bluuebunny/crossref_metadata_2025 huggingface dataset:
Reconstructive Surgery for Treatment of Urogenital Tuberculosis: 30 Years of Observation
Authors: Mochalova Tatiana P. , Starikov Igor Y.
Published: February 2006

Tuberculosis has continued to be a public health problem around the world. The urogenital tuberculosis clinic in
the Russian Scientific Research Institute of Phthisiopulmonology was
founded in 1950. The development of reconstruction operations for those
with urogenital tuberculosis began in 1960. Since then 4298 patients
with urogenital tuberculosis have been treated, and 2364 operations
have been performed: 885 to remove an organ, 531 to preserve an organ, and 948 for reconstruction. The cases of extrapulmonary tuberculosis in
recent years have increased to 6.0%. Surgery for urogenital
tuberculosis is performed after specific medical therapy has been
tried, but it is difficult, particularly if it is a reconstruction. The
clinical features and results of various ureteral neoimplantation
procedures using intestinal transplants (ileocystoplasty, sigmoidocystoplasty, cecocystoplasty) are discussed.
Selective Treatment of Differentiated Thyroid Carcinoma
Authors: Gemsenjäger Ernst , Heitz Philipp U. , Martina Benedict
Published: February 2006

Over a period of 20 years 84 papillary and 82 follicular carcinomas operated on by one surgeon and examined by
one pathologist were documented prospectively, treated selectively, and
followed for 1 to 20 years (median 7 years). Tumors with a low risk of
recurrence or incurable disease—i.e., papillary carcinoma pT1–3 N0 M0
(n= 56) and minimally invasive follicular carcinoma (n= 37)—were treated by a limited‐radicality
hemithyroidectomy or total thyroidectomy without radioiodine in 79 of
the 93 cases (85%). No unfavorable course was observed, and only one
curable recurrence (1.3%) developed contralaterally after
hemithyroidectomy for papillary cancer. Of the remaining 73 patients, including 100% of those with nodal involvement, 65 (89%) underwent
total thyroidectomy with radioiodine. Total thyroidectomy was achieved
in 34% of the cases by completion thyroidectomy, based on definitive
histologic examination. No instance of a serious, potentially incurable
recurrence and no tumor‐related death was observed in patients with a
papillary TNM stage I + II or with a minimally invasive follicular
carcinoma. Five of the patients (6%) with papillary carcinoma, all
with TNM stage III or IV, and seven of the patients (8.5%) with
follicular carcinoma, all grossly invasive and pT3 or pT4, had
tumor‐related deaths following total thyroidectomy in all and with
remnant ablation in 10 cases. A potentially curable node recurrence
occurred in two patients 1 and 10 years, respectively, after primary
treatment. Permanent hypoparathyroidism (n= 4)
(2.4%) and permanent recurrent laryngeal nerve palsy
(n= 2) (1.2%) were observed only in patients with a
grossly invasive follicular carcinoma and concomitant benign recurrent
goiter. We conclude that (1) hemithyroidectomy or total thyroidectomy
without radioiodine is adequate for papillary carcinoma pT1–3 N0 and
minimally invasive follicular carcinoma; (2) there were no nodal
recurrences in tumors recognized as node‐negative; and (3)
extracapsular excision of one or both lobes can be carried out
technically with low morbidity. The study confirms the prognostic value
of age‐related TNM classification for papillary carcinoma;
classification of follicular thyroid carcinoma as minimally invasive or
grossly invasive proved to be useful.
Muscle Force and Bone Mineral Density after Parathyroidectomy and Subcutaneous Autotransplantation for Secondary Hyperparathyroidism
Authors: Chou Fong‐Fu , Lee Chiang Hsuan , Lee Chien Te
Published: February 2006

The object of this study was to determine the muscle force and bone mineral density (BMD) of patients with secondary hyperparathyroidism before and 3 months after operation. Thirty‐nine patients with secondary hyperparathyroidism and regular dialysis were operated. Their ages were 47 ± 12 (mean ± SD) years and duration of dialysis was 70.5 ± 35.8 months. The clinical symptoms included bone pain in 23 patients (59%), skin itching in 21 (53.8%), general weakness in 13 (33.3%), conscious disturbance in 2, chest tightness in 1, and failure to thrive in 1. Total parathyroidectomy and autotransplantation of 60 mg of parathyroid gland into subcutaneous tissue was done routinely. BMD was measured in the lumbar spine (L2–L4) and left proximal femur, expressed as grams per square centimeter and as fracture risk. The extension force of the quadriceps muscle was measured at 60 degrees of right knee flexion, expressed as newtons (N) in a peak force and an average force. Three months after operation the BMD of the study group increased (in g/cm2) from 1.063 ± 0.181 to 1.148 ± 0.149 (p < 0.001) in L2–4 (n= 25), from 0.792 ± 0.14 to 0.875 ± 0.161 (p < 0.001), in femoral neck (n= 25), from 0.672 ± 0.171 to 0.754 ± 0.21 (p < 0.001) in Ward's triangle (n= 25), and from 0.69 ± 0.149 to 0.738 ± 0.143 (p < 0.001) in trochanter (n= 25). Fracture risk also was reduced significantly 3 months after operation at L2–4 (p= 0.003), femoral neck (p= 0.001), Ward's triangle (p= 0.003), and trochanter (p= 0.005). Muscle force (in newtons) increased from 264.8 ± 110.5 to 326 ± 110.9 (p= 0.023) in peak force (n= 18) and from 195.3 ± 90.4 to 258 ± 99 (p= 0.012) in average force (n= 18). The patients with general weakness had improved muscle force more prominently than those without general weakness. In addition to skin itching, bone pain, and soft tissue calcification, general weakness that causes disability is an indication for surgery in secondary hyperparathyroidism. After parathyroidectomy and autotransplantation, the muscle force tends to increase, especially in those with general weakness. An increment of BMD and reduction of fracture risk are also found after surgery.
Quality of Life following Radical Surgical Treatment of Gastric Carcinoma
Authors: Thybusch‐Bernhardt Anja , Schmidt Christian , Küchler Thomas , Schmid Andreas , Henne‐Bruns Doris , Kremer Bernd
Published: February 2006

Quality of life (QOL) in patients with gastric cancer who underwent total gastrectomy has so far not been studied using the EORTC QLQ‐C30 (Quality of Life Core Questionnaire of the European Organization for Research and Treatment of Cancer) as a standardized European QOL instrument. The aim of this study was to evaluate the effect of radical procedures such as extensive lymph node resection and combined resection of adjacent organs on patients' QOL. From 1992 to 1996, 152 patients underwent total gastrectomy. All patients alive on July 1, 1996 were included in the study (77/152). For assessing QOL, the EORTC QOL questionnaire QLQ‐C30 version 2.0 and a validated gastric cancer module were sent home to the patients for self‐completion. The response rate was 91%. It was possible to evaluate the questionnaires of 62 patients who had undergone resection with curative intent including 13 extended gastrectomies (21%). Of the 62 resections, 50 were combined with D2 lymphadenectomy (80.6%). The global health status was not negatively influenced by D2 lymphadenectomy and extended gastrectomy. Patients with splenectomy were more affected by treatment than patients without splenectomy. Radical gastrectomy combined with D2 lymphadenectomy is the treatment of choice for gastric cancer patients, concerning not just survival but QOL as well.
Rectal Cancer Surgery in a District General Hospital: Controlled Follow‐up Study
Authors: Schütz Gaston , Aleksic Marko , Ulrich Bernward
Published: February 2006

Local recurrence after curative surgery of rectal cancer indicates failure of the initial treatment. In recent years reported local recurrence rates have steadily decreased. In this study 364 patients treated for rectal cancer were analyzed retrospectively to determine if it is still justified to treat this disease in small nonspecialized hospitals. An overall local recurrence rate of 9.7% was found for all operation methods used. Local recurrence rates were 11.6% for patients treated by low anterior resection, 8.4% for the patients who sustained an amputation of the rectum, and 7.1% for the patients treated by transanal tumor resection. None of the patients in whom we performed a total mesorectal excision has developed local recurrent disease during the observation period. Careful surgical technique and close follow‐up of the patients being prerequisites, the results of this study justify continuing to treat rectal cancer in nonspecialized centers.
Malnutrition: Organic and Functional Consequences
Authors: Mora Rafael J.F.
Published: February 2006

Malnutrition in its various forms is without doubt the commonest disease. Acute malnutrition resulting from a total lack of ingestion clearly shows that not only are water and electrolytes a priority for survival but also energy reserves. It also shows that the maximum wasting that the lean body mass can withstand is around 40% before the organism collapses and death occurs. Malnutrition is more often the results of insufficient ingestion, and the term protein‐calorie malnutrition has been suggested for the most frequently occurring type. This can give rise to confusion because the deficiency in these patients is not limited to these macronutrients but extends, rather, to micronutrients, which are equally important to the functioning of the body. A useful approach for the surgeon is to analyze how the various organs and systems have been affected. The effects on the gastrointestinal tract, the immunologic system, and formation of scar tissue are reviewed.
Postoperative Protein Sparing
Authors: Wilmore Douglas W.
Published: February 2006

Postoperative nitrogen sparing refers to a therapy that decreases net nitrogen loss from the body following an operation. Protein sparing has long been regarded as a surrogate marker for improved outcome, but a critical review of the evidence indicates that this relation is difficult to establish, especially in the short term. Thus, specific endpoints that evaluate outcome are needed to determine the efficacy of a specific therapy that spares protein. Cost effectiveness must also be considered. A variety of therapies were evaluated using protein‐sparing, efficiency, and cost criteria. Evidence was reviewed for glucose, amino acids, parenteral nutrition, enteral nutrition, growth hormone, and glutamine administered during the perioperative period. Only three areas could be identified that spared nitrogen and provided efficacy: (1) preoperative total parenteral nutrition (TPN) for 7 to 10 days before operation in a depleted patient (≤15% body weight loss); (2) the use of growth hormone with nutritional support to promote wound healing (especially in burns) and possibly to enhance muscle strength (particularly in the elderly); and (3) the use of glutamine‐supplemented TPN in severely ill surgical patients to decrease mortality. The issue of early tube feeding in trauma patients is still confusing. This therapy must be evaluated by an appropriate study in trauma patients that compares a tube‐fed group with an unfed control group. Only by demonstrating improved outcomes and enhanced cost saving with our protein‐sparing therapy can we continue to enhance the care of our surgical patients.
Postoperative Total Parenteral Nutrition
Authors: Waitzberg Dan L. , Plopper Caio , Terra Ricardo M.
Published: February 2006

Surgical trauma induces complex physiologic changes that lead to catabolism and loss of body cell mass. This reaction is usually mild but can be exacerbated by previous malnutrition and postoperative complications. To avoid severe metabolic distress, nutritional therapy may be prescribed, using the enteral route whenever possible. Postoperative total parenteral nutrition (TPN) is indicated for patients already receiving TPN preoperatively, those severely malnourished prior to major surgery, those unable to eat satisfactorily for 7 days, or patients presenting with severe complications. Postoperative TPN should last for at least 7 days. The total energy requirements are between 30 and 35 kcal/kg/day. About 50% to 70% should be provided in the form of carbohydrates, and 20% to 30% in the form of lipids. The optimal input rates for glucose and lipids are 4 to 5 g/kg/day and 80 mg/kg/hr, respectively. The ideal nitrogen administration is 250 to 300 mg/kg/day, and the optimal calorie/nitrogen ratio is 150 to 200. Some specific amino acids can be added as intravenous dipeptides. An adequate follow‐up must include clinical and biochemical parameters. Several trials evaluated the impact of TPN in postoperative patients, but further well designed, controlled clinical trials are still necessary to address a great number of unanswered questions.
Perioperative Nutrition Support for Patients Undergoing Gastrointestinal Surgery: Critical Analysis and Recommendations
Authors: Torosian Michael H.
Published: February 2006

There is a high incidence of malnutrition in hospitalized patients undergoing gastrointestinal surgery. Malnutrition is clearly associated with increased morbidity and mortality after major gastrointestinal surgery. The efficacy of perioperative nutrition support to reduce surgical complications and mortality significantly has been an area of active clinical investigation over the past three decades. From multiple prospective, randomized trials, significant benefit from perioperative nutritional support has been demonstrated in severely malnourished patients undergoing major surgery. Results of the prospective, randomized trials studying the effects of perioperative nutrition support on patients undergoing gastrointestinal surgery are reviewed and critically analyzed.
Artificial Nutritional Support in Patients with Gastrointestinal Fistulas
Authors: Dudrick Stanley J. , Maharaj Ashwin R. , McKelvey Alicia A.
Published: February 2006

Gastrointestinal (GI) fistulas allow abnormal diversions of GI contents, digestive juices, water, electrolytes, and nutrients from one hollow viscus to another or to the skin, potentially precipitating a wide variety of pathophysiologic effects. Mortality rates have decreased significantly during the past few decades from as high as 40% to 65% to 5.3% to 21.3% largely as a result of advances in intensive care, nutritional support, antimicrobial therapy, wound care, and operative techniques. The primary causes of death secondary to enterocutaneous fistulas have been, and continue to be, malnutrition, electrolyte imbalances, and sepsis, especially in high‐output fistulas, which continue to have a mortality rate of about 35%. Priorities in the management of GI fistulas include restoration of blood volume and correction of fluid, electrolyte, and acid‐base imbalances; control of infection and sepsis with appropriate antibiotics and drainage of abscesses; initiation of GI tract rest including secretory inhibition and nasogastric suction; control and collection of fistula drainage with protection of the surrounding skin; and provision of optimal nutrition by total parenteral nutrition (TPN) or enteral nutrition (EN) (or both). The role of nutrition support in the management of enterocutaneous fistulas as either TPN or EN is primarily one of supportive care to prevent malnutrition, thereby obviating further deterioration of an already debilitated patient. It has been shown in several studies that TPN has substantially improved the prognosis of GI fistula patients by increasing the rate of spontaneous closure and improving the nutritional status of patients requiring repeat operations. Moreover, other studies have shown that nutritional support decreases or modifies the composition of the GI tract secretions and is thus considered to have a primary therapeutic role in the management of fistula patients. Finally, if a fistula has not closed within 30 to 40 days, or if it is unlikely to close because of a variety of collateral or compounding pathophysiologic conditions, consideration must be given to operative resection of the fistula while continuing to maintain the previous nutritional and metabolic support. The morbidity and mortality rates in such unfortunate patients remain high despite the many recent advances in surgical and metabolic technology.
Laparoscopic Assisted Cystectomy and Lymphadenectomy for Bladder Cancer: Initial Experience
Authors: Denewer A. , Kotb S. , Hussein O. , El‐Maadawy M.
Published: February 2006

This study discusses our initial experience in the field of laparoscopic management of bladder carcinoma. Ten patients with invasive bladder tumors of variable histology and ranging from stage T2 to T3b were submitted to this procedure. Intraoperative assessment, lateral dissection, posterior dissection, anterior dissection, and urethral transection were achieved laparoscopically. The specimen retrieval and continent pouch construction was performed through a limited abdominal incision. This new regimen allows precise radical lymphadenectomy, early postoperative mobility, fewer wound complications, and shorter hospital stay. The early postoperative results of this procedure are encouraging. Modification and continuous refinement of the technique is still ongoing.
Gastrointestinal Disease following Heart Transplantation
Authors: Mueller Xavier M. , Tevaearai Hendrick T. , Stumpe Frank , Hurni Michel , Ruchat Patrick , Fischer Adam P. , Seydoux Charles , Goy Jean‐Jacques , von Segesser Ludwig K.
Published: February 2006

With advances in heart transplantation, a growing number of recipients are at risk of developing gastrointestinal disease. We reviewed our experience with gastrointestinal disease in 92 patients undergoing 93 heart transplants. All had follow‐up, with the median time 4.8 years (range 0.5–9.6 years). During the period of the study we progressively adopted a policy of low immunosuppression aiming toward monotherapy with cyclosporine. Nineteen patients (20.6%) developed 28 diseases related to the gastrointestinal tract. Thirteen patients required 18 surgical interventions, five as emergencies: closure of a duodenal ulcer, five cholecystectomies (one with biliary tract drainage), a sigmoid resection for a diverticulitis with a colovesical fistula, a colostomy followed by a colostomy takedown for an iatrogenic colon perforation, appendectomy, two anorectal procedures, and six abdominal wall herniorrhaphies. At the onset of gastrointestinal disease, 8 patients were on standard triple‐drug immunosuppression, all of them within 6 months of transplantation; 13 were on double‐drug immunosuppression; and 7 were on cyclosporine alone. All the patients with perforations/fistulas were on steroids. Among the 11 infectious or potentially infectious diseases, 10 were on triple‐ or double‐drug immunosuppression. One death, a patient who was on triple‐drug immunosuppression, had a postmortem diagnosis of necrotic and hemorrhagic pancreatitis. Except for an incisional hernia following a laparoscopic cholecystectomy, there was no morbidity and, importantly, no septic complications. We concluded that a low immunosuppression policy is likely to be responsible for the low morbidity and mortality of posttransplant gastrointestinal disease, with a lower incidence of viscous perforation/fistula and infectious gastrointestinal disease.
Nonembolic Predictors of Stroke Risk in Coronary Artery Bypass Patients
Authors: Pompilio Giulio , Lotto Attilio A. , Agrifoglio Marco , Antona Carlo , Alamanni Francesco , Spirito Rita , Biglioli Paolo
Published: February 2006

The aim of this study was to identify and stratify the most important nonembolic risk factors for stroke after coronary bypass grafting. From June 1994 to June 1997 a series of 1532 patients (pts) underwent isolated myocardial revascularization on cardiopulmonary bypass (CPB). A retrospective chart review selected 1417 pts in whom the presence of aortic calcification or left ventricular mural thrombi was not detectable by echocardiogram, angiogram, and intraoperative records. Univariate and multivariate analyses were conducted to identify nonembolic variables independently correlated to postoperative stroke. A predictive model of stroke probability was then constructed by means of a mathematic method with the variables selected from logistic regression analyses. The global incidence of stroke was 1.8%. Univariate analysis revealed that, among 29 preoperative and operative variables, age, vasculopathy, emergency operation, previous cerebrovascular accident (CVA), CPB, and aortic cross‐clamping times were factors strongly associated with postoperative stroke (p < 0.01). A first logistic regression analysis (LRA) selected as independent predicting variables (p < 0.05) age [odds ratio (OR) 1.07/year], vasculopathy (OR 4), previous CVA (OR 7.2), CPB time (OR 1/year), and emergency operation (OR 4.2). In a second stepwise LRA, age and CPB time were subdivided into cohorts as follows: age ≤ 65 years, > 65 but < 75 years, ≥ 75 years; CPB time ≤ 120 minutes, > 120 but < 180 minutes, ≥ 180 minutes. Both age ≥ 75 years (p= 0.024; OR 3.3) and CPB time ≥ 180 minutes (p= 0.002; OR 4.2), were found to be predictors of postoperative neurologic damage. Finally, a probability table of stroke risk was obtained with the logistic regression coefficients. A lower stroke probability (0.7%) was calculated in the absence of risk variables and a higher one in the presence of all of them (83.3%). Between these extremes, a total of 158 combinations of stroke probabilities were obtained. We concluded that previous CVA, vasculopathy, emergency operation, and age > 75 years are variously associated with a high risk of nonembolic stroke after myocardial revascularization. A duration of CPB longer than 3 hours strongly increases the probability of neurologic damage in the presence of the aforementioned variables.
Perioperative Blood Transfusion as a Prognostic Indicator in Patients with Hepatocellular Carcinoma
Authors: Asahara Toshimasa , Katayama Kouji , Itamoto Toshiyuki , Yano Masatsugu , Hino Hiroshi , Okamoto Yuzo , Nakahara Hideki , Dohi Kiyohiko , Moriwaki Katsufumi , Yuge Osafumi
Published: February 2006

We studied the relation of perioperative blood transfusion and the outcomes in 175 patients with hepatocellular carcinoma (HCC) who underwent hepatic resection from 1986 to 1994 in our hospital. Hepatectomy was performed in 23 (13.1%) patients with and 152 (86.9%) without blood transfusions. The cumulative cancer‐free survival rates for patients who had received blood transfusion was significantly lower than that for patients who had not received blood transfusions (p= 0.003). Further examinations revealed a significant difference in cancer‐free survival rates for stage I–II patients (n= 75) of HCC (p= 0.02) but not for stage III–IV patients (n= 56) (p= 0.06). Cox regression analysis for recurrence revealed that blood transfusion was the most significant prognostic indicator (p= 0.001) for recurrence in stage I–II patients but not in stage III–IV patients (p= 0.99). These results suggest that a perioperative blood transfusion may be a significant prognostic indicator for patients with HCC who had underwent hepatectomy, especially in stage I–II patients of HCC.
Preoperative Assessment of Body Fluid Disturbances in Patients with Obstructive Jaundice
Authors: Padillo Francisco J. , Rodriguez María , Gallardo Jose M. , Andicoberry Beatriz , Naranjo Antonio , Martín‐Malo Alejandro , Miño Gonzalo , Sitges‐Serra Antonio , Pera‐Madrazo Carlos
Published: February 2006

Postoperative renal dysfunction in obstructive jaundice (OJ) patients has been associated with hypovolemia and depletion of the extracellular water compartment (ECW). The aim of the study was to evaluate the preoperative status of body compartments in OJ patients measured by two methods. In a prospective study 39 OJ patients (11 benign and 28 malignant obstructions) were investigated, with 15 healthy subjects used as a control group (CG). Bioelectrical impedance analysis (BIA) determinations and values derived from anthropometric measurements were used to assess body compartment status. The coefficient of variation of BIA was below 4% in both OJ and CG subjects. No differences were found in intracellular water. However total body water (TBW) and ECW were reduced in OJ patients (50.5 ± 4.6 vs. 56 ± 8% body weight, p= 0.05; and 21 ± 4.5 vs. 23.8 ± 2.5% body weight, p < 0.05, respectively). There were no differences between benign and malignant obstructions. Seventy four percent of OJ patients had an ECW volume below the mean ± 2 SD in the CG subjects. Anthropometric and BIA determinations correlated closely for TBW measurements in both CG (r= 0.92, p < 0.001) and OJ patients (r= 0.91, p < 0.001). Bland‐Altman analysis also showed that for TBW the BIA was in agreement with anthropometry. In the present study, BIA offered a good correlation with anthropometric determinations and was a reliable method for body fluid disturbances assessment in jaundiced patients.
Value of Intravenous Cholangiography prior to Laparoscopic Cholecystectomy
Authors: Jansen Marc , Truong Son , Treutner Karl‐Heinz , Neuerburg Jörg , Schraven Christoph , Schumpelick Volker
Published: February 2006

We performed a retrospective study on 163 patients for evaluation of the benefit of intravenous cholangiography prior to laparoscopic cholecystectomy. Radiographic evaluation of the various areas of the biliary system was classified regarding resolution of anatomic structures: well detailed (excellent), impaired image but reliable interpretation possible (good), insufficient contrast with limited assessment (poor), no reliable judgment possible (insufficient). The common bile duct could be described as “good” in 96.3%, whereas the cystic duct could be described as “good” in only 54.6%. Concrements of the gallbladder were recognized in 72.4%, and common bile duct stones were diagnosed in only two of three patients. A distal junction of the cystic duct was found in nine cases, but there was no influence on the following operative procedure. Only one of two patients with a short cystic duct was identified. We found no improvement after routine use of intravenous cholangiography concerning the evidence of common bile duct stones or the avoidance of lesions of the common bile duct. Hence routine use of intravenous cholangiography prior to laparoscopic cholecystectomy is not justified.
Factors Influencing Morbidity and Mortality after Pancreaticoduodenectomy: Critical Analysis of 221 Resections
Authors: Böttger Thomas C. , Junginger Theo
Published: February 2006

n = 209) or total (n= 12) pancreaticoduodenectomy, in 12 cases combined with portal vein resection, was performed. Surgical complications were seen in 25%, but less than half of them were severe. General complications were seen in 18.5%. The 30‐ and 90‐day mortality rates were 3.1%, and 5.7%, respectively. In a regression analysis the intraoperative blood loss, preoperative serum bilirubin, diameter of the pancreatic duct, and occurrence of surgical and nonsurgical complications had an independent influence on mortality. In addition to the experience of the surgeon in selecting the patients and his or her personal technical skills when performing a pancreaticoduodenectomy, better anticipation and management of postoperative complications is essential for improving the results of this operation.
Thoracic Epidural Anesthesia for Pain Relief and Postoperation Recovery with Modified Radical Mastectomy
Authors: Yeh Chun‐Chang , Yu Jyh‐Cherng , Wu Ching‐Tang , Ho Shung‐Tai , Chang Tzu‐Ming , Wong Chih‐Shung
Published: February 2006

p < 0.001) and decreased pethidine consumption (17.2 ± 7.0 vs. 76.3 ± 17.4 mg) (p < 0.001) were observed in the TEA group than in the GA group, respectively. A worse visual analog scale (VAS) pain score was observed in the GA group (5.7 ± 0.6) than in TEA patients (4.3 ± 0.4) (p < 0.01). The average bed rest time was significantly shorter in the TEA group (16.9 ± 0.9 hours) (p < 0.01) than in the GA group (27.1 ± 4.1 hours). Overall satisfaction scores were significantly higher in the TEA group (4.4 ± 0.1) (p < 0.01) than in the GA group (3.5 ± 0.2). Side effects were observed at a higher frequency in the GA group (16/32) (p < 0.0001) than in the TEA group (3/32). The frequency of pethidine injection for pain relief was significantly lower in the TEA group (8/32) (p < 0.0001) than in the GA group (24/32). The total hospital cost (NT 64,392 ± 3,523 vs. NT 53,806 ± 2,817) (p= 0.0342) and anesthesia cost (NT 7,968 ± 246 vs. NT 5,268 ± 262) (p < 0.0001) are also significantly lower in the TEA group than the GA group. In conclusion, TEA provided better postoperative pain relief and recovery and lower cost than GA for MRM surgery.
Comparative Study of Carbohydrate Antigen 195 and Carcinoembryonic Antigen for the Diagnosis of Pancreatic Carcinoma
Authors: Andicoechea Alejandro , Vizoso Francisco , Alexandre Enrique , Martínez Aránzazu , Díez María Cruz , Riera Luis , Martinez Enrique , Ruibal Alvaro
Published: February 2006

p < 0.001). Sensitivity was increased to 92.5% with the simultaneous use of the two antigens, but the difference was statistically significant only with CEA (p < 0.001). The specificity of CA195 calculated from all patients with benign diseases was lower than that of CEA (73.1% vs. 89.8%). However, using a cutoff value of 100 U/ml for CA195, the specificity of this antigen (82%) was higher than that of CEA. These results demonstrate that marked elevations of tumor antigen CA195 are relatively specific for pancreatic carcinoma, and that this antigen is superior to CEA for diagnosing pancreatic cancer by virtue of its higher sensitivity.
Characteristics of Hepatocellular Carcinoma in Patients with Negative Virus Markers: Clinicopathologic Study of Resected Tumors
Authors: Shiraishi Masayuki , Hiroyasu Shungo , Nagahama Masayoshi , Tomita Syuji , Miyahira Takumi , Kusano Toshiomi , Furukawa Masato , Muto Yoshihiro
Published: February 2006

n = 11), hepatitis C virus antibody positive (HC, n= 21), and non‐BC (both HbsAg and HCVAb negative, n= 12). Seven patients were excluded from the study because of operative death (n= 3), a history of alcohol abuse (n= 3), or the presence of dual positive HB and HC virus markers (n= 1). The data were analyzed by either an analysis of variance (ANOVA) or a contingency table. The age of the non‐BC patients was higher (63.0 ± 4.1, ± SE) than that of HB patients (54.0 ± 3.2, p < 0.05) but was identical to that of the HC group (62.0 ± 1.8). Among the preoperative laboratory data, the serum glutamic oxaloacetate and glutamate pyruvate transaminoses (GOT, GPT) levels were statistically lower in the non‐BC patients (32.8 ± 4.8 and 28.0 ± 4.4 IU/L, respectively) than in the HB and HC patients. The pathologic features of the resected specimens in the non‐BC patients showed more invasive growth than in specimens from the HB or HC patients. The clinical stages (defined based on the criteria of the Japanese Association of Hepatocellular Carcinoma) were also more advanced in the non‐BC patients than in the other groups. Postoperative survival time showed no significant difference among the groups. In conclusion, the non‐BC patients had comparatively greater invasive growth and more advanced clinical stages than the HB and HC patients, despite the absence of liver cirrhosis, and so demonstrated the same poor survival data as observed in the HB and HC patients.
A Community Practice Model for Community Psychologists and Some Examples of the Application of Community Practice Skills from the Partnerships for Success Initiative in Ohio
Authors: Julian David A.
Published: February 2006

This paper provides an opportunity to consider the concept of community practice from the vantage point of community psychology. The author argues that community psychology has significant potential to change organizations, communities, and other settings to benefit setting occupants. However, it is the author's contention that the full realization of this potential is contingent upon an organized effort to engage in formal community practice. The author defines community practice in terms of four skill sets related to mobilization, planning, implementation, and evaluation. The author also describes settings that might support community practice and discusses implications for training and the field of community psychology in general. Finally, the author illustrates several community practice skills and roles in the context of a local community‐based initiative in Ohio called Partnerships for Success.
Intimate Partner Violence, Welfare Receipt, and Health Status of Low‐Income African American Women: A Lifecourse Analysis
Authors: Yoshihama Mieko , Hammock Amy C. , Horrocks Julie
Published: February 2006

Although the association among intimate partner violence (IPV), welfare receipt, and health status has been well‐established, little is known about the temporal sequencing of these events. In a random sample of low‐income African American women in an urban Midwestern county, lifecourse data about IPV and welfare receipt were obtained using the Life History Calendar method (D. Freedman, A. Thornton, D. Camburn, D. Alwin, & L. Young‐DeMarco, 1988), along with data about mental and physical health status. Controlling for relevant factors, longitudinal analyses found that previous experience of IPV increased women's odds of receiving welfare benefits in a given year, but previous welfare receipt did not. Cumulative IPV, but not cumulative welfare receipt, was associated with current and past‐year health problems. These findings are consistent with the hypothesis that IPV leads women to turn to welfare assistance, and that compromised physical and mental health due to past cumulative IPV interferes with women's gainful employment.
Clinical Research the Six Sigma Way
Authors: Liu Elliott W.
Published: February 2006

Process improvement has been a dominant movement in many manufacturing industries in the last two decades. In recent years, many service- and transactional-based companies are successfully implementing Six Sigma to improve business success. Most of the pharmaceutical and biopharmaceutical companies have not broadly recognized integration of breakthrough process improvement methods with clinical research practices. Although this phenomenon is interdisciplinary, its internal structure and the nature of its interactions with other disciplines in clinical development organizations have not been studied in depth. This article will discuss the author's comparative analysis of the Six Sigma and other quality management methodology. A case study is also presented to demonstrate breakthrough reduction of cycle time in Clinical Report Form entry process with near zero defect level of quality.
Preliminary results on correlation between neural response imaging and ‘most comfortable levels' in cochlear implantation
Authors: Akin I , Kuran G , Saka C , Vural M
Published: February 2006

During cochlear implantation, precise placement of the cochlear electrodes against the cochlear nerve is one of the most important steps, necessary to enable the patient to be aware of the stimulus from the implanted device. Neural response imaging (NRI) is a new tool which measures the evoked compound action potential generated as a result of electrical stimulation of the cochlea by properly placed electrodes during surgery.

The aim of this study was to examine the correlation between intra-operative NRI recordings and ‘most comfortable levels’ (M levels) measured during standard fitting with the SoundWave fitting software, in cochlear implantation patients. Seven adult subjects were included in the study. The average duration of profound bilateral deafness was seven years (range = 19 years) and the mean age at implantation was 24 years (range = 17–34 years). All subjects underwent implantation and reached the one-month fitting session; one patient reached the two-month fitting session. The intra-operative NRI threshold (tNRI) was observed to be much higher than the first fitting M levels. The tNRI was 203 per cent of the sequential M value and 246 per cent of the paired M value. All but one intra-operative tNRI values were greater than 150 clinical units (CU), and all first fitting M levels were on average below 100 CU. No obvious correlation was found between individual intra-operative tNRI and first fitting M levels. The M levels at one month were much higher than the first fitting M levels, with much more dispersion.
Rossby-wave driven zonal flows in the ionospheric E-layer
Authors: KALADZE T. D. , WU D. J. , POKHOTELOV O. A. , SAGDEEV R. Z. , STENFLO L. , SHUKLA P. K.
Published: February 2006

A novel mechanism for the generation of large-scale zonal flows by small-scale Rossby waves in the Earth's ionospheric E-layer is considered. The generation mechanism is based on the parametric excitation of convective cells by finite amplitude magnetized Rossby waves. To describe this process a generalized Charney equation containing both vector and scalar (Korteweg–de Vries type) nonlinearities is used. The magnetized Rossby waves are supposed to have arbitrary wavelengths (as compared with the Rossby radius). A set of coupled equations describing the nonlinear interaction of magnetized Rossby waves and zonal flows is obtained. The generation of zonal flows is due to the Reynolds stresses produced by finite amplitude magnetized Rossby waves. It is found that the wave vector of the fastest growing mode is perpendicular to that of the magnetized Rossby pump wave. Explicit expression for the maximum growth rate as well as for the optimal spatial dimensions of the zonal flows are obtained. A comparison with existing results is carried out. The present theory can be used for the interpretation of the observations of Rossby-type waves in the Earth's ionosphere.
The enactment of the field of cultural and artistic production of popular music in Brazil: a case study of the ‘Noel Rosa Generation’ in the 1930s
Authors: Frota Wander Nunes
Published: February 2006

The electromagnetic recording system came to Brazil in 1927 – just about two years or so after its establishment in Europe and the United States. With its higher technical specificities and capabilities, the electromagnetic system provided an opportunity for high-pitch and low-voice interpreters of song to be recorded. It seems likely that these artists would not have been recorded at that time had the mechanical system still been in vogue. At least in Brazil, this was the ‘revolution’ associated with the electromagnetic recording system: a new artistic generation emerged from the poor and middle-class inhabitants of Rio de Janeiro – then Brazil's capital city – to help produce what most prominent popular music critics and historians dub the ‘Golden Age’ in Brazilian popular music (see, for instance, Vasconcellos 1974; Tinhorão 1981; Cabral 1996). In my view, this Golden Age coincides with and is tantamount to the inception of a field of cultural and artistic production of popular music. Despite an obvious contrast in proportion and impact, there are nevertheless clear sociological similarities between this decisive moment in the history of Brazilian popular music and those moments Bourdieu (1993) describes in nineteenth-century French literature, theatre and impressionist painting.
IASPM's 13th Biennial Conference: a review from the periphery
Authors: Shin Hyunjoon , Kim Pil Ho
Published: February 2006

Some ten years ago, a group of graduate students in South Korea started reading ‘canons’ of popular music studies, such as those by Simon Frith, Iain Chambers, Keith Negus, Tony Mitchell, and Roy Shuker, among others. No formal discipline, be it music, communication, sociology or economics, embraced the group with open arms. Its members did not even know of the existence of IASPM until a few years later. Being ‘local’ without global connection, at the margins of academia in the periphery of Anglo-American cultural/intellectual centres, was an uneasy position to say the least.
Work and the household in the inter-war Soviet Union
Authors: KESSLER GIJS
Published: February 2006

The article examines patterns of work and employment in urban households of the inter-war Soviet Union. Drawing on population censuses and time-budget surveys, it analyses trends in labour participation and gainful employment for men, women and different age-groups from the mid-1920s to the late 1930s. Particular attention is devoted to the division of labour within the household. The single most important change over this period was a substantial increase in labour participation rates, in particular among women. This was a direct result of the state-led industrialization drive of the 1930s, which simultaneously caused a booming demand for labour and a rapid decline of real wages. Households reacted to this challenge by increasing the number of working members per household. Self-employment, targeted by state repression from the late 1920s, practically disappeared, leaving paid employment as the only viable form of gainful employment. Within the household, the increase in female labour participation rates put a heavy strain on women, who came to face a double burden of employment and household duties, including child-care. In three-generation extended households, which were the norm at the time, this resulted in a division of labour between the generations, with the household members of working age concentrating on paid employment and the elderly members of the household on child-care and subsidiary agriculture.
Regulation of phytoplankton dynamics by vitamin B12
Authors: Sañudo‐Wilhelmy S. A. , Gobler C. J. , Okbamichael M. , Taylor G. T.
Published: February 2006

Despite the biological necessity of vitamin B12 (cobalamin), its importance in phytoplankton ecology has been ignored for nearly three decades. Here we report strong and selective responses of phytoplankton communities to varying low levels (5–87 pM) of dissolved B12 in several coastal embayments. The ecological importance of this vitamin is inferred from observed declines in dissolved B12 levels as field populations of large (>5 μm) phytoplankton increased. In contrast, biomass of small (<5 μm) phytoplankton varied independently of B12 concentrations. These observations were corroborated by field‐based nutrient amendment experiments, in which B12 additions stimulated growth of large phytoplankton taxa 6‐fold over unamended controls. In contrast, small taxa (<5 μm) were largely unaffected. This study provides the first evidence of vitamin B12's influence on phytoplankton field population dynamics based on direct chemical measurements of cobalamin, and implicates B12 as an important organic regulator of photoautotrophic fertility in marine systems.
Effect of the Canary Islands in the blockage and mixing of the North Atlantic eastern water masses
Authors: Machín F. , Pelegrí J. L.
Published: February 2006

We apply an inverse model to a hydrographic cruise that completely closes the Canary Islands to investigate their effect on the water masses transports. Most central waters are transported south between the eastern islands and the African coast, with 2.5 Sv out of a total of 3.5 Sv. Intermediate waters are effectively blocked by the islands passages, with Mediterranean/Antarctic waters predominantly found north/south of the islands, and most deep waters loop around the archipelago plateau. A process model upholds the existence of intense two‐way exchange between central and intermediate waters along the eastern passage, with vertical velocities of order 10−5 m s−1.
Processes influencing tidal mixing in the region of sills
Authors: Xing Jiuxing , Davies Alan M.
Published: February 2006

A non‐hydrostatic model in cross sectional form with idealized topography representing a sill and forced by a barotropic tidal flow is used to examine the role of a hydraulic transition and internal lee waves in determining mixing in the sill region. Calculations using smooth topography show that unsteady lee waves are generated on the sill slope during flood tide. These waves propagate toward the sill when the tide reverses leading to enhanced mixing in the sill region. The addition of small scale topography on the leeside of the sill changes the lee wave distribution with an associated increase in mixing depending upon wavelength and amplitude of topography. Calculations show the importance of the hydraulic transition, lee waves and small scale topography in determining mixing in sill regions compared to smooth large scale topography.
Ancient DNA derived from alkenone‐biosynthesizing haptophytes and other algae in Holocene sediments from the Black Sea
Authors: Coolen Marco J. L. , Boere Arjan , Abbas Ben , Baas Marianne , Wakeham Stuart G. , Sinninghe Damsté Jaap S.
Published: February 2006

Holocene sea surface temperatures (SST) of the Black Sea have been reconstructed using sedimentary C37 unsaturated alkenones assumed to be derived from the coccolithophorid haptophyte Emiliania huxleyi, whose fossil coccoliths are an important constituent of the unit I sediments. However, alkenones can also be biosynthesized by haptophyte species that do not produce microscopic recognizable coccoliths. A species‐specific identification of haptophytes is important in such U37K′‐based past SST reconstructions since different species have different alkenone‐SST calibrations. We showed that 18S rDNA of E. huxleyi made up only a very small percentage (less than 0.8%) of the total eukaryotic 18S rDNA within the up to 3600‐year‐old fossil record obtained from the depocenter (>2000 m) of the Black Sea. The predominant fossil 18S rDNA was derived from dinoflagellates (Gymnodinium spp.), which are predominant members of the summer phytoplankton bloom in the modern Black Sea. Using a polymerase chain reaction/denaturing gradient gel electrophoresis method selective for haptophytes, we recovered substantial numbers of a preserved 458‐base‐pair (bp)‐long 18S rDNA fragment of E. huxleyi from the Holocene Black Sea sediments. Additional fossil haptophyte sequences were not detected, indicating that the E. huxleyi alkenone‐SST calibration can be applied for at least the last ∼3600 years. The ancient E. huxleyi DNA was well protected against degradation since the DNA/alkenone ratio did not significantly decrease throughout the whole sediment core and 20% of ∼2700‐year‐old fossil E. huxleyi DNA was still up to 23,000 base pairs long. We showed that fossil DNA offers great potential to study the Holocene paleoecology and paleoenvironment of anoxic deep‐sea settings in unprecedented detail.
Experimental design for groundwater modeling and management
Authors: McPhee James , Yeh William W.‐G.
Published: February 2006

This study aims to develop a methodology for data collection that accounts for the application of simulation models in decision making for groundwater management. Simulation model reliability is estimated by comparing the effects that a perturbation in the model parameter space has over the model output as well as over the solution of a multiobjective optimization problem. The problem of experimental design for parameter estimation is formulated and solved using a combination of genetic algorithm and gradient‐based optimization. Gaussian quadrature and Bayesian decision theory are combined for selecting the best design under parameter uncertainty. The proposed methodology is useful for selecting a robust design that will outperform all other candidate designs under most potential “true” states of the system. Results also show that the uncertainty analysis is able to identify complex interactions among the model parameters that may affect the performance of the experimental designs as well as the attainability of management objectives.
Schouten tensor and bi-Hamiltonian systems of hydrodynamic type
Authors: Bogoyavlenskij Oleg I.
Published: February 2006

The necessary conditions are derived for existence of a bi-Hamiltonian structure for a given hydrodynamic type system. One of the conditions is the vanishing of its Haantjes tensor. A theorem is proved on the canonical forms of the generic bi-Hamiltonian systems. The Schouten (2,1)-tensor Sijk is connected with any Hamiltonian system of hydrodynamic type. The complete symmetry of the (3,0)-tensor Sijk is demonstrated. The necessary conditions for existence of a single nondegenerate Hamiltonian structure are obtained in terms of the special differential k-forms Ωp1⋯pk(u1,…,uk).