bluuebunny/crossref_metadata_2025 huggingface dataset:
EDXRF and TXRF analysis of aerosol particles and the mobile fraction of soil in Botswana
Authors: Chimidza Samuel , Viksna Arturs , Selin Lindgren Eva
Published: August 2002

Surface soil and airborne particles were sampled at two locations in Botswana, Serowe and Gaborone. EDXRF and TXRF were used to analyse the soil samples for elemental concentrations and the mobile (bio‐available) fractions of the soil. EDXRF was also used for analysis of the aerosol particles in two size fractions, PM2.5 and PM2.5–10. To extract the mobile fraction, the soil samples were leached in ammonium acetate solution at pH 7. Most of the elements in the soils were found to have very low mobility at the two locations. In order to identify elements for which the major sources in the fine and coarse airborne particles are anthropogenic, elemental concentrations in the soil were used to calculate enrichment factors of airborne particles with respect to titanium in soil. From the calculated enrichment factors, it appears that the elements attributed to bio‐mass burning and those attributed to car exhausts have strong anthropogenic sources in Serowe and Gaborone, respectively. Copyright © 2001 John Wiley & Sons, Ltd.
Specifying and Refining Internal Operations in Z
Authors: Derrick John , Boiten Eerke , Bowman Howard , Steen Maarten
Published: August 2002

An important aspect in the specification of distributed systems is the
role of the internal (or unobservable) operation. Such operations are not part of the interface to the environment (i.e. the user cannot invoke them), however, they are essential to our understanding and correct modelling of the system. In this paper we are interested in the use of the formal specification notation Z for the description of distributed systems. Various conventions have been employed to model internal operations when specifying such systems in Z. If internal operations are distinguished in the specification notation, then refinement needs to deal with internal operations in appropriate ways.

Using an example of a telecommunications protocol we show that standard Z refinement is inappropriate for refining a system when internal operations are specified explicitly. We present a generalisation of Z refinement, called weak refinement, which treats internal operations differently from observable operations when refining a system. We discuss the role of internal operations in a Z specification, and in particular whether an equivalent specification not containing internal operations can be found. The nature of divergence through livelock is also discussed.
A Note on Kobayashi's and Yonezawa's “Asynchronous Communication Model Based on Linear Logic”
Authors: de Groote Philippe , Perrier Guy
Published: August 2002

We explain why the Kobayashi–Yonezawa translation of CCS into linear logic does not work properly. Then we introduce our own translation and prove its correctness.
Expressive Power of Specification Languages
Authors: Hayes Ian J.
Published: August 2002

By abstracting away from a particular specification language and considering a ‘specification’ to be just a set of implementations, one can define a partial order on specification languages that reflects their expressive power. In addition, one can show that there is no universal specification language that can express all such ‘specifications’.
Formalization of Time and Space
Authors: Hehner Eric C. R.
Published: August 2002

Time and space limitations can be specified, and proven, in exactly the same way as functionality. Proofs of time bounds, both implementation-independent and real-time, and of space requirements, both worst-case and average-case, are given in complete detail.
Case Study in Protocol Validation: Validating an ATM Signalling Protocol
Authors: Vassiliou-Gioles Theofanis , Schieferdecker Ina
Published: August 2002

This paper discusses validation techniques for communication protocols and analyzes the practical use of selected validation techniques in an automated manner. A case study on validating the ATM (Asynchronous Transfer Mode) Signalling Protocol as specified by ITU-T in Q.2931 is used for this analysis. Different error classes are identified and validated. An assessment of the different validation techniques in terms of effort and quality of results is given. As a result of the case study, an evaluation of the Q.2931 SDL specification completes the paper.
Revising Z: Part I – logic and semantics
Authors: Henson Martin C. , Reeves Steve
Published: August 2002

This is the first of two related papers. We introduce a simple specification logic Z

C

comprising a logic and a semantics (in ZF set theory) within which the logic is sound. We then provide an interpretation for (a rational reconstruction of) the specification language Z within Z

C

. As a result we obtain a sound logic for Z, including a basic schema calculus.
Surgery and Adjuvant Therapy in Patients with DiffusePeritonitis: Cost Analysis
Authors: Welcker Katrin , Lederle Jens , Schorr Markus , Siebeck Matthias
Published: August 2002

In a prospective, randomized, controlled trial the effect of high dose intravenous antithrombin III andintraabdominal donor serum was analyzed in 36 patients with diffusesecondary peritonitis. The direct cost for treatment was 25,370 eurosper patient, and the post acute hospital care costs and societal costswere 6273 euros. The cost for intensive care of these patientsaccounted for approximately 83% of the direct costs, while theexpenditures for operating theater and general wards accounted for 9%each. The most expensive factors were staff, medication, and bloodproducts. The hospital incurred a deficit of 3696 euros for eachpatient after reimbursement from public health insurance companies.Quality of life as assessed by the gastrointestinal quality of lifeindex (GIQI) showed a good outcome. On average 11 quality adjusted lifeyears (QALY) were achieved. The cost per QALY was 2631 euros. Use ofadjuvant therapy was associated with a reduced duration of intensivecare unit (ICU) treatment, times on mechanical respiration, andhemofiltration; the cost of treatment was reduced by 6614 euros perpatient. The additional cost of antithrombin III (5155 euros) was morethan offset by the savings made when adjuvant therapy was used.
Inhibitory Effect of Loxiglumide (CR 1505), a CholecystokininReceptor Antagonist, onN‐Nitrosobis(2‐oxopropyl)amine‐induced BiliaryCarcinogenesis in Syrian Hamsters
Authors: Ogura Yoshifumi , Matsuda Shinsuke , Itho Morihiro , Sasaki Hideto , Tanigawa Kanji , Shimomura Makoto
Published: August 2002

We evaluated the cholecystokinin (CCK)receptor antagonist loxiglumide (CR1505) for a possible inhibitoryeffect on biliary carcinogenesis in a hamster model. Experimental groupI underwent cholecystoduodenostomy and ligation of the distal end ofthe common bile duct, after which the animals were injected withN‐nitrosobis(2‐oxopropyl)amine (BOP) alone. Group II, afterthe same surgical procedure as in group I, were given injections of BOPand then given loxiglumide in their diet. The sham‐operated groupunderwent simple laparotomy and then were given injections of BOP.Loxiglumide significantly inhibited BOP carcinogenicity in thegallbladder and extrahepatic bile duct but not in the intrahepatic bileducts or pancreas. Autoradiography showed that loxiglumidesignificantly suppressed 125I‐Bolton‐Hanter (BH)‐CCK‐8binding to CCK receptors in the gallbladder and extrahepatic bile ductbut not in the liver or pancreas, and CCK binding to its receptors wasobserved in an area identified as cancer tissue. CCK receptorantagonists have an inhibitory effect on BOP carcinogenesis in theextrahepatic biliary tract, including the gallbladder and extrahepaticbile duct, of Syrian hamsters. The difference in the inhibitory effectof loxiglumide on biliary carcinogenesis in hamsters according to sitemay be due to differences in CCK receptors or the affinity ofloxiglumide for such biliary tract organs. A difference betweencarcinogenesis in the intrahepatic bile ducts and extrahepatic biliarytract may be another reason.
Immunohistochemical Expression of P53and Oncogenes in Ulcerative Colitis‐associated ColorectalCarcinoma
Authors: Brüwer Matthias , Schmid Kurt W. , Senninger Norbert , Schürmann Guido
Published: August 2002

The role of the tumor suppressor gene p53and proto‐oncogenes mdm‐2, waf‐1,and bcl‐2 in sporadic colorectal carcinoma (CRC) hasbeen well investigated. However, little is known about the role ofthese genes in the development of ulcerative colitis‐associatedcolorectal carcinoma (CAC). Colectomy specimens from patients with CAC,patients with ulcerative colitis (UC) and dysplasia, patients withlong‐standing UC without carcinoma or dysplasia, and patients with CRC were investigated in comparison to normal colon (NC) specimens frompatients with diverticulosis without histologic signs of inflammation.Immunohistochemistry was performed with antibodies against p53, mdm‐2,waf‐1, and bcl‐2; and staining was evaluated semiquantitatively with anexpression of more than 20% of tumor cell nuclei or epithelial cellnuclei in nontumor specimens considered "positive." Statisticalanalysis was performed using Fisher’s exact test. In carcinomas, p53 was positive in 50% of CRC tissues and 60% of CACtissues without statistical difference. Positive expression of p53 was found in most high‐grade dysplasia but not inlow‐grade dysplasia (p < 0.01). Whereas mdm‐2 and bcl‐2 were only sporadicallyexpressed, waf‐1 was observed in most specimens, with ahigh prevalence in UC without carcinoma or dysplasia (11/15). NCspecimens were always negative for all antibodies. Immunohistochemicalexpression of p53, mdm‐2, waf‐1, and bcl‐2 issimilar for CAC and CRC. The malignant potential of dysplasia in UC ispartially confirmed by a high prevalence of p53 and waf‐1 expression, suggesting that CAC may develop alongpathways that are different from CRC. High expression ofwaf‐1 in nonmalignant long‐standing UC has to be provedover a long‐term course in its role as an independent cancer riskfactor in UC patients.
Surgical Indications and Strategies for Necrotizing Enterocolitis in Low Income Countries
Authors: Banieghbal Behrouz , Schoeman Leonie , Kalk Fredrick , da Fonseca John M. , Davies Michael R.Q.
Published: August 2002

In high income countries, mortality of neonates due to necrotizing enterocolitis (NEC) is decreasing due to advances in early detection and sepsis management. Surgical strategies,
by and large, are becoming less relevant as the sophistication of intensive care facilities increases in those countries. Management of septic neonates with NEC in low income countries, however, due to inherent resource constraints cannot achieve the same standards as those reported from high income countries. Surgeons therefore play an important role because they can offer different surgical strategies in line with the deficiency of their environment. Over a 4‐year period,
172 neonates who had surgery for NEC in a single institution were prospectively followed up. Standard surgical practices of the high income countries were compared to those adopted by the authors. The end point was early mortality, taking into account the anatomical zones of the involved intestine. Survival was increased from 21% to 84% by early surgery and by extending the length of colon resected in cases of ileocolic NEC. In this approach, a short resuscitative period is followed by intestinal resection including most of the diseased colon as well as the perforated/dead bowel. A more modest improvement in survival was noted with a planned re‐look laparotomy in neonates with generalized NEC.
Contractility In Vitro and Mitochondrial Response in Small and Large Rabbit Bowel after Anastomosis
Authors: Testini Mario , Portincasa Piero , Scacco Salvatore , Piccinni Giuseppe , Minerva Francesco , Lissidini Germana , Papa Francesco , Loiotila Luigi , Bonomo Giovanni Martino , Palasciano Giuseppe
Published: August 2002

Leakage of a large bowel anastomosis remains the most serious postoperative complication in gastrointestinal surgery. In a recent experimental study we found that surgically induced hypoxia resulted in more derangement of a variety of biochemical markers in the large bowel (LB) than in the small bowel
(SB). We explored the question of whether spontaneous and agonist‐induced contractility of SB and LB muscle strips was influenced by surgical procedures and how contractility was related to energetic oxidative metabolism capacity in smooth muscle mitochondria. Sixty male New Zealand rabbits were operated on under general anesthesia. Segments of ileum and colon were resected from each rabbit, and an end‐to‐end anastomosis was constructed. A representative subset of segments from SB (n = 14) and LB (n = 14) at time 0
was used as controls. Tracts containing an anastomosis were resected at days 2, 7, and 14 after operation. At each time point, 20 segments adjacent to the anastomosis of both SB and LB were used for tensiometric and biochemical studies. Tensiometric studies demonstrated modifications in the smooth muscle function at both the acute and chronic stages with intestinal inflammation that may contribute to surgical stress‐associated abnormal motility. Biochemical data showed that the respiratory capacity of the resected LB was more impaired than that of the SB. In both SB and LB, changes in respiratory activity preceded tensiometric changes. Thus abnormalities of contractility after surgical stress are more evident in LB than SB in segments adjacent to the anastomoses. This could be the consequence of abnormal biochemical changes, as adenosine triphosphate (ATP) is required for membrane potential maintenance, calcium homeostasis, and actin–myosin interactions.
Treatment of Erectile Dysfunction: What Should We Do Next?
Authors: Tsukamoto Taiji , Sato Yoshikazu , Horita Hiroki , Itoh Naoki
Published: August 2002

Abstract

Because sildenafil (Viagra) is scheduled to be clinically available in the near future, urologists in Japan must prepare for changes in the treatment of erectile dysfunction. The drug will surely influence our current clinical style of diagnosis and treatment of the dysfunction. We herein discuss this issue, referring to favorable and unfavorable effects that will be brought about by the drug. We also propose several future studies that we should do, including those on testosterone replacement therapy. We present results of our experiment using testosterone replacement therapy in aged rats and speculate about the mechanism by which the hormone replacement works in the sex center of the brain.
Growth Factors in Clinical Practice
Authors: Jiang Zhu‐Ming , Wilmore Douglas W. , Liu Wei , Liu Yue‐Wu
Published: August 2002

Growth factors enhance protein synthesis and thus reduce the catabolic response to injury. As a result of bioengineering and new manufacturing techniques several anabolic agents have become available for clinical use and have been evaluated in surgical patients with catabolic illness. Data support the anabolic effects of growth home in such patients, but its expense and possible deleterious effects during the acute phase of illness limit its use to selected patient groups. Insulin‐like growth factor‐1 has also been studied, but specific indications for its use have not been identified in catabolic patients. Testosterone and derivatives of this hormone exert anabolic effects, but few randomized trials include catabolic surgical patients, and higher doses of some derivative compounds are associated with hepatic dysfunction. Nonetheless, as we move into the future, studies will determine the specific doses for administration of these and other anabolic factors in specific patient groups. Anabolic therapy will shorten the length of therapy and improve the outcome in the future.
Relation between Effective Utilization of Exogenous Fat Emulsion as Energy Substrate and Oxygen Metabolism after Surgery
Authors: Sane Souji , Baba Masamichi , Kusano Chikara , Shirao Kazusada , Yamada Haruhiko , Aikou Takashi
Published: August 2002

It is known that fat oxidation is increased in patients who have sustained surgical stress, but it is not clear whether fat emulsion should be administered during the early postoperative period. The aim of this study was to evaluate the utilization of exogenous fat emulsion after major surgery. Total parenteral nutrition composed of glucose/amino acids or glucose/amino acids/fat was administered for 6 days to 18 patients who had undergone esophagectomy. The caloric intake was significantly less than the resting energy expenditure (REE), and there was no difference in substrate utilization in either group up to postoperative day (POD) 2. After POD 4, fat utilization was significantly increased in the fat group. The total ketone body concentration was higher in the fat group than in the glucose group on POD 1 and 2. The arterial ketone body ratio (AKBR), which reflects the rate of turnover of the Krebs cycle, was positively correlated with the caloric intake/REE ratio. It was negatively correlated with the oxygen delivery index, oxygen consumption, and lactate concentration between POD 0 and POD 2. The lactate concentration was decreased and the AKBR was increased by POD 4. Fat emulsion was effectively utilized as energy substrate after POD 4, after the relative tissue hypoxia had improved and the AKBR had increased. The utilization of exogenous fat emulsion was closely related to deficient caloric intake and oxygen metabolism.
Risk Factors for Recurrence after Resection of Hepatitis C Virus‐related Hepatocellular Carcinoma
Authors: Kubo Shoji , Hirohashi Kazuhiro , Tanaka Hiromu , Tsukamoto Tadashi , Shuto Taichi , Ikebe Takashi , Yamamoto Takatsugu , Wakasa Kenichi , Nishiguchi Shuhei , Kuroki Tetsuo , Kinoshita Hiroaki
Published: August 2002

Although there have been many studies of the risk factors for recurrence after resection of hepatocellular carcinoma (HCC), the subjects were patients with various viral status in the previous studies, and hepatitis C viremia has not been evaluated. We investigated risk factors, including hepatic C viremia and histologic findings of noncancerous hepatic tissue, for recurrence after resection of hepatitis C virus (HCV)‐related HCC. A total of 223 patients who underwent liver resection for HCV‐related HCC were studied. HCV viremia, laboratory data, degree of HCC malignancy, histologic findings in noncancerous hepatic tissue, preoperative interferon therapy, and operative methods were evaluated for recurrence risk by univariate and multivariate analyses. Serum levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and total bilirubin, and the proportion of patients with a high histologic activity score (mild to severe active hepatitis) were significantly higher in patients with HCV viremia than in those without viremia. Serum albumin was significantly lower in patients with HCV viremia. By univariate analysis, older age (> 65 years old), HCV viremia, elevated AST (> 40 IU/L) and ALT (> 45 IU/L), large tumors (> 40 mm), multiple HCCs, moderately or poorly differentiated HCC, portal invasion, mild to severe active hepatitis, and lack of preoperative interferon therapy were risk factors for recurrence. Multivariate analysis showed that older age, HCV viremia, high AST, multiple HCCs, and portal invasion were independent risk factors. For HCV‐related HCCs, not only the degree of maliganacy of the HCC but also HCV viremia and active hepatitis are risk factors for recurrence.
Assessment of Proliferative Activity of Glandular Cells in Hyperfunctioning Parathyroid Gland Using Flow Cytometric and Immunohistochemical Methods
Authors: Xiao‐Lin Pan , Koide Naohiko , Kobayashi Shinya , Kobayashi Masaru , Sugenoya Akira , Iida Futoshi , Katsuyama Tsutomu , Usuda Nobuteru , Nagata Tetsuji
Published: August 2002

The proliferative activity of epithelial cells in hyperfunctioning parathyroid glands was estimated by flow cytometric and immunohistochemical procedures. A total of 30 parathyroid glands, 29 hyperfunctioning glands, and 1 normal gland were studied. The pathology of the 29 glands was determined to be hyperplasia in 19 and adenoma in 10. The S‐phase cell population was expressed in terms of the S‐phase fraction (%SPF) calculated from the histogram by DNA flow cytometry and in terms of the BrdU immunostaining labeling index (BrdU LI). Cells in all stages of the cell cycle were studied by Ki‐67 immunostaining and expressed in terms of the labeling index (Ki‐67 LI). Both BrdU LI and Ki‐67 LI values were low, ranging from 0% to 0.58% and from 0.21% to 2.62%, respectively. The BrdU LIs were lower than the Ki‐67 LIs, ranging from one‐sixth to one‐twelfth of the values depending on the disease. There were significant correlations between the two indices (p< 0.001). The %SPF determined by flow cytometry was consistently higher than both the BrdU LI and the Ki‐67 LI. This discrepancy cannot be explained precisely, and further improvements are required for the flow cytometric analysis of %SPF. The cell cycle study by BrdU and Ki‐67 immunohistochemistry suggested that the glandular cells of the hyperfunctioning parathyroid were characterized by low proliferative activity. No evidence of rapid cell turnover rate assumed from the flow cytometric study could be observed in the hyperfunctioning parathyroid gland.
Adrenal Surgery in the Elderly: Too Risky?
Authors: Lo Chung Yau , van Heerden Jon A. , Grant Clive S. , Söreide Jon Arne , Warner Mark A. , Ilstrup Duane M.
Published: August 2002

Surgical treatment for adrenal disease may be withheld from elderly patients because of concern about prohibitive operative morbidity and mortality. To obtain objective data in our practice, we analyzed the results of adrenalectomy for patients aged 65 years and older. From 1984 to 1993 there were 85 patients (41 men, 44 women) with ages ranging from 65 to 84 years (median 69 years) who underwent adrenalectomy for Cushing syndrome (n= 19), pheochromocytoma (n= 16), adrenocortical carcinoma (n= 7), benign adenoma (n= 26), or primary hyperaldosteronism (n= 17) at our institution. Median follow‐up was 26 months (range 1 month to 9.1 years). A retrospective review with respect to preoperative risks and postoperative morbidity and mortality was performed utilizing the American Society of Anesthesiologists (ASA) physical status classification and the modified Goldman multifactorial cardiac risk scheme. Survival was estimated by the Kaplan‐Meier methods. Operative mortality was 7% (six patients). No patients with pheochromocytoma or primary hyperaldosteronism died during the postoperative period. Patients undergoing adrenalectomy for adrenocortical carcinoma had a significantly higher operative mortality (43%) (p= 0.006). Postoperative complications developed in 19 patients (22%), and there was a reoperation rate of 6% (5 patients). Nineteen percent of patients required postoperative intensive care admission and had a median stay of 2 days (range, 1–38 days). Median hospital stay was 7 days (range 3–47 days). Seventy‐three patients (86%) remained alive at study completion. Two‐ and five‐year survivals were 86% and 84%, respectively. Goldman class II or greater was an excellent predictor of increased morbidity (p= 0.032) and mortality (p= 0.036). With the exception of adrenocortical carcinoma, adrenal surgery for elderly patients can be performed with acceptable morbidity and mortality. The Goldman multifactorial cardiac risk scheme reliably predicts postoperative outcome in this elderly group of patients.
Preoperative Change of Thyroid Stimulating Hormone Receptor Antibody Level: Possible Marker for Predicting Recurrent Hyperthyroidism in Patients with Graves’ Disease after Subtotal Thyroidectomy
Authors: Sugino Kiminori , Mimura Takashi , Ozaki Osamu , Iwasaki Hiroyuki , Wada Nobuyuki , Matsumoto Akihiko , Ito Kunihiko
Published: August 2002

To make the surgical treatment for Graves’ disease more ideal, it is important to elucidate factors related to postoperative thyroid dysfunction in addition to thyroid remnant. Because TSH receptor antibody (TRAb) is thought to be one of the essential causes of Graves’ disease, we investigated whether preoperative changes in serum TRAb levels are related to postoperative recurrent hyperthyroidism. Between 1987 and 1992 a total of 1520 patients with Graves’ disease were treated by subtotal thyroidectomy. Of these patients 335 visited Ito Hospital with no history of drug treatment of their disease and were treated surgically after several courses of antithyroid drug (ATD) therapy. There were 68 males and 267 females with a mean age of 25.8 years. The mean follow‐up period was 48 months (range 12–84 months). Factors analyzed by univariate and multivariate analysis were as follows: age, sex, duration of ATD treatment, weight of resected thyroid, weight of thyroid remnant, preoperative titer of MCHA, TRAb at the time of initial examination (TRAb1), TRAb at the time of surgery (TRAb2), and ΔTRAb, the difference between TRAb1 and TRAb2 (ΔTRAb = TRAb1 − TRAb2). The chi‐square test was used for univariate analysis and a logistic model for multivariate analysis. Of this group, 119 patients were euthyroid (35.5%), 50 were hyperthyroid (14.9%), and 166 were hypothyroid (49.3%). Significant factors related to recurrent hyperthyroidism were weight of thyroid remnant and ΔTRAb in both univariate and multivariate analyses. ΔTRAb is a possible new marker for predicting postoperative recurrent hyperthyroidism. If the preoperative TRAb level is not improved by ATDs in patients with Graves’ disease, the thyroid remnant should be made smaller.
Duodenal but not gastric transection disturbs motility of the sphincter of Oddi in the dog
Authors: Shibata Chikashi , Sasaki Iwao , Naito Hiroo , Ohtani Noriya , Sato Shoichi , Ise Hideo , Matsuno Seiki
Published: August 2002

The aim of the present study was to elucidate the effect of gastric and duodenal transection on biliary manometry in anesthetized dogs. The basal biliary pressure and increase in pressure during saline perfusion at rates of 1.0 and 1.5 ml/min were studied in intact controls, during infusion of cholecystokinin (CCK) alone, and after gastric and duodenal transection. CCK dose‐dependently lowered the basal pressure and the increase in pressure during perfusion. Gastric transection 1.5 cm proximal to the pylorus did not affect these parameters. In contrast, duodenal transection 1.0 cm distal to the pylorus significantly increased these parameters compared to all other groups. These observations suggest that the proximal duodenal transection, as performed during conventional distal gastrectomy, may contribute to the pathogenesis of postgastrectomy gallstone formation by altering motor function of the sphincter of Oddi.
Surgical Perspective on Invasive Candida Infections
Authors: Dean David A. , Burchard Kenneth W.
Published: August 2002

Invasive and disseminated Candida infections have become a major source of morbidity and mortality in the modern surgical intensive care unit. The most common risks for invasion and dissemination are the use of antibiotics, central venous lines, total parenteral nutrition, burns, immunosuppression, and other markers for severity of illness (APACHE > 10, ventilatory use for > 48 hours). Data suggest that colonization can be a late predictor of invasive disease in today's critically ill surgical patient and that prophylaxis or early treatment in high risk patients is warranted, particularly before invasive/disseminated disease becomes life‐threatening. When advanced disease is present, the diagnosis of invasive or disseminatedCandida infection is often prompted by clinical suspicion and supported by consistent clinical data; laboratory tests alone lack sufficient sensitivity and specificity to direct therapeutic decision‐making. Once the diagnosis of invasive or disseminatedCandida infection is ascertained, early systemic treatment, along with treatment of localized infection, is as fundamental as with any other serious infectious disease. Reported toxicity and efficacy supports the use of fluconazole for most patients with invasive/disseminated Candida infections. For the most critically ill surgical patient amphotericin B remains the treatment of choice. Prophylaxis and early treatment strategies with minimally toxic agents may diminish the need to use more toxic therapy in the most severely ill patients.
Role of Fine‐needle Aspiration Biopsy and Frozen Section Examination in Determining the Extent of Thyroidectomy
Authors: Hamming Jaap F. , Vriens Menno R. , Goslings Bernard M. , Songun Ilfet , Fleuren Gert J. , van de Velde Cornelius J.H.
Published: August 2002

Traditionally the extent of thyroidectomy in patients with nodular thyroid disease has been based on peroperative frozen section examination (FS). Fine‐needle aspiration biopsy (FNAB) and FS were evaluated with regard to the reliability to determine whether an operation for cancer is necessary. Both methods were performed in 240 patients operated for nodular thyroid disease and compared with the final histology on paraffin sections. Altogether 72 (30%) patients were found to have a malignant lesion on final histology. Only a malignant FNAB diagnosis and a malignant FS diagnosis were considered positive results for determining the extent of thyroidectomy. The test characteristics were equal: the sensitivity of FNAB and FS was 67%, the specificity 99%, and the accuracy 89%. The positive predictive value was 96% for FNAB and 98% for FS; the negative predictive values were 88% and 87%, respectively. Further analysis of the results indicates that FS is not necessary for patients with a malignant FNAB result. These patients should undergo a therapeutic operation for malignancy. When the FNAB result is uncertain, patients should undergo diagnostic surgery, and definitive surgery should be based on the final histology. Routine use of FS can be omitted.
Amitogenic Alginates: Key to First Clinical Application of Microencapsulation Technology
Authors: Hasse Christian , Zielke Andreas , Klöck Gerd , Schlosser Anja , Barth Peter , Zimmermann Ulrich , Sitter Helmut , Lorenz Wilfried , Rothmund Matthias
Published: August 2002

Microencapsulation refers to a technique of immunoisolation by coating single cells or tissue with a semipermeable membrane. By combining microencapsulation with a specific tissue culturing method, iso‐, allo‐, and xenotransplantation of parathyroid tissue has been achieved without immunosuppression in a long‐term animal model. Prior to its clinical use, continued analyses of the alginate, used as a coating substance, determined its mitogenic properties. Purification of the commercially available alginate was achieved using patented electrophoretic procedures, resulting in an amitogenic alginate suitable for use in humans. However, this alginate exhibited entirely different physical properties. We have recently shown that isotransplanted parathyroid tissue remains vital and functioning in vivo over long periods of time using the novel amitogenic alginate. It is essential to document, whether the alginate is able to maintain immunoisolation. We have therefore assessed its in vivo function compared to the mitogenic alginate in a transgenic animal model. Altogether 600 parathyroid glands from 300 Lewis rats (donor animals) were excised and subjected to tissue culture. Thereafter they were allotransplanted to 30 parathyroidectomized Dark‐Auita rats, microencapsulated with the amitogenic or the mitogenic alginate or naked, with 10 recipient animals in each group. Total serum calcium and parathyroid hormone levels were monitored continuously at weekly intervals for 30 weeks. After 26 weeks the transplant beds were excised and subjected to histologic examination. More than 6 months after allotransplantation 9 of 10 animals that had received amitogenic transplants, compared to 7 of 10 animals in the group with mitogenic microcapsules were normocalcemic. Animals that had received naked parathyroid tissue were hypocalcemic as soon as 2 weeks after allotransplantation. Correspondingly, normocalcemic animals showed vital parathyroid tissue inside the microcapsules, which were surrounded by a significantly smaller rim of fibroblasts when amitogenic alginate had been used. In addition to confirming physiologic long‐term function, we were able to document for the first time that immunoisolation can also be achieved with the novel amitogenic alginate, which is suitable for clinical use.
Popliteal Artery Aneurysms
Authors: Davidovic Lazar B. , Lotina Slobodan I. , Kostic Dusan M. , Cinara Ilijas S. , Cvetkovic Slobodan D. , Markovic Dragan M. , Vojnovic Bojan R.
Published: August 2002

Altogether 59 patients with 76 popliteal artery aneurysms were treated during the last 36 years. There were 50 (85%) male and 9 (15%) female patients with an average age of 61 years. Nineteen (32%) patients had bilateral aneurysms. The clinical manifestations of the aneurysms included ruptures 4 (5.3%); deep venous thrombosis 4 (5.3%); sciatic nerve compression 1 (1.3%); leg ischemia 52 (68.4%), and asymptomatic pulsatile masses 15 (19.7%). Seventy (92%) aneurysms were atherosclerotic, one (1.3%) mycotic, and four (5.3%) traumatic; one (1.3%) developed owing to fibromuscular displasia. Seven (9.2%) small, asymptomatic aneurysms were not operated on. Reconstructive procedures (end‐to‐end anastomosis, graft interposition, bypass) after aneurysmal resection or exclusion using a medial or posterior approach were done in 59 cases. An autologous saphenous vein graft was used in 49 cases, polytetrafluoroethylene (PTFE) in 5, and heterograft in 2 cases. The in‐hospital mortality rate was 2.9%, the early patency rate 93.3%, and limb salvage 95%. The long‐term patency rate after a mean follow‐up of 4 years was 78% and long‐term limb salvage 89%. The total limb salvage was 73%, and the total amputation rate was 27%. The dangerous complications associated with popliteal artery aneurysms and the good results after elective procedures suggest that operative treatment is appropriate.
Cardiac Abnormalities Associated with Morbid Obesity
Authors: Herrera Miguel F. , Oseguera Jorge , Gamino Rosa , Gutiérrez‐Cirlos Carlos , Vargas‐Vorackova Florencia , González‐Barranco Jorge , Rull Juan A.
Published: August 2002

Morbidly obese patients are at increased risk for structural and functional abnormalities of the heart. This paper summarizes the effects of obesity on the heart, the effect of weight reduction on cardiac function, the impact of coronary artery disease on cardiac cardiomyopathy, and our experience in obesity heart disease at the Instituto Nacional de la Nutrición in Mexico.
Microsomal Cytochrome P‐450 Monooxygenase System and Its Drug‐metabolizing Activity after Partial Portal Vein Ligation in the Rat
Authors: Izuishi Kunihiko , Wakabayashi Hisao , Kokudo Yasutaka , Maeba Takashi , Ryu Munemasa , Maeta Hajime
Published: August 2002

Percutaneous transhepatic portal vein embolization (PTPE) has been used to decrease the risk of hepatic failure after hepatectomy in patients with poor liver function. The effect of PTPE on hepatic drug‐metabolizing activities is not clear. Therefore we examined the effect of portal vein branch ligation, a model of PTPE, on hepatic drug‐metabolizing activities in Sprague‐Dawley rats. Ligated and nonligated lobes were harvested separately. Drug‐metabolizing activities and concentrations of components of the microsomal cytochrome P‐450 monooxygenase system were examined. In ligated lobes, drug‐metabolizing activities (lidocaine and aminopyrine) and enzymatic concentrations of the microsomal cytochrome P‐450 monooxygenase system gradually decreased over 10 days. In nonligated lobes these functions were depressed rapidly to 60% of those before PBL but then recovered 10 days after PBL. From the viewpoint of drug metabolism, hepatic dysfunction occurred in both ligated and nonligated lobes.
Contribution of the Renal Medulla to Enhanced Ketogenesis with Ringer's Acetate Administration during Hepatic Inflow Occlusion RID="" ID="" This International Society of Surgery (ISS)/Société Internationale de Chirurgie (SIC) article was presented at the 37th World Congress of Surgery International Surgical Week (ISW97), Acapulco, Mexico, August 24–30, 1997.
Authors: Nakatani Toshio , Sakamoto Yoshimasa , Ando Hirofumi , Kobayashi Kunio
Published: August 2002

We have reported that the administration of Ringer's acetate solution (AR) maintains plasma ketone body concentrations even during hepatic ischemia due to enhanced ketogenesis in the kidney. In this study we tried to clarify which part of the kidney, cortex or medulla, contributes to the enhanced ketogenesis. During 20 minutes of hepatic inflow occlusion, AR or Ringer's lactate solution (LR) was administered. Ketone body concentrations in arterial and renal venous blood and renal cortical and medullary tissue were measured enzymatically. Results are expressed as means ± SEM. At
20 minutes of hepatic inflow occlusion, arterial ketone body concentrations decreased to 38% of preischemic values with the LR infusion but increased under AR administration and were four times higher than that with LR. The renal arteriovenous difference in ketone body concentration was 16 ± 14 μmol/ml before hepatic inflow occlusion and −52 ± 14 with AR administration, indicating that renal ketogenesis occurred during hepatic ischemia. Total ketone body concentrations in the renal cortex and medulla were 56 ± 6 and
61 ± 5 μmol/g, respectively with LR, but increased to 186
± 29 and 248 ± 25 μmol/g, respectively during AR administration. The concentration in the medulla was higher
(p= 0.12) than that in the cortex but did not reach statistical difference. Renal ketogenesis increases during hepatic inflow occlusion with AR administration. It is likely that the enhancement of ketogenesis takes place predominantly in the medulla of the kidney.RID="" ID="" Correspondence to: T. Nakatani, M.D., Department of Emergency and Critical Care Medicine, Kansai Medical University, 10‐15 Fumizonocho, Moriguchi, Osaka 570‐8507, Japan
Tumors of the Appendix and Colon
Authors: Hatch Kathryn F. , Blanchard D. Kay , Hatch George F. , Wertheimer‐Hatch Laura , Davis Gregory B. , Foster Roger S. , Skandalakis John E.
Published: August 2002

This collective review includes all available case reports of smooth muscle (stromal) tumors of the appendix and large intestine in the world literature. When compiling this review, we endeavored to examine cumulative as well as recently collected data on both benign and malignant smooth muscle tumors spanning the period 1875 to 1996. In total, there were reports of 331 leiomyomas (LMs) and 263 leiomyosarcomas (LMSs). The peak age of incidence of LM was 30 to 39 years, and the peak age of incidence of LMSs was 50 to 59 years. The female/male ratio was slightly higher for LM, and the male/female ratio was higher for LMS. The descending colon and sigmoid colon were the most common sites of both benign and malignant smooth muscle tumors. The growth of LMs most often occurred extraluminally, whereas LMSs tended to grow within the lumen of the colon. With both tumor types pain was the most frequent presenting complaint, followed less commonly by complaints of a palpable mass or gastrointestinal bleeding. LMSs tended to be larger at diagnosis than LMs, though the duration of symptoms for both types of tumor was most often reported to be between 1 month and 1 year. Finally, LMSs were found to metastasize most commonly to the liver, with metastatic disease reported in 43% of all cases.
Does Hyperthermia Induce Peritoneal Damage in Continuous Hyperthermic Peritoneal Perfusion?
Authors: Shido Akemi , Ohmura Shigeo , Yamamoto Ken , Kobayashi Tsutomu , Fujimura Takashi , Yonemura Yutaka
Published: August 2002

To investigate the mechanisms of the peritoneal damage induced by continuous hyperthermic peritoneal perfusion (CHPP), protein and fluid loss during and after CHPP and continuous normothermic peritoneal perfusion (CNPP) was studied. Sixteen patients with advanced gastric cancer underwent peritoneal perfusion therapy with saline solution containing 150 to 300 mg cisplatin and 30 to 60 mg mitomycin C for 60 minutes. The temperature in Douglas' pouch was maintained at 42.0°C in the CHPP group (n= 9) and 37.0°C in the CNPP group (n= 7) during perfusion. No statistical differences were found in patients' characteristics between the groups except the maximum temperature in Douglas' pouch during perfusion (41.6°± 0.4°C and 37.6°± 0.4°C in CHPP and CNPP groups, respectively, p < 0.05). The amount of protein lost into the perfusate was 0.35 ± 0.22 g/kg body weight in the CHPP group and 0.37 ± 0.19 g/kg in the CNPP group, showing no significant difference. On the day of surgery, there was no significant difference in the amount of protein and fluid lost through the abdominal drains between the CHPP group (27.9 ± 24.6 mg/kg/hr and 0.94 ± 0.63 ml/kg/hr, respectively) and the CNPP group (25.9 ± 8.6 mg/kg/hr and 1.03 ± 0.31 ml/kg/hr, respectively). We could not find any significant differences in postoperative protein and fluid loss between the groups on the following 3 days either. We conclude that the peritoneal damage by CHPP is not caused by the hyperthermia but by the peritoneal perfusion with saline solution containing anticancer drugs.
Preincisional Dextromethorphan Treatment for Postoperative Pain Management after Upper Abdominal Surgery
Authors: Wu Ching‐Tang , Yu Jyh‐Cherng , Liu Sy‐Tzu , Yeh Chun‐Chang , Li Chi‐Yuan , Wong Chih‐Shung
Published: August 2002

Previous studies showed that ketamine, an N‐methyl‐d‐aspartate (NMDA) receptor antagonist, provides a preemptive analgesic effect and preemptive analgesia improves postoperative pain management. The aim of this study was to examine whether premedication with dextromethorphan (DM) improves postoperative pain management after upper abdominal surgery. Sixty (American Society of Anesthesiologists class 1 and 2 of either gender) patients scheduled for upper abdominal surgery were included in the study. Patients were randomly assigned to one of four groups: control, DM‐10, DM‐20, and DM‐40. In the control group, chlorpheniramine maleate (CPM, 20 mg) was injected immediately before induction of anesthesia intramuscularly (IM). In the DM‐10, DM‐20, and DM‐40 groups, patients were premedicated with DM 10 mg, 20 mg, and 40 mg IM, respectively. After operation, patient‐controlled analgesia (PCA) with morphine was given for pain relief. The time to the first PCA trigger, morphine consumption, pain scores, and analgesic‐related side effects were recorded at 1, 2, 4, 24, 48, and 72 hours after surgery. The time to first PCA trigger for the control group was 17.8 ± 1.4 minutes, for group DM‐10 20.2 ± 1.6 minutes, for group DM‐20 32.4 ± 1.9 minutes, and for DM‐40 77.9 ± 6.5 minutes. The morphine delivered and PCA triggering frequency were 5.5 ± 0.5/11.3 ± 0.8 times for the controls, 5.5 ± 0.4/14.1 ± 1.3 times for DM‐10, 3.1 ± 0.3/6.3 ± 1.2 times for DM‐20, and 0.2 ± 0.1/0.3 ± 0.2 times for DM‐40 during the first hour after operation. For the first day, the figures are 19.9 ± 1.2/23.9 ± 1.4 for the controls, 15.6 ± 1.2/17.3 ± 2.4 for DM‐10, 12.6 ± 0.7/15.9 ± 1.6 for DM‐20, and 5.0 ± 0.21/5.6 ± 0.9 for DM‐40. On the first day, the cough pain scores were 6.67 ± 0.23, 6.53 ± 0.16, 6.67 ± 0.23, and 5.73 ± 0.18 for the controls, DM‐10, DM‐20, and DM‐40 groups, respectively. All data showed dose‐dependent better pain relief in DM‐premedicated patients. We conclude that DM premedication offers preemptive analgesia and reduces postoperative pain and morphine requirement.
Measuring the Tumor Volume of Gastric Carcinoma by Computer Image Analysis: Clinical Significance
Authors: Kikuchi Shiro , Hiki Yoshiki , Sakakibara Yuzuru , Kakita Akira , Kuwao Sadahito
Published: August 2002

The tumor diameter of gastric carcinoma, measured by gross or histologic examination, is a rough indicator of actual tumor size. Therefore we investigated the utility of three‐dimensional reconstruction of tumors in gastric carcinoma. Altogether 105 primary gastric carcinoma lesions, consisting of 16 advanced and 89 early carcinomas, were analyzed. A total of 942 lesion tissue sections, comprising 2 to 37 sections per lesion (mean 9 sections), were examined histologically. Surface rendering using a computer graphics analysis program was then performed from serial sections to create a three‐dimensional reconstruction of tumor morphology from which to measure tumor volume. For the 105 lesions the tumor diameter ranged between 4 and 106 mm (average ± SE: 32.4 ± 2.0 mm), and tumor volume ranged between 4 and 5853 mm3 (average ± SE: 773.0 ± 104.6 mm3). A significant correlation was found between tumor diameter and the log of the tumor volume (r= 0.733, p < 0.0001). Although the logs of tumor volume for advanced carcinomas were all > 2.5, in 11 of these 16 patients (66%) the tumor diameter was < 4 cm, and in one patient < 2 cm. In addition, tumor diameter did not differ significantly between the 16 advanced and the 89 early gastric carcinomas (p= 0.114), whereas the log of the tumor volume did (p < 0.0001). In conclusion, conventional measurements of tumor diameter as a rough indicator of tumor size can predict the actual tumor size of a gastric carcinoma. Three‐dimensional reconstruction using computer graphics provides a better estimation of true tumor size and extent of progression than tumor diameter.
The Effects of Doxycycline on Nitric Oxide and Stromelysin Production in Dogs With Cranial Cruciate Ligament Rupture
Authors: Jauernig Silvia , Schweighauser Ariane , Reist Martin , Von Rechenberg Brigitte , Schawalder Peter , Spreng David
Published: August 2002

Objective—To investigate the potential of doxycycline to reduce stromelysin and inducible nitric oxide synthase (iNOS) activity in dogs with osteoarthritis (OA) secondary to spontaneous cranial cruciate ligament (CCL) rupture.

Study Design—Prospective, clinical study.

Animals—Eighty‐one dogs with OA secondary to CCL rupture and 54 normal dogs.

Methods—Dogs with OA secondary to CCL rupture were divided into 2 groups before surgery. The Doxy‐CCl group received 3 to 4 mg/kg doxycycline orally every 24 hours for 7 to 10 days (n = 35). The CCL group received no treatment (n = 46). Synovial fluid, articular cartilage, synovial membrane, and CCL samples were collected during surgery (Doxy‐CCL group and CCL group) or immediately after euthanasia from healthy dogs (control group). Synovial fluid samples were examined cytologically. Total nitric oxide (NOt) concentrations were measured in the supernatant of explant cultures of all tissue samples, and stromelysin activity was measured in the supernatant of explant cultures of cartilage.

Results—NOtconcentrations measured in cartilage were significantly lower in the Doxy‐CCL group than in the CCL group, but were not different from those measured in the control group. Doxycycline treatment did not have a significant effect on cartilage stromelysin levels.

Conclusion—The findings in this study indicate that doxycycline inhibits NO production in cartilage in dogs with CCL rupture.

Clinical Relevance—Doxycycline may have a role in the treatment of canine OA by inhibiting NO production.