bluuebunny/crossref_metadata_2025 huggingface dataset:
Mapping technological capabilities into product markets and competitive advantage: the case of cholesterol drugs
Authors: Afuah Allan
Published: August 2002

While a lot of attention has been paid to those characteristics of capabilities that give firms a competitive advantage, a lot less attention has been given to supporting empirical evidence and to the deployment of these capabilities. This paper presents a model for mapping firm capabilities into customer value and competitive advantage in different markets. With empirical evidence from cholesterol drugs, I illustrate how the model can be used to estimate customer value and competitive advantage from technological capabilities. Copyright © 2002 John Wiley & Sons, Ltd.
Local versus global mimetism: the dynamics of alliance formation in the automobile industry
Authors: Garcia‐Pont Carlos , Nohria Nitin
Published: August 2002

The alliance dynamics among the 35 largest firms in the worldwide automobile industry indicates that the likelihood of an alliance between any two firms depends on the local density of alliances among the members of their strategic groups, rather than on the global density of alliances in the industry. These results suggest that firms most closely observe and imitate the strategic behavior of firms who occupy the same strategic niche rather than the behavior of firms in their industry defined more broadly. Copyright © 2002 John Wiley & Sons, Ltd.
A base62 transformation format of ISO 10646 for multilingual identifiers
Authors: Wu Pei‐Chi
Published: August 2002

ISO 10646 Universal Character Set (UCS) is a 31‐bit coding architecture that covers symbols in most of the world's written languages. Identifiers in programming languages are usually defined by using alphanumeric characters of ASCII, which represent mainly English words. An approach for working around this deficiency is to encode multilingual identifiers into the alphanumeric range of ASCII. For case‐sensitive languages, an encoding that utilizes [0–9][A–Z][a–z] can be more space‐efficient for multilingual identifiers. This paper proposes a base62 transformation format of ISO 10646 called UTF‐62. The resulting string of UTF‐62 is within a [0–9][A–Z][a–z] range, a total of 62 base characters. UTF‐62 also preserves the lexicographic sorting order of UCS‐4. Copyright © 2001 John Wiley & Sons, Ltd.
Reduced field response to perforant path stimulation after adrenalectomy: Effect of nimodipine treatment
Authors: Stienstra C. , Van Diepen M. , Ten Dam M. , Joëls M.
Published: August 2002

Adrenalectomy enhances apoptosis in the rat dentate gyrus and concurrently decreases the field response of dentate cells to perforant path stimulation. Recent data showed that calcium current amplitude is increased 1 day prior to the appearance of apoptotic cells, pointing to calcium as a risk factor for the onset of apoptosis. We here tested if in vivo administration of nimodipine—thus presumably reducing dentate calcium influx through L type calcium channels—prevents the appearance of apoptotic cells and the change in field responses after adrenalectomy. It was found that nimodipine does not largely alter the number of animals with apoptosis nor the average number of apoptotic cells in the tip of the suprapyramidal blade of the dentate gyrus. After nimodipine treatment, field responses in the dentate gyrus of adrenalectomized rats were comparable to responses in adrenally intact rats. However, this was due to a reduction of the field response in slices from adrenally intact rats, rather than a prevention of synaptic impairment in adrenalectomized rats. The data clearly indicates that in vivo nimodipine treatment is insufficient to prevent apoptosis and synaptic impairment after adrenalectomy. Synapse 44:1–7, 2002. © 2002 Wiley‐Liss, Inc.
Alleviation of motor hyperactivity and neurochemical deficits by endocannabinoid uptake inhibition in a rat model of Huntington's disease
Authors: Lastres‐Becker Isabel , Hansen Henrik H. , Berrendero Fernando , De Miguel Rosario , Pérez‐Rosado Alberto , Manzanares Jorge , Ramos José A. , Fernández‐Ruiz Javier
Published: August 2002

Recent studies have demonstrated a loss of cannabinoid CB1 receptors in the postmortem basal ganglia of patients affected by Huntington's disease (HD) and in transgenic mouse models for this disease. These studies have led to the notion that substances that increase the endocannabinoid activity, such as receptor agonists or inhibitors of endocannabinoid uptake and/or metabolism, might be useful in the treatment of hyperkinetic symptoms of this disease. In the present study, we employed a rat model of HD generated by bilateral intrastriatal injections of 3‐nitropropionic acid (3‐NP), a toxin that selectively damages striatal GABAergic efferent neurons. These rats exhibited biphasic motor disturbances, with an early (1–2 weeks) hyperactivity followed by a late (3–4 weeks) motor depression. Analysis of GABA, dopamine, and their related enzymes, glutamic acid decarboxylase and tyrosine hydroxylase, in the basal ganglia proved marked decreases compatible with the motor hyperkinesia. In addition, mRNA levels for CB1 receptor, neuronal‐specific enolase, proenkephalin, and substance P decreased in the caudate‐putamen of 3‐NP‐injected rats. There were also reductions in CB1 receptor binding in the caudate putamen, the globus pallidus, and, to a lesser extent, the substantia nigra. By contrast, mRNA levels for tyrosine hydroxylase in the substantia nigra remained unaffected. Interestingly, the administration of AM404, an inhibitor of endocannabinoid uptake, to 3‐NP‐injected rats attenuated motor disturbances observed in the early phase of hyperactivity. Administration of AM404 also tended to induce recovery from the neurochemical deficits caused by the toxin in GABA and dopamine indices in the basal ganglia. In summary, morphological, behavioral, and biochemical changes observed in rats intrastriatally lesioned with 3‐NP acid were compatible with a profound degeneration of striatal efferent GABAergic neurons, similar to that occurring in the brain of HD patients. As expected, a loss of CB1 receptors was evident in the basal ganglia of these rats. However, the administration of substances that increase endocannabinoid activity, by inhibiting the uptake process, allowed an activation of the remaining population of CB1 receptors, resulting in a significant improvement of motor disturbances and neurochemical deficits. These observations might be relevant to the treatment of hyperkinetic symptoms in HD, a human disorder with unsatisfactory symptomatic treatment for most patients. Synapse 44:23–35, 2002. © 2002 Wiley‐Liss, Inc.
Dopamine transporter‐dependent induction of C‐Fos in HEK cells
Authors: Yatin Servet M. , Miller Gregory M. , Norton Courtney , Madras Bertha K.
Published: August 2002

The psychostimulants cocaine and amphetamine increase expression of the immediate early gene (IEG) c‐fos indirectly, via D1 dopamine receptor activation. To determine whether dopamine transporter substrates and inhibitors can affect c‐Fos expression directly, we investigated their effects on c‐Fos protein and c‐fos mRNA in HEK‐293 (HEK) cells transfected with the human dopamine transporter (hDAT). In untransfected HEK cells, methylphenidate and cocaine produced a small but statistically significant increase in c‐Fos, whereas dopamine and amphetamine did not. In hDAT cells, DAT substrates (dopamine, amphetamine) increased c‐Fos immunoreactivity 6‐ and 3‐fold (respectively). The DAT inhibitors cocaine, methylphenidate, and bupropion also increased c‐Fos approximately 3‐fold in hDAT cells. If coincubated with dopamine, the inhibitors attenuated dopamine‐induced c‐Fos in hDAT cells. The magnitude of c‐fos mRNA induction by substrates and inhibitors paralleled induction of c‐Fos protein immunoreactivity. The results indicate that substrates or inhibitors of the DAT can trigger induction of IEG expression in the absence of D1 dopamine receptor. For substrates, IEG induction is DAT‐dependent, but for certain DAT inhibitors the cellular response can be elicited in the absence of the DAT in HEK cells. Oxidative stress may partly, but not fully, account for the DA‐induced c‐Fos induction as an inhibitor of oxidative stress Trolox C, attenuated DA‐induced c‐Fos induction. Protein kinase C (PKC) may also partially account for c‐Fos induction as a specific inhibitor of PKC Bisindolylmaleimide I (BIS) attenuated DA‐induced c‐Fos by 50%. DAT substrate and inhibitor effects on IEGs, other fos‐related antigens, and possible mechanisms that contribute to c‐Fos induction warrant investigation in presynaptic neurons as a potential contribution to the long‐term effects of psychostimulants. Synapse 45:52–65, 2002. © 2002 Wiley‐Liss, Inc.
Opioid peptide receptor studies. 15. Relative efficacy of 4‐[(N‐allyl‐3‐methyl‐4‐piperidinyl)phenylamino]‐N,N‐diethylbenzamide and related compounds at the cloned human δ‐opioid receptor
Authors: Xu Heng , Lu Yi‐Feng , Thomas James B. , Carroll F. Ivy , Rice Kenner C. , Rothman Richard B.
Published: August 2002

Previous data obtained from both binding and functional assays demonstrated that (−)‐4‐[(N‐allyl‐3‐methyl‐4‐piperidinyl)phenylamino]‐N,N‐diethylbenzamide [(−)‐RTI5989‐54] displays selective binding and full agonist activity relative to (±)‐RTI5989‐54 for the δ opioid receptor. The present study was conducted to evaluate the activities of structurally diverse opioid receptor δ ligands in the [35S]GTP‐γ‐S binding assay, comparing the relationship between receptor binding, activation, efficacy, and intrinsic efficacy. The data, obtained with cloned human δ receptors, demonstrated that (−)‐RTI5989‐54 behaves like the highly selective δ agonist SNC80. Addition of the hydroxyl group to RTI5989‐54 (RTI5989‐61) or replacement of the allyl group with the trans‐crotyl group on the piperidine nitrogen of RTI‐5989‐61 (RTI5989‐62) increased binding affinity, produced full agonist activity, and decreased intrinsic efficacy at the δ opioid receptor. The order of potency for the EC50 (GTP‐γ‐S) was RTI5989‐62 (0.20 nM) > RTI5989‐61 (0.43 nM) > SNC80 (1.92 nM) > DPDPE (3.50 nM) > (−)‐RTI5989‐54 (17.6 nM) > (±)‐RTI5989‐54 (65.6 nM) > (+)‐RTI5989‐54 (483 nM). RTI5989‐61 and RTI5989‐62 were fully efficacious, but had intrinsic efficacy values that were 2.2–3.1 times lower than that of DPDPE and SNC80. Comparison of the binding Ki in competitively inhibiting [125I]IOXY binding to the functional Ki for δ antagonists [Ki (IOXY)/Ki (GTP‐γ‐S)] shows that antagonists might antagonize agonist‐evoked neurochemical effects with equal magnitude while occupying different proportions of target receptors. Synapse 40:269–274, 2001. © 2001 Wiley‐Liss, Inc.
Differentially altered mGluR1 and mGluR5 mRNA expression in rat caudate nucleus and nucleus accumbens in the development and expression of behavioral sensitization to repeated amphetamine administration
Authors: Mao Limin , Wang John Q.
Published: August 2002

Altered glutamatergic transmission in the striatum may be implicated in behavioral sensitization to repeated amphetamine (AMPH) administration. Quantitative in situ hybridization histochemistry was performed to define the effects of acute and chronic AMPH exposures on mRNA expression of Group I metabotropic glutamate receptors (mGluRs) in the striatum. Behavioral ratings indicated that the motor activity of rats was significantly higher after the final of five daily AMPH injections (4 mg/kg, i.p.) than that after the first of five daily AMPH, indicative of the development of behavioral sensitization. Moreover, the motor activity of rats treated with five daily AMPH was significantly greater than that of rats treated with five daily saline in response to a 2 mg/kg challenge dose of AMPH 7, 14, 28, and 60 days after the discontinuation of drug treatments, indicative of the persistent expression of behavioral sensitization. Three hours after acute administration of AMPH to naive rats, mGluR1 and mGluR5 mRNA expression in the dorsal (caudatoputamen) and ventral (nucleus accumbens) striatum showed no change as compared to acute saline injection. In rats that developed behavioral sensitization to repeated AMPH, mGluR1 levels in the dorsal and ventral striatum were increased by 53% and 43%, respectively, 3 h after the final AMPH treatment. However, this change did not persist during withdrawal since it was not observed 7, 14, and 28 days after the discontinuation of AMPH treatment. Conversely, mGluR5 levels were markedly reduced 3 h after the final of five daily AMPH treatments in the entire striatum of sensitized rats (34% and 77% of controls in the dorsal and ventral striatum, respectively). The reduction persisted at 7, 14, and 28 days of withdrawal. These results reveal a close linkage between striatal Group I mGluR gene expression and behavioral sensitization to AMPH. This may indicate functional implications of the two subtypes of Group I mGluRs in the regulation of behavioral sensitization to the dopamine stimulant. Synapse 41:230–240, 2001. © 2001 Wiley‐Liss, Inc.
Cloning of glycerol‐3‐phosphate dehydrogenase genes (ZrGPD1 and ZrGPD2) and glycerol dehydrogenase genes (ZrGCY1 and ZrGCY2) from the salt‐tolerant yeast Zygosaccharomyces rouxii
Authors: Iwaki Tomoko , Kurono Sachko , Yokose Yuki , Kubota Kenji , Tamai Youichi , Watanabe Yasuo
Published: August 2002

The ZrGPD1 and ZrGPD2 genes encoding putative glycerol‐3‐phosphate dehydrogenases were isolated from the salt‐tolerant yeast, Zygosaccharomyces rouxii. Both genes are homologous to GPD1 of Saccharomyces cerevisiae and are constitutively expressed in Z. rouxii cells. Putative glycerol dehydrogenase genes, ZrGCY1 and ZrGCY2, which are highly homologous to GCY1 of S. cerevisiae, were also isolated. Since the level of transcripts of ZrGCY1 and ZrGCY2 increased in Z. rouxii cells subjected to salt stress, it is suggested that the pathway of the signal transduction of salt stress controls the expression of these genes. The Accession Nos of these sequences in GenBank are as follows: ZrGPD1, AB047394; ZrGPD2, AB047395; ZrGCY1, AB047396; ZrGCY2, AB047397. Copyright © 2001 John Wiley & Sons, Ltd.
Comparative use of four different marker systems for the estimation of digestibility and low food intake in a group of captive giraffes (Giraffa camelopardalis)
Authors: Clauss Marcus , Lechner‐Doll Matthias , Flach Edmund J. , Tack Cliff , Hatt Jean‐Michel
Published: August 2002

In a feeding trial with four captive giraffes, nutrient digestibility was determined using four different marker systems. Although cobalt‐ethylenediaminetetraacetic acid proved to have no utility as a digestibility marker in this study, reasonable values could be obtained using C36 n‐alkane, acid detergent lignin, and acid insoluble ash as markers. A comparison of methods and literature data suggests that the values derived from the C36 n‐alkane assay are the most reliable absolute values. Apparent digestibility ranges thus determined were 63.5–74.3% for dry matter, 73.4–82.4% for crude protein, 49.9–62.2% for neutral detergent fiber, and 49.7–63.7% for acid detergent fiber. However, digestibility data gained by the ADL method provided the most stringent inter‐individual comparisons. It is concluded that both alkanes and lignin can be used for giraffe digestibility studies. These captive giraffes ingested a smaller quantity of food than has been reported for other giraffes from both the wild and other zoos. Energetic calculations showed that these animals might be on the brink of an energy deficit. A similar situation has been described at least once before in captive giraffes, and the results are of direct relevance to the peracute mortality syndrome, a condition of captive giraffes in which severe depletion of body fat stores occurs. Reasons for the seemingly low food intake could not be elucidated, but observations suggested that these giraffes were ready to ingest more if more palatable or suitable food was offered. Monitoring food intake in other giraffe groups and designing a diet that is both palatable and nutritious are important objectives of captive giraffe management. Zoo Biol 20:315–329, 2001. © 2001 Wiley‐Liss, Inc.
Modelling and Verifying of a ‘Cash-Point Service’ Using MOBY/PLC
Authors: Dierks Henning , Tapken Josef
Published: August 2002

M

OBY

/

PLC

is a graphical design tool for PLC-Automata, a special class of hierarchical real-time automata suitable for the description of distributed real-time systems that are implementable on a widely used hardware platform, so-called Programmable logic controllers (PLCs). In the full paper we sketch the modelling language in use and some features of M

OBY

/

PLC

, like several validation methods and code generation. We employ this tool suite to deal with the benchmark case study (‘cash-point service’).
Composing and Refining Dense Temporal Logic Specifications
Authors: Cau Antonio
Published: August 2002

A dense temporal logic development method for the specification, refinement, composition and verification of reactive systems is introduced. A reactive system is specified by a pair consisting of a machine and a condition that indicate the valid computations of this machine. Compositionality is achieved by indicating whether each step is an environment step, a system step, or a communication step. Refinement can be expressed straightforwardly in the logic because the stutter problem is elegantly solved by using the dense structure of the logic. Compositionality enables us to break refinement between complex systems into refinement between small and simple systems. The latter can then be verified by existing proof rules for refinement which are reformulated in our formalism.
The Leech and the Physician: Biology, Etymology, and Medical Practice with Hirudinea medicinalis
Authors: Mory Robert N. , Mindell David , Bloom David A.
Published: August 2002

The history of the word “leech” and the practice of leeching reveal interconnected social histories. We give the linguistic and medical histories of the word, and explore its biology and clinical history. Our historical account extends from the earliest known record of leeching to current research. Despite historical variation in its reputation as a therapeutic technique, leeching remains useful today in a number of applications. Further investigation may well disclose even more uses for the leech, particularly for its enzymes with anesthetic, anticoagulant, and antimetastatic properties.
Thyroid Gland Surgery in an Endemic Region
Authors: Seiler Christian A. , Glaser Christine , Wagner Hans E.
Published: August 2002

To assess the incidence, indications, and complications of (reoperative) thyroid gland surgery in an endemic region, we have retrospectively analyzed 1318 patients operated on between 1983 and 1994. There were 166 reoperations (13.5%). In comparison to the primary operation the indication for reoperation showed an increased rate of premalignant and malignant tumors (+16%) and a decreased rate of hyperthyroid disorders (−30%). The largest group operated on had benign multinodular goiters, with the same rate of indication for primary (57.4%) and secondary (57.8%) surgery. Permanent recurrent laryngeal nerve palsy rate following primary operation occurred at rates of 1.7% (1983–1990) and 0.7% (1991–1994) and for secondary operation 3.5% (1983–1990) and 5.6% (1991–1994), respectively. The change in recurrent nerve palsy rate in the later years was due to a more extensive resection policy at the primary operation and a more liberal approach to reoperative surgery. The high rate of reoperation for benign goiters (13%) and the new data of goitrogenesis have therefore directed our policy to more extensive resection of the thyroid tissue at the initial operation, increasing the rate of lobectomy from 27% (1982–1990) to > 90% (1991–1994) and at the same time lowering morbidity. Extensive resection of nodular tissue during the initial operation safely reduces the incidence of recurrent goiter and subsequently reduces the rate of reoperation and eliminates the high risk of morbidity associated with reoperative thyroid surgery. The indications for reoperation should be strict, and when unavoidable a modified lateral approach may be helpful.
Highlights from Endocrine Surgical History
Authors: Welbourn Richard B.
Published: August 2002

Endocrine surgery includes excision of diseased or sometimes normal endocrine glands and occasionally the transplantation of endocrine tissues. Male castration was performed for social reasons in prehistoric times, and thyroid operations were described during the twelfth century. Until the end of the nineteenth century most operations were undertaken to relieve the local effects of pathologic enlargement of the thyroid, ovaries, pituitary, and adrenals; and with the development of anesthesia, antisepsis, and effective hemostasis, thyroidectomy for benign, nontoxic goiter was perfected. Thyroid deficiency followed total thyroidectomy, and thyroid replacement therapy was developed. Toxic goiter was sometimes relieved by partial thyroidectomy. After the discovery of hormones early this century, knowledge of endocrinology increased, and many syndromes of hormonal excess were described. Surgeons began to operate to relieve them. Results improved with mastery of surgical technique, especially for operations on the thyroid, parathyroids, and pituitary; with the development of methods for diagnosis of syndromes and the localization of lesions; with teamwork; and with the use of hormones, drugs, and radiotherapy as alternative or additional forms of therapy before, during, and after operation. Notable advances followed adequate resection of thyroid tissue and the use of iodine and antithyroid drugs before operation for toxic goiter. The use of cortisone rendered adrenalectomy safe for the relief of cancer of the breast and prostate and of Cushing's syndrome. For about 40 years increasing numbers of surgeons have specialized in endocrine surgery as a discipline within general surgery, and results of treatment have improved greatly.
Lower Limb Intraarterial Thrombolysis as an Adjunct to the Management of Arterial and Graft Occlusions
Authors: Braithwaite Bruce D. , Quiñones‐Baldrich William J.
Published: August 2002

Intraarterial thrombolysis is used increasingly for management of arterial and bypass graft occlusions. Current research has been directed at the indications for and methods of catheter‐directed thrombolysis. Streptokinase, urokinase, and tissue plasminogen activator (t‐PA) are the most commonly used agents. They are administered by a variety of techniques and in various doses involving intrathrombic infusions, thrombus lacing, high‐dose bolus therapy, and pulse‐spray lysis. The latter methods appear to produce thrombolysis within a few hours, so this chemical therapy has the potential to become the first‐line management for all episodes of acute limb ischemia. The role of thrombolysis is to return patients to their prethrombotic or preembolic state, so the underlying condition can be treated by radiologic intervention, surgery, or anticoagulation. Intraarterial thrombolysis is indicated for occlusions of less than 2 weeks’ duration where the limb is able to withstand a period of further ischemia. Older occlusions should be treated by surgery, reserving intraoperative lysis for specific situations.
Values of Ultrasonography, Sestamibi Scintigraphy, and Intraoperative Measurement of 1‐84 PTH for Unilateral Neck Exploration of Primary Hyperparathyroidism
Authors: Chapuis Yves , Fulla Yvonne , Bonnichon Philippe , Tarla Emmanuel , Abboud Bassam , Pitre Jol , Richard Bruno
Published: August 2002

Unilateral neck exploration (UNE) is a controversial approach to the treatment of primary hyperparathyroidism (PHP), and most surgeons favor bilateral neck exploration. The aim of this study was to assess the value of ultrasonography, sestamibi scintigraphy, and intraoperative measurement of urinary cyclic AMP (UcAMP) or 1‐84 PTH in 200 patients undergoing unilateral neck exploration under local anesthesia. Conditions for UNE were (1) a presumed solitary adenoma detected by ultrasonography, (2) no thyroid disease, and (3) no family history of PHP or multiple endocrine neoplasia. Patient's consent was obtained for conversion to bilateral exploration according to surgical and biologic findings. Sensitivity of ultrasonography was 92.5%. Sestamibi scintigraphy, performed in 70 patients, was less sensitive than ultrasonography (80%). Persistent PHP was accurately detected by intraoperative measurement of UcAMP or 1‐84 PTH in all cases. At follow‐up, 96.0% of the patients were cured either after unilateral neck exploration only (90.5%), or after conversion into bilateral exploration. Ultrasonography and intraoperative measurement of 1‐84 PTH allow unilateral neck exploration with excellent results in a selected group of patients with PHP.
Preoperative Ultrasonography and Prediction of Technical Difficulties during Laparoscopic Cholecystectomy
Authors: Daradkeh S.S. , Suwan Z. , Abu‐Khalaf M.
Published: August 2002

A prospective study was carried out to investigate the value of preoperative ultrasound findings for predicting difficulties encountered during laparoscopic cholecystectomy (LC). Altogether 160 consecutive patients with symptomatic gallbladder (GB) disease (130 females, 30 males) referred to the Jordan University Hospital were recruited for the purpose of this study. All patients underwent detailed ultrasound examination 24 hours prior to LC. The overall difficulty score (ODS), as a dependent variable, was based on the following operative parameters: duration of surgery, bleeding, dissection of Calot's triangle, dissection of gallbladder wall, adhesions, spillage of bile, spillage of stone, and difficulty of gallbladder extraction. Multiple regression analysis was used to assess the significance of the following preoperative ultrasound variables (independent) for predicting the variation in the ODS: size of the GB, number of GB stones, size of stones, location of GB stones, thickness of GB wall, common bile duct (CBD) diameter, and liver size. Only thickness of GB wall and CBD diameter were found to be significant predictors of the variation in the ODS (adjusted R2= 0.25). We conclude that the preoperative ultrasound examination is of value for predicting difficulties encountered during LC, but it is not the sole predictor.
Infective Complications after Abdominal Surgery in Patients Infected with Human Immunodeficiency Virus: Role of CD4+ Lymphocytes in Prognosis
Authors: Emparan Carlos , Iturburu Ignacio M. , Ortiz J. , Mendez Jaime J.
Published: August 2002

Risk factors associated with surgical infections are related to many events that modulate the immune system and affect the surgical procedure. The aim of this study was to determine the influence of low CD4+ lymphocyte counts in 24 patients with human immunodeficiency virus (HIV) undergoing abdominal surgery. Blood samples were obtained, and the lymphocyte population was evaluated perioperatively, as was the nutritional status of the patient. All the patients received selective antibiotic prophylaxis depending on the surgical procedure performed: (1) clean surgery: splenectomies (n= 8); (2) clean‐contaminated: cholecystectomy and biliary tract surgery (n= 8); and (3) contaminated: appendectomy (n= 8). Depending on their CD4 count, two groups were formed: one with 200 to 500 cells/ml (n= 11) and the other with < 200 cells/ml (n= 13). When surgical infection was suspected, surgical drainage and microbiologic cultures were undertaken. For statistical evaluation of the groups ANOVA and the chi‐square test were used; p < 0.05 was considered significant. Altogether 14 patients (58.3%) had a wound infection, and the mean (± SD) CD4 count in those patients was decreased (221.7 ± 75.1) compared with that of the 10 patients in the uneventful group (386 ± 81.2). Surgical infection rates were 50% for clean procedures, 62.5% for clean‐contaminated procedures, and 62.5% for contaminated surgery. The group of patients with CD4 counts of < 200 cells/ml had an increased incidence of surgical infection, regardless of the type of surgery (p= 0.002). Thus the surgical infection rates in HIV patients undergoing abdominal surgery are dramatically increased. The CD4 and subsequently depressed neutrophil populations increase the risk of surgical infection during major procedures regardless of the type of surgery performed.
Importance of Arterial Blood Supply to the Femur and Tibia for Transplantation of Vascularized Femoral Diaphyses and Knee Joints
Authors: Kirschner Martin H. , Menck Johannes , Hennerbichler Alfred , Gaber Othmar , Hofmann Gunther O.
Published: August 2002

The role of the periosteal and intraosseous blood supply to the femur and the proximal tibia was investigated to improve the operating technique for transplantation of allogenic vascularized femoral diaphyses and knee joints in humans. Altogether 48 limbs were injected with gelatin, red latex milk, or Revertex and macroscopically prepared; 41 limbs were studied for the variation and division of the truncus profundo‐circumflexus. In 200 femurs and 200 tibias the location of the nutrient foramen was determined. The arteries supplying the periosteum of the distal femur and the proximal tibia have defined nutritive areas. The following technique should be followed: If the femoral artery alone is prepared as the vascular pedicle, the optimal section for resection of the femur in knee joint transplantations is 6 to 12 cm above the level of the femur condyles and 5 to 7 cm below the tibial plateau. For the transplantation of femoral diaphyses, the deep femoral artery can be used if the lateral femoral circumflex artery is protected. The proximal line of resection is defined between the greater and lesser trochanter. For shorter grafts one must consider the number and location of nutrient foramens. For longer grafts the distal branches of the femoral artery must be respected as the intraosseous blood supply reaches distally down to the level of about 8 cm above the femoral condyles. In all these operations the variation of the truncus profundo‐circumflexus and the trifurcation of the popliteal artery must be considered.
Choledochoduodenostomy for Common Bile Duct Stones
Authors: de Aretxabala Xabier , Bahamondes Juan Carlos
Published: August 2002

Among the techniques for dealing with common bile stones, choledochoduodenostomy (CDS) represents a useful alternative. This operation is indicated mainly in patients with recurrent stones, giant stones, or concomitant common bile stricture and duct stones. At the present time most of the patients undergoing CDS have been already undergone endoscopic retrograde cholangiography or ultrasonography to study the common bile duct and the cause of symptoms. The common bile duct diameter is of paramount importance when determining the feasibility of performing a CDS, the critical size being 1.2 cm. The most common operation is a side‐to‐side anastomosis employing absorbable sutures. Stomal patency is the most important factor for preventing classic complications such as cholangitis and sump syndrome. These complications are rare, being observed in only 5% of the patients. Long‐term results of the operation show that it is a safe procedure that should be considered a good option in selected patients with choledocholithiasis.
Improving Results of Pancreaticoduodenectomy for Pancreatic Cancer
Authors: Yeo Charles J. , Cameron John L.
Published: August 2002

This report from The Johns Hopkins Hospital reviews the results of pancreaticoduodenal resection during the decade of the 1990s, focusing on two recent publications. The first to be discussed involves a cohort of 650 consecutive patients undergoing pancreaticoduodenectomy (PD), with 443 patients having periampullary adenocarcinomas, 282 of whom had a pathologic diagnosis of pancreatic adenocarcinoma. The second report to be discussed involves the use of adjuvant chemoradiation therapy in a cohort of 174 patients who had successfully undergone PD for pancreatic adenocarcinoma. In both of these cohorts the operative mortality was less than 2%, and the median survival for resected pancreatic adenocarcinoma approximated 20 months.
DNA Ploidy Status and Proliferative Activity as Markers of Malignant Potential in Barrett's Esophagus: Flow Cytometric Study Using Routinely Paraffin‐embedded Tissue
Authors: Giménez Alberto , Minguela Alfredo , de Haro Luisa M. , Parrilla Pascual , Bermejo Juan , Pérez Domingo , García Ana M. , Ortiz María A. , Molina Joaquín , Álvarez Rocío
Published: August 2002

Regular endoscopic surveillance is recommended for patients with Barrett's esophagus to detect dysplasia and to diagnose carcinoma while it is in an early and possibly treatable stage. However, there are numerous unknown aspects regarding the natural history of dysplasia in this disease, and there is still a need for more accurate markers of risk of a malignant change. The aim of this study was to investigate the usefulness of DNA flow cytometry in Barrett's esophagus to define subgroups of patients showing similar histologic findings but with a different malignancy potential. Routinely formalin‐fixed and paraffin‐embedded tissues of 43 patients with Barrett's esophagus were processed for flow cytometric measurements (ploidy, proliferative index) and the results were compared with the histologic evolution observed in these patients. Only in the group of patients with “indefinite” dysplasia did we find statistically significant differences between the samples from patients with and without progression to more severe lesions (mean proliferative index of stable patients: 5.2% versus 8.3% in patients with progression, p= 0.001, Student's t‐test). The presence in the flow cytometric analysis of a DNA aneuploid cell line is closely related to the presence of severe histologic alterations (i.e., high‐grade dysplasia: p < 0.001, Fisher's exact test). Our results suggest that this procedure is at least capable of distinguishing between a real, although incipient, neoplastic process and morphologic changes of a reactive or reparative type. The increment in the tissue proliferative index could be an indicator of an early genomic instability which, with time, will develop into lesions with a more altered DNA content: aneuploidy.
Ultrasound of the Thyroid and Parathyroid Glands
Authors: Barraclough Beverley M. , Barraclough Bruce H.
Published: August 2002

The superficial position of thyroid and parathyroid glands facilitates the use of diagnostic ultrasound (US) as an imaging technique. Techniques of image acquisition and interpretation are described in detail. Size and morphology of glands can be defined easily. The most important use of US guided biopsy in relation to thyroid and parathyroid glands is to increase diagnostic accuracy.
Value of Axillary Sentinel Nodal Status in Breast Cancer
Authors: Cserni Gábor , Boross Gábor , Baltás Béla
Published: August 2002

Axillary clearance in node‐negative breast cancer patients is performed only for staging and prognostic purposes. The sentinel node concept may provide an alternative conservative approach for these patients. This paper reports on the learning experience with lymphatic mapping involving the use of patent blue dye for the identification of sentinel lymph nodes (SLNs), followed by axillary dissection. The histopathology of the SLNs included serial sectioning and immunostaining for cytokeratin and epithelial membrane antigen, the remaining nodes being processed as usual. Of the 70 mapping procedures, 58 were successful; the surgical performance revealed a well defined learning period. The mean diameter of the successfully mapped tumors was 2.4 cm (ranging from in situ carcinoma to 4.8‐cm invasive cancer). The mean numbers of SLNs and non‐SLNs were 1.3 (range 1–3) and 19 (range 7–42), respectively. There were 36 SLN‐positive cases, 21 of which had metastases only to these nodes. There were 19 node‐negative cases, and 3 SLNs were falsely negative. Possible causes of the errors during lymphatic mapping are analyzed in the light of experiences published to date. SLN biopsy seems a good approach to enhancing the selectivity of axillary lymphadenectomy, but the limitations of the procedure must be evaluated and carefully considered.
Surgical Mortality, Survival, and Quality of Life after Resection for Gastric Cancer in the Elderly
Authors: Wu Chew‐Wun , Lo Su‐Shun , Shen King‐Han , Hsieh Mao‐Chih , Lui Wing‐Yiu , P'eng Fang‐Ku
Published: August 2002

Although there were some studies on clinicopathologic characteristics, operative morbidity, and mortality in elderly patients with gastric cancer, no reports have specifically focused on survival and quality of life after resection. A total of 433 patients aged ≥ 65 years (1987–1994) who underwent gastric resection for gastric adenocarcinoma were studied. Two groups were considered: patients aged 65 to 74 years and those > 74 years. Most of the patients (78.1%) had advanced diseases, and nearly half (41.3%) had associated chronic disease(s). Resections with curative intention were performed in 362 patients (83.6%). The overall operative morbidity rate was 21.7% and mortality rate 5.1%. Although operative procedures were similar in both groups, patients aged >74 years had a higher mortality rate than those aged 65 to 74 years (10.1% vs. 3.5%; p= 0.034). Age and extent of gastric resection were two independent factors negatively affecting mortality. The cumulative survival rates for patients who underwent curative resection were 86.2%, 72.4%, 67.2%, 62.9%, and 60.0% at 1, 2, 3, 4, and 5 years, respectively. Nearly all patients (96%) after surgery had normal work and daily activities. Some patients appeared to lack energy (16%) or experienced a period of anxiety or depression. There was no statistical difference in survival and quality of life assessed by the Spitzer index after curative resection between the two groups. Therefore resection with curative intention can be performed for the elderly with acceptable morbidity and mortality rates, possible long‐term survival, and good quality of life, but a limited operation should be considered in the very elderly patients.
Release of Endotoxin‐binding Proteins during Major Elective Surgery: Role of Soluble CD14 in Phagocytic Activation
Authors: Hiki Naoki , Berger Dieter , Mimura Yoshikazu , Frick Julia , Dentener Mieke A. , Buurman Wim A. , Seidelmann Manuela , Kaminishi Michio , Beger Hans G.
Published: August 2002

Our previous study demonstrated that soluble CD14 (sCD14) modulates the biologic activity of circulating endotoxin, which appears after surgery. In this study, we examined the behavior of endotoxin‐binding proteins, such as sCD14, lipopolysaccharide‐binding protein (LBP), and bactericidal/permeability‐increasing protein (BPI), in patients' plasma after major abdominal surgery and the phagocytic secretion of sCD14 from peripheral blood mononuclear cells (PBMCs) throughout the observation period. In a prospective study, 15 patients undergoing major abdominal surgery (gastrectomy, n= 3; pancreatectomy, n= 10; colectomy, n= 2) were involved in this study. The endotoxin‐binding proteins were perioperatively (preoperatively; postoperative hour 6; days 1, 2, 3, 4, 5, 7, and 10) measured by an enzyme‐linked immunosorbent assay (ELISA). To exclude the hemodilution effect of samples, each parameter was corrected by dividing the respective value by the albumin concentration. The phagocytic activity at each time point was tested as an ex vivo sCD14 secretion from PBMCs in the presence and absence of exogenously added endotoxin, Escherichia coli 055B5 (1 ng/ml). Significant endotoxemia (0.35 ± 0.13 EU/ml; p < 0.05) was observed 6 hours after the beginning of surgery. The sCD14/albumin value rapidly increased at 6 hours after surgery, peaked on day 1, and sequentially declined, whereas the BPI/albumin and LBP/albumin ratios increased more gradually and peaked on day 2. The secretion of sCD14 from 2 × 106 PBMCs was significantly enhanced from 6 hours after operation. The increased plasma level of sCD14 may be explained by the parallel‐enhanced sCD14 PBMC production. Activated secretion of these endotoxin‐binding proteins may play a role in regulating the biologic activity of circulating endotoxin.
Manipulation of the Metabolic Response in Clinical Practice
Authors: Kehlet Henrik
Published: August 2002

Surgical injury is followed by profound changes in endocrine metabolic function and various host defense mechanisms leading to catabolism, immunosuppression, ileus, impaired pulmonary function, and hypoxemia. These physiologic changes are supposed to be involved in the pathogenesis of postoperative morbidity. Effective afferent neural blockade with continuous epidural local anesthetic techniques inhibits a major part of the endocrine metabolic response, leading to improved protein economy but without important effects on inflammatory or immunologic responses. In contrast, pain treatment with other modalities such as nonsteroidal antiinflammatory drugs (NSAIDs) and opioids has only a small inhibitory effect on endocrine metabolic responses. Preoperative high‐dose glucocorticoid therapy provides additional pain relief and improves pulmonary function, but it reduces the inflammatory response (acute‐phase proteins, cytokines, hyperthermia) and immune function. Minimally invasive surgery leaves the endocrine metabolic responses largely unaltered but reduces the inflammatory response and immune suppression. Thus several techniques are available to modify the stress responses in elective surgery patients. The effect of these techniques to alter endocrine metabolic and inflammatory responses during severe surgical illness has not been established. Neural blockade and minimally invasive surgery have improved outcome following elective surgery, especially when integrated into a multimodal postoperative rehabilitation program. Application of this knowledge from pathophysiologic responses to uncomplicated surgical injury should be explored in patients with severe surgical illness.
Realignment of the Radius in Canine Antebrachial Growth Deformities Treated With Corrective Osteotomy and Bilateral (Type II) External Fixation
Authors: Quinn Mary K. , Ehrhart Nicole , Johnson Ann L. , Schaeffer David J.
Published: August 2002

Objective—To identify factors affecting radial alignment after oblique corrective osteotomy stabilized with a type II external fixator and to evaluate the results of this treatment for antebrachial growth deformities.

Study Design—Retrospective study

Sample Population—Twenty‐eight dogs with unilateral antebrachial growth deformities treated with acute corrective osteotomy stabilized with a type II external fixator.

Methods—Medical records and preoperative and postoperative radiographs of the affected and contralateral limb were reviewed. Cause of deformity, age, weight, and gender were recorded. Radial length, varus/valgus angulation, and cranial/caudal angulation were measured from radiographs of the treated and contralateral limbs. Preoperative and postoperative angulation and length discrepancy were compared between affected and contralateral limbs.

Results—Correction of varus/valgus angle discrepancy was achieved by using acute corrective osteotomy stabilized with type II external skeletal fixation. No significant change was noted for correction of cranial/caudal angle discrepancy or length discrepancy between the affected and control limb.

Clinical Relevance—Varus/valgus angle deformities can be treated successfully with type II external fixation after oblique corrective osteotomy. Patients with significant length or cranial/caudal angle discrepancies or both that negatively impact function may require the use of hinged circular fixators or other dynamic techniques to achieve adequate correction.
Evaluation of Risk Factors for Luxation After Total Hip Replacement in Dogs
Authors: Dyce Jonathan , Wisner Erik R. , Wang Qiang , Olmstead Marvin L.
Published: August 2002

Objective—To identify risk factors for luxation after canine total hip replacement (THR).

Study design—Retrospective study.

Sample population—256 client‐owned dogs that underwent THR.

Methods—Patient data surveyed included signalment, body weight, diagnosis, prior hip surgery, implant size, intraoperative complications, and angle of lateral opening of the acetabular component.

Results—Postoperative complications were recorded in 20 cases (7.8%). The most common complication was dorsal luxation which occurred in 12 dogs (4.7%). The interval between joint replacement and luxation ranged from 1 to 116 days (mean, 44 days). In 1 case, luxation was attributable to failure of the repair of an intraoperative fracture of the greater trochanter. Excluding this case, the mean angle of lateral opening in those dogs that sustained luxation was 62° (range, 46°‐75°). The mean angle of lateral opening overall was 48° (range, 18°‐76°). The angle of lateral opening was the only factor that had a statistically significant effect on whether luxation occurred (P= .035). Acetabular revision, performed primarily to reduce the angle of lateral opening, was performed in 8 dogs and successfully prevented subsequent luxation.

Conclusion—Luxation of the prosthesis is substantially under the control of the surgeon. It is recommended that the acetabular cup be inserted at an angle of lateral opening of 35° to 45°. In those cases of THR luxation in which an inappropriate angle of lateral opening is identified, acetabular revision arthroplasty generally results in a good clinical outcome.
Thoracoscopic Pericardectomy Performed Without Pulmonary Exclusion in 9 Dogs
Authors: Dupré Gilles P. , Corlouer Jean‐Philippe , Bouvy Bernard
Published: August 2002

Objective—To show the feasibility of thoracoscopic pericardectomy without pulmonary exclusion in dogs.

Study design—Prospective clinical study.

Sample population—Nine client‐owned dogs.

Methods—Dogs referred for the treatment of pericardial effusion by thoracoscopic pericardectomy were intubated with a standard endotracheal tube, mechanically ventilated, and placed in dorsal recumbency. The thoracoscope was introduced into the thorax lateral to the xyphoid process. The operating instruments were inserted at the level of the ventral third of each sixth intercostal space. The pericardium was cut and retrieved through 1 instrument portal.

Results—Lung inflation did not interfere with the surgical dissection. A subphrenic pericardectomy was performed in all dogs without iatrogenic trauma. Operative time, from portal placement to skin closure, ranged from 60 to 100 minutes for the first 2 dogs and decreased to 30 to 45 minutes for the latter 7 dogs.

Conclusions—The reported technique avoids the need for selected intubation which requires special tubes, can be technically difficult to perform, and is not recommended in compromised animals in which bilateral lung ventilation is necessary to ensure adequate tissue oxygenation.

Clinical relevance—Thoracoscopic pericardectomy offers several advantages over open techniques, including less postoperative pain and morbidity, shorter hospital stay, and improved cosmetic appearance. It can be performed without pulmonary exclusion.
Thoracoscopic‐Assisted Diaphragmatic Hernia Repair Using a Thoracic Rib Resection
Authors: Malone Erin D. , Farnsworth Kelly , Lennox Tiffany , Tomlinson Julia , Sage Abby M.
Published: August 2002

Objective—To describe the surgical treatment of a dorsal diaphragmatic hernia in an adult horse using thoracic rib resection aided by thoracoscopy and a flank incision.

Study Design—Case report.

Animal Population—One client‐owned horse.

Results—A six‐year‐old Dutch warmblood gelding was admitted for colic‐associated colonic incarceration in a diaphragmatic hernia. Seven weeks after the initial colic surgery, the gelding underwent surgery to repair the defect. Thoracoscopy and a flank incision were used to identify the location of the hernia and the subsequent site of rib resection. The stomach was adhered to the edges of the defect, leaving only a small residual hole. Resection of the 14th rib provided excellent exposure of the defect and closure of the remaining hernia.

Conclusion and Clinical Relevance—Thoracic rib resection can provide access to diaphragmatic hernias in adult horses. Thoracoscopy or a flank incision, or both, may aid in determining which rib is best resected.