bluuebunny/crossref_metadata_2025 huggingface dataset:
Overview of Surgical Pathology of the Thyroid Gland
Authors: Nishiyama Ronald H.
Published: August 2002

The purpose of this overview is to provide timely information on selected topics on the surgical pathology of the thyroid gland. Selected publications of the author and his colleagues at the University of Michigan and the Maine Medical Center form the basis of this review. Information provided in our reports is updated by perusal of recent, pertinent publications. The following questions summarize the contents of the overview. What is a “lateral aberrant thyroid”? Does it always represent metastatic carcinoma? What are dyshormogenetic goiters? Can “focal thyroiditis” in thyroid glands removed for the treatment of Graves' disease and toxic nodular goiters be predictive of the development of postoperative hypothyroidism? What is the pathology of autonomously functioning (hot) nodules? Do tall‐cell, columnar‐cell, and diffuse sclerosing types of papillary carcinomas forbode bad prognoses? What is the controversy over Hurthle cell tumors? Does the presence of a better differentiated component in an anaplastic thyroid carcinoma modify its biologic behavior? Are poorly differentiated carcinomas unique histologic variants? Does their histology affect prognosis? What is the most common small‐cell tumor of the thyroid gland? Has the Chernobyl nuclear disaster affected the incidence of childhood thyroid carcinoma? Are these radiation‐induced tumors more aggressive? The answers, some of which are controversial, are found in this overview. The aims here were to provide information to surgeons and pathologists and to improve the care of patients with thyroid disease.
Hashimoto's Disease and Thyroid Lymphoma: Role of the Surgeon
Authors: Pasieka Janice L.
Published: August 2002

With the turn of the century, the role of the surgeon in the treatment of diseases such as Hashimoto's and thyroid lymphoma has diminished. That is not to say that the surgeon must not have a thorough understanding of these diseases and the role he or she plays in their diagnosis and treatment. Hashimoto's disease is a common disease. Not infrequently the endocrine surgeon is faced with a thyroid nodule in a background of Hashimoto's disease. Interpretation of fine‐needle aspiration (FNA) of a nodule in a patient with the background of Hashimoto's disease may be misleading if the surgeon fails to understand the limitations of FNA. The role of the surgeon in the treatment and diagnosis of thyroid lymphomas has evolved from surgical debulking to open biopsy. With the use of irradiation and chemotherapy, the need for surgical debulking has nearly disappeared. The recent development of ancillary techniques such as light chain restriction, flow cytometry, gene rearrangement, and immunohistochemical staining have enabled cytopathologists to diagnose thyroid lymphoma by FNA, further diminishing the surgeon's role in the diagnosis and treatment of this disease.
Antibiotic Prophylaxis for Appendectomy in Children: Critical Appraisal
Authors: Tönz Martin , Schmid Philipp , Kaiser Georges
Published: August 2002

Prophylactic antibiotics are widely used during surgery, above all for clean‐contaminated or contaminated procedures. Because factors other than the degree of contamination play a critical role in regard to postoperative infectious complications, it is not evident that recommendations for antibiotic prophylaxis for an adult population can be transferred to children. The aim of the study was to analyze the incidence of postoperative infections in children undergoing appendectomy for suspected appendicitis to evaluate critically the effectiveness of prophylaxis. The charts of all children undergoing appendectomy between 1988 and 1998 were analyzed. In general, appendectomies were performed without antimicrobial prophylaxis. If a perforated appendicitis was found at operation, antibiotics were given intraoperatively. Postoperative infectious complications were defined as wound infections, intraabdominal infections, or prolonged postoperative pyrexia. During the study period of 10 years, 954 patients underwent appendectomy. In 24% of cases the appendix was perforated. Patients received prophylactic antibiotics at the surgeon's discretion. These patients were excluded from further analysis. Among those with non‐perforated appendicitis (n= 633), Infectious complications occurred in 19 (3%). Analyzing subgroups according to histologic diagnosis, the incidence was 4.2% (16/382) for gangrenous appendicitis and 1.2% (3/251) for simple appendicitis or normal appendix. These figures are clearly lower than those reported from an adult population, indicating that results from adults cannot a priori be transferred to children, and that general recommendations concerning antimicrobial prophylaxis must be considered carefully for this age group.
Growth Regulation of Thyroid and Thyroid Tumors in Humans
Authors: Goretzki Peter E. , Simon Dietmar , Dotzenrath Cornelia , Schulte Klaus‐Martin , Röher Hans‐Dietrich
Published: August 2002

In a study of growth regulation of the human thyroid gland and thyroid tumors we investigated the impact of iodine and that of the thyroid‐specific growth‐stimulating hormone TSH. Further studies included locally active growth factors such as the epidermal growth factor, insulin‐like growth factor, and tissue transforming growth factors alpha and beta. In addition to studies of growth regulation by the various growth factors in mostly normal thyrocytes, the impact of tumor‐specific mutations in oncogenes and tumor‐suppressor genes was investigated. The results demonstrated distinct changes in tissue specificity and sensitivity to external stimuli. This rather complex view on thyrocyte growth regulation may be confusing, but it describes the biologic reality more precisely. Increased knowledge of the regulatory processes may lead to the development of new tumor‐ and patient‐specific therapeutic approaches, especially for preventing benign goiter recurrence and for treating follicular and papillary thyroid cancers.
Thyroid Nodules: Rational Management
Authors: Wong Christopher K.M. , Wheeler Malcolm H.
Published: August 2002

Thyroid nodules are the commonest disorder presenting to the endocrine surgeon. Most of the lesions are benign, but the principal problem facing the clinician is that of identifying the malignant nodule requiring surgery. Current diagnostic methods are reviewed, and the role of intraoperative frozen section in particular is examined in a series of 155 patients undergoing thyroidectomy for solitary thyroid nodule. It is concluded that when the fine‐needle aspiration cytology (FNA) result is malignant intraoperative frozen section is unnecessary and contributes little to the management. Frozen section, however, is considered to be of value when the FNA result is reported as benign, suspicious, or inadequate. It permits identification of many malignant lesions that would otherwise require a second operation to complete a total thyroidectomy. Details of the indications for surgery and the operative strategy are discussed.
Molecular Analysis of Mechanisms Regulating Drug Sensitivity and the Development of New Chemotherapy Strategies for Genitourinary Carcinomas
Authors: Naito Seiji , Koga Hirofumi , Yokomizo Akira , Sakamoto Naotaka , Kotoh Shuji , Nakashima Michitaka , Kiue Akira , Kuwano Michihiko
Published: August 2002

Abstract

The emergence of drug‐resistant tumors during treatment remains one of the major obstacles in cancer chemotherapy. Overexpression of P‐glycoprotein encoded by the multidrug resistance 1 (MDR1) gene or multidrug resistance‐associated protein (MRP) (or both) and decreased expression of DNA topoisomerase II are responsible for expression of the multidrug resistance (MDR) phenotype. The expression of P‐glycoprotein is also often observed in untreated cancers showing spontaneous MDR, such as renal cell carcinoma. Regarding cisplatin resistance, decreased cisplatin accumulation, an increase in cisplatin detoxification by glutathione‐related enzymes or metallothionein (or both), and increased repair of DNA damage are all considered to play an important role. The combination of reversal agents targeting such drug resistance markers may be a way to improve the outcome of chemotherapy. Regarding the presently available reversal agents, however, clinically relevant chemosensitizing doses cannot be given to humans without inducing significant toxicity. The development of new agents that reverse drug resistance without causing significant toxicity and their clinical application based on the mechanisms regulating drug sensitivity may therefore be a potentially effective new treatment strategy for genitourinary carcinomas.
Bedside Percutaneous Tracheostomy: Clinical Comparison of Griggs and Fantoni Techniques
Authors: Byhahn Christian , Wilke Hans‐Joachim , Lischke Volker , Rinne Thorsten , Westphal Klaus
Published: August 2002

Elective tracheostomy is widely considered the preferred airway management of patients on long‐term ventilation. In addition to open tracheostomy, a number of percutaneous procedures have been introduced during the last two decades, among them techniques according to Griggs (guidewire dilating forceps, or GWDF) and to Fantoni (translaryngeal tracheostomy, or TLT). The aim of the study was to evaluate these two techniques in terms of perioperative complications, risks, and benefits in critically ill patients. A series of 100 critically ill adult patients on long‐term ventilation underwent elective percutaneous tracheostomy, either according to the Griggs (n= 50) or Fantoni (n= 50) technique. Tracheostomy was performed under general anesthesia at the patient's bedside. The mean (±SD) operating times were short, 9.2 ± 3.9 minutes (TLT) and 4.8 ± 3.7 minutes (GWDF) on average. Perioperative complications were noted in 4% of patients during either TLT or GWDF and included massive bleeding, mediastinal emphysema, posterior tracheal wall injury, and pretracheal placement of the tracheostomy tube. With regard to oxygenation, pre‐ and postoperative arterial oxygen tension divided by the fraction of inspired oxygen (PaO2/FiO2) ratios did not vary significantly, and no perioperative hypoxia was noted regardless of the technique used. We conclude that both TLT and GWDF represent attractive, safe alternatives to conventional tracheostomy or other percutaneous procedures if carefully performed by experienced physicians and under bronchoscopic control.
Teaching Hospital Perspective of the Quality of Trauma Care in Lagos, Nigeria
Authors: Onwudike Madu , Olaloye Olufemi A. , Oni Olusola O.A.
Published: August 2002

Information including respiratory rate, blood pressure, Glasgow Coma Scale, and anatomic injuries were obtained for all injured patients consecutively admitted to the Lagos University Teaching Hospital (LUTH) during the 9‐month period from September 1995 to May 1996. The data were analyzed using the UK Major Trauma Outcome Study (MTOS) methodology. The Revised Trauma Score (RTS), the Injury Severity Score (ISS), and the Probability of Survival (Ps) were calculated for each patient. In addition, the “M,”“z,” and “w” scores were calculated for blunt injuries. Of the 253 patients (median age 28 years; male/female ratio 4:1) studied, 85% suffered blunt trauma, 75% of which were due to RTA. About 60% of RTA victims were pedestrians. Only 8% of nonpedestrian victims wore protective devices. The mean ISS was 10, the mean RTS 6.98, and the mean Ps 0.96. The “m” statistic for blunt trauma was 0.91, and there were 122 survivors compared to the 163 predicted. The “z” and “w” scores were −18.49 and −24.55, respectively. Altogether, 42.7% of patients with ISS > 15 and 40.7% with RTS < 7.5 died. According to these results, the severity of injuries encountered in Lagos is comparable to those reported from the United Kingdom and the United States, but the death rate is higher.
Pathology and Nomenclature of Human Gastrointestinal Neuroendocrine (Carcinoid) Tumors and Related Lesions
Authors: Klöppel Günter , Heitz Philipp U. , Capella Carlo , Solcia Enrico
Published: August 2002

The pathology and nomenclature of the neuroendocrine cell proliferations in the gut are reviewed. The neoplastic lesions are discussed within the light of a new classification system that attempts to consider the morphologic, functional, and biologic features of the tumors.
Disadvantages of Muscle‐Sparing Thoracotomy in Patients with Lung Cancer
Authors: Sugi Kazuro , Nawata Sumihiko , Kaneda Yoshikazu , Nawata Kouiti , Ueda Kazuhiro , Esato Kensuke
Published: August 2002

At our institute patients with lung cancer had traditionally undergone lobectomy with mediastinal lymph node dissection using a standard posterolateral approach. The considerable morbidity associated with the standard posterolateral thoracotomy led us to investigate an alternative muscle‐sparing approach. A prospective, randomized study of 30 patients with primary lung cancer (stage I or II) was performed to compare the following: operative field size, number of dissected lymph nodes, surgery time, postoperative pain, shoulder range of motion, and pulmonary function test results between patients who underwent either standard thoracotomy (SP group, n = 15) or the muscle‐sparing thoracotomy (MS group, n = 15). The procedure should provide enough operative field size to access the mediastinum. Compared with the standard posterior thoracotomy, the muscle‐sparing thoracotomy supplied a smaller operative field (218 ± 31 versus 165 ± 41 cm2) and required more surgery time (87 ± 13 minutes) than the standard posterior thoracotomy (66 ± 12 minutes). There were no significant differences in the number of dissected mediastinal lymph nodes. During the early postoperative days, pain and restriction of shoulder flexion were significantly less in the MS group than in the SP group. There were no significant differences in pulmonary function between the two groups. In terms of the operative field there is a marked disadvantage with the muscle‐sparing incision compared with standard thoracotomy. The operative field is significantly smaller than with a standard thoracotomy, requiring more time to dissect the mediastinum; however, the pain is less and shoulder range of motion is superior to what is seen after standard thoracotomy during the early postoperative period. We conclude that there is no overall advantage to using the muscle‐sparing incision in patients with lung cancer.
Clinical Spectrum and Outcome of Functional Extraadrenal Paraganglioma
Authors: O’Riordain Diarmuid S. , Young William F. , Grant Clive S. , Carney J. Aidan , van Heerden Jon A.
Published: August 2002

Functioning extraadrenal paragangliomas represent more than 10% of all pheochromocytomas, occur at diverse anatomic locations, and are said to have a higher malignancy rate than intraadrenal pheochromocytomas. Sixty‐six patients had surgery for catecholamine‐producing paragangliomas between 1952 and 1992. Median follow‐up was 8.8 years. Median age was 40 years (11–67 years); the male/female ratio was 29:37. Familial disease occurred in 9 patients (13.6%), and 10 patients (15.2%) also developed adrenal pheochromocytoma. Solitary paragangliomas occurred in 52 patients: 46 abdominal, 4 thoracic, and 2 head and neck. Fifty‐three tumors developed in 14 patients with multiple paragangliomas: 38 abdominal and 15 thoracic. Of 28 patients with solitary tumors undergoing localization studies over the past 10 years accurate localization was achieved in 27. There was one operative death; 15 patients had persistent disease; and 50 were cured postoperatively. Of those cured, nine developed recurrence, disease‐free survival being 86%, 80%, and 80% at 5, 10, and 20 years. Metastatic disease was found in 14 patients (21%), 7 of whom have died. An additional 10 patients (15%) had locally invasive disease, of whom 4 have died. Cause‐specific survivals at 5, 10, and 20 years were 90%, 83%, and 72%. Risk factors for death from pheochromocytoma were tumor size > 5 cm (p= 0.0002), metastatic disease (p= 0.001), and tumor invasion (p= 0.0023). Cause‐specific survival for patients with tumors > 5 cm was 59% at 15 years compared to 100% among patients with tumors ≤ 5 cm (p= 0.0003). Functional paragangliomas are frequently malignant and are associated with a high incidence of persistent or recurrent disease. Tumor size > 5 cm and the occurrence of invasive or metastatic disease are strong predictors of outcome. Most tumors are abdominal, and imaging is highly successful for localization.
Early and Late Results of Ascending Aorta Surgery: Risk Factors for Early and Late Outcome
Authors: Ergin M. Arisan
Published: August 2002

This study was designed to evaluate risk factors for in‐hospital mortality and midterm survival in patients undergoing ascending aorta surgery at a single institution during an 11‐year period. Between 1984 and 1994 a total of 158 patients underwent an ascending aorta procedure at our institution. Their mean age was 59.6 ± 12.3; 115 (73%) were male, 33 (21%) had a history of congestive heart failure, 61 (39%) had an acute type A dissection, 21 (13%) underwent redo operations, and 55 (35%) were operated on an emergency basis. In‐hospital mortality was 9.7%
(10/103) for elective procedures and 36.4% (20/55) for emergency operations (
p < 0.0001). Multivariable stepwise logistic regression analysis identified the cardiopulmonary bypass time
[odds ratio (OR) = 1.01/min, p= 0.0021], emergency operation (OR = 2.27, p= 0.0022), arch replacement (OR = 2.71, p= 0.0067), and the need of femoral vein cannulation at intervention (OR = 1.89,p= 0.0375) as independent predictors of in‐hospital death. When this kind of analysis was performed, evaluating only the variables known before surgery, acute type A dissection (OR =
2.21, p= 0.0009) and preoperative NYHA class (OR
= 1.88 per class, p= 0.0290) were independent risk factors for in‐hospital death. Follow‐up ranged from 10 to 126 months
(median 42 months), with Kaplan‐Meier survivals of 69 ± 4%, and
60 ± 5% at 5 and 7 years, respectively; survival rates for hospital survivors were 85 ± 4% and 67 ± 7% at 5 and 7 years, respectively. Cox regression analysis has identified arch replacement [relative risk (RR) = 2.48, p <
0.0001], perioperative myocardial infarction (RR = 2.44,p= 0.0003), preoperative NYHA class (RR = 1.97 per class, p= 0.0009), acute type A aortic dissection
(RR = 1.44, p= 0.0238), the need of femoral vein cannulation at intervention (RR = 1.55, p=
0.0332), and redo operation (RR = 1.44, p=
0.0851) as independent predictors of reduced survival at follow‐up. When this kind of analysis was performed on hospital survivors only, postoperative tracheostomy (p= 0.0003, RR =
3.42), reexploration for bleeding (p= 0.0003, RR
= 3.77), and the occurrence of postoperative ventricular arrhythmias
(p= 0.0007, RR = 2.45) emerged as risk factors. Multiple factors affect the early and late outcome after ascending aorta surgery; our data suggest that the preoperative clinical status of the patients and the priority of surgery and aortic dissection are the main determinants of the early results; on the other hand, the early postoperative course is the main determinant of the late outcome of hospital survivors.
Thyroid Cancer in Patients with Familial Adenomatous Polyposis
Authors: Perrier Nancy D. , van Heerden Jon A. , Goellner John R. , Williams E. Dillwyn , Gharib Hossein , Marchesa Pierenico , Church James M. , Fazio Victor W. , Larson Dirk R.
Published: August 2002

The association between thyroid cancer and familial adenomatous polyposis (FAP), albeit rare, is well known. It has been suggested that the thyroid tumors have unique histologic characteristics and may be follicular in origin. Because of their rarity, treatment and long‐term prognosis are uncertain. Twelve such patients (prevalence 399/100,000) seen during 1949–1995 were retrospectively reviewed. Histology was independently re‐reviewed by two pathologists. There were 11 female patients (two sisters) and 1 male patient, with a mean age of 28 years (range 15–61 years). Eight patients (66%) had multicentric tumors and five (42%) bilateral disease. Average tumor diameter was 1.8 cm (range 0.2–5.0 cm). Regional nodal metastases were present in two patients. All 12 thyroid cancers in this series were papillary. The one male patient demonstrated “typical” histology with variable papillary and follicular architecture, whereas the 11 female patients had tumors with unusual histology as described by Harach. Five patients (41%) were treated by total thyroidectomy, five with near‐total thyroidectomy, and two with lobectomy alone. Mean follow‐up was 142 months (range 7 months to 30 years). Regional recurrent disease occurred in two patients, one of whom died of the disease. The 5‐ and 20‐year survivals were 90% and 77%, respectively. The results indicated that all tumors in this study were papillary, although atypical histology was encountered in 91%. The mean age (28 years) is younger than that of patients with sporadic disease. Multicentricity and bilateral disease are common. In view of this finding, total thyroidectomy should be strongly considered. Long‐term prognosis is excellent. The finding of unusual histology in a young patient with papillary thyroid carcinoma should arouse the suspicion of FAP.
Laparoscopy with Laparoscopic Ultrasonography in the TNM Staging of Pancreatic Carcinoma
Authors: John Timothy G. , Wright Andrew , Allan Paul L. , Redhead Doris N. , Paterson‐Brown Simon , Carter David C. , Garden O. James
Published: August 2002

A prospective study was performed comparing laparoscopy with laparoscopic ultrasonography (LapUS), transabdominal ultrasonography (USS), computed tomography (CT), and selective visceral angiography with portal phase venography (SVA) for the assessment of resectability in 50 patients with pancreatic or periampullary cancer. The results were stratified by TNM stages. Tumor unresectability was demonstrated in 36 patients (72%). The sensitivity of LapUS for demonstrating the index lesion was 96%. Laparoscopic ultrasonography failed to predict factors precluding resection by T stage in six patients, and there were no significant differences in the ability of any modality to predict local resectability (predictive value 58–73%). Laparoscopic ultrasonography did not overestimate T stage and was significantly more specific for assessing unresectability compared with USS (100% vs. 64%, p < 0.05) and CT (100% vs. 47%, p < 0.005). No imaging investigation was able to assess the N stage accurately. Metastases were confirmed in 16 patients (32%), with LapUS proving significantly more sensitive than USS (94% vs. 29%, p < 0.001) and CT (94% vs. 33%, p < 0.005). The addition of LapUS to the laparoscopic examination did not change the M stage in any patient, as all metastases were superficially located. Laparoscopy with LapUS was the most reliable method for assessing overall tumour resectability and was significantly more predictive than CT (97% vs. 79%, p < 0.005). These results confirm that laparoscopy is indispensable for detecting occult intraabdominal metastases. LapUS reliably predicts tumor unresectability, offsetting the tendency of USS and CT to overestimate T stage. Methods of accurate N staging remain elusive, and the use of routine SVA is not justified.
Diagnosis and Staging of Pancreatic Cancer by Positron Emission Tomography
Authors: Berberat Pascal , Friess Helmut , Kashiwagi Mikiya , Beger Hans G. , Büchler Markus W.
Published: August 2002

The detection of pancreatic cancer or the discrimination between pancreatic cancer and chronic pancreatitis remains an important diagnostic problem. Several imaging modalities are now used to diagnose pancreatic cancer, including transabdominal ultrasonography (US), contrast‐enhanced computed tomography (CT), magnetic resonance imaging (MRI), endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasonography, and selective angiography. None of these six methods is perfect: Each has advantages and disadvantages, and their sensitivity and specificity are in a high range. In 1990 positron emission tomography (PET) was first applied to diagnose pancreatic cancer. This new diagnostic modality is based on functional changes in the pancreatic cancer cells caused by enhanced glucose metabolism. Increased glucose utilization is one of the characteristics of malignantly transformed cells, independent of their origin. The technical development of PET has allowed this new procedure to be used for clinical evaluation. Using 2‐(18F)‐fluoro‐2‐deoxy‐d‐glucose, PET can identify pancreatic cancer and differentiate pancreatic cancer from chronic pancreatitis with a sensitivity of 85% to 98% and a specificity of 53% to 93%. However, high sensitivity and high specificity are strongly dependent on the tumor stage. At present PET is still experimental and is available only in specialized centers. It may represent a new and noninvasive diagnostic procedure for the detection and the staging of pancreatic cancer. Further clinical studies, especially including patients with early tumor stages (small tumor size), are needed. This review discusses the possibilities and limits of PET and evaluates its importance in the future.
Anaplastic Thyroid Carcinoma Survival
Authors: Voutilainen Petri E. , Multanen Markku , Haapiainen Reijo K. , Leppäniemi Ari K. , Sivula Arto H.
Published: August 2002

Anaplastic thyroid carcinoma is a rare, highly malignant tumor of elderly people. The purpose of this retrospective study was to characterize the patient population and to detect a potential subgroup with better prognosis or any intervention that would be useful. From 1967 through 1994 a total of 33 anaplastic thyroid carcinomas were operated on at the Second Department of Surgery, Helsinki University Central Hospital. There were 26 females and 7 males with mean age of 66.0 years (range 36–89 years). At the time of diagnosis 16 of 33 patients had distant metastases, and 32 of 33 of the tumors had invaded the thyroid capsule. Disease‐specific survival was 9.7% (95% confidence interval from 2.0% to 25.9%) at 1 year using the product limit survival analysis. In the stepwise Cox proportional hazards regression model, local resectability (p= 0.0002), presence of distant metastases at diagnosis (p= 0.0014), radiotherapy (p= 0.014), and radioiodine ablation (p= 0.039) were independent prognostic factors. We concluded that even though statistically significant, independent, prognostic factors can be found the survival of the patients with the best prognostic characteristics is still poor. Only one patient, who had an anaplastic carcinoma focus within an encapsulated follicular thyroid carcinoma, survived in this series. At present there seems to be no surgical treatment that would be efficient for treating symptomatic anaplastic thyroid carcinoma.
Clinical Application of a Blood Pressure Autoregulation System during Hypotensive Anesthesia
Authors: Onodera Hisashi , Maetani Shunzo , Aung Tun , Kan Shugen , Sakamoto Tadahiro , Shiragami Gohtaro , Furutani Eiko , Araki Mituhiko , Imamura Masayuki
Published: August 2002

A blood pressure autoregulation system based on the state‐predictive control method was developed to minimize intraoperative blood loss and hence avoid blood transfusion. In this report, the system is further improved by incorporating fuzzy logic with a fail‐safe function and an individual parameter‐identifying function. The safety and stability of this system had been confirmed by preclinical experiments with dogs. Thereafter clinical application with 17 patients was conducted to maintain their mean arterial pressure at around 60 mmHg during major surgery. The use of this system resulted in decreased blood loss and more speedy and accurate surgery due to a clearer surgical field. Unwanted effects of hypotension were not observed clinically or in laboratory tests. This system is therefore safe, stable, and effective in reducing the blood loss during major surgery that otherwise might cause substantial blood loss.
Anastomotic Diameters and Strictures following Esophagectomy and Total Gastrectomy in 256 Patients
Authors: Johansson Jan , Zilling Thomas , von Holstein Christer Staël , Johnsson Folke , Öberg Stefan , Walther Bruno
Published: August 2002

The prevalence of anastomotic strictures in esophageal anastomoses provides us with limited information about the anastomotic healing process. This prospective study evaluates the exact esophageal anastomotic diameters in 256 patients who underwent esophagectomy and esophagogastrostomy without pyloroplasty (n= 107) or total gastrectomy and Roux reconstruction (n= 149). No perioperative chemoradiotherapy was given. Anastomotic strictures and diameters were assessed during endoscopy by a separately inserted (inflated to the anastomotic width) balloon catheter. The anastomotic diameters increased significantly during the first postoperative year in the esophagectomy (p= 0.001) and gastrectomy (p < 0.001) groups. The anastomoses in the gastrectomy group were significantly wider than those in the esophagectomy group 3 (25.7 versus 19.9 mm), 6 (28.5 versus 22.0 mm), and 12 (30.5 versus 23.3 mm) months after surgery (p < 0.001). Neither the anastomotic site (neck or chest) in the esophagectomy group (p= 0.176) nor that in the gastrectomy group (abdomen or chest) (p= 0.577) influenced the anastomotic diameter. Benign anastomotic strictures were most frequently found after 3 months and after esophagectomy. Esophagojejunostomies performed with 2 linear stapling devices or cartridge size 28 mm showed the widest anastomoses with only 1 stricture. Esophagogastric anastomoses following esophagectomy are narrower and develop more strictures than esophagojejunal anastomoses after total gastrectomy, but both dilate during the first year.
Tumors of the Small Intestine
Authors: Blanchard D. Kay , Budde Jason M. , Hatch George F. , Wertheimer‐Hatch Laura , Hatch Kathryn F. , Davis Gregory B. , Foster Roger S. , Skandalakis John E.
Published: August 2002

This collective review includes all available case reports and series of smooth muscle (stromal) tumors of the small intestine in the world literature from 1881 to 1996. We identified 1074 patients with leiomyoma (LM) and 1689 with leiomyosarcoma (LMS). Our purpose was to update our previous review, which encompassed case reports and series from 1881 to 1959, which included 350 LMs and 257 LMSs. The peak incidence of smooth muscle tumors in the small intestine in both male and female patients was between the ages of 50 and 59. Most commonly, the presenting complaint was gastrointestinal bleeding. Computed tomography was found to detect LM and LMS most successfully and had the additional advantage of locating metastatic disease. The jejunum contained the highest numbers of smooth muscle tumors, followed by the ileum and then the duodenum, with malignant lesions in all locations typically attaining larger diameters than benign tumors. The overall rate of metastatic spread of LMS ranged from 24% to 50%, with the liver being most commonly involved. Unlike other sarcomas, both hematogenous and lymphatic spread were common. The 5‐year survival of 705 patients with LMS from 22 series was 27.8%. For both benign and malignant smooth muscle tumors of the small intestine, surgery remains the treatment of choice, with little efficacy reported for irradiation, chemotherapy, or both.
Intraperitoneal Gossypibomas: The Need to Count Sponges
Authors: Lauwers Patrick R. , Van Hee Robrecht H.
Published: August 2002

Intraperitoneal forgotten foreign bodies are prone to create adhesions and to encapsulate, or to provoke an exudative response, with or without accompanying bacterial infection. Often a process of self‐extrusion is initiated. This is also true for gossypibomas, retained surgical sponges. Presentation is possible as a pseudotumoral, occlusive, or septic syndrome; several cases, however, have remained asymptomatic for as long as several decades. Ultrasonography and radiology (especially computed tomography) contribute significantly to the detection of gossypibomas; magnetic resonance imaging is a less used technique. Detection by plain radiography is difficult. Ultrasonography demonstrates a hyperreflective mass with hypoechoic rim and a strong posterior shadow. Computed tomography shows a well defined mass with internal heterogenous densities. Therapy consists of operative removal of the foreign body in association with resolving its complications. Adding a series of five cases to the existing literature reports, the fate of intraperitoneal forgotten surgical sponges is reviewed.
Persistence of a fig wasp population and evolution of dioecy in figs: a simulation study
Authors: Kameyama Tomoyuki , Harrison Rhett , Yamamura Norio
Published: August 2002

The relationship between fig trees and their pollinator wasps is a well‐known example of species‐specific obligate mutualism. In this article we present a stochastic model of this mutualistic system, referring to data on a dioecious fig (Ficus schwarzii) in Borneo, and examine the conditions for the persistence of a wasp population for a given period. (1) When the average duration of the flowering interval of fig trees is short, even a small fig population can sustain a wasp population successfully. A population whose average period of flowering cycle is half that of another population can sustain a wasp population with a number of trees less than half of the other population. (2) The wasp survival rate (WSR) is higher when (a) the variation of the interval periods of fig flowering is smaller, (b) the fig population size is larger, and (c) figs can prolong their receptivity to wait for a wasp if no wasps are available. (3) WSR is predictable from the average proportion of the fig's receptive phases, in which wasps are available, to their total receptive phases. (4) The persistence period of a wasp population increases exponentially with the number of fig trees. Based on these results we propose a new hypothesis, as a possible scenario, on the evolution of dioecy from monoecy in Ficus.
Hsp27: Novel Regulator of Intracellular Redox State
Authors: Arrigo André‐Patrick
Published: August 2002

Small stress proteins are molecular chaperones that modulate the ability of cells to respond to several types of injuries. In this regard, a protection generated by the expression of mammalian small stress proteins against the cell death induced by oxidative stress has been described. This review summarizes the current knowledge of the protective mechanism generated by the expression of the major mammalian small stress protein Hsp27 in cells exposed to oxidative stress. A possible role of this chaperon protein in the presentation of oxidized proteins to the proteasome degradation machinery is proposed.
Complex I and Parkinson's Disease
Authors: Greenamyre J. Timothy , Sherer Todd B. , Betarbet Ranjita , Panov Alexander V.
Published: August 2002

Complex I of the mammalian electron transfer chain is composed of at least 43 protein subunits, of which 7 are encoded by mtDNA. It catalyzes the transfer of electrons from NADH to ubiquinone and translocates protons from the mitochondrial matrix to the intermembrane space. It may also play direct roles in the mitochondrial permeability transition and in cell death pathways. Despite the limitations of current complex I assays, biochemical studies have suggested the presence of a mild, systemic defect of complex I in Parkinson's disease (PD). Recent experimental work has modeled this abnormality using rotenone to systemically inhibit complex I. Chronic rotenone exposure accurately recapitulated the pathological, biochemical, and behavioral features of PD. Thus, relatively subtle complex I abnormalities‐‐either genetic or acquired‐‐may be central to the pathogenesis of PD.
Enhanced MgB2 Superconductivity Under High Pressure
Authors: Liu Zhen-Xing  , Jin Chang-Qing  , You Jiang-Yang  , Li Shao-Chun  , Zhu Jia-Lin  , Yu Ri-Cheng  , Li Feng-Ying,
Published: August 2002

We report on in situ high-pressure studies up to 1.0 GPa on the
MgB2 superconductor which was high-pressure synthesized. The
as-prepared sample is of high quality in terms of sharp superconducting
transition (T
c) at 39 K from the magnetic measurements. The
in situ high-pressure measurements were carried out using a Be-Cu
piston-cylinder-type instrument with mixed oil as the pressure
transmitting medium which warrants a quasi-hydrostatic pressure
environment at low temperature. The superconducting transitions were
measured using the electrical conductance method. It is found that
T
c increases by more than 1 K with pressure in the low-pressure
range, before the T
c value decreases with the further increase
of the pressure.
Metallic adhesion and tunnelling at the atomic scale
Authors: Schirmeisen A , Cross G , Stalder A , Grütter P , Dürig U
Published: August 2002

We simultaneously measured the distance dependence of the force and the tunnelling current between a W(111) tip and a Au(111) sample in an ultrahigh vacuum atT= 150 K. The tip was characterized by field ion microscopy. Even at atomically close contact no evidence of structural instabilities was found. The scaling of the force curves show an unexpectedly long distance scaling parameter of λ = 0.2 nm. We conclude that not only the apex atoms contribute to the adhesion forces, but the first three layers play an almost equal role. Using a model that correlates the force and the tunnelling current, we are able to extract the tip density of states. Possible reasons for the long scaling length are discussed.
Simple predictions from ALCOR
c
for rehadronization of charmed quark matter
Authors: Lévai P , Biró T S , Csörgo T , Zimányi J
Published: August 2002

We study the production of charmed hadrons with the help of ALCOR
c
, the algebraic coalescence model for rehadronization of charmed quark matter.
Mesonic ratios are introduced as factors connecting various anti-baryon to baryon
ratios. The resulting simple relations could serve as tests of quark matter formation
and coalescence type rehadronization in heavy ion collisions.
Microscopic coloured quark dynamics in the soft non-perturbative regime - description of hadron formation in relativistic S + Au collisions at CERN
Authors: Scherer S , Hofmann M , Bleicher M , Neise L , Stöcker H , Greiner W
Published: August 2002

The quark molecular dynamics model is used to study microscopically the dynamics of the coloured quark phase and the subsequent hadron formation in relativistic S+Au collisions at the CERN-SPS. Particle spectra and hadron ratios are compared to both data and the results of hadronic transport calculations. The non-equilibrium dynamics of hadronization and the loss of correlation among quarks are studied.
J- and H-Aggregates of Porphyrins with Surfactants: Fluorescence, Stopped Flow and Electron Microscopy Studies
Authors: MAITI NAKUL C. , MAZUMDAR SHYAMALAVA , PERIASAMY N.
Published: August 2002

The interaction of cationic surfactants such as CTAB (cetyl trimethyl ammonium bromide) with tetrakis-(4-sulfonato phenyl) porphine ( H 4 TPPS 2−), a dianion, leads to the formation of two premicellar aggregates of porphyrin when [CTAB] is below CMC (critical micelle concentration) and a micellized monomer when [CTAB] is above CMC. The premicellar aggregates are labeled as J- and H-aggregates because of their characteristic spectroscopic properties. Simple inorganic cations such as K +, Ba 2+, Ca 2+ and Zr 4+ also induce the formation of the J-aggregate but not of the H-aggregate. The formation of the J-aggregate is preceded by kinetic intermediates, while no intermediate was observed prior to the formation of the H-aggregate. The rate of formation of the H-aggregate was faster than that of the J-aggregate. The fluorescence depolarization (anisotropy) properties of the monomer and the H- and J-aggregates were studied and compared. The size and structure of the J-aggregate were examined by transmission electron microscopy (TEM). The structure of the J-aggregate reveals a fiber-like (linear stacking) or domain-like (helical stacking) arrangement of the porphyrin molecules.
Customerization: The next revolution in mass customization
Authors: Wind Jerry , Rangaswamy Arvind
Published: August 2002

In this conceptual paper, we propose that the next stage of evolution
of mass customization is customerization—a buyer-centric company strategy
that combines mass customization with customized marketing. Spurred by the
growth of Internet and related technologies, many leading companies (e.g.,
Dell) are beginning to deploy customerization on a large scale. In this
paper we define customerization, and describe how it is different from the
related strategies of mass customization, personalization, and one-to-one
marketing. We also describe the opportunities and challenges companies face
in deploying a customerization strategy, and the potential benefits that
they might realize.
A longitudinal examination of the relation between co‐offending with violent accomplices and violent crime
Authors: Conway Kevin P. , McCord Joan
Published: August 2002

Although the idea that youthful offenders are affected by the company they keep is widely accepted, evidence in support of this idea is based primarily on reports provided by offenders and their peers. As an alternative to relying on reports of criminal behavior, a method that may overestimate the role that peers play in criminal behavior, the current research on co‐offending uses court records to identify and track over time individuals who are known to commit crimes together. The present investigation is the first co‐offending study to track patterns of violent criminal behavior (over an 18‐year period) among a sample of urban offenders and their accomplices. The study tests whether violence “spreads” from violent offenders to those inexperienced in violence. Results indicate that nonviolent offenders who commit their first co‐offense with violent accomplices are at increased risk for subsequent serious violent crime. Findings suggest that lessons of violence can be learned “on the street,” where knowledge is passed along through impromptu social contexts, including those in which offenders commit crimes together. Aggr. Behav. 28:97–108, 2002. © 2002 Wiley‐Liss, Inc.
Race Matters: The Unspoken Variable in the Teaching‐Learning Transaction
Authors: Johnson‐Bailey Juanita
Published: August 2002

Johnson‐Bailey points to the importance of examining and understanding race as a variable with an impact on the teaching‐learning transaction.
Radiation therapy and combination of cladribine, cyclophosphamide, and prednisone as treatment of Bing‐Neel syndrome: Case report and review of the literature
Authors: Delgado Julio , Canales Miguel Angel , Garcia Beatriz , Alvarez‐Ferreira Javier , Garcia‐Grande Antonio , Hernandez‐Navarro Fernando
Published: August 2002

Waldenström's macroglobulinemia is a low‐grade lymphoma that produces monoclonal IgM. Central nervous system symptoms are frequent in Waldenström's macroglobulinemia, mostly associated with blood hyperviscosity. Nevertheless, central nervous system infiltration by malignant cells (Bing‐Neel syndrome) has rarely been reported. We describe the case of a 72‐year‐old man with Waldenstrom's macroglobulinemia and central nervous system infiltration by malignant cells with tumor formation. All similar cases reported in the literature are reviewed and the different therapeutic approaches discussed. Am. J. Hematol. 69:127–131, 2002. © 2002 Wiley‐Liss, Inc.
Mutation of bcl‐x gene in non‐Hodgkin's lymphoma
Authors: Yamaguchi Hiroki , Inokuchi Koiti , Tarusawa Miki , Dan Kazuo
Published: August 2002

The bcl‐x gene product has two forms, bcl‐xl and bcl‐xs. The bcl‐xl form, similar to bcl‐2, inhibits apoptosis. Reverse transcriptase‐‐polymerase chain reaction‐‐single‐stranded conformation polymorphism (RT‐PCR‐SSCP) gel analysis was used to screen for mutations of the bcl‐xl transcript of 50 non‐Hodgkin’s lymphoma (NHL) cases. One missense mutation in a patient with diffuse large B‐cell lymphoma was found. Sequence analysis of this case showed that AGC (Ser) was mutated to GGC (Gly) in codon 154. An examination of mutation and/or polymorphism in born marrow samples of this case and 50 normal controls by the RT‐PCR‐SSCP method could not detect bandshifts. Mutation of the bcl‐x gene in NHL has not been reported previously. There is a possibility that mutation of the bcl‐x gene play a role in the tumorigenesis of NHL. Am. J. Hematol. 69:74‐76, 2002. © 2002 Wiley‐Liss, Inc.
CD5‐negative phenotype of monoclonal B‐lymphocytosis of undetermined significance (MLUS)
Authors: Wang Chen , Amato Dominick , Fernandes Bernard
Published: August 2002

Monoclonal B lymphocytosis of undetermined significance (MLUS) is a benign condition of clonal lymphocytosis. Because of its clonal small lymphocytes and indolent clinical course, MLUS resembles and may be indistinguishable from an early stage of chronic lymphocytic leukemia (CLL). In this study we characterized the immunophenotype of MLUS. The clonal B lymphocytes from three patients of typical MLUS were shown to be CD5− and CD23− phenotype. Their immunophenotypic features remained unchanged during the clinical course. The results indicate a distinct immunophenotype of MLUS that can be useful for its diagnosis and differentiation from CLL. Am. J. Hematol. 69:147–149, 2002. © 2002 Wiley‐Liss, Inc.
Invasive pulmonary aspergillosis in neutropenic patients during hospital construction: Before and after chemoprophylaxis and institution of HEPA filters
Authors: Oren Ilana , Haddad Nohad , Finkelstein Renato , Rowe Jacob M.
Published: August 2002

Between September 1993 and December 1993, during extensive hospital construction and indoor renovation, a nosocomial outbreak of invasive pulmonary aspergillosis occurred in acute leukemia patients treated in a regular ward that has only natural ventilation. The observed infection rate was 50%. Chemoprophylaxis with intravenous continuous low‐dose amphotericin B was then instituted as a preventive measure. During the next 18 months invasive pulmonary aspergillosis developed in 43% of acute leukemia patients. After that period a new hematology ward was opened with an air filtration system through high‐efficiency particulate air filtration (HEPA) filters, and a bone marrow transplantation program was started on the hematology service. During the following three years, none of the acute leukemia or bone marrow transplantation patients who were hospitalized exclusively in the hematology ward developed invasive pulmonary aspergillosis, although 29% of acute leukemia patients who were housed in a regular ward, because of shortage of space in the new facility, still contracted invasive pulmonary aspergillosis. Overall, 31 patients were diagnosed with invasive pulmonary aspergillosis during almost five years: 74% of patients recovered from invasive pulmonary aspergillosis, and 42% are long‐term survivors; 26% of patients died of resistant leukemia with aspergillosis, but no one died of invasive pulmonary aspergillosis alone. In conclusion, during an on‐going construction period, an extremely high incidence rate of invasive pulmonary aspergillosis in acute leukemia patients undergoing intensive chemotherapy was observed. Institution of low‐dose intravenous amphotericin B prophylaxis marginally reduced the incidence rate of invasive pulmonary aspergillosis. Keeping patients in a special ward with air filtration through a HEPA system eliminated invasive pulmonary aspergillosis completely. Among patients who developed invasive pulmonary aspergillosis, early diagnosis and treatment are probably the explanation for the favorable outcome. Am. J. Hematol. 66:257–262, 2001. © 2001 Wiley‐Liss, Inc.