuya , Koyama Syuntaro , Muto Terukazu , Watanabe Hidenobu , Hatakeyama Katsuyoshi
Published: December 2004

Controversies exist regarding the application of the pylorus‐preserving pancreatoduodenectomy (PPPD) to malignancies. This study was intended to disclose the pattern of spread of ampullary cancer and to substantiate that tumor spread at resectable stages does not involve the tissues preserved by PPPD. We examined 40 consecutive Whipple pancreatoduodenectomy specimens: mucosal cancer, 4 cases; cancer invading (but not penetrating) the sphincter of Oddi, 1; cancer invading the submucosa of the duodenum, 12; cancer invading the proper muscle of the duodenum, 5; cancer invading the subserosal layer of the duodenum, 7; and cancer invading pancreatic parenchyma, 11. Five cases of mucosal cancer or cancer invading (but not penetrating) the sphincter spread locally without nodal involvement and showed a 5‐year survival of 80% without recurrence, being better (p<0.05) than the 40% survival for patients with more advanced cancers. Sixty‐three percent of the remaining 35 cases had metastasis to regional lymph nodes. The 5‐year survival of 28% among those with cancer penetrating the proper muscle was worse (p<0.05) than the 59% survival for those with less advanced cancers. No cases had involved the anatomic structures that would have been preserved by a PPPD. In three cases (7.5%), gastric cancer coexisted. In conclusion, ampullary cancer not penetrating the sphincter spreads locally. Once penetrating the sphincter, it often spreads regionally and causes recurrence. Cancer penetrating the proper muscle of the duodenum bears a worse prognosis. PPPD is an attractive alternative to the Whipple operation for ampullary cancer because no involvement was found in the tissue preserved by the PPPD. However, surgeons should be aware of a concomitant gastric cancer when doing a PPPD.
Traumatic rupture of the aortic isthmus: An emergency?
Authors: Pate James W. , Fabian Timothy C. , Walker William
Published: December 2004

The objectives of this study were to explore the hypotheses that: (1) patients with traumatic rupture of the aortic isthmus (TRA) who have not exsanguinated into the pleural cavity upon hospital presentation are unilikely to develop rupture of the hematoma during the time necessary to investigate all injuries and attend to those of more immediate danger; and (2) appropriate medical therapy can prevent free rupture of the hematoma. The medical records of 112 patients who were proved to have TRA at the isthmus resulting from injury within the preceding 7 days were reviewed. Fifty of these patients received medical treatment aimed at decreasing aortic wall stress; 46 were managed under a formal protocol. The available English language and European literature for the past 15 years was surveyed for evidence of the effects of delay between injury and aortic repair. Eight patients died before aortic repair, six of aortic exsanguination (all within 4 hours of injury). Of 77 patients for whom the time of injury was recorded and the aorta was repaired, 36 were repaired within 12 hours of injury and 41 between 12 hours and 24 weeks; none developed aortic hemorrhage. No patient receiving adequate medical therapy died of rupture of the hematoma. Other major surgery preceded aortic repair in 33 patients. We conclude that the concept that traumatic rupture of the aorta should always take priority over other injuries is incorrect. Pharmacologic reduction of wall stress appears to decrease the probability of rupture of the periaortic hematoma.
Carcinoembryonic antigen levels in the peritoneal cavity: Useful guide to peritoneal recurrence and prognosis for gastric cancer
Authors: Nishiyama Masahiko , Takashima Ikuhiro , Tanaka Takashi , Yoshida Kazuhiro , Toge Tetsuya , Nagata Nobuo , Iwamori Shigeru , Tamura Yoichi
Published: December 2004

At the time of laparotomy, peritoneal washings were collected from 155 gastric cancer patients and the levels in carcinoembryonic antigen (CEA) determined. The CEA levels in peritoneal washings were statistically independent of those in sera and could more reliably predict the presence of peritoneal metastasis than a cytologic study. Peritoneal recurrence was seen in 14 of 118 patients after curative operation. Of the 14 patients, 10 (71%) had elevated levels of CEA (100 ng/g protein) at surgery. Of these 10 cases, 2 of the tumors were classified as stage IB and 4 had no serosal invasion. Only one patient with peritoneal metastasis and a low CEA level was free from relapse more than 1 year after operation. Kaplan‐Meier's analysis showed that a high CEA level in peritoneal washings was a predictor of poor prognosis in patients who underwent either curative or noncurative resection. A proportional hazards regression analysis showed that a high CEA level in peritoneal washings was statistically significant in terms of predicting a shorter interval until peritoneal recurrence (p=0.0002) and for survival (p=0.0001). The CEA level in peritoneal washings is therefore of value as an indicator of peritoneal recurrence and prognosis.
Fiber: Effect on bacterial translocation and intestinal mucin content
Authors: Frankel Wendy , Zhang Wei , Singh Anu , Bain Allison , Satchithanandam Subramaniam , Klurfeld Dave , Rombeau John
Published: December 2004

Total parenteral nutrition (TPN) and elemental diet (ED) produce intestinal atrophy and increase bacterial translocation (BT) to mesenteric lymph nodes. The increased rate of BT may be due to alterations in mucosal structure, enzyme activity, or mucin content. Fiber improves intestinal structure and function in rats and may reduce the rate of BT. This study determined whether the addition of fiber to TPN or ED would maintain intestinal integrity and decrease BT to the mesenteric lymph nodes. Fifty‐six adult male Sprague‐Dawley rats underwent placement of jugular catheters and were assigned to one of five dietary groups: TPN, TPN+oral oat fiber (TPNF) 2 g/day, ED, ED+oral oat fiber (EDF) 2 g/day, or AIN‐76 (control); they were pair‐fed for 7 days. On day 8 the mesenteric lymph nodes were removed for bacterial cultures; and jejunal mucosal weight, DNA, protein, alkaline phosphatase, maltase, and jejunal mucin content were measured. Enteral nutrition significantly decreased BT when compared to parenteral feeding, and fiber significantly decreased BT when administered to rats receiving TPN or ED. Improvements in intestinal mucosal structure were not consistently associated with decreased rates of BT. Additionally, BT occurred independently of jejunal mucin concentration. Mechanisms other than maintenance of mucosal structure or mucin content are important in the mediation of fiber‐induced decreased BT in rats receiving TPN or ED.
Hereditary breast cancer and family cancer syndromes
Authors: Lynch Henry T. , Lynch Jane , Conway Theresa , Watson Patrice , Feunteum Jean , Lenoir Gilbert , Narod Steven , Fitzgibbons Robert
Published: December 2004

Hereditary breast cancer (HBC) shows extant clinical and genetic heterogeneity. Clinically one finds the onset of breast cancer at an early age, an excess of bilaterality, and patterns of multiple primary cancer such as combinations of breast and ovarian carcinoma in the hereditary breast‐ovarian cancer (HBOC) syndrome. In addition to HBOC, one sees a variety of putative breast cancer‐prone genotypes inclusive of hereditary site‐specific breast cancer, and the Li‐Frameni (SBLA) syndrome that is characterized by cancers involving all three germinal layers including sarcomas, brain tumors, leukemia, lymphoma, and adrenal cortical carcinoma in addition to often markedly early‐onset breast cancer. Breast cancer is also associated with autosomal dominantly inherited Cowden's disease and autosomal recessively inherited ataxia‐telangiectasia. Examples of pedigrees depicting clincal examples of these several HBC syndromes are presented in order to describe HBC's heterogeneity. The recent identification of the BRCA1 gene in early‐onset hereditary sitespecific breast cancer and the HBOC syndrome has led to new challenges for the genetic counselor. We review genetic counseling, which embraces surveillance and management recommendations that are responsive to the natural history of HBC and address the concept for future development of centers of expertise for HBC in the interest of improving cancer control.
Management of metastatic breast cancer
Authors: Wong Karmen , Henderson I. Craig
Published: December 2004

Systemic treatment almost certainly prolongs the median survival of women with metastatic breast cancer, and it may prolong the survival of a small number of patients substantially. Even with conventional therapy, 10% or more patients may live into the second decade after recurrence. However, the disease cannot be eradicated, and the primary goal of treatment remains palliation and improvement of the quality of life. Because of the great variability in the pattern and course of the disease from one patient to another, therapy should be selected judiciously to maximize response and minimize toxicity. In some clinical situations, such as pathologic fractures and brain metastases, local therapies alone, such as surgery or irradiation, are the treatments of choice. Patients who will respond to endocrine therapy are well defined, and all patients with the characteristics of an endocrine responder deserve a chance at palliation with this modality alone because of its limited toxicity. A number of new forms of endocrine therapy with more specific targets at estrogen and progesterone receptor sites are now in clinical trials. When used appropriately, chemotherapy significantly improves patient quality of life despite its toxicity. No drug combinations, schedules, or doses have been shown to prolong survival or provide better net palliation than classic CMF (oral cyclophosphamide with intravenous methotrexate and 5‐fluorouracil) or CAF (intravenous cyclophosphamide, doxorubicin, and 5‐fluorouracil). Treatment with these combinations in excess of 6 to 9 months provides only marginal additional benefits and no survival advantage. The role of high dose chemotherapy with autologous bone marrow transplantation remains a promising area of investigation, but the available survival data are entirely compatible with the possibility that this modality will eventually prove inferior to conventional therapy. Many new cytotoxic agents with unique mechanisms of action are currently under investigation, including taxol, taxotere, Topotecan, and amonafide. Taxol may be the most promising therapy now available for patients whose disease has become refractory to doxorubicin. Biologic therapies using monoclonal antibodies against a specific oncogene or its product have entered clinical trials, and novel drug delivery systems using liposomes are under evaluation.
Adjuvant therapy of breast cancer
Authors: Davidson Nancy E. , Abeloff Martin D.
Published: December 2004

About 180,000 American women will be diagnosed with early stage breast cancer during 1993. In many of these patients breast cancer is a systemic disease at diagnosis and thus not curable by local treatment alone. The development of optimal forms of systemic adjuvant therapy has been a major area of research for more than 30 years. The two most widely employed types of adjuvant therapy, cytotoxic chemotherapy and tamoxifen, have been shown to improve relapse‐free and overall survival in certain patient subsets. This review highlights recent advances in adjuvant therapy of early stage breast cancer and discusses current treatment guidelines.