bluuebunny/crossref_metadata_2025 huggingface dataset:
Differential expression of proteins in rat plasma exposed to benzene
Authors: Lee Hyun‐Ju , Lee Do‐Youn , Joo Won‐A , Sul Donggeun , Lee Eunil , Kim Chan‐Wha
Published: October 2004

Benzene, a ubiquitous environmental contaminant, is an important solvent in the chemical industry and is also known as a constituent of petroleum. It has been reported that benzene is associated with hematotoxicity including leukemia in humans and cancer in laboratory animals. To study protein expression alterations in rat plasma exposed to benzene, rats were exposed to levels of 1, 10, 100 ppm benzine for 6 h/day and 5 d/week for 2 or 6 weeks. Two‐dimensional gel electrophoresis of rat plasma was carried out, and approximately 1000 protein spots were detected on the gels. The 11 spots which showed significantly different expression were selected and identified with matrix‐assisted laser desorption/ionization‐time of flight‐mass spectrometry. Analyzing the targeted 11 spots, there was no correlation between the 2 and 6 weeks benzene‐inhaled groups on up‐regulated proteins (zinc finger protein, and tristetraprolin) and on down‐regulated proteins (cAMP‐regulated guanine nucleotide exchange factor II, protein kinase and unknown protein). The overexpressed proteins (inhibitor of κB‐like protein, GTP‐binding protein rab14, T‐cell receptor alpha chain, and somatostatin transactivating factor‐1) were detected only in groups inhaling benzene for 6 weeks. Among them the expression level of T‐cell receptor alpha chain was confirmed by Western blot.
Local orbitals for the study of the π→π* excitation in polyenes
Authors: Pitarch‐Ruiz J. , Evangelisti S. , Maynau D.
Published: October 2004

Localized orbitals have recently been employed in large ab initio calculations, but their use has generally been restricted to ground‐state problems. In this work, we analyze the molecular orbitals of the excited states, optimized with a recently proposed local procedure. This method produces local orbitals of the CAS–SCF type, which permits its application to the study of excited states. In particular, we focus on the π→π* triplet excited state in polyenes, calculated using a 2/2 CAS space which includes two electrons in one π and one π* orbitals. In small polyenes, these two singly occupied active orbitals are delocalized all along the molecule. The extent of the delocalization is analyzed by studying polyenes of increasing size. Different polyenes have been studied, going from C14H16 to the C70H72 polyene. The relation of the π→π* excitation with the cation and anion systems is also discussed. © 2004 Wiley Periodicals, Inc. Int J Quantum Chem, 2005
Use of C60 cluster projectiles for sputter depth profiling of polycrystalline metals
Authors: Sun S. , Szakal C. , Roll T. , Mazarov P. , Wucher A. , Winograd N.
Published: October 2004

We have investigated the merits of fullerene cluster ions as projectiles in time‐of‐flight secondary neutral mass spectrometry (ToF‐SNMS) sputter depth profiling of an Ni:Cr multilayer sample similar to the corresponding NIST depth profiling standard. It is shown that sputter erosion under bombardment with C60+ ions of kinetic energies between 10 and 20 keV provides good depth resolution corresponding to interface widths of several nanometres. This depth resolution is maintained during the complete removal of the multilayer stack with a total thickness of 500 nm. This finding is in contrast to the case where atomic Ga+ projectile ions of comparable kinetic energy are used, demonstrating the unique features of cluster projectiles in sputter depth profiling. Copyright © 2004 John Wiley & Sons, Ltd.
Error estimation in peak‐shape analysis of XPS core‐level spectra using UNIFIT 2003: how significant are the results of peak fits?
Authors: Hesse R. , Chassé T. , Streubel P. , Szargan R.
Published: October 2004

An error analysis for numerically evaluating random uncertainties in x‐ray photoelectron spectroscopy has been implemented in version 2003 of the spectra treatment and analysis software UNIFIT in order to improve the understanding of the statistical basis and the reliability of the model parameters for photoelectron spectra. The theoretical basis as well as two approaches to obtain error limits of the fit parameters have been considered. Several test spectra have been analysed and discussed. A representative example has been chosen to demonstrate the relevance of the error estimation for practical surface analysis. Suggestions for the minimization of errors in the peak‐fitting procedures are presented. Copyright © 2004 John Wiley & Sons, Ltd.
Variation of the electron inelastic mean free path during depth profiling of the Fe/Si interface as determined by quantitative REELS
Authors: Prieto P. , Hofmann S. , Elizalde E. , Sanz J. M.
Published: October 2004

The aim of this work is to determine the dependence of the electron inelastic mean free path (IMFP) at the Fe/Si interface during depth profiling by sputtering with 3 keV Ar+ ions. In order to estimate the variation of the IMFP at the interface, reflection electron energy‐loss spectroscopy (REELS) measurements were performed after different sputtering times at the Fe/Si interface with three different primary electron energies (i.e. 0.5, 1 and 1.5 keV). Even though it is highly likely that a compound (i.e. FexSi) is formed at the interface, all the experimental REELS spectra could be analysed as a linear combination of those corresponding to pure Si and Fe. Using the model developed by Yubero and Tougaard for quantitative analysis of these REELS spectra we could estimate the IMFP values along the depth profile at the interface. The resulting IMFPs are observed to vary linearly with the average composition (as determined by REELS) at the Fe/Si interface as it is sputter depth profiled. The energy dependence of the IMFP for different compositions is presented and discussed. For completeness, we have determined the energy‐loss functions as well as the IMFPs of the pure elements (i.e. Fe and Si). Copyright © 2004 John Wiley & Sons, Ltd.
An XPS study of microporous and mesoporous titanosilicates
Authors: Moretti G. , Salvi A. M. , Guascito M. R. , Langerame F.
Published: October 2004

In this contribution we report on an XPS study of microporous and mesoporous titanosilicates, in particular microporous titanium silicalite TS‐1, ordered mesoporous Ti‐MCM‐41 and [Ti]‐MCM‐41 and amorphous mesoporous silica–titania (MST) catalysts.

Our aim was to obtain both photoemission and x‐ray‐excited Auger data for Ti species on these catalysts and use them in a Ti Wagner plot to rationalize the dependence of the local electronic structure on the atomic environment. Isolated Ti(IV) species coordinated to four and six oxygen anions and segregated TiO2 clusters were detected on all catalysts by a curve‐fitting procedure of Ti 2p, O 1s and related peaks.

The presence of the Si 2p peak excited by an O Kα ghost makes the detection of Ti LMM Auger transitions in mesoporous samples impossible due to the low Ti loadings and its homogeneous distribution in the silica matrix. Small TiO2 clusters are eventually segregated within the mesopores of the catalysts and not at their external surface. On TS‐1 microporous catalysts with similar Ti loadings to the mesoporous catalysts we were able to detect Ti LMM Auger transitions, and by the Ti Wagner plot we clearly identify the presence of octahedrally coordinated Ti(IV) species. Thus, it is suggested that on TS‐1 the in‐framework (O)4Ti species are easily changed to (O)4(H2O)2Ti species by insertion of water molecules from the atmosphere. Small TiO2 clusters (diameter <5 nm), eventually present on samples with Ti loading >2 wt.%, are segregated at their external surface and present spectroscopic features similar to (O)4(H2O)2Ti species. Copyright © 2004 John Wiley & Sons, Ltd.
Monte‐Carlo simulation of secondary electron emission by x‐ray irradiation—an application of x‐ray absorption near‐edge structure (XANES)
Authors: Iyasu Takeshi , Tamura Keiji , Shimizu Ryuichi , Zhang Zengming , Koshikawa Takanori , Yoshikawa Hideki , Fukushima Sei
Published: October 2004

A Monte‐Carlo simulation program has been developed for describing x‐ray absorption near‐edge structure (XANES) observed by synchrotron radiation. The Monte‐Carlo simulation was applied for interpreting XANES spectroscopy on a polycrystalline Ag specimen under synchrotron irradiation with photon energy 3340–3390 eV around the absorption edge of the Ag Lα line at 3352 eV.

The results clearly indicate that Monte‐Carlo simulation describes the experimental results with considerable success. Dependence of secondary electron yield on the incident angle of synchrotron radiation was also studied. Copyright © 2004 John Wiley & Sons, Ltd.
Relation between liver pathology and prognosis in patients with portal hypertension
Authors: Aiden McCormick P. , Burroughs Andrew K.
Published: October 2004

The most common causes of variceal bleeding are cirrhosis, schistosomiasis, and extrahepatic portal venous obstruction. The prognosis for an individual patient depends on the severity of the bleeding episode and the underlying liver function. Liver function is determined to a large extent by the underlying liver pathology. Patients with noncirrhotic portal hypertension or cirrhosis with good liver function have good short‐ and long‐term prognoses. In patients with established cirrhosis, the presence of alcoholic hepatitis, hepatocellular carcinoma, or portal venous thrombosis may adversely affect prognosis. In addition to affecting prognosis, the underlying pathology may also influence choice of treatment. This point is particularly true for treatments such as shunt surgery, liver transplantation, or transjugular intrahepatic shunts.
Surgical management of acute variceal hemorrhage
Authors: Rikkers Layton F. , Jin Gongliang
Published: October 2004

The advent of more effective nonoperative therapies, mainly endoscopic variceal sclerosis, has decreased the need for emergency surgery for control of acute variceal hemorrhage. In centers where it is available, nonoperative portal decompression by transjugular intrahepatic portosystemic shunting (TIPS) is likely to have a further impact. When acute or chronic sclerotherapy fails or when bleeding is secondary to gastric varices or portal hypertensive gastropathy, emergency surgery may be life‐saving and should be done promptly before worsening hepatic functional decompensation develops. Child's class C liver disease is not a contraindication to emergency surgery; many patients who fail nonoperative attempts at control of bleeding are of this risk status. The most commonly utilized emergency procedures are portacaval and interposition mesocaval shunts, both of which are effective, and esophageal transection, which is associated with a higher incidence of late rebleeding. An emergency distal splenorenal shunt is appropriate for selected patients who are not actively bleeding at the time of surgery. TIPS is the preferred alternative for acute or chronic endoscopic sclerotherapy failures who are candidates for liver transplantation within the succeeding 6 to 12 months.
Total shunting and elective management of variceal bleeding
Authors: Stipa Sergio , Balducci Genoveffa , Ziparo Vincenzo , Stipa Francesco , Lucandri Giorgio
Published: October 2004

A 20‐year experience with treatment of esophageal varices in patients with cirrhosis is reported. Considering that total shunts are well tolerated iminediately after operation (hospital mortality rate for all elective procedures being 6.4%), that they offer a good protection against rebleeding (rebleeding variceal rate of 7.6%), and that they offer the same long‐term survival as given by other shunts (5‐and 10‐year survival rates of 57% and 31%, respectively), the authors affirm that these kinds of shunts are still useful in well selected cases. Late follow‐up results of a prospective randomized trial of elective mesocaval shunts compared to portacaval shunt have shown no significant differences in operative mortality, reoleeding rates, encephalopathy rates, or survival. Based on this information, the authors currently use portacaval shunt as their operation of choice.
Role of distal splenorenal shunt for long‐term management of variceal bleeding
Authors: Henderson J. Michael
Published: October 2004

Distal splenorenal shunt (DSRS) has been studied extensively over the past 25 years to define its role in management of variceal bleeding. The operative technique of the shunt has not changed, but more aggressive attempts at portal‐azygos disconnection have been studied for their effect on maintenance of portal perfusion. Control of variceal bleeding is achieved in about 90% of patients. Portal flow to the liver is maintained in >90% of patients with nonalcoholic etiology of portal hypertension and in 50% to 84% of patients with alcoholic cirrhosis depending on the degree of portal‐azygos disconnection. Encephalopathy and liver failure do not seem to be accelerated by DSRS but depend on the severity of the underlying liver disease. Reported survival likewise depends on the etiology of portal hypertension and the severity of liver disease: >90% survival can be achieved in portal vein thrombosis and patients with cirrhosis and normal liver function, but 50% to 60% 3‐to 5‐year survivals are reported for patients with more advanced disease. DSRS offers one treatment modality for management of variceal bleeding that must fit into an overall strategy for these patients. Full evaluation is the key to allow selection of patients for pharmactherapy, sclerotherapy, variceal decompression, or liver transplantation.
Long‐term management of variceal bleeding: The place of pharmacotherapy
Authors: Lebrec Didier
Published: October 2004

Portal hypertension is treated by reducing portal pressure in order to prevent esophageal variceal bleeding or recurrent bleeding. Because portal hypertension depends on both elevated portal tributary blood flow and intrahepatic vascular resistance, the pharmacologic therapy of this sydrome consists in reducing portal blood flow or vascular resistance, or both. The pharmacologic prevention of first bleeding or recurrent bleeding has been performed with nonselective β‐adrenergic antagonists (propranolol or nadolol). Certain controlled studies have shown that this type of drug signifcantly reduces the risk of first bleeding by approximately 40% in patients with esophageal varices. A meta‐analysis showed that death due to bleeding was also significantly lower in the β‐blocker group than in the placebo group. Moreover, β‐blockers are effective in patients in both good and poor condition and with all types of cirrhosis. The efficacy of β‐blockers on the risk of recurrent bleeding is less clear, but these substances significantly decrease the risk of rebleeding, by approximately 30%. Recurrent bleeding in patients treated with β‐blockers is associated with the occurrence of hepatocellular carcinoma or lack of compliance. In conclusion, it is clear that different substances have portal hypotensive effects and can be used to treat or prevent complications of portal hypertension. However, other drugs should be tested, and other clinical studies are needed to identify good responders.
Role of liver transplantation in management of esophageal variceal hemorrhage
Authors: Ringe Burckhardt , Lang Hauke , Tusch Günther , Pichlmayr Rudolf
Published: October 2004

The management of esophageal variceal hemorrhage ranges from conservative to surgical modalities. Before introduction of liver transplantation as a potentially curative therapy of the underlying etiology, decompressive portosystemic shunt operations have been the mainstay of mostly palliative procedures Our own experience with surgery for advanced hepatic disease and portal hypertension over 20 years includes 803 liver transplantations and 201 portosystemic shunts, emphasizing our primary objective of treatment. The results after shunt surgery were favorable in Child class A candidates when performed electively and with selective decompression. After liver replacement the clinical status of the patient, including hepatic function and extrahepatic complications, had a strong influence on postoperative outcome, with the chance of excellent long‐term survival. The additional risk of previous shunt surgery for subsequent transplantation could be reduced over time. Based on this experience and reports from others there are enough reasonable arguments for shunt and transplantation. Instead of the choice being controversial, the two forms of therapy should supplement each other and be available in the same center that specializes in the treatment of patients with diseases that eventually lead to liver failure and portal hypertension Selection of either approach must depend on etiology, stage of the disease, and proper timing. Shunt procedures may be indicated in stable patients with the risk of bleeding after sclerotherapy failure, in those with contraindications to transplantation, or as a bridge to transplantation. The role of liver transplantation has been clearly established in patients with progressive or endstage (otherwise intractable) hepatobiliary disease.
Surgical management of extrahepatic portal hypertension and variceal bleeding
Authors: Orozco Hector , Takahashi Takeshi , Mercado Miguel Agel , Prado Eduardo , Chan Carlos
Published: October 2004

Variceal bleeding remains an important complication in extrahepatic portal vein thrombosis (EPVT). As for portal hypertension due to other etiologies, an elective treatment to decrease the risk of subsequent rebleeding is warranted. The results of the Sugiura‐Futagawa procedure (SP) in 38 patients with variceal bleeding secondary to EPVT are reported: 20 women and 18 men, with a mean age of 28±2 years (SEM). Thirty‐seven patients were classified as Child‐Pugh class A, and one patient as class B. In terms of diagnosis, 45% of patients had idiopathic EPVT, and 18% had associated hypercoagulability disorders; 52% of patients had associated splenic vein thrombosis. The SP was completed in two surgical stages in 18 patients and in one surgical stage in 14; 6 patients had only the abdominal stage. One patient had mild postoperative encephalopathy, and three patients rebled at long‐term follow‐up study. There were two operative deaths. Actuarial survival was 70% at 64 months. It is concluded that the SP is an excellent alternative for patients with variceal bleeding secondary to EPVT.
Acute variceal hemorrhage: The persistent bleeder. A plea for management
Authors: Barsoum Maged S. , Boulos Fathi I. , Aly Abdel Motty H. , Saad Mohamed , Soliman Moustafa A. , Doss Wahid H. , Zakaria Serag , Thakeb Fouad
Published: October 2004

A group of 1910 patients with acutely bleeding esophagogastric varices were managed in the Kasr El Aini sclerotherapy project; 458 of the patients (24%) were lost to follow‐up. The remaining patients were studied in five groups: group I (294/401 patients), rigid versus flexible sclerotherapy; group II (254/336 patients), intravariceal versus paravariceal sclerotherapy; group III (174/227 patients), timing of initial sclerotherapy and the optimum frequency of sclerotherapy sessions; group IV (80/99 patients), splenectomy devascularization operation alone versus combined surgery with sclerotherapy; group V (650/847 patients), management of failures of and recurrences after sclerotherapy. The mean period of follow‐up was 72 months. Rigid sclerotherapy was significantly superior to flexible sclerotherapy for emergency control of acute bleeding but was associated with significantly more morbidity. Paravariceal injection achieved insignificantly better initial control of bleeding and had more morbidity than intravariceal injection, which obliterated the varices in a significantly larger proportion of patients. Emergency injection of the acute bleeder should be carried out soon after admission, with sclerotherapy sessions repeated every 2 weeks. Combined sclerotherapy with splenectomy and devascularization was significantly more effective for controlling bleeding than surgery alone. Surgery should be done without delay for continued bleeding after the second attempt of sclerotherapy and in patients who rebleed after their third sclerotherapy session. Survival, however, was not significantly improved by the different modalities of sclerotherapy.
Reliable procedure for closing the duodenal stump for bleeding posterior duodenal ulcer
Authors: Meyer Christian , Rohr Serge , de Manzini Nicolo , Dai Bernadette
Published: October 2004

Bleeding posterior duodenal ulcers is a critical problem espelally in patients of advanced age. Surgical treatment should obtain fficient and stable hemostasis and avoid digestive fistulas due to leakage if the duodenal stump. The main difficulty lies in the closure of the duodenal stump. A procedure using intramural dissection of the duodellum and closure by means of a stapler is reported for a series of 40 patients without recurrent bleeding or duodenal fistula. Seven patients (17%) died from associated diseases, especially respiratory insufficiency (3 patients) and cirrhotic liver failure (2 patients).
Prognostic factors for gastric cancer influencing clinical practice
Authors: Harrison J. D. , Fielding J. W. L.
Published: October 2004

Despite a slow decline in the incidence of gastric cancer over the last 90 years, we can still expect to see over 100,000 patients die of this disease each decade in England and Wales. The 5‐year survival rate has not improved during this century, which is largely due to the stage at diagnosis being unchanged. There are a number of prognostic determinants in gastric cancer which have clinical relevance. Age is an important determinant; patients under 40 years commonly have more advanced diffuse lesions than older patients so that a higher index of suspicion needs to be maintained in younger patients with persistent symptoms. Conflicting reports make it unclear whether the duration of symptoms bears any relationship to tumor stage, but there is some evidence that actively shortening the symptom duration by early investigation can have a beneficial effect in the proportion of patients diagnosed with early cancers. The site of the tumor is important; unfortunately, the proportion of patients with cardia lesions is increasing and this has had the effect of reducing the overall survival. Tumor size should not play a part in the decision to resect a lesion as most studies show no clear relationship between tumor size and stage. Tumor stage is the most important prognostic determinant and efforts to increase the proportion of stage I cancers presenting for surgery can be shown to alter the natural history of the disease, by diagnosing it when it is still surgically curable.
Review of adjuvant chemotherapy for gastric cancer
Authors: Nakajima Toshifusa
Published: October 2004

Controlled randomized studies that compared surgery alone to adjuvant chemotherapy for gastric cancer were reviewed. The amount of residual tumor after surgery, selection of drug regimens, compliance with drug administration, and trial design seem to be responsible for the success of adjuvant chemotherapy. Though there are few beneficial regimens of adjuvant chemotherapy with statistical significance, single drug therapy with mitomycin C (MMC) and combination therapy with 5‐fluorouracil (5FU) and methyl‐CCNU, MMC/5FU/cytosine arabinoside (MFC), and 5FU/Adriamycin/MMC (FAM) seem to have potential survival benefit for patients with curative surgery. Incorporation of new drugs into adjuvant or neoadjuvant chemotherapy might open a new aspect of multimodality therapy for gastric cancer.
Organ‐specific support in multiple organ failure: Pulmonary support
Authors: Barie Philip S.
Published: October 2004

The catastrophic pulmonary failure that complicates management of patients with multiple trauma or sepsis syndrome with shock is recognizable to nearly all experienced surgeons. However, the spectrum of injury is broad, the distribution of lung injury may be heterogeneous within a single patient, and may patients will not develop acute respiratory distress syndrome (ARDS) even after a major predisposing insult. The lung responds stereotypically to many disparate insults, so a better conceptual construct of ARDS may be to consider it as one component of the multiple organ dysfunction syndrome. Support of oxygen transport with positive pressure ventilation and high levels of positive end‐expiratory pressure, long the mainstay of pulmonary support, has been criticized for its predilection to cause barotrauma. Newer modes of ventilation, such as pressure‐controlled, inverse‐ratio ventilation and permissive hypercapnia, are under investigation but have not yet been reported with scientific rigor. However, pulmonary support extends beyond the support of gas exchange. Fluid management requires close attention so that the circulation is supported but lung water accumulation is minimized. Nosocomial pneumonia greatly increases the mortality rate in ARDS, but is difficult to diagnose and must be sought aggressively. Until recently, pharmacologic therapy has held little promise, but inhalation of very low concentrations of nitric oxide appear to decrease pulmonary vascular pressures and intrapulmonary shunt. It remains unknown whether nitric oxide is effective therapy for the underlying injury, or is simply treatment for certain manifestations.
Long‐term outcome of cholecystoenterostomy as a definitive biliary drainage procedure for benign disease
Authors: Oishi Andrew J. , Sarr Michael G. , Nagorney David M. , Traynor Michael D. , Mucha Peter
Published: October 2004

Our aim was to examine the long‐term success of cholecystoenterostomy performed for the relief of benign extrahepatic biliary obstruction. Concern about the ability of cholecystoenterostomy to provide reliable long‐term biliary decompression has led many to abandon its use for benign biliary obstruction. Thirty‐four patients who underwent cholecystoenterostomy for benign biliary obstruction over a 17‐year period were reviewed. Patients were followed until cholecystoenterostomy failure, death, or to date. Failure was defined as recurrent biliary obstruction or cholangitis requiring therapeutic intervention. Mean follow‐up was 8.0 years. Early postoperative morbidity occurred in 11 patients (32%), but only one early complication (cholangitis) was related directly to the cholecystoenteric anastomosis. Five patients (15%) experienced late biliary tract complications related directly to the cholecystoenterostomy including recurrent biliary stones with biliary obstruction in four and anastomotic stricture in one. All required reoperation and conversion to choledochoenterostomy at a mean of 112 months. Cholecystoenterostomy can provide reasonably effective long‐term biliary decompression in selected patients with benign biliary obstruction.
Occult well differentiated thyroid carcinoma presenting as cervical node disease
Authors: Sanders Laura E. , Rossi Ricardo L.
Published: October 2004

Records of 92 patients with differentiated thyroid carcinoma presenting as cervical adenopathy without a palpable mass were reviewed to identify prognostic factors and to evaluate therapy. Patients were treated between 1940 and 1990 and were observed for 3 to 48 years (median 18 years). Follow‐up data were obtained by chart review, correspondence, and telephone contact. Among the group, 20 patients had unilateral and 72 bilateral thyroid lobectomy, with node dissection in 77. Thyroid hormone was used in 50 patients and radioactive iodine in 20. Patients were younger than the overall population of patients with differentiated thyroid carcinoma, with more men and more multifocal thyroid disease. Risk group defined by age and sex was the most important determinant of survival. All women 50 years of age or younger and all men 40 or younger (low risk group) survived independent of the type of initial operation or use of thyroid‐stimulating hormone suppression or radioactive oidine. Of the low risk patients, 16% had recurrent disease but were treated successfully with surgery or radioactive iodine; 28% of the older patients (high risk) died of disease. A trend for better survival was noted in high risk patients undergoing bilateral thyroideetomy and in patients receiving thyroid suppression. Of the high risk patients, 26% had recurrent disease, with a 71% mortality rate. Age and sex are the primary determinants of survival. Therapy should be based on risk factors. Low risk patients should have conservative thyroid surgery and modified or limited node dissection. However, bilateral thyroid surgery may facilitate the use of radioactive iodine when required. Use of prophylactic radioactive iodine or thyroid suppression should be selective. For high risk patients, we suggest bilateral thyroidectomy, modified or limited node dissection, thyroid suppression, and radioactive iodine.
Optimal timing and indications for cholecystectomy in cardiac transplant patients
Authors: Begos Dennis G. , Franco Kenneth L. , Baldwin John C. , Lee Forrester A. , Revkin James H. , Modlin Irvin M.
Published: October 2004

Cardiac transplant is performed with increasing frequency as the treatment for end‐stage cardiac disease. Although cholelithiasis is more frequent in both pretransplant and posttransplant patients, no standard management approach exists. Because many such patients are cared for outside the transplant center, it is important that general surgeons develop an appropriate strategy to manage this entity. We present our experience with 11 patients from our institution who underwent cholecystectomy before or after cardiac transplantation. In addition, we have reviewed the 76 reported cases of cholecystectomy performed in precardiac or postcardiac transplant patients from centers throughout the world. Any procedure in this patient group requires critical consideration in regard to the timing and type of procedure. Pretransplant patients are well recognized cardiac risks, and posttransplant immuno‐suppressed patients are at considerable risk for septic complications. Six patients underwent cholecystectomy prior to heart transplant. Five were performed laparoscopically, one as an open procedure. We also report five laparoscopic cholecystectomies in patients after cardiac transplant. One patient in the pretransplant group died 7 days after surgery from an uncontrollable arrhythmia. There were no hemodynamic or septic complications in either group. Current summated experience (87 cases) indicates that the mortality rate for urgent cholecystectomy in the posttransplant group is at least 36%. Because the first presentation of gallstones in this population is often acute cholecystitis, asymptomatic calculi cannot be considered benign. Elective cholecystectomy, laparoscopic or open, is tolerated well both before and after transplant. Given these facts, it seems reasonable to recommend pretransplant screening and posttransplant surveillance for gallstones. Prophylactic pretransplant laparoscopic cholecystectomy should be undertaken in the stable patient to avoid the substantial mortality associated with postoperative acute cholecystitis.
Diaphragmatic or transdiaphragmatic thoracic involvement in hepatic hydatid disease: Surgical trends and classification
Authors: Gómez Ramon , Moreno Enrique , Loinaz Carmelo , De la Calle Angel , Castellon Camilo , Manzanera Marina , Herrera Vicente , Garcia Arturo , Hidalgo Manuel
Published: October 2004

We performed a retrospective study of 19 patients who had been operated on for hepatic hydatid disease with diaphragmatic or transdiaphragmatic (D‐TD) thoracic involvement chosen from a total of 444 patients who underwent operations for hepatic hydatid disease. In all cases D‐TD involvement was confirmed by ultrasonography, CT, or MRI scan. We propose a new classification (grades 1–5) based on the degree of development of D‐TD involvement. Before 1984 exposure was obtained by thoracophrenolaparotomy (nine cases) and later by right subcostal incision. Only four patients required atypical pulmonary resection. In 13 cases the diaphragm was repaired, and all 24 hepatic cysts were treated with total (16 cases) or partial (8 cases) cystopericystectomy. There was no operative mortality, and the most serious morbidity consisted of a biliary fistula and a biliobronchial fistula. For treatment of these patients we recommended right subcostal incision and total or near‐total cystopericystectomy as a first choice of surgical technique.
Laparoscopic surgery of hepatic hydatid disease: Initial results and early follow‐up of 16 patients
Authors: Alper Aydin , Emre Ali , Hazar Hovsep , Özden İlgin , Bilge Orhan , Acarli Koray , Arloğul Orhan
Published: October 2004

Surgery is the main modality in the treatment of hepatic hydatid disease. In this report, a laparoscopic surgical method is described, and the results in the first 16 cases are presented. The method involves the use of an aspirator‐grinder apparatus that achieves effective evacuation of viable cyst contents with the patient benefiting from the laparoscopic approach. Cavity infection occurred in two patients and was treated conservatively. In another patient, postoperative ultrasonography revealed a thick‐walled cavity containing a dense fluid. Because the patient was symptomatic, pericystectomy was performed during the sixth postoperative month. Early postoperative parameters and the early follow‐up results in other patients (2–17 months) are encouraging. The method is particularly suitable for uncomplicated, early‐stage cysts located in laparoscopically accessible locations.
Video‐assisted endoscopic esophagectomy with stapled intrathoracic esophagogastric anastomosis
Authors: Liu Hui‐Ping , Chang Chau‐Hsiung , Lin Pyng Jing , Chang Jen‐Ping
Published: October 2004

Thoracic esophagus was usually removed through the transhiatal approach or via an open thoracotomy. The long incision and spreading of the ribs usually resulted in much pain and interference with chest wall mechanics. Today, with the development of a video‐assisted endoscopic procedure, many intrathoracic lesions can be removed through small incision. Since March 1992 we have attempted 20 esophagectomies and reconstruction using a right thoracoscopic approach in 16 males and 4 females whose average age was 56 years. Indications for its use were esophageal cancer in 17 patients (squamous cell carcinoma in 12 patients, adenocarcinoma in 5) and caustic stenosis in 3. It is our impression that video‐assisted endoscopic esophagectomy and reconstruction potentially causes less trauma, less postoperative discomfort, and a rapid functional recuperation. Our initial experiences showed that it is a feasible, effective procedure.
Effect of hepatic artery chemotherapy on survival of patients with hepatic metastases from colorectal carcinoma treated with cryotherapy
Authors: Preketes A. P. , Caplehorn J. R. M. , King J. , Clingan P. R. , Ross W. B. , Morris D. L.
Published: October 2004

Thirty‐eight patients with unresectable multiple liver metastases from colorectal carcinoma were treated with either hepatic artery chemotherapy (HAC) and cryotherapy (n=27) or cryotherapy alone (n=11). Follow‐up survival data were summarized using Cox regression. Allowing for the effect of the pathology of the primary tumor and the preoperative carcinoembryonic antigen (CEA) level, those patients who did not receive HAC after cytoreduction were three times as likely to die as those given HAC (RR 3.3, 95%; CI 1.2–9.3). The estimated median survival of patients treated with cryotherapy alone was 245 days, whereas for those given more than 3 months of HAC plus cytoreduction therapy it was 570 days. It is recommended that all patients who receive cryotherapy for multiple liver metastases from colorectal rectal carcinoma be given subsequent hepatic artery chemotherapy.
Recommended width of excision for primary malignant melanoma
Authors: O'Rourke Michael G. E. , Bourke Christopher
Published: October 2004

Wide local excision for melanoma with margins of 3 to 5 cm have been advocated in the literature for nearly 140 years. These reports have grouped all stages of melanoma rather than addressing primary early stage disease. Breslow first advocated limited excision margins for these tumors. We have been excising all thicknesses of melanoma with a limited margin (1.00–1.50 cm, mostly 1.00 cm) since 1975. We advocate a 1 cm excision margin irrespective of tumor thickness. Clark has shown that melanoma invades in a vertical fashion, and thus one would expect to be more generous in depth than in width on a pathologic basis. Two studies have shown that there is no difference in the increase in locoregional recurrence and no change in death rate from the disease with more conservative treatment margins. Excision of this lesion is not an office procedure. It should be performed meticulously in an operating room, preferably under light general anesthesia.
Local hyperthermia and systemic chemotherapy for treatment of recurrent melanoma
Authors: Di Filippo Franco , Carlini Sandro , Garinei Rosa , Perri Pasquale , Anzà Michele , Ferranti Francesca , Saracca Elena , Schiratti Monica , Cavaliere Francesco , Cavaliere Renato
Published: October 2004

Thirty‐two patients with recurrent (skin) or metastatic (skin, mode, or both) melanoma have been treated with a hyperthermiacisplatin regimen. The hyperthermic treatment was carried out for 60 minutes at 43°C with the MHS‐SMA and the Sapic SVO3 ALENIA devices once a week. When the tumor temperature reached 42°C, cisplatin was administered at a dosage of 50 mg/m2 given by intravenous bolus infusion. The treatment was repeated four times and the tumor response evaluated 4 weeks after the last treatment. Significant systemic or local toxicity was not seen. In terms of results, there were 9 patients with complete responses (28.1%), 13 with partial responses (40.6%), 8 with no change (25.0%), and two with disease progression (6.3%). The objective response rate was 68.7%. The response duration for those with complete responses ranged from 4 to 49 mònths (median 20 months). The median time to progression for patients with partial responses and those with no change was 6 and 5 months, respectively, with ranges of 1–7 and 1–10 months, respectively. The 4‐year actuarial survival rates were 47.6% and 20.3% for the complete and incomplete responders, respectively. These results can be considered satisfactory, taking into account that most patients were pretreated with radiotherapy, chemotherapy or both, confirming the therapeutic potential of the hyperthermia and cisplatin regimen.
Hyperthermic isolated limb perfusion for malignant melanoma: Response and survival
Authors: Bryant Peter J. , Balderson Glenda A. , Mead Paul , Egerton William S.
Published: October 2004

Response to and survival after hyperthermic isolated limb perfusion (HILP) with melphalan in patients with malignant melanoma at the Royal Brisbane Hospital were reviewed in order to assess the major determinants of response to treatment. Data were collected by clinical chart review and direct patient contact. Response was assessed by clinical observation and measurement of nodules. Survival was calculated from the date of perfusion to the date of patient death. Since 1965 there have been 85 patients (38 men, 47 women) who have undergone 109 limb (102 leg, 7 arm) perfusions. The mean age was 58 years (range 32–82 years). The number of patients per disease stage (M.D. Anderson classification) was as follows: stage I, 5 patients; stage II, 8 patients; stage IIIa, 41 patients; stage IIIab, 25 patients; and stage IIIb, 8 patients. The mean duration of perfusion was 81 minutes. Melphalan was given in divided doses, with a mean total dose 1.39 mg/kg. The mean maximal limb temperature was 41.5°C. Major complications occurred during 20 perfusions (18%). There was one postoperative death from myocardial infarction, and one patient required amputation. Median patient follow‐up was 2.65 years (range 1–27 years). A complete response was noted in 34 patients (40%), a partial response in 36 patients (42%), and no response in 11 patients (13%). response could not be assessed in four patients. The actuarial 5‐year survival for the whole group was 45%: stage I, 80%; stage II, 75%; stage IIIa, 44%; stage IIIab, 23%; stage IIIb, 56%. The two significant determinants of response to perfusion were disease stage (p=0.00005) and nodal status (p=0.03). The major determinant of survival was a complete perfusion response (p=0.0012). Less advanced disease responds better to perfusion and is associated with increased survival after perfusion.
Diagnostic outcome of repeated mammography screening
Authors: Arnesson Lars‐Gunnar , Vitak Bedrich , Månson Jan‐Christer , Fagerberg Gunnar , Smeds Staffan
Published: October 2004

Mammographic screening for breast cancer within health service routines was evaluated for the years 1987–1992, with special focus on repeated screening during 1989–1992. The overall attendance rate by women aged 40 to 74 years was 82.8%. During 1989–1992 malignancy was found in 2.6/1000 screened women, giving a 87.4% positive predictive rate at surgery and 95.9% efficiency. Among women aged ≥45, the positive predictive rate was >94%. Fine‐needle aspiration (FNA) biopsy showed invasive cancers in 84% and highly suspected cancer in another 15%; 60% of the lesions were nonpalpable. For first‐time (prevalence) screening (1987–1988) the positive predictive rate was 86% and the malignancy yield 6.4/1000. In women aged 40–44 years there were few surgical referrals (1.6%), but the positive predictive rate at surgery was only 48.3%, indicating diagnostic difficulties in young women. The median size of all invasive cancers was 12 mm: 84% were classified as pT1, and 23% had lymph node involvement. Stage II disease was found in 27% of all malignancies. The use of FNA in the diagnostic workup for breast cancer screening is of crucial importance to the maintenance of high positive predictive rates at surgery. Moreover, regular analysis is important even when mammographic screening is incorporated into the routine work of health services.
Tuberculosis of the breast masquerading as carcinoma: A study of 100 patients
Authors: Shinde S. R. , Chandawarkar R. Y. , Deshmukh S. P.
Published: October 2004

One hundred patients with tuberculous mastitis were referred to the Tata Memorial Hospital, a cancer center, with a clinical diagnosis of malignancy. This study identifies the possible causes of misdiagnosis and reviews the management of these patients. A lump in the breast with or without ulceration was the commonest presentation, the others being diffuse nodularity and multiple sinuses. Concomitant axillary lymph nodes were found in one‐third of the patients. Tuberculosis lesions such as nodular mastitis, disseminated mastitis, and sclerosing lesions clinically mimicked a fibroadenoma, carcinoma, and fibrocystic mastitis depending on the mode of presentation. A young, multiparous, lactating woman with a lesion should arouse the suspicion of tuberculous mastitis, although pretherapcutic pathologic confirmation of a benign disease is mandatory. Mammography, fine‐needle aspiration cytology, and excision biopsy for this purpose are successful in 14%, 12%, and 60% of cases, respectively. Acid‐fast bacilli were identified in 12% patients. All patients received antituberculous chemotherapy, and 14% patients required simple mastectomy, due to either lack of response to chemotherapy (10%) or large painful, ulcerative lesions involving the entire breast (4%). Axillary dissection was performed in only 8% patients with large ulcerated axillary nodes. All patients, followed for a minimum of 2 years, were free of disease after therapy.
Clinical management of blunt trauma patients with unilateral rib fractures: A randomized trial
Authors: Gabram Sheryl G. A. , Schwartz Robert J. , Jacobs Lenworth M. , Lawrence Denise , Murphy Marlene A. , Morrow Jeffrey S. , Hopkins Julia S. , Knauft R. Frederic
Published: October 2004

Optimal pain management is essential in blunt trauma patients sustaining significant chest trauma. The purpose of this randomized prospective trial was to measure the difference in pulmonary function in nonintubated patients with unilateral multiple rib fractures receiving two modalities of pain relief: systemic narcotic medications alone or local anesthetics given by intrapleural catheter (IPCs). Forty‐two patients were randomized to receive systemic narcotic medications or IPCs for pain control. The patients with IPCs statistically had more compromised pulmonary function as measured by forced vital capacity (FVC) on admission; however, they tended toward a greater objective improvement of FVC on discharge. When analyzing a cohort of severely impaired patients (initial FVC<20%), half of the systemic medication patients compared to only 10% of the IPC group failed and required another mode of therapy. Catheter complications were minor and did not contribute to overall morbidity. The IPC patients had fewer failures than the systemic medication patients.
Octreotide for treatment of postoperative alimentary tract fistulas
Authors: Paran Haim , Neufeld David , Kaplan Ofer , Klausner Joseph , Freund Uri
Published: October 2004

Eighteen patients with postoperative fistulas of the gastrointestinal tract were treated with the somatostatin analog octreotide between November 1989 and November 1992. Fourteen patients had enterocutaneous fistulas: seven from the duodenum and seven from the ileum. Another three patients had pancreatic fistulas, and one patient had a biliary fistula. Within 24 hours of octreotide treatment, a mean reduction of 52% in the intestinal fistulas' output, 40% in the pancreatic fistulas, and 30% in the biliary fistula was noted. In the intestinal fistulas group the closure rate was 72% after a mean of 11 days. Early closure (mean 6 days) was achieved in all three pancreatic fistulas. In the patient with the biliary fistula a 30% reduction was observed twice following the administration of octreotide, and an increase occurred when it was withheld. The reduction rate of the secretions in high‐output intestinal fistulas (>500 ml/day) was higher than in the low‐output fistulas (63±8% versus 39±4%, p<0.05). Fistula output and the initial response to octreotide treatment had no value in predicting spontaneous healing. In conclusion, octreotide is a valuable tool for the conservative treatment of fistulas of the digestive tract. It is especially valuable for management of high‐output enteric fistulas and pancreatic fistulas.
Impaired liver function and long‐term prognosis after hepatectomy for hepatocellular carcinoma
Authors: Yasui Motoshi , Harada Akio , Torii Akihito , Nakao Akimasa , Nonami Toshiaki , Takagi Hiroshi
Published: October 2004

Patients with hepatocellular carcinoma (HCC) show a wide variety of histologic changes in the noncancerous liver parenchyma, and these changes may affect the prognosis. In this study, we grouped patients according to the extent of liver impairment and investigated their long‐term prognosis after hepatectomy for HCC. A total of 194 patients were divided into two groups according to their plasma clearance rate of indocyanine green (ICG‐K) values: those with values <0.13 min‐1 (group A, n=97) and those with values of ≥0.13 min‐1 (group B, n=97). Eighty‐nine patients with stage I or II HCC were also divided into two groups: those with values <0.13 min‐1 (group C, n=52) and those with values of ≥0.13 min‐1 (group D, n=37). Group B patients tended to survive longer than group A patients during 4 years after hepatectomy, and group D patients survived significantly longer than group C patients (p<0.01). There was no significant difference in the recurrence‐free survival rates between those in groups A and B or groups C and D. Because patients with poor liver function frequently had multiple recurrent lesions and limited therapeutic options, patients with good liver function received more intensive treatment. In conclusion, the extent of liver impairment is one of the factors determining long‐term prognosis after hepatectomy for HCC, especially during the early stage of the disease.
History of replantation: From miracle to microsurgery
Authors: Kocher Mininder S.
Published: October 2004

Severed body parts, from fingers to extremities, are now being routinely reattached at medical centers around the world. The dream of replantation traces its rich history from miracles and legends to early laboratory experiments and clinical attempts, culminating in today's commonplace procedure.