bluuebunny/crossref_metadata_2025 huggingface dataset:
[18F]FluorThanatrace ([18F]FTT) PET Imaging of PARP-Inhibitor Drug-Target Engagement as a Biomarker of Response in Ovarian Cancer, a Pilot Study
Authors: Pantel Austin R. , Gitto Sarah B. , Makvandi Mehran , Kim Hyoung , Medvedv Sergey , Weeks Joanna K. , Torigian Drew A. , Hsieh Chia-Ju , Ferman Benjamin , Latif Nawar A. , Tanyi Janos L. , Martin Lainie P. , Lanzo Shannon M. , Liu Fang , Cao Quy , Mills Gordon B. , Doot Robert K. , Mankoff David A. , Mach Robert H. , Lin Lilie L. , Simpkins Fiona
Published: November 2022

Purpose:

PARP inhibitors have become the standard-of-care treatment for homologous recombination deficient (HRD) high-grade serous ovarian cancer (HGSOC). However, not all HRD tumors respond to PARPi. Biomarkers to predict response are needed. [18F]FluorThanatrace ([18F]FTT) is a PARPi-analog PET radiotracer that noninvasively measures PARP-1 expression. Herein, we evaluate [18F]FTT as a biomarker to predict response to PARPi in patient-derived xenograft (PDX) models and subjects with HRD HGSOC.

Experimental Design:

In PDX models, [18F]FTT-PET was performed before and after PARPi (olaparib), ataxia-telangiectasia inhibitor (ATRi), or both (PARPi-ATRi). Changes in [18F]FTT were correlated with tumor volume changes. Subjects were imaged with [18F]FTT-PET at baseline and after ∼1 week of PARPi. Changes in [18F]FTT-PET uptake were compared with changes in tumor size (RECISTv1.1), CA-125, and progression-free survival (PFS).

Results:

A decrease in [18F]FTT tumor uptake after PARPi correlated with response to PARPi, or PARPi-ATRi treatment in PARPi-resistant PDX models (r = 0.77–0.81). In subjects (n = 11), percent difference in [18F]FTT-PET after ∼7 days of PARPi compared with baseline correlated with best RECIST response (P = 0.01), best CA-125 response (P = 0.033), and PFS (P = 0.027). All subjects with >50% reduction in [18F]FTT uptake had >6-month PFS and >50% reduction in CA-125. Utilizing only baseline [18F]FTT uptake did not predict such responses.

Conclusions:

The decline in [18F]FTT uptake shortly after PARPi initiation provides a measure of drug-target engagement and shows promise as a biomarker to guide PARPi therapies in this pilot study. These results support additional preclinical mechanistic and clinical studies in subjects receiving PARPi ± combination therapy.

See related commentary by Liu and Zamarin, p. 1384
Host-parasite relationship between Aphelenchoides besseyi and soybean
Authors: Calandrelli Angélica , Silva Monique T.R. , Miamoto Angélica , Rinaldi Luanna K. , Favoreto Luciany , Meyer Maurício C. , Machado Andressa C.Z. , Silva Santino A. , Dias-Arieira Cláudia R.
Published: November 2022

Aphelenchoides besseyi is a concern to Brazilian agriculture, since the losses caused by the green stem and foliar retention syndrome in soybean, especially in hot and humid climates, could reach high levels. However, limited information is available regarding the host-parasite relationship. The objective of this study was to evaluate the capacity of A. besseyi to penetrate soybean roots and its movement in soybean tissues until reaching the top parts. Plants inoculated with 1000 A. besseyi were evaluated for root penetration from 1-28 days after inoculation (DAI), and post-penetration and movement inside tissues by staining them with acid fuchsin. Plant development, chronology of the symptoms and the number of pods were also evaluated at 60 DAI. Aphelenchoides besseyi was found in the cortex and xylem vessels of roots from 1 DAI. During the experimental period, the number of nematodes from roots to shoots increased more than 123, 330 and 430%, respectively, for roots, stems + petioles + inflorescences, and leaves, demonstrating the ascendent movement of A. besseyi. Necrotic lesions in young leaves and apical tissues were observed from 8 DAI; the typical symptom of ‘amachamiento’ was observed from 10 DAI, with enlargement of nodes and lesions in inflorescences and, at 30 DAI, stunted plants were detected. At 60 DAI, inoculated plants had lower numbers of pods and exhibited severe symptoms including abortion of flowers and tissue splitting and cortical lesions in a few pods and roots. These observations emphasise the importance of A. besseyi for Brazilian soybean production.
Host plant status and damage threshold of spinach (Spinacia oleracea) for the temperate root-knot nematode Meloidogyne chitwoodi
Authors: Taning Lirette M. , Chann Leakena , Fleerakkers Sander , Cap Nathalie , Formesyn Ellen , Tirry Luc , Wesemael Wim M.L.
Published: November 2022

Problems with plant-parasitic nematodes remain a major challenge in most field vegetable crops worldwide. In agricultural fields in Belgium, these problems have increased in recent years. A major problem is the quarantine root-knot nematode Meloidogyne chitwoodi. The host plant status of the most commonly grown cultivars of spinach (Spinacia oleracea) and the damage threshold for M. chitwoodi were determined in a climate-controlled glasshouse and in a naturally infested field. The yield data with the final population densities were fitted to Seinhorst’s yield and population dynamic models, respectively. The damage threshold values (T) for the relative fresh weight yield were 0.14, 1.08, 11.53 J2 (100 cm3 soil)−1, minimum yield (m) of 0.84, 0.64, 0.52 and maximum yield () of 12.51, 12.44 and 9.60 for ‘Gnu’, ‘Meerkat’ and ‘Whale’ spinach cultivars, respectively. The maximum multiplication rates (a) were 3.81, 2.38 and 2.72, whilst the maximum population densities (M) were 563, 916, and 922 J2 (100 cm3 soil)−1 for ‘Gnu’, ‘Meerkat’ and ‘Whale’, respectively. Meloidogyne chitwoodi had an impact on the spinach yield. The higher the nematode density the lower the yield and vice versa. The tested cultivars were all hosts for M. chitwoodi but differences between cultivars occurred. ‘Kolibri’ and ‘Rhino’ were tested as the least sensitive cultivars for M. chitwoodi during the host screening test and bring opportunities for resistance breeding. This is the first report of spinach as a host for M. chitwoodi.
Unduly Indicated? Provisional Measures and Subsequent Adverse Findings at the International Court of Justice
Authors: Merlin Jean-Baptiste
Published: November 2022

The method currently applied by the International Court of Justice for the purpose of indicating provisional measures does not fully preclude the risk that provisional measures might prove in retrospect to have been unjustified in specific circumstances. The question arises whether a litigating State might be entitled to reparation for the prejudice incurred from complying with onerous provisional measures in such cases. While the Court has only exceptionally come close to such a situation, it has not been faced with reparation claims yet. However, developments since LaGrand should prompt an examination of how the Court’s judicial practice may address the risk of problematic discrepancy between provisional measures and the Court’s final decision.
Will the ICJ Objectively Assess the Statehood of Palestine? A Brief Reflection
Authors: Ahmed Kawser
Published: November 2022

Is Palestine a state? The International Court of Justice (ICJ) is expected to address this question in the Case concerning Relocation of the United States Embassy to Jerusalem (Palestine v. United States of America) during the preliminary objections stage. In the meanwhile, scholars have discussed possible options that international law can offer to deal with the question of Palestine’s statehood. The suggestions include, for example, state recognition, the Vienna formula, etc. This article, however, envisages that in determining Palestine’s statehood the ICJ is likely to adopt an objective assessment test on the basis of international legal criteria of statehood.
Proliferation of Standards of Proof in International Administrative Tribunals
Authors: Tavadian Alexandre , Ducamin Clément
Published: November 2022

All international organizations have or ought to have a code of conduct. When international civil servants breach their basic obligations and engage in misconduct, they may face disciplinary proceedings and be subject to a wide range of sanctions, including dismissal and other forms of separation from service. However, different international organizations apply dissimilar standards of proof for establishing the alleged facts that constitute misconduct. For instance, in some institutions, the applicable standard of proof is “beyond a reasonable doubt”, while in others, it is a balance of probabilities. The lack of consistency is attributable to the jurisprudence of various international administrative tribunals. This article compares how six international administrative tribunals interpret and apply the evidential threshold to disciplinary cases. It identifies practical difficulties caused by a lack of a uniform approach and recommends remedial measures for international organizations and international administrative tribunals.
Chinese international lawyer and British doctoral supervisor
Authors: Chen Li
Published: November 2022

This article draws upon multi-archival research to rediscover Hwang King Hung, a forgotten Chinese international lawyer who was the first ethnic Chinese person to receive a PhD in Law from Cambridge University. Specifically, it aims to shed light on how Hwang was trained by Hersch Lauterpacht, Hwang’s doctoral supervisor, and how Lauterpacht played a crucial role in training eminent Chinese international lawyers in the first part of the 20th century. It further aims to challenge the traditional Eurocentrism of international legal history and inspire further research into the lived experiences of the pioneer generation of international lawyers from China.
Mobilising, Politicising and Serving: The Ambivalence of the ‘Revitalisation’ of Argentine Trade Unionism
Authors: Rouxel Pierre
Published: November 2022

Since the beginning of the 2000s, a significant literature has developed around the study of the “revitalisation” of trade unionism. These contributions often take up typologies that oppose the ‘old’ and the ‘new’ and thus tend to harden the contours of what would constitute a ‘trade union renewal’. From this perspective, this article re-examines the nature and limits of this process, in the light of the Argentine case. It is based on a field survey of two comisiones internas that are emblematic of the ‘bottom-up revitalisation’ of Argentinean trade unionism since the 2000s. The localized and in-depth study of these two collectives makes it possible to document the concrete conditions of trade union work, by relating them to the socialization trajectories of the delegates and the social contexts in which they evolve. In this way, the article shows the constraints that lead delegates to internalise a ‘sense of limits’ in their work of politicising trade union action, thus highlighting the articulations between militant practices and service practices that characterise their modes of action.
Ophiogomphus tibeticus sp. nov. from Sichuan, China (Anisoptera: Gomphidae)
Authors: YU XIN , LI LINYAN , GU HAIJUN
Published: November 2022

A new gomphid species, Ophiogomphus tibeticus sp. nov., from Zoige alpine Wetland, Sichuan is described and illustrated. Assignment to the genus Ophiogomphus Selys, 1854 is based on both morphological and molecular analyses. This new species differs from other known Ophiogomphus mainly in the shape of the caudal appendages.
A new species of Thalleulia Razowski, 2004 from Costa Rica with the first reported female of the genus (Lepidoptera: Tortricidae: Euliina)
Authors: BROWN JOHN W.
Published: November 2022

The genus Thalleulia Razowski, 2004 was previously represented by three species known only from Ecuador, each described from a single male. A new species, Thalleulia bisexta, n. sp., is described and illustrated from Costa Rica, based on both sexes. Female genitalia indicate a close relationship between Thalleulia and Inape Razowski, 1988.
Dual Induction of the Epo-Egr-TNF-α Plasmid in Hypoxic Human Colon Adenocarcinoma Produces Tumor Growth Delay
Authors: Salloum Rabih M. , Mauceri Helena J. , Hanna Nader N. , Gorski David H. , Posner Mitchell C. , Weichselbaum Ralph R.
Published: November 2022

Gene therapy is a modality for the treatment of solid tumors that involves the introduction of a suicide gene into the tumor cells. Genetic radiotherapy involves the placement of a radiation-sensitive promoter upstream from a suicide gene. Because of their irregular vasculature some solid tumors are chronically hypoxic and hence are resistant to conventional treatment with chemotherapy and ionizing radiation (IR). The purpose of this study was to demonstrate that regional tumor hypoxia could be exploited to improve local tumor control. The cDNA coding the erythropoietin hypoxia-responsive element (EPO) was placed upstream from the Egr-TNF-α construct. WIDR human colon adenocarcinoma cells were injected into the right hind limb of nude mice and treated with Epo-Egr-TNF-α plasmid with or without IR. Tumor volumes were measured by calipers and tumor necrosis factor (TNF)-α content of the tumor was determined by enzyme-linked immunosorbent assay. Treatment with the combined regimen of Epo-Egr-TNF-α plasmid + IR resulted in significant tumor growth delay. Tumor TNF-α content was increased by 30 per cent in the combined treatment group compared with each treatment alone. Regional tumor hypoxia can be exploited successfully to induce tumor growth delay, enhance local control, and enhance the therapeutic ratio.
Why Do Breast Cancer Mortality Rates Vary across States?
Authors: Maggard Melinda A. , Thompson Jesse E. , Ko Clifford Y.
Published: November 2022

In 2001 approximately 40,000 deaths from breast cancer will occur in the United States. Although some estimates suggest possible state-to-state variations in breast cancer mortality rates the reasons for such differences remain unknown. Our objective was to confirm whether breast cancer mortality rates are significantly different by state and to identify predictors for such variation. Administrative data from the National Center for Health Statistics (NCHS) report were used to determine statewide death rates. Analyses were similarly performed with the Surveillance, Epidemiology, and End Results (SEER) cancer database to determine predictors of high versus low mortality rates. State-level variation in breast cancer mortality rates was demonstrated in the NCHS database. A subsequent analysis of high versus low mortality states in the SEER cancer registry demonstrates that stage at presentation was a significant predictor of mortality, as “high” mortality states had more patients presenting with later-stage disease. We conclude that variations in the breast cancer mortality rates exist between states. A nearly 50 per cent increase is observed between the states with the highest and lowest mortality rates. Adjusted analyses demonstrate that stage at presentation is a more important predictor of mortality variation than treatment differences. As such breast cancer mortality rates may be best improved by targeting screening and access-to-care issues rather than treatment.
The Use of Intraperitoneal Bupivacaine to Decrease the Length of Stay in Elective Laparoscopic Cholecystectomy Patients
Authors: Paulson Jayne , Mellinger John , Baguley William
Published: November 2022

This prospective, double-blind, randomized, and placebo-controlled study evaluates the effectiveness of intraperitoneal bupivacaine in decreasing the length of stay for elective laparoscopic cholecystectomy patients. Seventy-seven patients undergoing elective laparoscopic cholecystectomy before noon at a single institution and by a single group of surgeons were entered into the study. The pharmacy randomly assigned each patient to one of four study groups (control, pre-dissection, postdissection, and both). Two syringes (A and B) containing 15 cm3 of either normal saline or 0.5 per cent bupivacaine were sent with the patient to surgery. Syringe A was sprayed over the perihepatic area before any dissection, and B was sprayed over the perihepatic area just before port removal. Preoperative, intraoperative, and postoperative data were collected. Sixty-six patients completed the study: control, 14; predissection, 18; postdissection, 15; and both, 19. There was no statistical difference between the predissection, postdissection, and both groups regarding same-day discharge. Therefore, these groups were combined for comparison against the control group. The study found that patients receiving bupivacaine at any time during the surgery were more likely to go home the same day as their procedure (79% vs 43%, respectively: P < 0.02).
Breast Sentinel Lymph Node Biopsy Using Radioisotope Injection: Is One-Day Better than Two-Day Protocol?
Authors: Chok Siu-Ho , Chow Louis W.C. , Wong Kam-Ho , Cheng Kam-Chau , Ho Wai-Yin
Published: November 2022

Sentinel lymph node (SLN) biopsy is an evolving treatment approach for patients with operable breast cancer. There have been a number of variations in the biopsy technique. One is the timing of radioisotope injection, which might have a significant influence on the radiation exposure of the personnel in the operating room. The present study aims to compare the one-day with the two-day protocol to see which one is associated with a lower radiation hazard while giving similar results. There were 60 patients recruited; half of them had the SLN biopsy 4 hours after the injection and the other half 24 hours later. Patient characteristics were comparable in both groups. The mean numbers of SLNs found per patient were 1.46 and 1.96 respectively. There was a statistically significant difference in the dosage of radioactivity present in the resected specimen between both groups of patients. However, there were still a number of confounding factors, so the proposed hypothesis of getting less radiation exposure to the medical personnel by using a two-day approach should be further investigated.
Workforce Patterns of Rural Surgeons in West Virginia
Authors: Gates Robert L. , Walker John T. , Denning David A.
Published: November 2022

Rural general surgeons perform a wide variety of procedures and have practices different from those of surgeons in larger communities. Because of this residents completing a classical general surgery training program may not be prepared for the rural setting. The 219 licensed physicians in West Virginia who list general surgery as their practice specialty with the State Board were surveyed to determine the nature of the rural surgery workforce and to examine the caseload of these surgeons. The majority of rural surgeons were satisfied with their current situation; however, 22 per cent stated that they would leave the practice of medicine if financially able. One-third of these surgeons regarded the rural setting as having an adverse impact on their practice. More than half of those surveyed stated that they would not encourage a young person to pursue a career in medicine. For one-third of rural surgeons general medicine was part of daily practice. The caseload varied by community size. Surgeons in communities of fewer than 10,000 people performed a lower percentage of general surgical procedures than surgeons in urban areas. They listed obstetric and gynecologic (9%), urologic (5%), otolaryngologic (9%), and orthopedic (4%) procedures as part of their regular cases. Endoscopic procedures comprise 17 to 24 per cent of total procedures regardless of community size. We conclude that resident surgeons planning to pursue a career in rural general surgery should broaden their operative and general medicine experiences to meet the needs of the communities in which they will serve.
Papillary Carcinoma of the Breast: Characteristics and Classification
Authors: Bansidhar Brian J. , Garguilo Gerard A.
Published: November 2022

Papillary carcinoma is a rare but perplexing entity. The varied histopathological appearances make accurately diagnosing this tumor a difficult task. This review is a brief overview of the basic findings and a general classification of papillary carcinoma of the breast. Through an extensive literature review we have attempted to put forth a basic scheme of how papillary carcinoma is categorized with accepted treatment guidelines and protocol. A working knowledge of this tumor will facilitate a better understanding of its diagnosis and treatment with a reduction in overall morbidity.
Annular Pancreas in the Adult: Two Case Reports and Review of More than a Century of Literature
Authors: Maker Vijay , Gerzenshtein Jacob , Lerner Terrence
Published: November 2022

This paper brings the diagnosis and treatment of this interesting yet infrequent condition to contemporary standards through an assessment of past literature and a re-evaluation of the problem in view of technological advances. Two cases of annular pancreas are cited with a review of the last 183 years of literature. Only 100 cases, however, were reported in enough detail to examine outcomes in general and to arrive at a reasonable conclusion in terms of recommendations for diagnosis and operative intervention in adult annular pancreas. Two observations are brought to light. Despite all present diagnostic tools including endoscopic retrograde cholangiopancreatography diagnosis at best is made in only 60 per cent of patients preoperatively. Intraoperative expertise remains the best diagnostic modality available to date. Enteroenterostomy seems to be the intervention of choice for a multitude of anatomic and physiologic reasons and with a wide array of surgical options available when additional factors need to be addressed.
Hemodynamic Monitoring in the Elderly Undergoing Elective Colon Resection for Cancer
Authors: Kavarana Minoo N. , Azimuddin Khawaja , Agarwal Avinash , Balsano Nicholas , Cayten C. Gene , Agarwal Nanakram
Published: November 2022

Controversy surrounds the use of pulmonary artery catheters (PACs). We evaluated the influence of preoperative hemodynamic monitoring and optimization on the outcome in elderly patients undergoing elective resection for colon cancer. We performed a retrospective analysis of all elderly patients (age >65 years) who had undergone elective colon resection during 1985 to 1995. Sixty patients had preoperative insertion of PAC; 217 patients were managed without PAC. Charts were reviewed for Goldman's cardiac risk index (CRI), preoperative risk factors, and hospital mortality. On the basis of CRI the patients were divided into two groups (<10 and >10). There was no significant difference between PAC or no-PAC patients for age, previous myocardial infarction, congestive heart failure, hypertension, chronic obstructive pulmonary disease, renal insufficiency, hemoglobin, and albumin. There were 12 deaths (4.3%). CRI, which was a significant predictor of mortality in the no-PAC group (2.2% mortality for CRI <10 vs 15.8% for CRI ≥10; P < 0.001), was insignificant in the PAC group (2.5% mortality for CRI <10 vs 5% for CRI ≥10, P = not significant). Although preoperative optimization using PAC was not beneficial in the low-CRI group it resulted in a threefold reduction in mortality (5% vs 15.8%) in the high-CRI group. We conclude that preoperative optimization of cardiovascular function using a PAC is only beneficial in reducing mortality in high-risk (CRI ≥10) elderly patients undergoing elective colon resection.
Use of Porcine Small Intestinal Submucosa in Ehlers-Danlos Syndrome Type IV
Authors: Wiedeman James E. , Ritter Eric M.
Published: November 2022

Ehlers-Danlos syndrome (EDS) Type IV results in inadequate production of type III collagen and can lead to devastating vascular, gastrointestinal, and uterine complications. A case is presented of spontaneous colonic perforation in a patient with EDS Type IV complicated by multiple intestinal fistulas managed with porcine small intestinal submucosa. Early success with this technique would suggest additional applications in a variety of complicated gastrointestinal problems.
Training Fourth-Year Medical Students in Critical Invasive Skills Improves Subsequent Patient Safety
Authors: Martin Marcel , Scalabrini Bertrand , Rioux Andre , Xhignesse Marie-Anne
Published: November 2022

Complications after procedures performed by residents are thought to occur most often early in the first postgraduate year (PGY-1). We evaluated the number of pneumothoraces (PTXs) caused by central venous line insertion (CVLI) by two groups of PGY-1 residents in both the first 3 months of residency and the entire year from 1996 through 2000 to determine the impact of CVLI training on PTX. From 1996 through 1998 fourth-year medical students had no specific training in CVLI and learned on the job as residents. Starting with the Class of 1999 we replaced this approach with a structured program in CVLI. Didactic sessions detailing anatomy and technique were followed by skill performance in a fresh cadaver model. Students performed skills initially under the direct supervision of a faculty member, who provided immediate feedback. Videotapes of this performance were reviewed with the students by both surgeons and kinesiologists to correct deficits before repeat sessions. Skills were repeated until competence was attained. Graduating students have made up greater than 90 per cent of our two hospitals’ PGY-1 residents since 1996. Because these residents are responsible for CVLI we are able to obtain performance follow-up in actual clinical settings. We obtained the number of PTXs caused by CVLI for the years 1996 through 2000 as well as for the first 3 months of each academic year (July through September) to determine the impact of our program on this serious complication. The number of PTXs during the first 3 months of 1996–1998 remained stable. After the introduction of our teaching program the number decreased significantly in the years 1999–2000 when compared with 1996–1998 ( P = 0.004, t test). The overall yearly decrease for 1999 versus 1996–1998 approached significance ( P = 0.06). The introduction of a structured teaching program of CVLI skills appears to have a positive impact in reducing morbidity of PTX. The greatest impact occurs within the first 3 months of the new PGY-1 academic year.
Popliteal Artery Trauma in a Rural Level I Trauma Center
Authors: Sagraves Scott G. , Conquest Anne M. , Albrecht Robert J. , Toschlog Eric A. , Schenarts Paul J. , Bard Michael R. , Powell C. Steve , Rotondo Michael F.
Published: November 2022

Popliteal vascular trauma has historically been an urban phenomenon. We hypothesized that rural popliteal artery injury would result more often from blunt mechanisms of injury (MOD, have a longer time to operation, and result in a higher amputation rate. We retrospectively reviewed all cases of popliteal artery injury from December 1994 to May 2001 at our rural trauma center. Age, gender, Injury Severity Score (ISS), MOI, scene transport versus transfer from a referring hospital, time to operation, and operative times were studied. Significance was determined by Student's t test with a P value ≤0.05. Thirty-two popliteal artery injuries were found. Blunt trauma accounted for 50 per cent of the injuries. Eighty-eight per cent of the patients were transferred from a referring hospital. Patients transported directly from the scene had a higher ISS. Longer operative times translated into an increased need for fasciotomy. The amputation rate was 19 per cent. This is the first attempt to delineate the specific nature of rural popliteal artery trauma. The amputation rate was not different between the two different MOI and was independent of the time to operation. Of those patients receiving an amputation 83 per cent were transferred from another hospital and despite a statistically lower ISS still required an amputation.
The Relationship of Injury Severity Score and Glasgow Coma Score to Rehabilitative Potential in Patients Suffering Traumatic Brain Injury
Authors: Toschlog Eric A. , MacElligot Jacinta , Sagraves Scott G. , Schenarts Paul J. , Bard Michael R. , Goettler Claudia E. , Rotondo Michael F. , Swanson Melvin S.
Published: November 2022

The predictive utility of the Injury Severity Score (ISS) and Glasgow Coma Score (GCS) in relation to rehabilitative potential and functional outcome in traumatic brain injury (TBI) is untested. The purpose of this study was to define the relationship of ISS and GCS to rehabilitative potential using the functional independence measure (FIM) score. Trauma and inpatient rehabilitation (IR) registries were queried for demographic, disposition, and injury scoring data. FIM scores at admission (A) and discharge (D) were assessed including IR FIM gain (G). Analysis of variance was used to examine the relationship of ISS and GCS to FIM with predictive utility investigated through bivariate analysis. Of 5488 patients admitted to a Level I trauma center (1999–2000) 1437 suffered TBI with 285 (20%) entering IR. Compared with low-ISS patients the high-ISS patients had significantly lower FIM-A and FIM-D, but FIM-G was static. GCS results were similar, excluding FIM-G which was significantly higher for GCS ≤8 compared with GCS >8. Bivariate analysis revealed no ISS correlation with FIM-G ( r = 0.16) and a weak GCS correlation (FIM-G r = -0.15). As prospective predictive measures ISS and GCS correlate weakly with rehabilitative potential in TBI patients. Severely injured patients including those with severe TBI have a rehabilitative gain toward functional independence that is similar to that of when compared with those less severely injured.
Hepatic Portal Vein Gas: Clinical Features and Outcomes
Authors: Najafian Hadi , Habibi Mehran , Reilly Terrance
Published: November 2022

Hepatic portal vein gas (HPVG) is found as branching gas extending to near the periphery of the liver. Increased utilization of CT may identify HPVG in more patients. In the past HPVG was associated with acute abdomen and high mortality. Our recent experience suggested a less morbid outcome with this entity. We wanted to identify clinical features associated with HPVG that could help us with planning care. We reviewed seven patients with CT-detected HPVG presenting over 4 months. We analyzed their histories, examinations, and laboratory data. Five of seven patients had laparotomies. Of these five one had a therapeutic resection of an ischemic bowel. All other laparotomies were nontherapeutic. Two of seven patients had no surgical intervention. One of the two refused surgery and subsequently died. The other was treated medically and recovered. Physical examination and laboratory findings were not reliable indicators of intra-abdominal catastrophe. Furthermore CT scans are inaccurate for predicting the etiology of HPVG. Close observation may be appropriate in stable patients with HPVG without other specific findings.
A Case of External Carotid Artery Pseudoaneurysm from Hyoid Bone Fracture
Authors: Campbell Amy S. , Butler Allen P. , Grandas Oscar H.
Published: November 2022

Carotid artery pseudoaneurysms are detected most commonly after acute traumatic injuries to the head and neck. Pseudoaneurysms of the carotid artery are rare after blunt trauma. The most common site of injury occurs in the internal carotid artery with greater than 70 per cent of those injuries resulting from motor vehicle collisions. We report a case of external carotid artery pseudoaneurysm secondary to chronic arterial trauma. The patient presented with a one-week history of left ear pain and a pulsatile left neck mass. Radiologic studies revealed a 2.8-cm neck mass compatible with a pseudoaneurysm of the external carotid artery. Primary repair of the aneurysm was performed. Exploration of the pseudoaneurysm cavity at the time of surgery revealed a fracture of the hyoid bone. We believe this to be the contributing factor to the formation of a pseudoaneurysm in this patient. This is the first reported case of external carotid pseudoaneurysm caused by chronic arterial injury secondary to hyoid bone fracture.
Results of Long-Term Follow-Up for Transanal Excision for Rectal Cancer
Authors: Gonzalez Quintin H. , Heslin Martin J. , Shore Gregg , Vickers Selwyn M. , Urist Marshall M. , Bland Kirby I.
Published: November 2022

Low anterior resection and abdominoperineal resection are the surgical techniques used most frequently in the treatment of rectal cancer. It is our hypothesis that selected patients with early T stage, well or moderate grade of differentiation, and small tumor size are good candidates for transanal excision in terms of minimal morbidity, low recurrence rate, and sphincter preservation. From January 1993 until August 2001 30 patients underwent transanal excision; three patients were excluded because they had histology other than adenocarcinoma. Factors analyzed included those related to the patient [age (years), gender, race, body mass index, and anal tone], tumor [size (cm), distance from the anal verge (cm), differentiation, and American Joint Committee on Cancer stage], and additional treatment. Median follow-up of the group was 40.7 months (range 0.6–99) and the primary end points were local and distant recurrence. Data are presented as mean (range). The median age of the group was 58.9 years (range 27–94); 52 per cent were female and 48 per cent were male. The mean body mass index was 25.9 (range 22.7–36.7). Preoperatively 81, 11, and 4 per cent of the patients had stage I, II, and III/IV cancer, respectively. Preoperative size of the tumor was 2.0 cm (1–3 cm), and distance from the anal verge was 5.0 cm (3–15 cm). Blood loss was 50 cm3(5–200 cm3), and there were no operative complications. Tumor differentiation levels were well (37%) and moderate (63%). All patients had negative margins. Additional treatment consisted of radiation therapy in seven patients (six postoperative and one preoperative). Chemotherapy was given to seven patients (six postoperative and one preoperative). The local recurrence rate was 7.4 per cent (two patients), and 3.7 per cent recurred distantly (one patient). Transanal excision of low rectal cancer in selected patients is an acceptable alternative to formal resection. Important selection criteria include early T stage, well or moderate differentiation, relatively small tumor size, and negative microscopic margins. The roles of radiation and chemotherapy remain controversial.
Liberal Use of CT Scanning Helps to Diagnose Appendicitis in Adults
Authors: Brandt Mary-Margaret , Wahl Wendy L.
Published: November 2022

Appendicitis can be difficult to diagnose as patients get older and the incidence of other intraabdominal processes increases. We hypothesize that with the use of helical computed tomography (CT), we will be better at diagnosing appendicitis in adults. We reviewed all the medical records of patients 18 years and older who were admitted to our service with the diagnosis of appendicitis (ICD-9: 540.0, 540.1, 540.9, and 541) from January 1999 through October 2002. In addition to demographics, we collected pathology results, if CTs were done, and CT results. This study was approved by the Institutional Review Board (IRB) of the University of Michigan. Three hundred thirty patients with the diagnosis of appendicitis were admitted to our service. We found the negative appendectomy rate in all patients to be 12.1 per cent. In all patients who had CT scans, the negative appendectomy rate was 7.3 per cent. In patients ≥45 years, patients without CT had 5.6 per cent negative appendectomy rate versus 5 per cent ( P = 0.02) with CT scanning. There were no mortalities. Our negative appendectomy rate in adult patients is lower than previously published reports. We believe our high rate of CT scanning helped in making the correct diagnosis. We recommend liberal use of CT scanning to help diagnose appendicitis in adults.
Stapled Hemorrhoidectomy: A Review of Our Early Experience
Authors: Dixon Matthew R. , Stamos Michael J. , Grant Stuart R. , Kumar Ravin R. , Ko Clifford Y. , Williams Russell A. , Arnell Tracey D.
Published: November 2022

Treatment of hemorrhoids may safely be accomplished by using a circular stapler instead of the conventional open procedure for large symptomatic hemorrhoids. Our purpose was to assess the safety and early post-op results of this new surgical technique as it was introduced into clinical practice. Medical records from 62 patients treated by circumferential mucosectomy/stapled hemorrhoidectomy were obtained from 6 surgeons. Preoperative factors assessed included demographics, comorbidities, prior anorectal surgery, hemorrhoid grade, and the indications for surgery. Operative factors examined included operating time, use of perioperative antibiotics, and oversewing of the suture line. Postoperative factors included complications and date of last follow-up. Sixty-two patients underwent this operation, and complications were reported in six patients (10%). There was one death unrelated to the hemorrhoid surgery. Postoperative pain, defined as requiring pain control with intravenous medication, hospital admission, or an emergency department visit, occurred in two patients. Two patients reported postoperative bleeding. One patient experienced bleeding the first evening, and the second patient had bleeding 1 week postoperatively. The first patient was admitted overnight and required no blood transfusion or further intervention. The second patient was subsequently found to have a bleeding diverticulum. One patient experienced urinary retention that resolved with conservative management. Postoperative follow-up was available for over 90 per cent of the patients at a median of 4 weeks postoperatively. No additional complications were discovered at follow-up. This data suggests that stapled hemorrhoidectomy is a safe and effective approach to hemorrhoidal disease. Our findings indicate an acceptable complication rate among a group of surgeons beginning to integrate this modality into clinical practice.
Intubation after Cervical Spinal Cord Injury: To be done Selectively or Routinely?
Authors: Velmahos George C. , Toutouzas Konstantinos , Chan Linda , Tillou Areti , Rhee Peter , Murray James , Demetriades Demetrios
Published: November 2022

Patients with cervical spinal cord injuries (CSCIs) often develop acute respiratory failure and require intubation. It is unknown if intubation should be offered preemptively in all CSCI patients or selectively based on signs of acute respiratory failure. The purpose of this study was to evaluate the role of routine early intubation in CSCI patients. The medical records of 68 patients with CSCI were reviewed. Univariate and multivariate analyses were used to identify independent risk factors for the need of intubation. Statistical significance was considered at P < 0.05. Fifty patients (74%) required intubation and 27 (40%) developed pneumonia. Of patients with CSCI above C5, 87.5 per cent required intubation compared with 61 per cent of patients with CSCI at C5-C8 ( P = 0.026). Similarly, of patients with complete quadriplegia, 90 per cent required intubation compared to 48.5 per cent of patients with incomplete quadriplegia or paraplegia ( P < 0.001). Of 31 patients not presenting with overt signs of acute respiratory failure on admission, 13 (42%) decompensated later and were eventually intubated up to 53 hours after admission. Six of these 13 patients had emergent intubation due to acute desaturation and developed pulmonary complications associated with emergent intubation. There were 3 independent risk factors for the need of intubation: Injury Severity Score >16, CSCI higher than C5, and complete quadriplegia. The combination of the 2 latter risk factors resulted in intubation in 21 of 22 patients (95%). The majority of patients with CSCI require intubation. In patients with CSCI above C5 and complete quadriplegia, intubation should be offered routinely and early because delays may cause preventable morbidity.
Patterns of Injury and Outcomes Associated with Motocross Accidents
Authors: Gorski Tito F. , Gorski Yara C. , Mcleod Ginger , Suh David , Cordero Raymund , Essien Francis , Berry Dessia , Dada Festus
Published: November 2022

Motocross has become a popular recreation activity in Southern California, particularly in the Inland Empire area. In order to evaluate the patterns of injury and outcomes associated with motocross accidents, the Trauma Registry data and charts of all patients with motocross-related injuries from January 2000 to December 2001 were reviewed. Of the 270 patients studied, 265 were males and 5 were females, with a mean age of 26 years (range, 5–61). The mean Injury Severity Score was 6.8 (range, 1–38). Injuries involved extremity trauma in 52 per cent of patients closed head injuries in 33 per cent, blunt chest trauma in 23 per cent, abdominal trauma in 15 per cent, spinal trauma in 14 per cent, and pelvic trauma in 8 per cent. Surgery was required in 96 patients (36%), most commonly for treatment of orthopedic injuries. After initial evaluation, 179 patients were admitted (66%), 60 were discharged home (22%), 29 were transferred for higher level of care (11%), and two expired (1%). The mean hospital length of stay was 2.3 days (range, 1–9). Motocross accidents are most commonly associated with extremity injuries and closed head trauma. Although the overall mortality is low, the morbidity is high, with a large proportion of patients requiring surgery.
The Value of Laparoscopy in Management of Abdominal Trauma
Authors: Chelly Marjorie R. , Major Kevin , Spivak Jacob , Hui Thomas , Hiatt Jonathan R. , Margulies Daniel R.
Published: November 2022

The role of laparoscopy (LS) in abdominal trauma is controversial. Concerns remain regarding missed injuries and safety. Our objective for this study was to determine the safety and better define the role of LS in abdominal trauma victims. We performed a retrospective review of all patients who sustained abdominal trauma and underwent LS in a level I trauma center. The main outcome measures were age, gender, mechanism of injury (MOD, indication for laparoscopy, presence of intra-abdominal injury (IA), therapeutic laparoscopy (TxLS), need for laparotomy, length of hospital stay (LOS), missed injuries, complications, and deaths. Forty-eight patients underwent LS (62 per cent male; average age, 28 years; MOI, 35 (85%) penetrating, 7 (15%) blunt; mean ISS, 8). At laparoscopy, 58 per cent of patients had no intra-abdominal injury. IA injury was treated with laparotomy in 14 (29%) and TxLS in 6 (13%). One patient had a negative laparotomy (2%). No injuries were missed. No patients required reoperation. There was one complication: a pneumothorax. There were no deaths. LS was most valuable in penetrating trauma, avoiding laparotomy in more than two-thirds of patients with suspected intra-abdominal injury. LS can serve as a useful adjunct for the evaluation of blunt trauma. In a level I trauma center with LS readily available, the procedure is associated with a low rate of complications and missed injury.
What Predicts Serious Complications in Colorectal Cancer Resection?
Authors: Zingmond David , Maggard Melinda , O'Connell Jessica , Liu Jerome , Etzioni David , Ko Clifford
Published: November 2022

Virtually all volume-outcome studies use mortality as their outcome measure, yet most general surgical procedures have low in-patient death rates. We examined whether hospital surgical volume impacts other colorectal cancer resection outcomes and complications. Colorectal cancer (CRC) resections from 1996 to 2000 were identified using the California hospital discharge database. Comorbidity was graded using a modified Charlson index. Hospital CRC resection volume was calculated. Serious medical complications were defined as life-threatening cardiac or respiratory events, renal failure, or shock. Serious surgical complications were defined as vascular events, need for reoperation, or bleeding. Multivariate logistic regression analyses were performed to estimate the impact of predictors on complications. We identified 56,621 resections. Median age was 70 to 74 years. Eighty-one per cent of patients were white. Most had localized (57%) versus distant (22%) disease. Serious medical (17.5%) and surgical (9.8%) complications were not infrequent. In multivariate analyses, greater annual CRC surgical volume predicted lower odds of serious complication, but patient characteristics (age, comorbidity, and acuity of surgery) were more important. Although patients receiving CRC resection at lower-volume hospitals have greater odds of complication than patients treated at higher-volume institutions, patient factors remain the most important determinants of complication.
Thick Melanoma in the Elderly
Authors: Chang C.K. , Jacobs Ira A. , Theodosiou Elena , Salti George I.
Published: November 2022

The objective of this analysis is to ascertain the natural history of elderly patients greater than 65 years of age with thick melanoma (T4) who were treated with surgery only. Although there are multiple data on elderly patients, there is not a systematic review of survival in elderly patients over 65 years, and with our analysis we tried to enlighten this field in view especially of the growing population of the elderly in the United States. We retrospectively evaluated 112 patients with thick (≥4 mm) melanoma aged 65 or greater. Mean age was 73 years. Mean follow-up was 36 months. The overall survival (OS) and disease-free survival (DFS) were 69 and 52 months, respectively. Univariate analysis predicted worse OS and DFS when patients have positive lymph nodes, high mitotic rate, and increasing thickness. By multivariate analysis, lymph node status was most predictive of OS and DFS. Lymph node status is the most important prognostic factor in elderly patients with thick melanoma. Our analysis has shown that elderly patients that received no adjuvant treatment did significantly worse than the historical controls. Patients with nodal metastases are candidates for adjuvant therapy. Those without nodal disease constitute a favorable patient group and thus have much better prognosis and may not need adjuvant therapy. However, they must be closely monitored or enrolled in randomized trials. Thus, treatment for melanoma patients older than 65 should be as aggressive as in younger patients, and these patients should not be denied adjuvant treatment based on their age only.
Treatment of Bleeding in Severe Hemorrhagic Pancreatitis with Recombinant Factor VIIa
Authors: Schuster Rob , Lee Sarah J. , Rink Donald
Published: November 2022

Recombinant factor VIIa (rFVIIa) has been used to treat bleeding complications in patients with hemophilia. It acts at the site of vessel injury, forming a complex with tissue factor to activate the clotting cascade. Recent reports have shown rFVIIa may be a useful hemostatic agent in patients after obstetrical, urologic, trauma, or transplant procedures. We report the first documented case of bleeding from hemorrhage pancreatitis treated with rFVIIa.
Loop Colostomy without a Rod
Authors: Papachristou D.N. , Papachristou M.D.
Published: November 2022

Loop colostomy is traditionally prevented from retracting into the peritoneal cavity by a rod or other supporting device. The rod can be safely replaced by a single suture. The technique facilitates fitting of the ostomy bag and eliminates the need to remove the supporting element later on.