bluuebunny/crossref_metadata_2025 huggingface dataset:
Diet and activity pattern of howler monkeys (Alouatta palliata) in Los Tuxtlas, Mexico: effects of habitat fragmentation and implications for conservation
Authors: Cristóbal‐Azkarate Jurgi , Arroyo‐Rodríguez Víctor
Published: March 2007

Accelerated deforestation is causing the rapid loss and fragmentation of primary habitat for primates. Although the genusAlouattais one of the most studied primate taxa under these circumstances, some results are contradictory and responses of howlers to habitat fragmentation are not yet clear. In this paper, we conduct a cross‐study of the available researches on mantled howlers (Alouatta palliata) in forest fragments in Los Tuxtlas, Mexico, to (1) describe the diet and activity pattern of howlers; (2) analyze the similarity in the diet across studies; and (3) relate both fragment size and howler population density with different characteristics of their diet, home range size, and activity pattern. Howlers consumed 181 plant species belonging to 54 families.Ficuswas the most important taxa in the howlers' diet, followed by primary species such asPterocarpus rohrii,Nectandra ambigens,Poulsenia armata, andBrosimum alicastrum. Secondary and non‐secondary light‐demanding plant species, which are representatives of disturbed habitat, contributed with a high percentage of their feeding time. Only 23% of the species consumed were the same across all the studies, suggesting that howlers adapt their diet to the food availability of their respective habitats. Population density is the best predictor of howlers' ecological and behavioral changes in response to forest fragmentation, probably owing to its relationship with food availability. Howlers respond to the increase in population densities by increasing the (1) diversity of food species in the diet; (2) consumption of non‐tree growth forms; and (3) consumption of new plant items. Home range size is also predicted by population density, but fragment size is a better predictor, probably owing to the fact that howler groups can overlap their home ranges. Our results emphasize the importance of conserving the larger fragments and increasing the size of small and medium‐sized ones. Am. J. Primatol. 69:1013–1029, 2007. © 2007 Wiley‐Liss, Inc.
Effect of ketamine anesthesia on daily food intake in Macaca mulatta and Cercopithecus aethiops
Authors: Springer Danielle A. , Baker Kate C.
Published: March 2007

Ketamine hydrochloride is frequently administered to non‐human primates as a means of chemical restraint. This procedure can be a frequent source of stress to monkeys at research facilities, impacting animal health, well‐being and research quality. This study was designed to measure ketamine's effect on daily food intake, a parameter that reflects and influences animal well‐being and directly impacts research studies. On five occasions, baseline daily food intake was compared to daily food intake occurring 24, 48, 72, 96, and 120 h after an intramuscular injection of 10 mg/kg ketamine in male African green monkeys (AGMs) (Cercopithecus aethiops) and male and female rhesus macaques (Macaca mulatta). AGMs and female rhesus macaques had significantly reduced daily food intake during the first 4 days after receiving ketamine. The AGMs continued to display significantly reduced daily food intake on the fifth day after ketamine. The male rhesus macagues showed a trend toward reduced daily food intake, greatest during the first 2 days and remaining less than baseline intake through the fifth day following ketamine. The degree of observed food intake reduction was most severe at the 24 h (mean percent intake reduction: AGMs: 57%; rhesus males: 48%; rhesus females: 40%) and 48 h time points (AGMs: 24%; rhesus males: 14%; rhesus females: 13%). A subset of the AGMs that did not receive ketamine, but observed other animals in the room receive ketamine, showed reduced food intake at 24 and 48 h after ketamine, though not to the degree associated with ketamine administration. These results indicate that ketamine anesthesia is associated with a prolonged reduction in daily food intake in AGMs and rhesus macaques. Frequent use of ketamine in non‐human primates may have a significant impact on animal health and well‐being, and alternatives to its use warrant consideration. Am. J. Primatol. 69:1080–1092, 2007. Published 2007 Wiley‐Liss, Inc.
Trisomy 17 in a baboon (Papio hamadryas) with polydactyly, patent foramen ovale and pyelectasis
Authors: Moore Charleen M. , Hubbard Gene B. , Dick Edward , Dunn Betty G. , Raveendran Muthuswamy , Rogers Jeffrey , Williams Vick , Gomez Jeremiah J. , Butler Stephanie D. , Leland M. Michelle , Schlabritz‐loutsevitch Natalia E.
Published: March 2007

Trisomy 13 in humans is the third most common autosomal abnormality at birth, after trisomy 21 and trisomy 18. It has a reported incidence of between 1:5,000 and 1:30,000 live births. It is associated with multiple abnormalities, many of which shorten lifespan. We describe here the first reported case of a baboon (Papio hamadryas) with trisomy of chromosome 17, which is homologous to human chromosome 13. The trisomic infant was born to a consanguineous pair of baboons and had morphological characteristics similar to those observed in human trisomy 13, including bilateral polydactyly in the upper limbs, a patent foramen ovale, and pyelectasis. Molecular DNA analysis using human chromosome 13 markers was consistent with the affected infant inheriting two copies of chromosome 17 derived from the same parental chromosome. This trisomy was, therefore, due to either an error in meiosis II or the result of postzygotic nondisjunction. The parental origin, however, could not be determined. Am. J. Primatol. 69:1105–1118, 2007. © 2007 Wiley‐Liss, Inc.
Réplique: A New Concept for Bonding in Carbodiphosphoranes?
Authors: Schmidbaur Hubert
Published: March 2007

Die Schlussfolgerungen, die aus Ergebnissen jüngster theoretischer und experimenteller Untersuchungen zur Chemie der Carbodiphosphorane gezogen werden, werden nochmals im Lichte des vor einigen Jahrzehnten erreichten Stands der Forschung betrachtet.
Réplique: A New Concept for Bonding in Carbodiphosphoranes?
Authors: Schmidbaur Hubert
Published: March 2007

The conclusions drawn from results of recent theoretical and experimental investigations on the chemistry of carbodiphosphoranes are reconsidered in light of the state‐of‐the‐art reached after extensive investigations that were carried out a few decades ago.
Reply to Réplique: A New Concept for Bonding in Carbodiphosphoranes?
Authors: Frenking Gernot , Neumüller Bernhard , Petz Wolfgang , Tonner Ralf , Öxler Florian
Published: March 2007

Neither is the synthesis of a molecule a mere technical conformation of a theoretical prediction, nor is a quantum chemical investigation a mere supplement to experimental work—the two sides rather complement each other. The theoretical study in question has shown that more compounds of the general formula EL2 with donor–acceptor bonds may exist which await synthesis.
Ontogenetic structural and material variations in ovine calcanei: A model for interpreting bone adaptation
Authors: Skedros John G. , Sorenson Scott M. , Hunt Kenneth J. , Holyoak Joshua D.
Published: March 2007

Experimental models are needed for resolving relative influences of genetic, epigenetic, and nonheritable functionally induced (extragenetic) factors in the emergence of developmental adaptations in limb bones of larger mammals. We examined regional/ontogenetic morphologic variations in sheep calcanei, which exhibit marked heterogeneity in structural and material organization by skeletal maturity. Cross‐sections and lateral radiographs of an ontogenetic series of domesticated sheep calcanei (fetal to adult) were examined for variations in biomechanically important structural (cortical thickness and trabecular architecture) and material (percent ash and predominant collagen fiber orientation) characteristics. Results showed delayed development of variations in cortical thickness and collagen fiber orientation, which correlate with extragenetic factors, including compression/tension strains of habitual bending in respective dorsal/plantar cortices and load‐related thresholds for modeling/remodeling activities. In contrast, the appearance of trabecular arches in utero suggests strong genetic/epigenetic influences. These stark spatial/temporal variations in sheep calcanei provide a compelling model for investigating causal mechanisms that mediate this construction. In view of these findings, it is also suggested that the conventional distinction between genetic and epigenetic factors in limb bone development be expanded into three categories: genetic, epigenetic, and extragenetic factors. Anat Rec, 2007. © 2007 Wiley‐Liss, Inc.
The Disease Activity Score in 28 joints in rheumatoid arthritis and psoriatic arthritis patients
Authors: Leeb Burkhard F. , Andel Ingrid , Sautner Judith , Fassl Christian , Nothnagl Thomas , Rintelen Bernhard
Published: March 2007

Objective

To assess the factorial structure of the Disease Activity Score including a 28‐joint count (DAS28) if applied in patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA).

Methods

DAS28 values from 85 consecutive PsA outpatients and 2 RA patient cohorts comprising 85 patients each were compared. The first RA cohort (RA1) consisted of age‐ and sex‐matched patients seen during the same period as the patients with PsA. The first 85 RA outpatients from September 2003 were included in the second cohort (RA2). Item weighting, factor loading, and internal consistency were assessed by factor analysis, principal component analysis, and calculation of Cronbach's alpha.

Results

The mean ± SD DAS28 scores of patients in the PsA, RA1, and RA2 cohorts were 3.2 ± 1.31, 3.21 ± 1.45, and 3.79 ± 1.44, respectively. A significant difference between the PsA and RA2 cohorts was found for DAS28 (P = 0.0063), swollen joint count (P = 0.007), and patient's global assessment (P < 0.001), but not for erythrocyte sedimentation rate. Internal consistency of the DAS28 in patients with PsA was considerably lower, item weighting showed remarkable differences, and factor analysis revealed that the DAS28 constitutes a bidimensional instrument in patients with PsA, whereas in both RA cohorts it appeared to be monodimensional.

Conclusion

With respect to its statistical properties, the DAS28 proved to be considerably different in PsA compared with RA. Therefore its application for disease activity assessment in patients with PsA cannot be recommended without a formal validation procedure.
Sonographic investigation of the temporomandibular joint in patients with juvenile idiopathic arthritis: A pilot study
Authors: Jank Siegfried , Haase Stephan , Strobl Heinrich , Michels Hartmut , Häfner Renate , Missmann Martin , Bodner Gerd , Mur Erich , Schroeder Dominik
Published: March 2007

Objective

To evaluate whether there are any correlations between the clinical parameters of temporomandibular joint (TMJ) arthritis and pathologic ultrasound (US) findings of the TMJ in patients with juvenile idiopathic arthritis (JIA).

Methods

We conducted prospective clinical and US investigations of the TMJs of 48 patients with JIA. The US investigation was performed by a 12‐MHz high‐resolution transducer, which was positioned parallel to the ramus of the mandible overlying the zygomatic arch in a closed‐mouth position and maximum open‐mouth position.

Results

Patients with ≥5 peripheral affected joints showed significantly more sonographically diagnosed destructive changes in the TMJ than did patients with <5 affected joints. There was no significance between the number of affected peripheral joints and disc dislocation in the closed‐mouth position. In the maximum open‐mouth position, there was a significant correlation between the number of affected peripheral joints and disc dislocation. Patients with a JIA duration >23 months had a significantly higher rate of disc dislocation and destructive changes. Patients with a JIA duration >60 months had a significantly higher rate of destructive changes of the TMJ than patients with a disease duration <60 months, but no statistical significance was found concerning disc dislocation.

Conclusion

The significant correlation between pathologic sonographic findings, duration of JIA, and the number of affected peripheral joints make the technique interesting for use as a diagnostic screening method.
Effectiveness of the introduction of an International Classification of Functioning, Disability and Health–based rehabilitation tool in multidisciplinary team care in patients with rheumatoid arthritis
Authors: Verhoef John , Toussaint Pieter J. , Zwetsloot‐Schonk Johanna H. M. , Breedveld Ferdinand C. , Putter Hein , VlielanD Theodora P. M. Vliet
Published: March 2007

Objective

To investigate whether the use of an International Classification of Functioning, Disability and Health (ICF)–based instrument to structure multidisciplinary care improves clinical effectiveness and satisfaction in patients with rheumatoid arthritis (RA) admitted for multidisciplinary team care.

Methods

Consecutive patients with RA admitted to an inpatient or day patient multidisciplinary team care ward were included during a 12‐month period before (period I) and after (period II) the introduction of an ICF‐based rehabilitation tool (Rehabilitation Activities Profile [RAP]). Patients were assessed at admission, discharge, and 6 weeks thereafter. The primary outcome measure was a patient‐oriented measure of functional ability (McMaster Toronto Arthritis Patient Preference Disability Questionnaire [MACTAR]), whereas secondary outcome measures included measures of physical and mental functioning, quality of life, disease activity, and patient satisfaction. Change scores between periods were compared using analysis of covariance.

Results

A total of 80 and 85 patients were included in periods I and II, respectively. Concerning the improvement of the MACTAR score and all other secondary clinical outcome measures, there was no significant difference between the 2 periods. Patient satisfaction with care was slightly higher in period II than in period I, with the differences regarding the total score of a multidimensional satisfaction questionnaire and the domains focusing on individual problems and empathy reaching statistical significance.

Conclusion

The introduction of the RAP did not change clinical effectiveness but had a modest beneficial impact on patient satisfaction with care in patients with RA admitted for multidisciplinary team care.
Caregiver recall of treatment recommendations in juvenile idiopathic arthritis
Authors: Civita Mirella De , Feldman Debbie Ehrmann , Meshefedjian Garbis A. , Dobkin Patricia L. , Malleson Pete , DuffY Ciarán M.
Published: March 2007

Objective

Health care providers in juvenile idiopathic arthritis (JIA) might refer to caregivers' self‐report of children's treatment‐related behaviors to assist in clinical decisions. However, caregivers may believe that they are adhering to treatment even though they have a different understanding of recommendations than that intended by the medical team. We examined whether caregiver recall of children's JIA treatment matched actual recommendations at baseline and 3, 6, 9, and 12 months.

Methods

A total of 235 primary caregivers were recruited from rheumatology clinics at 2 pediatric university–based teaching hospitals in Canada. Using the Parent Adherence Report Questionnaire, caregivers indicated whether their child was prescribed medications and/or exercises. Medical charts were reviewed to determine the prescribed treatment. Level of agreement between both sets of data was then examined.

Results

A total of 175 caregivers provided complete data. Mean age of the children was 10.2 years (68.6% girls); 44.6% were diagnosed with oligoarthritis. Kappa coefficients for medication represented substantial to almost perfect agreement beyond chance, with better levels of agreement at 12 months (κ = 0.81, 95% confidence interval [95% CI] 0.68, 0.94) than at baseline (κ = 0.61, 95% CI 0.47, 0.76). Kappa coefficients for exercise represented slight to moderate agreement beyond chance, with better agreement at 12 months (κ = 0.44, 95% CI 0.24, 0.63) than at baseline (κ = 0.27, 95% CI 0.08, 0.47).

Conclusion

Weaker agreement for the exercise regimen raises concern that caregivers may pay less attention to exercise recommendations or that these recommendations may not be easily understood.
A proposed revision to the ACR20: The hybrid measure of American College of Rheumatology response
Authors: Felson David ,   American College of Rheumatology Committee to Reevaluate Improvement Criteria
Published: March 2007

Objective

Although use of the American College of Rheumatology 20% improvement criteria (ACR20) has standardized response measurement in rheumatoid arthritis (RA) trials, the ACR20 has been criticized as less sensitive to change than are continuous measures of response, and its threshold for response (≥20%) is thought to be low. Our goal was to redefine response in RA in a manner that 1) corresponds to a clinical impression of response (clinical validity), 2) maximizes sensitivity to change, and 3) allows for calculation of the ACR20 to continue standardization of reporting.

Methods

We examined multiple different ways of defining response, including dichotomous definitions (patient improved versus not improved), ordinal definitions (degree of response scored on an ordinal scale), disease activity indexes, continuous definitions, and definitions that were hybrids of continuous and ordinal measures. Candidate definitions included the ACR20, ACR50, ACR70, the Disease Activity Score, the Simplified Disease Activity Index, the ACR‐N, the nACR, and the European League Against Rheumatism (EULAR) response. We also tested variations on these approaches. To test clinical validity, we administered a survey involving patients from a previous trial who had various levels of improvement and asked rheumatologists whether and by how much these patients improved. To determine sensitivity to change, we collected data from 11 large multicenter trials of disease‐modifying antirheumatic drugs (DMARDs) in RA comprising 3,665 patients (7 anti–tumor necrosis factor α arms, 4 conventional DMARD arms, 2 biologic arms) and ranked candidate definitions of response according to their average P value across trials in distinguishing active treatment from placebo or combination therapy versus single‐drug therapy.

Results

All 135 tested measures had clinical validity based on survey responses, although dichotomous measures did not capture the range of responses (e.g., the ACR20 did not capture the extra clinical improvement between the ACR20 and the ACR50). In trial analyses, continuous measures had the best sensitivity to change. Among the best scoring measures was a hybrid measure that retained information on the ACR20, ACR50, and ACR70 and combined that with the mean percent improvement in core set measures. When comparing 2 treatments, this hybrid measure had an average P value much lower than that for the ACR20. If a trial needed 200 patients to have 80% power (2‐sided α = 0.05) to detect a difference between treatments if it used the ACR20, the same trial would need 108 patients if the hybrid measure were used.

Conclusion

We suggest use of a new hybrid measure of RA response that maximizes sensitivity to change, correlates well with rheumatologists' impressions of improvement, and preserves the ACR20.
Prevalence of subjective poor health symptoms associated with exposure to electromagnetic fields among university students
Authors: Mortazavi S.M.J. , Ahmadi J. , Shariati M.
Published: March 2007

The number of people complaining about different symptoms that may be associated with exposure to electromagnetic fields (EMF) has increased rapidly during past years. Students use both mobile phones and video display terminals frequently. The purpose of this study was to investigate the association of mobile phone use and EMF health hazards. Basic demographic data and self‐reported symptoms were sought using a questionnaire administered to all apparently healthy students at Rafsanjan University of Medical Sciences (RUMS) and Vali‐e‐Asr University (VAU). Questions about some major confounding factors such as age, gender, amount of video display terminal work were also included. Exact Fischer Test was used for data analysis. Among self‐reported symptoms, headache (53.5%), fatigue (35.6%), difficulties in concentration (32.5%), vertigo/dizziness (30.4%), attention disorders (28.8%), nervousness (28.1%), palpitation (14.7%), low back pain (14.3%), myalgia (12.4%), and tinnitus (9.9%) were the main self‐reported symptoms. No significant differences in the prevalence of these symptoms were found between CRT users and those who did not use CRTs. A significant association was found between cordless phone use and difficulties in concentration (P < .05) or attention disorders (P < .05). However, after correction of the gender role, these differences were not significant. No association was found between mobile phone use and the above‐mentioned symptoms. No significantly higher prevalence of self‐reported symptoms was found in individuals who had used mobile phones, video display terminals or cordless phones more frequently than others. Mass‐media's lack of interest in the possible hazards of exposure to EMF in developing countries can explain the difference observed between the results of this study and those of other researchers in some developed countries who have shown an association between EMF exposure and the prevalence of self‐reported subjective symptoms. This finding can confirm the results obtained in provocative studies which indicated the role of psychological factors in electromagnetic hypersensitivity. More research is needed to clarify whether daily environmental EMF may cause health problems. Bioelectromagnetics 28:326–330, 2007. © 2007 Wiley‐Liss, Inc.
Tragfähigkeit von Spannbeton‐Fertigdecken aus Plattenbauten der DDR und deren mögliche Wiederverwendung als Massivdach
Authors: Avak Ralf , Schwuchow Ronald
Published: March 2007

Im Zuge des “Stadtumbau Ost” werden zahlreiche Gebäude“zurückgebaut”, die in Plattenbauweise errichtet wurden. Neben ökonomischen Erwägungen sollten im Sinne nachhaltigen Wirtschaftens auch Wiederverwendungsmöglichkeiten von Teilen dieser Bauwerke betrachtet werden. Um nicht an die vorhandenen Geometrien gebunden zu sein, wird geprüft, inwieweit sich die Randbedingungen bei der Wiederverwendung ändern können. Es wird über Versuche an Spannbetondeckenplatten berichtet, bei denen die wirksame Querzugbewehrung im Auflagerbereich durch Kürzung der Platten wegfällt und demzufolge auftretende Querzugspannungen vom Beton zu übernehmen sind.
Versuche an Fahrbahnübergängen mit Fuse‐Elementen für Erdbebenbelastungen
Authors: Fink Josef , Wahlberg Henrik , Hoffmann Simon , Hofer Michael
Published: March 2007

Die Rion‐Antirion Brücke nördlich von Patras, Griechenland, wurde im Sommer 2006 durch die fib als besonders bedeutsames Ingenieurbauwerk aufgrund zahlreicher innovativer Leistungen ausgezeichnet: Das außergewöhnliche Konzept dieser Schrägseilbrücke erforderte neben vielen anderen Neuerungen, auch die bisherige Funktion von Fahrbahnübergängen neu zu überdenken. Hierbei galt es, nicht nur eine technische, sondern auch die wirtschaftlichste Lösung für Bewegungen von insgesamt 2,48 m im Service‐ und 5,01 m im Erdbebenlastfall in Längsrichtung, sowie Bewegungen in Querrichtung zu finden. Der Bericht zeigt, wie die Lösung mittels Fuse‐Elementen im Sinne eines “Performance Based Design” in Erdbebensimulationen in ihrer Funktion bestätigt werden konnte. Anhand einer Versuchsserie an einer modularen Dehnfuge mit Schwenktraversen im Maßstab 1:1 wurden die Auslösemechanismen der Sollbruchstellen der Fuse‐Elemente unter Einwirkung einer realen Erdbebenbeanspruchung untersucht. Die Versuche im Rahmen des Europäischen Forschungsprojektes “ECOLEADER” wurden an der Versuchsanstalt CESI S.p.A. Area ISMES in Seriate bei Bergamo, Italien, in Zusammenarbeit mit der Herstellerfirma Maurer Söhne in München und dem Institut für Stahlbau, Holzbau und Mischbautechnologie der Universität Innsbruck durchgeführt.
Empfehlungen zur Mindestbewehrung von schubbeanspruchten Fugen. Ein mechanisches Modell und Ableitungen für die Bemessung
Authors: Lindig Volker
Published: March 2007

Sowohl Verbundkonstruktionen aus Stahlbetonfertigteilen und Ortbeton als auch nachträglich durch Ortbetonschichten ergänzte Stahlbetontragwerke charakterisieren sich durch das kraftschlüssige Zusammenwirken von Betongrenzflächen unterschiedlichen Alters und unterschiedlicher Festigkeit. Um ein plötzliches Abscheren oder ein Öffnen dieser Grenzflächen in Fugen unter Gebrauchslast zu vermeiden, ist eine Mindestbewehrung erforderlich. In den internationalen Regelwerken sind zur Mindestbewehrung von Verbundfugen sehr unterschiedliche oder keine spezifischen Festlegungen enthalten. Im Beitrag wird ein mechanisches Modell zur Bestimmung der Mindestbewehrungsrate von schubbeanspruchten Fugen abgeleitet. Mit diesem plastischen Ansatz wird die empfohlene Mindestbewehrungsrate für Verbundfugen in Abhängigkeit von der Fugenrauigkeit und den Baustoffkennwerten ermittelt und tabellarisch für in der Baupraxis häufig vorkommende Stahlsorten und Betonfestigkeitsklassen zusammengefasst. Oft genügt diese Mindestbewehrung. Sodann folgen Empfehlungen zur Vereinfachung der Fugenbemessung.
Some aspects of adenocarcinoma of the appendix
Authors: Slack W W
Published: March 2007

Five new cases of adenocarcinoma of the appendix are reported. Adenocarcinoma of the appendix must be carefully differentiated from carcinoma of the cæcum and histologically from a carcinoid tumour. In a proportion, some cases present as acute appendicitis; in these only microscopy will reveal the presence of carcinoma. Right hemicolectomy, it is suggested, is the correct treatment, even if this has to be done as a second operation after routine histological examination of the appendix associated with acute appendicitis seems to be relatively poor owing to the diffculties in early diagnosis and the ease with which the tumour can reach the peritoneum. On the other hand, when no overlying acute inflammatory lesion is present, the prognosis is much better.
Spontaneous rupture of the oesophagus
Authors: Hugh T B
Published: March 2007

Since the first report by Barrett, in 1947, of successful suture of a spontaneous rupture of the oesophagus, many survivals from this disaster have been reported. Unfortunately the condition is still frequently not diagnosed at an early stage. The history is usually characteristic, with sudden severe retrosternal or interscapular pain following vomiting. When this story is accompanied by rapid respiration and surgical emphysema in the supraclavicular areas, or mediastinal emphysema on radiographs, the diagnosis is certain, although there are pitfalls as the following case illustrates.
Total pelvic exenteration for locally advanced colorectal carcinoma
Authors: Shtrouzu K , Isomoto H , Kakegawa T
Published: March 2007

Twenty-six patients who underwent total pelvic exenteration for locally advanced colorectal cancer were studied retrospectively. The operative mortality rate was 8 per cent (two deaths). In patients with stage II primary disease the recurrence rate after curative surgery was three of seven, although the mean survival time was 58 months and the 5-year survival rate 71 per cent. Patients with stage III primary disease had a shorter mean survival time regardless of supposed curability (curative 14 months versus non-curative 9 months). Patients with stage IV disease had a mean survival time of 5 months. In patients who underwent curative surgery for recurrent disease the mean survival time was 33 months and 5-year survival rate 25 per cent, although in those receiving non-curative surgery the survival time was significantly shorter at 10 months (P < 0.05). Total pelvic exenteration is warranted for patients with stage II locally advanced colorectal carcinoma and is an option for those with recurrent carcinoma when performed with curvative intent.
Importance of human immunodeficiency virus-associated lymphadenopathy and tuberculous lymphadenitis in patients undergoing lymph node biopsy in Zambia
Authors: Bem C , Patil P S , Bharucha H , Namaambo K , Luo N
Published: March 2007

The relative importance of human immunodeficiency virus (HIV)-associated lymphadenopathy amongst patients presenting for lymph node biopsy in Central Africa is unknown. HIV-1 serology and histology of patients undergoing superficial lymph node biopsy during 1989–1990 in Lusaka, Zambia, were examined in a prospective cohort study of HIV serology and by retrospective review of laboratory records. Of 727 lymph nodes biopsied in Lusaka in 1989–1990, 380 (52 per cent) showed tuberculous lymphadenitis, 160 (22 per cent) histology suggestive of primary HIV lymphadenopathy and 66 (9 per cent) nodal Kaposi's disease. HIV serology was tested in 280 adults and was positive in 91 per cent (255 patients), including 89 per cent (153 of 171) of those with tuberculous lymphadenitis, 98 per cent (63 of 64) of those with histology suspicious of primary HIV lymphadenopathy and all (24 of 24) with nodal Kaposi's disease. Other HIV-associated lymphadenopathy included nodal lymphomas and lymphoepithelial cysts. HIV serology was tested in 22 children and was positive in eight, including four of 14 with tuberculous lymphadenitis. It is concluded that HIV-associated lymphadenopathy, especially tuberculous lymphadenitis, is very common amongst patients presenting for lymph node biopsy in Central Africa.
Audit of outcome of major surgery in the elderly
Authors: Walsh T H
Published: March 2007

The clinical outcome of 152 patients aged 65 years or over who were referred to the author's institute between August 1990 and August 1991 with certain specified gastrointestinal malignancies and acute, life-threatening abdominal conditions, were audited concurrently. Two groups were considered: patients aged 65–79 years and those over 80 years. The mortality rate within 30 days of surgery was 14 per cent in both age groups, although significantly fewer patients aged over 80 years (35 of 54) were considered suitable for surgery than in the 65–79 years age group (84 of 98) (0.01 >P>0.001). Morbidity after operation and cost of treatment were not significantly different between the two groups. Two years after surgery 40 per cent of the patients aged over 80 years and 58 per cent of those aged 65–79 years were alive. Quality of life in these survivors was good with 85 per cent of those aged over 80 years living at home and 72 per cent fit enough to undertake light work.
Cell kinetics in vivo of human breast cancer
Authors: Stanton P D , Cooke T G , Forster G , Smith D , Going J J
Published: March 2007

Rates of cell proliferation within tumours may provide prognostic information and help in the rational administration of chemotherapy and radiotherapy. in vivo labelling with 5-bromo-2′-deoxyuridine (BrdU) was used in 89 women with breast cancer to determine the labelling index for BrdU (BLI), the length of S phase (Tg) and the potential doubling time of the tumour (Tpot). Kinetic data were obtained in 84 patients. The median BLI was 3.2 per cent, Ts 12 h, and Tpot 12.5 days. There was no systematic difference in the labelling index determined by flow cytometry and by manual counting on sections. Labelling indices were significantly higher in aneuploid tumours, and in tumours not expressing oestrogen receptors, but were not correlated with tumour size, nodal status, or expression of c-erbB2. In vivo measurement of tumour cell kinetics can be made rapidly and reliably in the majority of human breast cancers, and may have a role to play in planning therapy.
Pattern of recurrence after oesophageal resection for cancer: Clinical implications
Authors: Law S Y K , Fok M , Wong J
Published: March 2007

Patterns of disease recurrence were reviewed in 108 patients who had curative resection for squamous cell cancer of the thoracic oesophagus. At a median follow-up of 20 months, 56 patients (52 per cent) had recurrence. Most presented within 2 years. Extrathoracic recurrence was found in 41 per cent of patients and intrathoracic recurrence in 25 per cent. Systemic organ metastases (26 per cent) were as frequent as intrathoracic recurrences. Twelve patients (11 per cent) developed cervical lymph node (CLN) recurrence; their mean time to recurrencewas 12.6 months, compared with 13.1 months for recurrence at locations other than the neck (P = 0.8). Median survival was 23 and 13 months respectively (P = 0.27). Preoperative chemotherapy lowered the recurrence rate from 60 per cent to 30 per cent, (P = 0.01) but did not affect survival. The addition of cervical lymphadenectomy would benefit few patients and must be counterbalanced with increased morbidity and cost. The frequency of systemic organ metastases calls for further investigation of the possible benefits of chemotherapy.
Management of intestinal obstruction after gastrectomy for carcinoma
Authors: Nakane Y , Okumura S , Akehira K , Okamura S , Boku T , Okusa T
Published: March 2007

Intestinal obstruction after operation for gastrointestinal cancer may be due to postoperative adhesions, a focal, potentially resectable, malignant deposit or diffuse carcinomatosis1,2. It is commonly assumed that the obstruction is due to advanced malignancy and that death is inevitable.
Effects and limitations of prolonged intermittent ischaemia for hepatic resection of the cirrhotic liver
Authors: Wu C-C , Hwang C-R , Liu T-J , P'eng F-K
Published: March 2007

Intermittent clamping of the hepatic pedicle during hepatectomy may reduce operative bleeding, but its limitations and long-term effects on the cirrhotic liver are unknown. Eighty-three patients with cirrhosis undergoing hepatectomy with repeated clamping for 15 min and declamping for 5 min were divided into three groups based on total clamping duration: group 1 less than 40 min (39 patients); group 2 40–80 min (28); group 3 more than 80 min (16). Larger tumours were associated with longer ischaemia times (P = 0.002), longer operating times, greater operative blood loss and increased blood transfusion requirements (P< 0.001), and resulted in higher postoperative levels of serum transaminases and lactic dehydrogenase (P< 0.001). Operative morbidity and mortality rates, and the late hepatic failure rate, were not affected. The longest total ischaemia time was 204 min but the uppermost time limit for hepatic ischaemia remains to be determined.
Intestinal barrier dysfunction in clinical and experimental obstructive jaundice and its reversal by internal biliary drainage
Authors: Parks R W , Clements W D B , Smye M G , Pope C , Rowlands B J , Diamond T
Published: March 2007

Intestinal mucosal barrier function in obstructive jaundice was assessed in an animal model and in patients. The effect of internal biliary drainage in patients was also examined. Bile duct ligation for 1 week in the rat resulted in significant bacterial translocation (in seven of 12 animals following ligation versus none of the sham-operated controls, P<0·01). Intestinal permeability, measured by the urinary recovery of orally administered polyethylene glycol, was also significantly increased (+ 66·2 per cent for ligation versus −11·6 per cent for sham, P<0·01). A prospective study was performed on 33 patients with obstructive jaundice undergoing internal biliary drainage, and results were compared with those in six non-jaundiced patients undergoing laparotomy or endoscopic retrograde cholangiopancreatography and in 11 healthy volunteers. The lactulose: mannitol ratio was used as an intestinal permeability index. Mean(s.e.m.) intestinal permeability assessed before operation was significantly increased in jaundiced patients compared with control patients (0·050(0·010) versus 0·016(0·003), P<0·005). The mean(s.e.m.) lactulose: mannitol ratio in the healthy volunteers was 0·020(0·003), which was similar to that in control patients. In the jaundiced group of patients the intestinal permeability index fell to within normal levels after 28 days of internal biliary drainage (0·050 before operation versus 0·021 at 28 days, P<0·02). These data indicate that intestinal barrier function is impaired in obstructive jaundice and that this impairment is reversed by return of bile to the gastrointestinal tract.
A 4-year prospective audit of the cause of death after infrarenal aortic aneurysm surgery
Authors: Sandison A J P , Panayiotopoulos Y , Edmondson R C , Tyrrell M R , Taylor P R
Published: March 2007

This study was a 4-year prospective audit of abdominal aortic aneurysm surgery including 222 aneurysm repairs: 106 elective, 76 urgent and 40 emergency. Twenty-five patients died: four who underwent elective surgery, seven urgent and 14 emergency. The two major causes of death, multiple organ failure and colonic ischaemia, were responsible for 11 of the 25 deaths. The three deaths from myocardial infarction all occurred in patients with a leaking aneurysm. Blood loss was significantly higher in patients with multiple organ failure and in those with colonic ischaemia. Methods to identify patients at high risk of massive blood loss and colonic ischaemia may be a way to reduce mortality.
Disconnection, pouch revision and reconnection of the ileal pouch-anal anastomosis
Authors: Sagar P M , Dozois R R , Wolff B G , Kelly K A
Published: March 2007

The aim of this retrospective study was to determine the outcome of patients with a dysfunctional pelvic ileal reservoir in whom disconnection of an ileal pouch-anal anastomosis (IPAA), pouch revision and reanastomosis had been carried out. There were 23 patients (15 women). At the revision operation functional problems were found to be due to a long efferent spout (nine patients), sepsis and/or fistula (four), a redundant blind limb (three), a twisted pouch (three), anastomotic problems (three) or no reservoir (one). The pouch was salvaged in 16 patients and a new pouch was constructed in seven. The pouch-anal anastomosis was resutured in 22 patients and stapled in one. Postoperative complications (all minor) occurred in six patients. Two patients underwent two revisions of IPAA. At a median follow-up of 5 (range 1–10) years, 11 patients reported good to excellent function, five reported fair function and one reported recurrent pouchitis. Revision surgery was unsuccessful in six of 23 patients (three had gross incontinence, two excessive bowel movements and one Crohn's disease), and they subsequently underwent pouch excision. It is concluded that revision of an ileal reservoir and IPAA can be undertaken safely with good results in carefully selected patients.
Conservative management of infective mastitis and breast abscesses after ultrasonographic assessment
Authors: O'Hara R J , Dexter S P L , Fox J N
Published: March 2007

Current practice in this unit for a suspected breast abscess is preliminary ultrasonographic scan, aspiration of any pus, antibiotic therapy and repeat aspiration in the outpatient clinic if necessary. Inflammatory masses are treated with antibiotics alone. A retrospective review of this strategy has been made. Over a 2-year interval 53 patients were admitted to hospital with a suspected breast abscess. Twenty-two abscesses were aspirated, of which 19 resolved and three required subsequent incision and drainage. Eight patients underwent primary incision and drainage, one of whom required a second drainage procedure. In five patients the abscess discharged spontaneously before intervention. The remaining 18 patients were found on ultrasonography to have inflammation without evidence of focal pus which settled with antibiotic therapy in all but two patients. One of these was found to have an inflammatory cancer and the other developed an abscess, which was drained. Aspiration combined with ultrasonographic imaging is an effective alternative to incision and drainage.
Hepatobiliary anatomy in patients with transposition of the gallbladder: Implications for safe laparoscopic cholecystectomy
Authors: Idu M , Jakimowicz J , Iuppa A , Cuschieri A
Published: March 2007

The surgical anatomy of six patients with sinistroposition of the gallbladder is described. Five of these were encountered in a consecutive series of 1764 patients undergoing laparoscopic cholecystectomy for symptomatic gallstone disease in two hospitals between 1989 and 1994, a prevalence of 0·3 per cent in patients undergoing this operation. Despite the left-sided transposition of the gallbladder, the biliary pain experienced by these patients was always on the right side. Preoperative diagnosis of this anomaly was made in only one of six patients despite routine preoperative external ultrasonography and selective preoperative cholangiography. In sinistroposition the cystic artery always crosses in front of the common bile duct from right to left. The cystic duct may open on the left or right side of the common hepatic duct. The anomaly does not preclude safe laparoscopic cholecystectomy but modifications of the port sites and use of the falciform lift facilitate the procedure in these cases. The anatomical features of the sixth case encountered in a patient undergoing resection of hilar cholangiocarcinoma indicate that sinistroposition of the gallbladder may be due to failure of development of segment IV of the liver.
Abdominal wounds in war
Authors: Coupland R
Published: March 2007

The reported mortality rate associated with abdominal wounds sustained in war varies considerably because of the heterogeneity of wounds and the different circumstances under which figures have been collected rather than different treatment strategies. This review draws together a personal experience, reports from ten wars, and information from a database for war wounded into an analysis of abdominal wounds. The analysis attempts to bring understanding to why people die with abdominal wounds in war and so clarifies logistic and treatment issues.
Surgery for biliary obstruction by tumour thrombus in primary liver cancer
Authors: Tantawi B , Cherqui D , van Nhieu J Tran , Kracht M , Fagniez P L
Published: March 2007

Five patients with primary liver cancer presented with obstructive jaundice due to extension of tumour thrombus into the biliary ducts. Three patients had hepatocellular carcinoma, two of whom had alcoholic cirrhosis, and the other two had a peripheral cholangiocarcinoma. Preoperative diagnosis of biliary thrombus was best achieved by ultrasonography and computed tomography which showed peripheral hepatic tumour with dilated bile ducts containing dense material. All patients underwent liver resection associated with biliary exploration, clearance and T-tube drainage. Major hepatectomy was required in four cases. There were no postoperative deaths; one patient developed a subphrenic collection of bile which was drained percutaneously. All patients survived more than a year; median survival was 29 months. There are two long-term survivors without recurrence at 29 and 80 months. Patients with primary liver cancer and jaundice due to migrated tumour fragments in the common bile duct may benefit from surgical resection which can result in long-term resolution of symptoms and occasional cure.
Clinical anatomy of the C1 dorsal root, ganglion, and ramus: A review and anatomical study
Authors: Tubbs R. Shane , Loukas Marios , Slappey John B. , Shoja Mohammadali M. , Oakes W. Jerry , Salter E. George
Published: March 2007

Discrepancies abound in the literature regarding the anatomy and incidence of the C1 dorsal roots, ganglia, and rami. The present study was performed to elucidate further the detailed anatomy of these structures and to review their clinical relevance. Thirty‐adult cadavers were used for this study. The mean age for this group was 72 years. C1 and C2 spinal nerves were identified in 100% of the specimens examined. In 46.6% of specimens, C1 dorsal rootlets were identified and of these, 28.5% had an associated dorsal root ganglion. In 50% of specimens, the spinal accessory nerve joined with dorsal rootlets of C1. C1 in these cases did not possess a dorsal root ganglion. There were no significant differences between left sides, gender, and age (P > 0.05). Additional knowledge regarding the C1 dorsal roots, ganglia, and rami may be of use to the clinician who treats various pain syndromes including medically and surgically intractable occipital neuralgia. Clin. Anat. 20:624–627, 2007. © 2007 Wiley‐Liss, Inc.
A geometric basis for calculation of right ventricular volume in man
Authors: Boak J. Gordon , Bove Alfred A. , Kreulen Thomas , Spann James F.
Published: March 2007

A clinically applicable method for determining right ventricular volume was developed using a new hemielliptical model. The model was derived from a detailed study of right ventricular geometry. Silicone rubber casts were made from 7 adult human right ventricles at autopsy. Cast volumes measured by water displacement ranged from 30 to 144 ml. Serial sections were made of each cast, and the product of the long and short axis of all sections was found to be directly related to the cross‐sectional area and independent of the region or the volume of the ventricle from which the slice originated. Further, using a hemielliptical model, the volume V of each ventricle could be calculated from the equation: V = (π/4) Σ dwh where, d is the depth, w is the width parallel to the septum, and h is the thickness of the cross section. Calculated volume agreed closely with displacement volume throughout (r equals; 0.99, slope equals; 1.05 ± 0.04, intercept equals; −3.6 ± 4., SEE equals; 4.27 ml). Using the same model, calculation of right ventricular surface area was found to agree closely with measured surface area (r equals; 0.99, slope equals; 0.94, intercept equals; −.6, SEE equals; 3.9).

This model can be used to calculate right ventricular volumes from biplane radiographs in man using the equation V equals; (π/4)(ARAO·ALAO)/HsbL where ARAO equals; the area of the 30° right anterior oblique image, A, HL equals; the area and height respectively of the 60° left anterior oblique image. For all 7 casts, radiographic volume agreed closely with directly measured volume (slope equals; 0.97, intercept equals; −5.5, r equals; 0.99, SEE equals; 4.7). Evaluation of positional effects showed that radiographic volume was most accurate when the 30° RAO/60° LAO projections were used. This study provides a method of calculating right ventricular volume, based upon right ventricular geometry, that may be applied to evaluating the volume of the right ventricle in man.
Coronary artery fistula: Estimation of shunt using 99m Tc‐Albumin particles
Authors: Blau Nathan , Adatepe Mustafa H. , Begg Frank R.
Published: March 2007

A 60‐year‐old man presented with complaints of angina pectoris and was found to have a coronary artery fistula between his left main trunk and main pulmonary artery. Particles of 99m Tc‐Albumin were injected in the ostium of the left coronary artery, and differential radioactive counts were obtained over both lung fields and myocardium. The degree of left to right shunt was calculated at 56% of total left coronary artery flow. The patient underwent ligation of the fistula without any complications. This case report represents a new application of myocardial radioisotopic scanning.
Plain film identification of failure of interior vena caval‐right atrial continuity
Authors: Folger Gordon M.
Published: March 2007

The identification of absence of continuity of the inferior vena cava (IVC) with the right atrium assumes major importance at the time of right heart catheterization. The appearance of the IVC in the lateral chest radiogram is diagnostically different from the normal when discontinuity is present and 2 radiographic patterns have been recognized: 1) total absence of the IVC shadow; 2) straightened and posteriorly directed IVC shadow contrasting sharply with the anteriorly directed normally continuous IVC. This latter sign is considered reproducibly accurate in the identification of the IVC which fails to have continuity with the right atrium.