bluuebunny/crossref_metadata_2025 huggingface dataset:
Minicholecystectomy vs conventional cholecystectomy: A prospective randomized trial—Implications in the laparoscopic era
Authors: Assalia Ahmad , Schein Moshe , Kopelman Doron , Hashmonai Moshe
Published: May 2005

The objective of this study was to compare results of elective “open” conventional cholecystectomy (CC) to those of minicholecystectomy (MC). A clinical prospective, randomized trial was designed. The setting was an academic general surgical unit. In the CC group were 26 patients; in the MC group were 24 patients. In the CC group a conventional open cholecystectomy was performed through a subcostal incision; in the MC group operation through an initial 5‐cm subcostal incision was done. Mean length of wound was 14.4 cm and 5.4 cm in the two groups, respectively (p<0.001). Mean operative time was 60 and 59 minutes, respectively. Mean operative difficulty, estimated on a 1–10 scale, was 3.4 and 5.6, respectively (p<0.05). Mean postoperative analgesia requirements (number of doses of 10 mg morphine sulphate) were 5.8 and 4.0, respectively (p=0.002). Mean duration of hospitalization was 4.7 and 3.0 days, respectively (p<0.001). Mean “overall patient satisfaction,” estimated on 1–10 scale, was 6 and 8.3, respectively (p=0.002). We conclude that Minicholecystectomy offers less pain, earlier recovery, and better cosmetic results than the conventional “open” procedure. Published results of MC compare favorably with those of laparoscopic procedures. The implications of these results in the “laparoscopic era” are discussed.
Tumor spread in superficial esophageal cancer: Histopathologic basis for rational surgical treatment
Authors: Nishimaki Tadashi , Tanaka Otsuo , Suzuki Tsutomu , Aizawa Kikuo , Watanabe Hidenobu , Muto Terukazu
Published: May 2005

To formulate a rational approach for the surgical treatment of patients with superficial esophageal cancer (SEC), tumor spread was clinicopathologically studied in 89 patients with SEC. There were 31 mucosal and 58 submucosal tumors. Lymph node metastases were not found in any of those with a mucosal tumor, while one or more lymph nodes were positive for cancer in 41.4% of those with a submucosal tumor. Furthermore, cancer metastasized to extramediastinal nodes, including cervical and abdominal nodes, in 14 patients, accounting for 58.3% of those with nodal metastasis. The 5‐year survival rate was 100% and there were no recurrences after esophagectomy in those with a mucosal tumor, whereas the survival rate of those with a submucosal tumor was 64.3% at 5 years (p<0.01). Based on the different biological behavior of mucosal and submucosal esophageal cancer, we conclude that mucosal tumors may be adequately treated by any type of local resection but submucosal tumors require a subtotal esophagectomy with systematic lymphadenectomy involving the cervical, mediastinal, and abdominal nodes for cure.
Operative procedures of reconstruction after resection of esophageal cancer and the postoperative quality of life
Authors: Kuwano Hiroyuki , Ikebe Masahiko , Baba Kinya , Kitamura Kaoru , Toh Yasushi , Matsuda Hiroyuki , Sugimachi Keizo
Published: May 2005

To investigate the influence of the operative procedures of reconstruction after resection of esophageal cancer on the postoperative quality of life, an interview was conducted and subjective and objective factors related to the quality of life were evaluated in 50 patients without a recurrence of esophageal cancer. Among the 50 cases, reconstruction by the antethoracal route was performed in 9 (group I) and by the retrosternal route in 24 (group II). Intrathoracic anastomosis was done in 17 (group III). A postoperative disturbance of the food passage was seen 22.0, 41.6, and 5.9% in groups I, II, and III, respectively. Dumping symptom was evident 11.1, 12.5, and 11.8%, respectively. Heartburn was seen only in two cases, in group III. A body weight loss of more than 1.0 kg from preoperative weight was seen in 33.3, 41.7, and 41.2% of groups I, II, and III, respectively. There was no difference in the postoperative performance status or laboratory data among the groups. Thus, although intrathoracic anastomosis was favorable for postoperative food passage, there was no significant difference in any other factors in the quality of life among the routes of reconstruction, and the quality of life gradually improved in patients of all groups as postoperative time passed in the cases without postoperative recurrence of esophageal cancer.
T‐lymphocyte transformation in experimental obstructive jaundice: The role of serum‐suppressive factors
Authors: Thompson Ronald L. E. , Ranjbar Shahin , Rowlands Brian J.
Published: May 2005

Infective complications are a significant problem in the management of patients with obstructive jaundice, despite the widespread use of prophylactic antibiotics. The cause of this may be suppression of the immune system. This study investigates the effect of serum from an animal model of extrahepatic biliary obstruction (BDL) for 7, 14, and 21 days on the lymphoproliferative response of a single population of T‐lymphocytes to the mitogen phytohemagglutinin (PHA). Mean stimulation counts for lymphocytes cultured with 7 days with BDL serum (938±90p=0.04) and for 21 days with BDL serum (844±253p=0.04) are significantly lower than control serum (2382±1340). The effect of 14 days BDL serum has some suppression of lymphocyte stimulation but this is not significant (1115±429p=0.06). There was no significant correlation with any clinical parameters including bilirubin and the duration of jaundice. We have concluded that serum from animals with obstructive jaundice is immunosuppressive, but further studies are required to identify the factor and its role in vivo.
The role of selective visceral angiography in the management of pancreatic and periampullary cancer
Authors: Murugiah Mahadavan , Windsor John A. , Redhead Doris N. , O'Neill John S. , Suc Bertrand , Garden O. James , Carter David C.
Published: May 2005

A prospective study was undertaken to evaluate selective visceral angiography (SVA) in the management of patients with pancreatic and periampullary cancer. Over a 30‐month period 52 patients with potentially resectable pancreatic or periampullary cancer underwent SVA; 4 patients had obvious angiographic evidence of widely disseminated disease and were not subjected to laparotomy while 2 further patients were eventually considered too frail for resection. The remaining 46 patients (median age 58 years, range 37–73 years, males 26, females 20) had no evidence of disseminated disease on ultrasonography and/or CT scanning and had both SVA and surgery and form the basis of this study. Vascular anomalies were detected in 16/46 (35%) patients. Hepatic metastases were wrongly diagnosed by angiography in 7 out of 9 patients (77%). SVA correctly predicted resectability or irresectability in 28/46 patients (overall predictive value 61%). Of the 27 patients who proved to have irresectable disease at operation, 11 were correctly identified by SVA (sensitivity 41%). Of the 13 patients reported to have irresectable disease, 2 underwent resection (false‐positive rate 15%). Of the 33 patients reported to have resectable disease, 16 were irresectable (false‐negative rate 48%). Overall there was a poor relationship between resectability and the angiographic features. On the basis of these data, SVA cannot be considered a sufficiently accurate means of assessing resectability. Its use for this purpose in patients with pancreatic and periampullary cancer is not justified.
Emergency surgical treatment for bleeding duodenal ulcer: Oversewing plus vagotomy versus gastric resection, a controlled randomized trial
Authors: Millat Bertrand , Hay Jean‐Marie , Valleur Patrice , Fingerhut Abe , Fagniez Pierre‐Louis ,   The French Associations for Surgical Research
Published: May 2005

The best surgical procedure to treat bleeding bulbar peptic ulcer is unknown. The rates of postoperative bleeding recurrence, duodenal leakage, and mortality were compared in patients undergoing oversewing plus vagotomy (O+V) or gastric resection (GR) with ulcer excision. Of 202 patients undergoing emergency surgery for massive, persistent, or recurrent bleeding from bulbar peptic ulcer, 120 patients were enrolled in a prospective randomized trial. Fiftynine were assigned to O+V and 61 to GR. One patient in each group was excluded after randomization. The two groups were well matched with respect to clinical and prognostic factors. The rate of postoperative bleeding recurrence was 17% after O+V and 3% after GR (p<0.05). The duodenal leak rate was higher after GR than after O+V (13% vs. 3%) (p<0.10) but was not different when the morbidity of reoperations for bleeding recurrence after O+V was considered on an “intention to treat” basis (12% vs. 13%). Overall postoperative mortality was similar: 22% (O+V) versus 23% (GR). Sixteen deaths were unrelated to the surgical procedure itself. Of 82 nonrandomized patients, 10 were not analyzed. In the 72 other nonrandomized patients, bleeding recurrence, duodenal leakage, and postoperative mortality rates were consistent with the results of the controlled trial, as they were 29% (O+V 32%; GR 0.7%), 16% (O+V 0.7%; GR 26%) and 27% (O+V 18%; GR 33.3%), respectively. We conclude that GR with ulcer excision is the procedure of choice for the emergency surgical treatment of bleeding duodenal ulcer because postoperative bleeding recurrence is lower, and the overall rates of mortality and duodenal leakage are the same as with O+V.
Refundoplication for recurrent gastroesophageal reflux
Authors: Luostarinen Markku E. , Isolauri Jouko O. , Koskinen Matti O. , Laitinen Jukka O. , Matikainen Martti J. , Lindholm T. Sam
Published: May 2005

Reoperation after a failed antireflux procedure is a surgical challenge. Many operative techniques have been proposed, but reports on systematic follow‐up with endoscopy and esophageal function tests are few. The purpose of the present study was to evaluate the results of repeated fundoplication in cases of recurrent reflux, including assessment of esophageal function. Of the 18 cases of repeat fundoplication performed for recurrent reflux during 1970–1991 at Tampere University Hospital, 15 were evaluated a median of 18 (range 5–152) months after reoperation. Follow‐up studies included endoscopy in all and esophageal function tests (esophageal 24‐hour pH recording, manometry, and radionuclide transit) in 14 cases. All the patients had defective fundic wrap before reoperation, whereas at follow‐up 12 of the 15 wraps were intact. Reflux symptoms were diminished in all 15. Six patients (40%), however, had objective recurrence of reflux (esophagitis or pathologic pH recording). Three of the recurrences were due to slipped fundic wrap, but the others were probably caused by impaired esophageal function. By repeat fundoplication the wrap could be repaired as reliably as in primary operation. Symptomatic outcome and objective results were reasonable. The results were, however, not as good as after primary operation, which was due to more impaired esophageal motility caused by prolonged reflux or repeated surgery (or both).
Expression of a potential metastasis suppressor gene (nm23) in thyroid neoplasms
Authors: Farley David R. , Eberhardt Norman L. , Grant Clive S. , Schaid Daniel J. , van Heerden Jonathan A. , Hay Ian D. , Khosla Sundeep
Published: May 2005

Identification of multiple clinical and pathologic prognostic factors in differentiated thyroid cancer has permitted some degree of risk stratification. However, these clinical indices fail to distinguish potential intrinsic differences in tumor virulence. The nm23 gene has been identified as a potential metastasis suppressor gene that is homologous to nucleoside diphosphate kinases. Studies in human breast cancer have shown a significant inverse correlation between nm23 levels and nodal involvement/tumor recurrence. Given the possible clinical utility of a marker of metastatic potential in the management of thyroid carcinoma, we examined 34 thyroid neoplasms and a human medullary thyroid cancer (MTC) cell line (TT) for nm23 expression. Normalized nm23 expression was assessed by Northern analysis of tumor RNA. nm23 Expression (tumor expression/TT cell expression, mean ±SE) was 1.14 ±0.15* in MTCs (n =5), 0.70 ±0.10* in follicular cancers (n=6), 0.51 ±0.11 in papillary cancers (n=19), and 0.31 ±0.03 in follicular adenomas (n=4) (*p< 0.05 when compared to adenomas). Within histologicgroups, we found no correlation between nm23 expression and nodal involvement or distant métastases. Our results indicate that thyroid neoplasms of different histologies express varying levels of the nm23 transcript. Although nm23 expression seems diminished in metastatic breast cancer, it appears not to be the case in metastatic thyroid cancer. The nm23 gene may therefore have different roles in the evolution and metastases of different neoplasms.
Operative ultrasonography during hepatobiliary and pancreatic surgery
Authors: Machi Junji , Sigel Bernard , Zaren Howard A. , Kurohiji Toshihiko , Yamashita Yuichi
Published: May 2005

On the basis of our experience with operative ultrasonography during hepatobiliary and pancreatic surgery, its indications, benefits, and disadvantages are summarized. High‐ resolution operative ultrasound scanning of the liver, biliary tract, and pancreas was performed during 357, 735, and 242 operations, respectively. The benefits of operative ultrasonography were categorized as acquisition of diagnostic information otherwise not available, replacement for or complement to operative radiography, and guidance of surgical procedures. Operative ultrasonography provided beneficial information during 73 of 82 hepatic operations (89.0%), 57 of 69 noncalculous biliary operations (82.6%), and 177 of 242 pancreatic operations (73.1%). Operative ultrasonography was significantly superior (sensitivity 93.3%) to other screening tests for diagnosing liver metastasis from colorectal carcinoma evaluated in 189 patients, and it detected previously unrecognized metastatic tumors in 18 patients (9.5%). For screening common bile duct calculi during 666 operations, operative ultrasonography and operative cholangiography were comparable in all indices of accuracy except for a higher predictability of a positive test of operative ultrasonography (94.8% versus 71.7%). For diagnosing portal vein invasion of pancreatic carcinoma, operative ultrasonography provided better overall accuracy than preoperative studies (89.7% versus 64.1%). On the basis of operative ultrasound findings, previously planned surgical procedures were altered in 32 of 82 hepatic operations (39.0%) and 24 of 145 pancreatic operations for chronic pancreatitis (16.6%). Operative ultrasound guidance of various surgical procedures was performed during 88 hepatic and 84 pancreatic operations, including 40 ultrasound‐ guided hepatectomies and 42 pancreatotomies. Operative ultrasonography has a number of advantages, such as safety and speed in performance, wide application, high diagnostic accuracy, and ability of guiding procedures. Its disadvantages are the limitation of the fields of view in certain applications, the need for special equipment, and a slow learning curve.
Operative results in 143 patients with hepatocellular carcinoma
Authors: Segawa Tohru , Tsuchiya Ryoichi , Furui Junichiro , Izawa Kunihide , Tsunoda Tsukasa , Kanematsu Takashi
Published: May 2005

A total of 143 patients who underwent hepatic resection for hepatocellular carcinoma in our department were reviewed. The review was conducted for two periods: 1970–1982 (early period) and 1983–1990 (late period), that is, the periods before and after introduction of the hepatic surgical technique involving the use of a microwave tissue coagulator and ultrasonic dissector. One patient underwent extended lobectomy, 12 lobectomy, 9 segmentectomy, and 26 partial hepatectomy during the early period. Two patients underwent extended lobectomy, 7 lobectomy, 9 segmentectomy, 36 subsegmentectomy, and 41 partial hepatectomy during the late period. Operative mortality and hospital mortality were 16.7% and 22.9% during the early period and 1.1% and 8.4% during the late period, respectively. The overall mortality rate was significantly lower during the late period than during the early period. Postoperative complications developed in 62.5% of the patients with hepatic resection during the early period and in 48.4% of the patients during the late period. The size of tumors during the early period was significantly greater than that during the late period. Intraoperative blood loss during the late period was significantly lower than that during the early period. The survival curve was better among patients who underwent hepatic resection during the late period than among those during the early period. The satisfactory results during the late period are due to the introduction of intraoperative ultrasonography, microwave tissue coagulation, and ultrasonic dissection for hepatic surgery.
Recent advances in medical imaging: Surgery planning and simulation
Authors: McEwan Christopher Neill , Fukuta Keizo
Published: May 2005

Three‐dimensional display of medical image data has under gone rapid development since its introduction. This article explores the current state‐of‐the‐art of 3‐dimensional imaging applied to surgery planning and discusses the various image acquisition sources: computed tomography (CT), cine CT, magnetic resonance imaging, and ultrasound. Since increased physician involvement is the goal of the surgery planning software described, the future directions discussed emphasize the inclusion of “expert“ knowledge and ways to facilitate realistic interaction for surgery simulation.
Cephaloceles: Classification, pathology, and management
Authors: David David J. , Proudman Timothy W.
Published: May 2005

A cephalocele is defined as a herniation of cranial contents through a defect in the skull. Cephaloceles are classified according to their contents and location. We have reviewed a total of 112 patients with cephaloceles, 51 of whom had sincipital meningoencephaloceles (fronto‐ethmoidal meningoencephaloceles). This group is distinctive in its demographic distribution, in the effect on growth of other facial structures, and in the combined craniofacial approach needed to treat them. This review is based on the sincipital encephaloceles with the other cephaloceles included for completeness. Despite many theories, the cause of congenital cephalocele is not known. Preoperative work‐up includes 3‐dimensional computed tomography scan of the facial skeleton, and surgical management is multidisciplinary in nature. The aim is to remove the lesion before the deformity has time to greatly distort facial growth, which appears to realign itself after surgery. The 50 patients who underwent surgery for fronto‐ethmoidal encephalocele all survived with minimal complications.
Early operation in craniofacial dysostosis
Authors: Mühlbauer Wolfgang , Anderl Hans , Heeckt Peter , Schmidt Andreas , Zenker Jörg , Höpner Frank , Schaarschmidt Bernd
Published: May 2005

Craniofacial dysostosis is encountered in different congenital malformations such as Kleeblattschädel deformity, Crouzon's disease, and Apert's, Chotzen's, Pfeiffer's, and Carpenter's syndromes. Premature closure of cranial and facial sutures leads to characteristic disfigurement of the skull with orbital and maxillary hypoplasia. Operative treatment should be performed as early in life as possible to prevent further functional and esthetic deficiencies, and psychosocial problems. Correction is done by an intracranial approach with mobilization, remodeling, and advancement of the deformed skull. Thirty‐two children have been operated during the first year of life with a maximum follow‐up of 8 years. Most favorable results were obtained in 28 cases. The rate of complications were lower than in a series of children operated on later in life. We advocate that complex 1‐stage corrections of craniofacial syndromes may be safely carried out during infancy utilizing modern techniques, expert pediatric anesthesia, and postoperative intensive care.
Facial clefts
Authors: van der Meulen Jacques C. H. , Vaandrager J. Michiel
Published: May 2005

Facial clefts, including those of the lip and palate, are extremely rare. Some arise at the junction of facial processes preventing fusion, others have their origin in or between ossification centers. Virtually all are associated with osseous deficiencies.

This article reviews the pathogenesis and morphology of these clefts. The principles of skeletal and soft tissue reconstruction are discussed and the experience of the authors with various new techniques is reported.
Correction of orbital hypertelorism in Asian patients
Authors: Ohmori Kitaro
Published: May 2005

In this article, correction of orbital hypertelorism in Oriental patients is summarized. An orbital osteotomy is currently used to correct an abnormally wide interorbital distance. At present, associated deformities such as a short nose and a depression deformity in the temporal region following orbital osteotomy can be partially corrected. In Oriental patients, the Mongolian fold can be enhanced after correction of orbital hypertelorism. This fold can be easily corrected by epicantoplasty.
Hemifacial microsomia
Authors: Poole Michael D.
Published: May 2005

Hemifacial microsomia is variable with respect to the degree of the deformity it presents, thus, treatment varies. Mild degrees of the condition are usually treated adequately by waiting until adolescence, when definitive surgical correction of any skeletal or soft tissue asymmetry can be dealt with. Some mild and moderate cases may benefit from orthodontic functional appliance therapy during growth, but orthodontic opinion is divided on the value of such therapy. Children with severe forms of hemifacial microsomia are improved in appearance during their school years by early surgery performed in the preschool period. A number of surgical approaches have been used at this stage. The technique currently being used by the author involves composite transfer of vascularized soft tissue for contouring, together with a vascularized costochondral strut to lengthen the affected side of the mandible. Early results using this method are satisfactory, but further work is required to assess the advantages of this over other techniques.
Midface retrusion
Authors: Ortiz‐Monasterio Fernando , Musolas Alberto
Published: May 2005

Experience with 162 patients for whom a midface advancement was performed over the last 10 years is reported. The series includes cases of primary maxillary hypoplasia, post‐cleft deformities, and major craniofacial anomalies. The indications and techniques applicable to each particular deformity are discussed and final results are analyzed. The overall facial esthetic concept is emphasized to ensure achievement of not only a good functional result, but also a pleasant appearance.
Craniofacial trauma
Authors: Merville L. C. , Diner P. A. , Blomgren I.
Published: May 2005

The treatment of combined major dislocations of the face and skull requires a craniofacial team consisting of a plastic maxillofacial surgeon, a neurosurgeon, an anesthesiologist, and radiologists. The best results can only be achieved at the primary intervention both from a functional and an esthetic standpoint. Careful preoperative clinical and radiologic examinations are mandatory to reach these high goals.

In primary repair, the cranial approach aims at constructing “a monobloc bone flap“ to suture meningeal tears and to reinforce them with a pericranial graft, to close the cranial base completely using cancellous bone grafts, and to exclude the frontal sinuses. The facial skeleton is repaired by constructing a rigid external facial frame and thereafter progressing centrally finishing with the “internal“ orbitonasal dislocations. The reconstruction aims at a self‐stabilizing bone puzzle fixed with interosseous wires, making external fixation unnecessary. Secondary repair requires osteotomies at fracture sites to reposition malunited fractures and the use of autogenous bone grafts for stabilization.
Advances in craniofacial tumor surgery
Authors: Jackson Ian T.
Published: May 2005

The use of craniofacial surgical techniques has stimulated the development of new approaches to the excision of skull base tumors. Experience gained from operating on 200 skull base tumors (45 nonmalignant and 155 malignant) is presented. The cranial base area is subdivided into specific areas, and surgical approaches have been devised. In addition, the use of vascularized tissue such as the galea, temporalis fascia, temporalis muscle, or free vascularized tissue transfer has prevented the complication of infection so frequently seen as a cause for morbidity and mortality in the past.

In this series, there were no major infections. The variety of pathology seen in this area is considerable. Therefore, in a series such as this operated on by a single surgeon, only trends can be observed. We suggest that with experience, surgery in this area is safe, and the long‐term survival of this mixture of tumors (primary, recurrent, carcinomas, and sarcomas) is between 40% and 50%, and, therefore, makes excisional procedures worthwhile.
The contribution of microsurgical reconstruction to craniofacial surgery
Authors: Jones Neil Ford
Published: May 2005

Craniofacial surgery has revolutionized the surgical treatment of congenital anomalies affecting the facial and cranial skeleton. Similar techniques have since been used in the reconstruction of patients with extensive craniofacial injuries and following craniofacial resection of tumors involving the midface. The application of microsurgical free flaps to some of these craniofacial problems is another significant advance.

Microsurgical transfer of deepithelialized skin flaps or omentum will allow the augmentation of soft tissue contour defects of the face in patients with hemifacial microsomia and Romberg's progressive facial hemiatrophy. Following craniofacial resection of extensive tumors of the midface, microsurgical free flaps and vascularized bone grafts will provide soft tissue coverage and, occasionally, both bone and soft tissue composite reconstruction of the resultant defect. Finally, intracranial infection, following Craniofacial Surgery and neurosurgical excision of tumors involving the skull base, may be effectively prevented by separation of the dura from the nasopharynx by microsurgical transfer of free muscle flaps and omentum.
Posttraumatic skeletal muscle proteolysis: The role of the hormonal environment
Authors: Bessey Palmer Q. , Jiang Zhu‐ming , Johnson Daniel J. , Smith Robert J. , Wilmore Douglas W.
Published: May 2005

To investigate the role of hormones as mediators of net skeletal muscle proteolysis following injury, healthy normal male volunteers received a continuous 76‐hour infusion of the 3 “stress“ hormones: hydrocortisone, glucagon, and epinephrine. As a control, each subject received a saline infusion during another 4‐day period. Ten paired studies were conducted. Diets were constant and matched on both occasions. Triple hormone infusion achieved hormone concentrations similar to those seen following mild‐moderate injury. After 72 hours of infusion, skeletal muscle intracellular glutamine concentrations were lower in the hormone studies than in the control group (N=4). Free amino acid concentrations in arterial whole blood and forearm amino acid efflux were little affected by hormonal infusion. Thus, alteration of the hormonal environment by the triple hormone infusion was not a sufficient stimulus to induce all of the changes in skeletal muscle proteolysis observed in critical illness. Since studies utilizing neurohormonal blockade have shown diminished net muscle proteolysis, the stress hormones appear to be necessary but not sufficient for the protein catabolic response to injury.
Modulation of inflammatory reactions by surgical trauma: Lack of relationship with corticosteroid secretion
Authors: Kinnaert Paul , Van Geertruyden Nancy , DePauw Luc , Van Gansbeke Bernard , Bournonville Bernadette , DeCoster‐Gervy Christine
Published: May 2005

The effect of surgery on inflammation was studied in male Wistar R/A rats using the carrageenin‐induced edema model. Swelling of the paw was measured in standardized arbitrary units 2, 4, and 6 hr after a subcutaneous injection of carrageenin iota in the subplantar region of the right hind limb. It was significantly depressed in rats submitted to laparotomy (5.0±0.4, 8.0±1.0, 13.7±1.9) when compared with controls simply anesthetized with ether (6.2±0.5, 15.5±1.2, 23.7±0.6) (p<0.001 at 4 and 6 hr). This inhibition lasted for at least 24 hr and was also observed after amputation, although in these experiments, the difference between operated animals and controls was not significant. Alterations of the inflammatory cellular infiltrate were studied using polyurethane sponges soaked with carrageenin lambda implanted subcutaneously in control animals and rats undergoing laparotomy or amputation. The total number of cells recovered from these sponges 5 hr after implantation was smaller in operated rats (2.9±0.4×106cells after laparotomy, 3.1±1.0 ×106cells after amputation) when compared with controls (11.1±1.9× 106cells and 10.3±1.3×106cells) (p<0.001 for laparotomy andp< 0.005 for amputation). The inhibitory effect of operative trauma was not abolished by bilateral adrenalectomy performed 12 days before laparotomy. In rats, surgical trauma induces a depression of remote inflammatory reactions. This phenomenon is not related to increased corticosterone levels.
Prognosis of patients over 75 years of age with a ruptured abdominal aortic aneurysm
Authors: Salo Jarmo A. , Perhoniemi Vesa J. , Lepäntalo Mauri J. A. , Mattila Petri S.
Published: May 2005

Forty‐seven patients (34 males and 13 females) over 75 years of age (mean: 79.7±3.8 SD) suffering from a ruptured abdominal aortic aneurysm were operated on between 1977 and 1986. In 16 patients (34%), the aneurysm had been diagnosed previously. Seventeen patients (36%) had a delay of 6 hours or more in the beginning of the treatment and 26 (55%) were in shock preoperatively. The mean diameter of the aneurysms was 8.9±2.6 cm (SD) and the mean operative bleeding was 8.5±7.8 (SD) liters. The mean operating time was 220±96 (SD) minutes. The 1‐month mortality was 60% (28 patients) and 63% (12 patients) of survivors had postoperative complications, mostly pneumonia. The 5‐year survival rate was 26%. In the analysis of risk factors associated with death, preoperative shock, old age, and a previously diagnosed but untreated abdominal aortic aneurysm were associated with a significantly worse prognosis.
Pancreas and islet transplantation
Authors: Sutherland David E. R. , Matas Arthur J. , Najarian John S.
Published: May 2005

Considerable evidence supports the hypothesis that the microangiopathic lesions of diabetes are secondary to disordered metabolism. This hypothesis underlies the rationale for whole pancreas and islet transplantation. Whole pancreas transplantation has had limited clinical success—only 1 of 47 recipients reported to the ACS/NIH Transplant Registry is currently alive. Major problems have been allograft rejection and complications related to either the exocrine pancreas or concomitant transplantation of the duodenum. Experimental approaches to whole pancreas transplantation include use of duct‐ligated organs or extraperitoneal transplantation of segmental grafts, with exocrine duct drainage established to either host ureter or a retroperitoneal Roux‐en‐y loop of bowel. The difficulties with whole pancreas transplantation have stimulated the development of techniques allowing transplantation of islet tissue as a free graft. Transplantation of purified adult islets, of dispersed neonatal pancreas, or of adult pancreatic fragments with exocrine enzymes inactivated can effectively ameliorate experimental diabetes when transplanted to either the intraperitoneal or portal vein sites. In dogs, adult pancreatic fragments containing both islet and exocrine tissue components can effectively ameliorate diabetes when transplanted to the spleen. The first clinical trials of islet transplantation used only small quantities of purified islets. Although insulin requirements of some recipients were reduced, a completely successful islet transplantation in humans has not been accomplished. Procurement of a sufficient quantity of islet tissue and prevention of allograft rejection are major problems, but solutions appear to be forthcoming from the laboratory. The ability of both whole pancreas and islet transplantation to prevent the development or halt the progression of secondary lesions in experimental diabetes provides an impetus to pursue such an approach in humans.
Comparison of postoperative complications following radical and modified radical mastectomy
Authors: Feigenberg Zvi , Zer Michael , Dintsman Moshe
Published: May 2005

A retrospective study was carried out by reviewing the files of 100 patients who had undergone radical mastectomy and 100 patients who had undergone modified radical mastectomy from 1966 to 1975 for the purpose of comparing early and late complications. In each group, 80 patients were involved in long‐term follow‐up. Immediate postoperative complications—notably seromas, wound infection, and flap necrosis—were found to be considerably fewer following modified radical mastectomy. There was also a significantly lower incidence of late complications, such as limb edema and recurrent infection, after modified radical mastectomy. Since the cure rates achieved by the two radical mastectomy procedures appear to be similar, it is concluded that modified radical mastectomy is the procedure of choice in stages I and II cancer of the breast.
The effect of selective proximal vagotomy with and without pyloroplasty on serum gastrin levels and acid secretion after feeding and sham feeding in dogs
Authors: Bauer H. , Holle F. , Okukubo F. , Andersson S. , Arnold R. , Creutzfeldt W.
Published: May 2005

In a first operative stage, 4 dogs were prepared with Heidenhain pouches (HP) and 3 with Pavlov pouches (PP), 2 of the latter with an additional esophageal cannula. In a second stage all dogs had a selective proximal vagotomy (SPV), and in a third stage a submucosal pyloroplasty (P). Sham feeding experiments were carried out on the 2 dogs with PP and an esophageal fistula before and after SPV. Feeding tests were performed in all animals after the three operative procedures. Gastrin release after sham feeding increased significantly after SPV, whereas PP acid secretion was abolished. Gastrin release after feeding increased significantly after SPV in both HP and PP dogs. Acid secretion from HP was correlated with the changes in postprandial serum gastrin levels. PP acid secretion was diminished after SPV, in spite of the elevated gastrin levels. Subsequent pyloroplasty induced a significant decrease in the postprandial gastrin levels in both HP and PP dogs. However, acid secretion decreased significantly only in HP dogs.
Ureterocystostomy in renal transplantation: Comparison of endo‐ and extravesical anastomoses
Authors: Hooghe L. , Kinnaert P. , Schulman C. C. , Toussaint C. , Van Geertruyden J. , Vereerstraeten P.
Published: May 2005

Among 241 renal transplants with implantation of the ureter into the urinary bladder, the endovesical technique of Politano and Leadbetter (PL) was used in 108 cases and the extravesical technique of Grégoir and Lieh (GrL) was used in 133. Urinary fistulas occurred in 10 patients (9.3%) with the PL technique and in only 1 patient (0.8%) with the GrL technique. The difference was highly significant (p<0.01). Stenosis of the ureter developed in 3 patients (2.8%) following the PL technique and in 9 patients (6.8%) after the GrL technique, an insignificant difference (p>0.10). None of the complications resulted in death or failure of transplantation. It is concluded that the extravesical technique of Grégoir and Lich is the best method of avoiding urinary leakage, which is the most dangerous urologic complication of kidney transplantation.
A 44‐year experience with tuberculous enterocolitis
Authors: Homan William P. , Grafe William R. , Dineen Peter
Published: May 2005

Thirty‐one eases of intestinal tuberculosis, diagnosed from 1932 through 1975 at The New York Hospital‐Cornell Medical Center, were reviewed with particular reference to the impact of antituberculous chemotherapy on the outcome of the disease and to the role of surgery in diagnosis and treatment. The chest X‐ray was 90% effective in demonstrating evidence of tuberculosis in this series. However, since even on gross examination differentiation of intestinal tuberculosis from Crohn's disease or neoplasia may be impossible, surgical exploration is indicated when diagnosis is in doubt and biopsy and culture of intra‐abdominal tissue should be performed for diagnostic purposes. The importance of instituting immediate therapy is emphasized by a 67% mortality rate in the prestreptomycin era and a 21% mortality rate in patients receiving appropriate drug therapy. Because of the success of chemotherapy, intestinal resection is seldom indicated, except in those cases in which scarring and stricture formation demand surgical relief of intestinal obstruction, or in which the complications of fistula, hemorrhage, or perforation may occur.
Experience with the use of propranolol in the surgical management of thyrotoxicosis
Authors: Starling James R. , Thomas Colin G.
Published: May 2005

A review of the preoperative preparation of 47 patients undergoing subtotal thyroidectomy for thyrotoxicosis was carried out to evaluate the role of propranolol hydrochloride. Based on the premise that subtotal thyroidectomy is performed at least risk in the patient who is euthyroid, propranolol has its primary role as an adjunct to preparation with thioamide drugs. The most common indications for its use are inadequate control with thioamides and drug toxicity. Less frequent indications are its use in pregnant patients and patients who cannot be relied on to comply with a medical regimen outside the hospital environment. Patients can safely be treated preoperatively in the hospital in a reasonable period of time. When propranolol is used without thioamide drugs, the addition of Lugol's solution is of value in control of the thyrotoxicosis.
Symptom Severity as a Predictor of Reported Differences of Prehospital Delay between Medical Records and Structured Interviews among Patients with AMI
Authors: Fukuoka Yoshimi , Dracup Kathleen , Ohno Miyoshi , Kobayashi Fumio , Hirayama Haruo
Published: May 2005

Background: The time interval from symptom onset to hospital arrival can guide the decision to start reperfusion for patients with acute myocardial infarction (AMI).

Aims: The aims of the study were 1) to examine the consistency and agreement of prehospital delay time between medical record review and structured patient interview and 2) to identify whether symptom severity is an independent predictor of differences in reported prehospital delay between these two data sources.

Methods: In this cross-sectional study, a convenience sample of 155 patients with AMI in Japan was recruited. The time and date of symptom onset were obtained from medical record review and a structured patient interview. The interviewer asked about severity of symptoms, using a scale on 0 to 10 scale, with 0 being “no symptom” and 10 being “the most severe symptoms imaginable”.

Results: The prehospital delay time from the medical record was significantly shorter than from the structured interview. Perfect agreement of reported prehospital delay time between two data sources was found in 46% of patients. Patients with symptom severity scores of greater than 8 on a 10-point scale were 2.2 times (95% CI: Odds Ratio 1.1 to 5.1) more likely to report different symptom onset time.

Conclusions: Prehospital delay time documented in the medical record was shorter than that identified from a structured interview. In addition, the discrepancy between the two data sources may be larger in those patients with severe AMI symptoms.
Fragility—The Price of Renewed Life. Patients Experiences of Open Heart Surgery
Authors: Karlsson Ann-Kristin , Johansson Mats , Lidell Evy
Published: May 2005

Background: Open heart surgery often implies a threat to life and is associated with fear and anxiety. It is also a strong encroachment on body and integrity and adjusting life afterwards could be difficult. Despite improvements in treatment the patients' reactions appear to be unchanged. Introducing a lifeworld perspective would supply a different kind of knowledge based upon the patients' own experiences coloured by their linguistic usage and bodily expressions.

Aim: The aim of this study was to describe patients' experiences of open heart surgery in a lifeworld perspective.

Method: Fourteen patients treated with coronary artery bypass surgery and/or heart valve operation were in-depth interviewed in 2003. The phenomenological method was used for the interviews as well as for the analysis. The informants reflected on their experiences of the illness, meetings with health care, family relations and wishes for the future.

Findings: The essence of the phenomenon was fragility. Fragility was understood through the following categories: distance, uncertainty, vulnerability, reliance and gratitude.

Conclusions: Patients want to be treated as unique individuals. They ask for more dialogues with the staff. Awareness of their supposed lifelong fragility implies that health care staff acquires an open and holistic approach.
BNP as a marker of diastolic dysfunction in the general population: Importance of left ventricular hypertrophy
Authors: Lukowicz T.v. , Fischer M. , Hense H.W. , Döring A. , Stritzke J. , Riegger G. , Schunkert H. , Luchner A.
Published: May 2005

BNP is a marker of systolic left ventricular dysfunction (LVSD) and heart failure. To assess BNP for the detection of diastolic dysfunction in the general population, we examined 1678 subjects within an age‐ and sex‐stratified survey (MONICA Augsburg). BNP was measured using a commercially available RIA (Shionogi).

BNP increased in subjects with diastolic dysfunction (mean 20.3±4.7 pg/ml vs. control 9.6±0.5 pg/ml, p<0.001), but to a lesser extent than in subjects with LV hypertrophy (LVH, mean 37.3±49.1 pg/ml, p<0.001 vs. control) or LVSD (mean 76.2±23.2 pg/ml, p<0.001 vs. control). Individuals with sole diastolic abnormality displayed BNP concentrations at the control level (mean 9.7±1.7 pg/ml). In univariate analysis, age, BMI, systolic blood pressure, left atrial size, LV mass index, diastolic dysfunction and EF displayed a significant correlation with BNP (p<0.001). However, LV mass index displaced diastolic dysfunction as a significant predictor of BNP in multivariate analysis. Upon ROC analysis, sensitivity and specificity for the detection of diastolic dysfunction by BNP were only 61% and 55%, respectively. Nevertheless, a normal BNP test virtually excluded the presence of diastolic dysfunction and concomitant LVH (NPV 99.9%).

Increased BNP concentrations in subjects with diastolic dysfunction are strongly related to LVH. Population‐wide screening for diastolic dysfunction with BNP cannot be recommended although a normal BNP test usually excludes diastolic dysfunction and LV hypertrophy.
Outcome of adenotonsillectomy for obstructive sleep apnea in children under 3 years
Authors: Mitchell Ron B. , Kelly James
Published: May 2005

OBJECTIVE

To study the outcome of adenotonsillectomy for obstructive sleep apnea (OSA) in children less than 3 years of age.

DESIGN AND SETTING

Prospective study at the University of New Mexico Children's Hospital. Children with OSA underwent pre‐ and postoperative full‐night polysomnography (PSG). Scores were compared using a paired t test. A P‐value <0.05 was considered significant.

RESULTS

The study population included 20 children. Fifteen (75%) were male. The mean age was 2.2 years (range, 1.1 to 3.0). Sixteen (80%) children had medical comorbidities. Over 25% of children had postoperative complications including laryngospasm and marked desaturations. The mean preoperative respiratory distress index (RDI) was 34.1 and the mean postoperative RDI was 12.2 (P < 0.0001). After surgery, 7 (35%) children had an RDI < 5. Thirteen (65%) had a postoperative RDI ≥ 5 indicating persistent OSA.

CONCLUSION AND SIGNIFICANCE

Children under 3 years show significant improvement in RDI after adenotonsillectomy for OSA, but they may develop complications after surgery. Postoperative PSG is recommended for children under 3 years of age to monitor the severity of persistent OSA. EBM rating: B‐2. (Otolaryngol Head Neck Surg 2005;132:681‐684.)
Migration and schizophrenia
Authors: Bhugra Dinesh
Published: May 2005

Objective: Since the beginning of the human race, individuals have migrated alone or in groups. This process of migration has often been considered to be an aetiological factor in the genesis of many mental disorders.

Method: Two studies collecting rates of first onset schizophrenia in Trinidad and in London using the same assessment instruments.

Results: The sending countries have low rates of schizophrenia. The impact of migration itself produces high stress but rates of schizophrenia are even higher in the second generation, suggesting that that other social factors may be responsible for the increase if genetic vulnerability is excluded.

Conclusion: Individual social factors, such as cultural identity and the impact of racism, are more likely to play a key role in the genesis of schizophrenia.
Epilepsy and Apoptosis Pathways
Authors: Henshall David C , Simon Roger P
Published: May 2005

Epilepsy is a common, chronic neurologic disorder characterized by recurrent unprovoked seizures. Experimental modeling and clinical neuroimaging of patients has shown that certain seizures are capable of causing neuronal death. Such brain injury may contribute to epileptogenesis, impairments in cognitive function or the epilepsy phenotype. Research into cell death after seizures has identified the induction of the molecular machinery of apoptosis. Here, the authors review the clinical and experimental evidence for apoptotic cell death pathway function in the wake of seizure activity. We summarize work showing intrinsic (mitochondrial) and extrinsic (death receptor) apoptotic pathway function after seizures, activation of the caspase and Bcl-2 families of cell death modulators and the acute and chronic neuropathologic impact of intervening in these molecular cascades. Finally, we describe evolving data on nonlethal roles for these proteins in neuronal restructuring and cell excitability that have implications for shaping the epilepsy phenotype. This review highlights the work to date on apoptosis pathway signaling during seizure-induced neuronal death and epileptogenesis, and speculates on how emerging roles in brain remodeling and excitability have enriched the number of therapeutic strategies for protection against seizure-damage and epileptogenesis.
Mechanism of strain-induced crystallization in filled and unfilled natural rubber vulcanizates
Authors: Poompradub Sirilux , Tosaka Masatoshi , Kohjiya Shinzo , Ikeda Yuko , Toki Shigeyuki , Sics Igors , Hsiao Benjamin S.
Published: May 2005

Structure evolution during deformation of unfilled natural rubber (NR) vulcanizate and filled ones with carbon black or calcium carbonate was investigated by the synchrotron x-ray diffraction. The crystallization onset strain, α0, was found to decrease by the inclusion of the filler. However, corrected α0 values into the effective strain ratio of deformable rubber portion were almost constant between filled and unfilled samples. Accordingly, our model of strain-induced crystallization of unfilled NR vulcanizates, assuming that melting temperature is independent of network-chain length (n), was applied to the filled samples. The discrepancy between classical theories and experimental results was thought to come from the distribution of n. By the inclusion of filler, the lateral crystallite size was decreased but the orientational fluctuation increased. The lattice of the strain-induced crystallites changed almost linearly with the nominal stress. In addition, the degree of lattice deformation decreased with the filler content, especially in the carbon black-filled system. All these experimental results are consistent with the proposed model.