bluuebunny/crossref_metadata_2025 huggingface dataset:
Perceptions of a Dental Career among Successful Applicants for Dentistry Compared with those of Fifth-Year Dental Students
Authors: Skelly Ann M , Fleming Garry JP
Published: November 2003

Purpose of the study

A focused and vocational university programme such as dentistry may limit the opportunities for graduates who find that clinical dentistry is not for them. It is important that those advising and recruiting people into the profession should ascertain whether applicants have a realistic idea of what lies ahead.

Basic procedures

On the presumption that final-year undergraduate students have acquired a more realistic impression of the profession than potential entrants, it was of interest to investigate possible differences in the perceptions of dentistry between the two groups. The perceptions of dentistry have been categorised and compared by anonymous questionnaire between final-year dental students (n=79) and successful undergraduate applicants (n=109) at the same institution in the United Kingdom. The overall response rate was 100% in both cases.

Main findings

It is clear that both groups are concerned with personal and professional matters followed by career opportunities and financial matters, respectively. Health matters pose the least concern. However a number of significant differences have emerged. Significantly fewer students (p=0.001) considered the dental career as a positive contribution to society. A greater proportion of applicants considered the study of mathematics at school to be useful (p=0.001). Significantly more applicants valued technical and manual skills as contributing to a ‘good’ dentist (p=0.001). More students mentioned occupational flexibility, security and independence as a positive aspect of a career (p=0.001); however students identified more job stresses in dentistry (p=0.001).

Principal conclusion

Applicants appeared to have a more ‘idealistic’ view of dentistry than the senior students, however similarities between the responses of students and applicants are encouraging for the future of the profession.
Introducing Problem-based Learning to Special Needs Dentistry—A Case Study
Authors: Bedi Raman , Champion Jackie A , Davies Roger
Published: November 2003

Introduction

In order to promote training and education in special-needs dentistry an attempt was made to introduce problem-based learning (PBL) as a method of postgraduate dental education. The aim of this paper was to review the principles of PBL and report on a case study using this methodology.

Method

The case study was of a PBL session, on the subject of ‘problems of obtaining appropriate dental care for people with epilepsy’, undertaken at a national conference. Delegates were asked to complete a pre- and post-session questionnaire on PBL and their attitudes to the session.

Results

The session received a mixed response. Only 33 (35%) thought the session was valuable and only 20 (31%) thought it was better than conventional teaching methods and yet over half (55%) said they would like to attend more PBL in special-needs dentistry. Professionals complementary to dentistry were more likely to find the PBL session of value and to prefer the method to a more conventional format than dentists were (chi-square=5.5, df=1, p<0.05 and chi-square=5.9, df=1, p<0.05 respectively).

Conclusion

Valuable feedback was received from delegates. This will enable improvements to be made in future courses so that the effectiveness of PBL can be optimised.
Outcomes Associated with Restored and Unrestored Deciduous Molar Teeth
Authors: Milsom Keith M , Tickle Martin , King David , Kearney-Mitchell Paula , Blinkhorn Anthony S
Published: November 2003

Introduction

Most dental treatment for children in the United Kingdom (UK) is provided by general dental practitioners (GDPs) working in the National Health Service (NHS). A working party of the British Society of Paediatric Dentistry, in a special publication from the Dental Practice Board, has suggested that failure to provide restorative care for the deciduous dentition is unacceptable, yet GDPs are filling fewer teeth in young children. The study aimed to evaluate the health outcomes obtained from restoring carious deciduous molar teeth.

Method

The dental records of 677 children cared for by 50 GDPs in the north west of England were analysed.

Results

The results showed that 18.8% of deciduous molars with unrestored caries and 17.0% with a history of restorative care went on to be extracted because of pain or sepsis.

Conclusion

The results suggest that the risk of carious deciduous molars being extracted is similar whether these teeth receive restorative care or not.
Managing Customer-Initiated Contacts with Manufacturers: The Impact on Share of Category Requirements and Word-of-Mouth Behavior
Authors: Bowman Douglas , Narayandas Das
Published: November 2003

The authors examine behavioral outcomes following a customer-initiated contact (CIC) with a manufacturer and develop a framework to explain the impact of vendor performance during a CIC on a customer's share of category requirements with a focal brand and word-of-mouth incidence following contact. The authors propose customer characteristics and context-specific factors that may relate to differences in the key characteristics of the underlying source model of share of category requirements and word of mouth. The authors then assess the overall importance of the explanatory variables in the source model and simultaneously test for systematic differences related to CIC-specific factors using survey data from more than 1700 CICs that involve more than 60 brands. A key assumption in much prior research that has examined customer–firm interactions is that CIC-specific factors, if they are included at all, create an automatic regularity that must be controlled for. The authors propose and find an additional effect. The responsiveness to factors under a firm's control varies across CICs, and therefore firms that adapt their processing have an advantage. Rather than provide a uniform response to all CICs, the authors' results offer managers several guidelines on how to customize their responses to the various CIC types and how to improve the efficiency and effectiveness of their firms' CIC management efforts.
The Role of Market Efficiency Intuitions in Consumer Choice: A Case of Compensatory Inferences
Authors: Chernev Alexander , Carpenter Gregory S.
Published: November 2003

The authors examine consumer inferences about product attributes that are unobservable at the time of the decision. Extant research predicts that in the absence of an explicit correlation between product attributes, consumers will infer that the brand that is superior on the observable attributes is also superior on the unobservable attributes. The authors propose an alternative inference strategy that makes the counterintuitive prediction that the apparently superior brand is inferior on the unobservable attributes. The authors refer to these inferences as “compensatory inferences” and assert that they are associated with consumers' intuitive theories about the competitive nature of a market. In a series of four experiments, the authors examine the occurrence of compensatory inferences and compare them with other inference strategies.
What to Say When: Advertising Appeals in Evolving Markets
Authors: Chandy Rajesh K. , Tellis Gerard J. , Macinnis Deborah J. , Thaivanich Pattana
Published: November 2003

The authors study how ad cues affect consumer behavior in new versus well-established markets. The authors use theoretical insights from consumer information processing to argue that the same ad cues can have different effects on consumer behavior, depending on whether the market is new or old. The authors then test these hypotheses in the context of a toll-free referral service, using a highly disaggregate econometric model of advertising response. The results indicate that argument-based appeals, expert sources, and negatively framed messages are particularly effective in new markets. Emotion-based appeals and positively framed messages are more effective in older markets than in new markets.
Understanding Reference-Price Shoppers: A Within- and Cross-Category Analysis
Authors: Erdem Tülin , Mayhew Glenn , Sun Baohong
Published: November 2003

The authors attempt to draw profiles of reference-price shoppers. Specifically, the authors study how selected factors that affect brand choice are correlated with consumer sensitivity to gains and losses with respect to internal reference prices. They also study the interaction between sociodemographics and gain and loss sensitivity. Furthermore, the authors analyze cross-category correlations in gain and loss sensitivity to shed light on their individual- and category-specific characters. In three categories, the results show significant heterogeneity in loss sensitivity among consumers and indicate that loss sensitivity is greater and more heterogeneous than gain sensitivity. Across categories, the results show that loss-sensitive shoppers are less influenced by past brand use and that both loss- and gain-sensitive shoppers more sensitive to price, display, and feature than the average consumer. Loss-sensitive households tend to be larger, and their heads are less likely to be fully employed, whereas gain-sensitive households have no clear demographic profile. The authors also discuss the limitations of latent-class models in profiling consumer segments and show how these problems are overcome using models with continuous, correlated multivariate distributions.
The Moderating Role of Commitment on the Spillover Effect of Marketing Communications
Authors: Ahluwalia Rohini , Unnava H. Rao , Burnkrant Robert E.
Published: November 2003

Spillover refers to the extent to which a message influences beliefs related to attributes that are not contained in the message. The authors find that when consumers are not familiar with a brand, negative information spills over to attributes that are associated with the target attribute but not mentioned in the message. However, positive information does not. When consumers like the brand, a spillover occurs for the positive information as well. When consumers are committed to the brand, the spillover of negative information is minimized, but positive information spills over more freely to other associated but unmentioned attributes.
Indications and Complications of Latissimus Dorsi Myocutaneous Flaps in Oncologic Breast Surgery
Authors: Apffelstaedt J.
Published: November 2003

The use of the latissimus dorsi myocutaneous flap (LDMF) in reconstructive breast surgery is well documented. Few reports exist of its use in oncologic breast surgery. This series describes indications and complications of the LDMF in locally advanced cancer. The records of 83 patients were analysed for age and sex, menstrual status, stage, indication, margins of resection, chemotherapy, radiotherapy, complications, and survival. The indication was to cover defects caused by resection of locally advanced breast cancer (67 cases), recurrent breast cancer (13 cases), radiation damage (2 cases), and surgical complications (1 case). The mean age of the patients was 50.2 years; 52% were postmenopausal. The flaps had mean diameters of 32 by 14 cm. The donor site was skin grafted. Clear margins were achieved in 83%. At the LDMF insertion site, wound infection required drainage in 1 case; flap necrosis required reintervention in 7 cases. In 2 cases a second skin graft was done for the LDMF donor site. The proportions of wound infections and incomplete skin graft take were significantly greater in patients receiving preoperative cyclophosphamide/methotrexate/5‐fluorouracil (CMF) versus cyclophosphamide/doxorubicin/5‐fluorouracil (CAF) chemotherapy (p <0.001 and p <0.05, respectively). The late complication rate was 7.2%. The mean follow‐up is 40.0 months. The complication rates for CMF versus CAF chemotherapy suggest an adverse effect of methotrexate, which warrants further investigation. The use of the LDMF made wide resection of locally advanced lesions and radionecrosis possible; major complications were rare. LDMF has its place in the armamentarium of the surgeon who regularly sees locally advanced breast cancer.
Gastrointestinal Recovery and Outcome after Laparoscopy‐assisted versus Conventional Open Distal Gastrectomy for Early Gastric Cancer
Authors: Mochiki Erito , Nakabayashi Toshihiro , Kamimura Hitoshi , Haga Norihiro , Asao Takayuki , Kuwano Hiroyuki
Published: November 2003

Laparoscopy‐assisted gastrectomy has been increasingly reported as the treatment of choice for early gastric cancer. However, there is little information regarding the benefits of laparoscopy‐assisted distal gastrectomy (LADG). LADG and conventional open distal gastrectomy (DG) for early gastric cancer were compared in terms of operative outcome, recovery of bowel function, complications, and changes in body weight. Thirty‐four patients underwent LADG for early gastric cancer. These patients were compared with 31 patients who underwent DG during the same period. For estimating gastrointestinal motility recovery, 20 radiopaque markers were inserted into the duodenum during surgery, and abdominal X‐rays were taken daily until all markers were seen in the ascending colon. Age, gender, and histologic differentiation of the lesions were matched. The LADG group required a significantly longer operative time and the dissection of fewer lymph nodes. Postoperative hospital stay and the occurrence of postoperative complications (ileus) were significantly shorter and less frequent in the LADG group. The LADG group showed a more rapid recovery of gastrointestinal motor function compared with the DG group during the early postoperative period. Body weight 24 months after LADG was about 100% of pre‐illness weight, but no further weight change was encountered in the DG group. For selected patients with early gastric cancer, LADG with lymphadenectomy can provide a rapid recovery and good quality of life without compromising the cure rate.
Dehydroepiandrosterone Sulfate and Growth Axis Hormones in Patients after Surgery
Authors: Osorio Alvaro , Vara‐Thorbeck Rafael , Rosell Jorge , Osorio Carlos , Ortega Esperanza , Ruiz‐Requena Estrella
Published: November 2003

We selected 38 patients scheduled for cholecystectomy and studied their serum concentrations of dehydroepiandrosterone (DHEA) and growth axis hormones [growth hormone/insulin‐like growth factor‐1 (GH/IGF‐1)]. We aimed to determine whether alterations in these concentrations resulted from surgical stress or, on the contrary, preceded surgery and were themselves a cause of chronic diseases that reduce life expectancy. We measured the serum concentrations of DHEA sulfate (DHEA‐S), ACTH,
cortisol, human GH (hGH), IGF‐1, and IGF‐1 binding protein‐3 (IGFBP‐3)
preoperatively and then 2 and 7 days after surgery; we also compared the preoperative findings with those of a healthy control group. The results were analyzed by gender because DHEA and GH/IGF‐1 are known to present sexual dimorphism. There were no significant differences between the preoperative and control results for any of the parameters studied. We found a significant reduction in the concentrations of DHEA‐S and IGF‐1 on days 2 and 7 after surgery versus the preoperative values. We conclude that the decrease in DHEA‐S in patients after surgery is a result of surgical trauma and does not precede surgical stress. The decrease in hormone levels observed in patients with chronic disease may therefore be a result, not a cause, of disease, as some have claimed. Further studies with a later endpoint would be of interest to assess any subsequent return of DHEA‐S levels to baseline measurements.
Clinical Outcome of Proximal versus Total Gastrectomy for Proximal Gastric Cancer
Authors: Shiraishi Norio , Adachi Yosuke , Kitano Seigo , Kakisako Kenji , Inomata Masafumi , Yasuda Kazuhiro
Published: November 2003

Tumors in the upper one‐third of the stomach has been increasing. Although the standard operation for proximal gastric cancer has been total gastrectomy, some have used proximal gastrectomy reconstructed by jejunum or gastric tube. The aim of this study was to evaluate the surgical results, hospital costs, and quality of life after gastrectomy for cancer. A consecutive series of 51 patients with stage I or II proximal gastric cancer was studied: 14 underwent proximal gastrectomy reconstructed by gastric tube (direct anastomosis between esophagus and remnant of tube‐like stomach), 17 proximal gastrectomy reconstructed by jejunum, and 20 total gastrectomy in Roux‐en‐Y fashion. Quality of life was estimated by a 24‐item questionnaire with a scoring system of 1 to 3, and hospital costs covered all charges during the hospital stay. Operating time, blood loss, and hospital stay for the gastric tube group were less than those for the jejunum group or the total gastrectomy group. Hospital charges for the gastric tube group were lower than those for the jejunum group or the total gastrectomy group (141 × 10 4 yen, 179 × 10 4 yen, 211 × 10 4 yen, respectively). Although the total score for quality of life was not significantly different among the three groups (35.9, 39.5, 37.6), the number of meals per day was less and the performance status was better in the gastric tube group. Jejunal interposition was less favorably accepted by the patients as a good operation they would recommend to others. The results indicate that, in patients with proximal gastric cancer, proximal gastrectomy reconstructed by gastric tube provides a shorter operating time, earlier recovery, lower hospital charge, and better performance status when compared with proximal gastrectomy reconstructed with jejunum or total gastrectomy.
One Hundred Citation Classics in General Surgical Journals
Authors: Paladugu Ramesh , Schein Moshe , Gardezi Syed , Wise Leslie
Published: November 2003

The number of times an article is cited in scientific journals reflects its impact on a specific biomedical field or specialty and reflects the impact of the authors’ creativity. Our objective was to identify and analyze the characteristics of the 100 most frequently cited articles published in journals dedicated to general surgery and its close subspecialties. Using the database (1945–1995) of the Science Citation Index of the Institute for Scientific Information, 1500 articles cited 100 times and more were identified and the top 100 articles selected for further analysis. The 100 articles were published between 1931 and 1990, with more than two‐thirds of them published after 1960. The mean number of citations per article was 405, (range 278–1013). Altogether, 84 of the articles originated from North America (USA 78, Canada 6) and the UK (12). New York State led the list of U.S. states with 14, and Harvard and Columbia University led the list of institutions with 6 articles each. The 100 articles were published in 10 surgical journals led by theAnnals of Surgery (n = 40), followed bySurgery (n = 15), Archives of Surgery (n = 12), Surgery, Gynecology and Obstetrics (n = 11), and British Journal of Surgery (n = 10). A total of 80 of the articles reported clinical experiences, 6 were clinical review articles, and 14 dealt with basic science. Eighteen articles reported a new surgical technique and six a prosthetic device. Gastrointestinal surgery and trauma and critical care led the list of the surgical fields, each with 25 articles, followed by vascular surgery (n = 15). Thirty‐four persons authored two or more of the top‐cited articles. This list of the top‐cited papers identifies seminal contributions and their originators, facilitating the understanding and discourse of modern surgical history and offering surgeons hints about what makes a contribution a "top‐cited classic." To produce such a "classic" the surgeon and his or her group must come up with a clinical or nonclinical innovation, observation, or discovery that has a long‐standing effect on the way we practice—be it operative or nonoperative. Based on our findings, to be well cited such a contribution should be published in the English language in a high‐impact journal. Moreover, it is more likely to resonant loudly if it originates from a North American or British "ivory tower."
Pedunculated Hepatocellular Carcinoma: Clinicopathologic Study of 18 Surgically Resected Cases
Authors: Yeh Chun‐Nan , Lee Wei‐Chen , Jeng Long‐Bin , Chen Miin‐Fu
Published: November 2003

We present the clinical features and outcomes of 18 surgically treated pedunculated hepatocellular carcinomas (P‐HCCs). Hepatocellular carcinoma is a notorious, hyperendemic disease in Taiwan. Pedunculated HCC, although not a novel finding, has been recognized and diagnosed early by various imaging modalities. However, the clinicopathologic picture has not been fully clarified, and the prognosis varies in each report. From 1986 to 1998 the clinical features of 18 surgically treated cases of P‐HCC were reviewed, including demographics, laboratory data, operative findings, pathologic features, and follow‐up results. Factors that may influence the outcomes were also analyzed. Clinical features and outcomes of 414 patients with nonpedunculated hepatocellular (HCC) were summarized for comparison. Of 432 surgical resected hepatocellular carcinomas, 18 (4.2%) were P‐HCCs. Larger tumor size, more capsule formation, less vascular invasion, and wider resection margins were significantly prominent in the patients in P‐HCC group compared with those in the NP‐HCC group. Multivariate stepwise logistic regression analysis revealed that the P‐HCC group had significantly larger tumors and wider resection margins. The 1‐, 3‐, and 5‐year survival rates of P‐HCC patients were 88.3%, 77.4%, and 45.6%, respectively. A significant difference in survival was found between the P‐HCC and NP‐HCC groups. P‐HCC patients without vascular invasion might have a significantly better survival demonstrated by log‐rank analysis stratified by capsular invasion, vascular invasion, resection, and tumor size. We present the clinical features and outcomes of 18 surgically treated pedunculated HCCs. Pedunculated HCCs might have a better survival than conventional HCCs after hepatic resection, especially if there is no vascular invasion.
Surgical Correction of Main Stem Reflux in the Superficial Venous System: Does It Improve the Blood Flow of Incompetent Perforating Veins?
Authors: Al‐Mulhim Abdulrahman Saleh , El‐Hoseiny Hamdoun , Al‐Mulhim Faisal Mohammed , Bayameen Omar , Sami Mohamad Mahmoud , Abdulaziz Khalid , Raslan Mahmoud , Al‐Shewy Ali , Al‐Malt Majid
Published: November 2003

Fifty‐seven limbs (33 patients) with chronic venous ulceration were selected for this study. The criterion for selection was the presence of isolated superficial venous reflux. Long saphenous vein reflux alone was observed in 39 (68.4%) limbs, short saphenous vein reflux alone in 4 (7.0%) limbs, and both long and short saphenous vein reflux in 14 (24.6%) limbs. Surgical correction of the refluxing saphenous system has allowed 46 (80.7%) ulcers to heal. The healing rates for all the ulcerated legs that had long saphenous vein reflux, short saphenous vein reflux, or a combination of the two were 85.4%, 75.0%, and 66.7%, respectively. Incompetent perforating veins (IPVs) were observed in 51 (89.5%) limbs; 74.5% of them regained their competence postoperatively (189 preoperatively vs. 59 postoperatively; p < 0.001), with a significant reduction in their mean diameter (p < 0.001). IPVs remained in 13 (25.5%) limbs: 3 limbs with persistent reflux in the tributaries of the saphenous system, 1 limb with a fixed ankle joint, and nine limbs with no evidence of macrovascular venous disease. In patients with a competent deep venous system, reflux in perforating veins is often abolished after eradication of saphenous reflux.
18‐Fluorodeoxyglucose‐Positron Emission Tomography in Inflammatory Breast Cancer
Authors: Baslaim Muna M. , Bakheet Siema M. , Bakheet Razan , Ezzat Adnan , El‐Foudeh Mahmoud , Tulbah Asma
Published: November 2003

Inflammatory breast cancer (IBC) is the most aggressive form of locally advanced breast cancer. It can be diagnosed based on a clinical or pathologic basis. We evaluated the usefulness of 18F‐fluorodeoxyglucose‐positron emission tomography (FDG‐PET) scans for diagnosing and staging IBC. We retrospectively reviewed the medical records of seven consecutive patients with IBC who underwent FDG‐PET scanning for the initial staging. Four patients had follow‐up PET scans after chemotherapy. All seven patients presented with diffuse breast enlargement, redness, and peau d’orange for 1 to 5 months’ duration. In addition, four patients had a palpable breast mass, and three had axillary lymph node enlargement. Mammography showed diffuse, increased parenchymal density and skin thickening in 85% and parenchymal distortion in 43%. There was no evidence of distant metastasis on computed tomography of the chest or abdomen. Pathologic examination of breast biopsy specimens showed infiltrating ductal carcinoma in six patients, and one had lobular carcinoma. All patients had prechemotherapy whole‐body PET scans that showed diffuse FDG uptake in the breast with superimposed intense foci in the primary tumor. Furthermore, there was skin enhancement in 100%, axillary lymph node in 85%, and skeletal metastases in 14% of the patients, confirmed by bone scintigraphy. Postchemotherapy FDG‐PET scans performed in four patients showed response in the primary tumor, axillary lymph nodes, and skeletal metastases. The FDG‐PET scan is thus useful for displaying the pattern of FDG breast uptake that reflects the extent of the pathologic involvement in IBC (i.e., diffuse breast involvement and dermal lymphatic spread). It can also detect the presence of lymph node and skeletal metastases, demarcating the extent of the disease locally as well as distally.
Expression of Elastic Components in Healthy and Varicose Veins
Authors: Buján Julia , Gimeno María J. , Jiménez Jose A. , Kielty Cay M. , Mecham Robert P. , Bellón Juan M.
Published: November 2003

This study evaluates possible changes in the synthesis/degradation of elastic components of the vein wall in an attempt to explain the development of varicosis. Healthy and varicose saphenous veins were subjected to immunohistochemical analysis using anti‐elastin, anti‐fibrillin‐1, anti‐elastase, anti‐transforming growth factor (TGF)‐β and anti‐latent TGFβ binding protein (LTBP)‐2 monoclonal antibodies. In situ hybridization was performed using specific probes for tropoelastin and fibrillin‐1. In healthy veins, elastin and fibrillin‐1 showed even, overlapping distribution patterns indicating their particular abundance in the adventitia and at the intima/media interface. The expression of tropoelastin and fibrillin‐1 was high in smooth muscle cells bordering the elastic laminae. Elastin, fibrillin‐1, and cells expressing fibrillin‐1 and tropoelastin mRNA showed a patchy disorganized pattern, particularly in the proximal varicose segments of patients under 50 years of age. Enhanced elastase activity was noted in both control and varicose specimens from elderly subjects. Varicose veins specimens showed greater LTBP‐2 and TGF expression. Both molecules were detected in the subendothelium and the media, particularly in areas of marked injury. Our findings suggest that the development of the varicose condition involves a restructuring of the elastic component of the vein wall, perhaps as a consequence of changes in the transcription mechanisms of muscle layer cells.
Laparoscopic and Thoracoscopic Partial Hepatectomy for Hepatocellular Carcinoma
Authors: Teramoto Kenichi , Kawamura Tohru , Takamatsu Susumu , Noguchi Norio , Nakamura Noriaki , Arii Shigeki
Published: November 2003

Several trials have been reported examining laparoscopic liver resections for the treatment of various kinds of liver tumors. However, there are no detailed reports on the use of laparoscopic (LH) and thoracoscopic (TH) hepatectomy for the treatment of hepatocellular carcinoma (HCC). Eleven laparoscopic and thoracoscopic partial liver resections were attempted for treating HCC. The indications for performing a laparoscopic or thoracoscopic partial hepatectomy were as follows: (1) the tumor was located on the surface of the liver; (2) the tumor was less than 3 cm in diameter; and (3) the tumor was not located adjacent to any large vessels. A TH was performed if the tumor was located in segment 8; an LH was performed if the tumor was located in segment 3, 4, or 5. Hand‐assisted operations were performed in two patients. The mean operating time was 186.1 ± 44.0 minutes (range 130–310 minutes). The operative blood loss was 218.3 ± 197.6 ml (range 20–650 ml). The mean postoperative hospital stay was 11.3 ± 5.7 days (range 7–26 days). Two patients experienced postoperative complications (wound infection and ascites). No local recurrences have occurred to date. The overall 5‐year survival rate and disease‐free 5‐year survival rate were 75.0% and 38.2%, respectively. Laparoscopic and thoracoscopic hepatic resections are less invasive than conventional surgical techniques and are useful for treating HCC in select patients.
Stress Response to Hepatectomy in Patients with a Healthy or a Diseased Liver
Authors: Lan Albert Kuo‐Mao , Luk Hsiang‐Ning , Goto Shigeru , Chen Shyr‐Ming Sheen , Eng Hock‐Liew , Chen Yaw‐Sen , de Villa Vanessa H. , Wang Chih Chi , Cheng Yu‐Fen , Chen Chao‐Long , Lee Ju‐Hao , Jawan Bruno
Published: November 2003

Partial hepatectomy is a major upper abdominal operation associated with certain stress to the patient. Successful adaptation to such stress is a prerequisite for survival. Donor hepatectomy with maximal safety is a principal concern during living donor liver transplantation. The purpose of the study was to compare the stress response by assessing cytokines and the acute‐phase response induced by hepatectomy in patients with a healthy liver and those with a diseased liver. Fourteen patients undergoing partial right hepatectomy were enrolled in this study. Seven of them were donors for living related liver transplantation (group I, or GI); the other seven were patients with hepatocellular carcinoma due to chronic hepatitis B (Child’s class A) (GII). Blood samples for interleukin‐6 (IL‐6), tumor necrosis factor‐α (TNFα), and C‐reactive protein (CRP) assays were collected before the operation, at the beginning and end of the operation, and 24 and 48 hours after the operation. The data were analyzed and compared in the same group using the Friedman test and between groups using the Mann‐Whitney U‐test. A value of p < 0.05 was regarded as significant. Results showed that resection of the liver in patients with both healthy and disease livers leads to significant increases in IL‐6 and CPR but not TNFα. Significantly lower levels of IL‐6 before and after operation in GI patients compared to those in GII patients suggests that GI patients adapted to surgical stress more easily than did the GII patients.
Medical and Radiation Oncology for Breast Cancer in Developing Countries with Particular Reference to Locally Advanced Breast Cancer
Authors: Murray Elizabeth M.
Published: November 2003

The first part of this review outlines the extent of the problem of breast cancer in developing countries, with particular reference to the difficulties surrounding breast cancer treatment in these countries. The second part is devoted to discussion of chemotherapy, hormonal therapy, and radiotherapy treatments suitable for developing countries. The goals of the review are to show how treatment strategies can be adapted in poorer countries and how oncologists from the developed world can play a role in developing countries. This review should be relevant to the developing world in general, but as the author comes from South Africa, many of the examples are from that country which has features of the developed and developing world.
Approach to Early Barrett’s Cancer
Authors: Stein Hubert J. , Feith Marcus , Rahden Burkhard A.H. v. , Siewert J. Rüdiger
Published: November 2003

Because of effective surveillance programs in patients with known Barrett’s esophagus, adenocarcinoma of the distal esophagus is increasingly diagnosed at early stages. With the introduction of limited surgical and endoscopic treatment modalities, the need for radical esophagectomy and extensive lymphadenectomy in such patients has been questioned. When selecting the approach to early Barrett’s cancer, the precancerous nature of the underlying Barrett’s esophagus, the frequent multicentricity of neoplastic alterations within the Barrett mucosa, the inaccuracy of current staging modalities, and the presence of lymph node metastases should be taken into account. Invasiveness and morbidity of the procedures, as well as quality of life aspects, should also be considered. From an oncologic point of view the minimum extent of a resection for early Barrett’s cancer should include a full‐thickness removal of the entire segment of the distal esophagus covered by intestinal metaplasia together with a regional lymphadenectomy. In appropriately selected patients this can be achieved by a limited surgical procedure involving transhiatal resection of the distal esophagus, but not by endoscopic mucosal ablation or endoscopic mucosa resection. Our experience with 49 limited surgical resections with regional lymphadenectomy indicates that this procedure is oncologically adequate and safe. Reconstruction with an interposed jejunal loop prevents postoperative gastroesophageal reflux and is associated with good quality of life. In contrast, endoscopic interventions are plagued by a high tumor recurrence rate, probably from persistence of Barrett’s mucosa and gastroesophageal reflux.
Pattern of Lymphatic Spread of Barrett’s Cancer
Authors: Feith Marcus , Stein Hubert J. , Siewert J. Rüdiger
Published: November 2003

As in squamous cell esophageal cancer, the presence and number of lymph node metastases constitutes the major prognostic factor in patients with adenocarcinoma of the distal esophagus (the so‐called Barrett’s cancer) who have had complete tumor resection (R0 resection). In contrast to squamous cell esophageal cancer, however, lymphatic spread in patients with Barrett’s cancer appears to follow certain rules. Lymphatic spread is closely correlated with the pT category of the primary tumor; it starts only after infiltration of the basal membrane, and initially it is limited to the regional lymph nodes. Lymph node metastases at distant locations—i.e., the upper mediastinum and the celiac axis—are found almost exclusively in patients with multiple positive regional nodes. Skipping of regional lymph node stations occurs in less than 5% of the patients. These observations set the stage for individualized and tailored lymphadenectomy strategies. The sentinel lymphadenectomy concept may be applicable to patients with early Barrett’s cancer.
Postlaryngectomy Voice Rehabilitation: State of the Art at the Millennium
Authors: Brown Dale H. , Hilgers Frans J.M. , Irish Jonathan C. , Balm Alfons J.M.
Published: November 2003

Total laryngectomy or laryngopharyngectomy remains the procedure of choice for advanced laryngeal/hypopharyngeal carcinoma, either as a primary procedure or as salvage following irradiation alone or concurrent chemoradiation therapy. Over the past 25 years there has been significant improvement in the rehabilitation of these patients, with speech restoration that has dramatically altered and improved their quality of life. This article reviews postlaryngectomy voice rehabilitation with a historical background as well as the present state‐of‐the‐art tracheoesophageal shunt voice with an artificial valve. Finally, this article reviews and compares artificial valve prostheses as to their voice characteristics, patient satisfaction, complications associated with the procedure, and devices used at a center in Europe (The Netherlands Cancer Institute, Amsterdam) and a North American center (The Wharton Head and Neck Center, Princess Margaret Hospital, University of Toronto, Canada).
Functional Reconstruction of the Oral Cavity
Authors: Neligan Peter C. , Gullane Patrick J. , Gilbert Ralph W.
Published: November 2003

Reconstruction of the oral cavity is an intricate subject that reflects the complexity of the oral cavity itself. There is no perfect reconstruction. Presented here are the current optimal choices for the various regions within the oral cavity. We are constantly seeking to improve these reconstructions in an effort to restore optimal function to patients unfortunate enough to require surgical excision of this most elaborate of anatomic structures.
Stress reactions among Swedish peacekeeping soldiers serving in Bosnia: A longitudinal study
Authors: Michel Per‐Olof , Lundin Tom , Larsson Gerry
Published: November 2003

Assessments of mental health (GHQ‐28) were performed on a Swedish battalion serving in Bosnia at 4 times: before deployment, immediately after deployment, 6 months after deployment, and 1 year after deployment. Complete responses were obtained from 316 participants (61% response rate). No significant change of mental health over time was noted. Individuals having experienced traumatic events in Bosnia, as well as stressful life events postdeployment, reported the poorest mental health. Logistic regression analysis showed that postdeployment stressors made the strongest contribution to registering a poor mental health score after one year.
Positive adaptation to trauma: Wisdom as both process and outcome
Authors: Linley P. Alex
Published: November 2003

Positive adaptation to psychological trauma and wisdom both have a rich history in European literature and philosophy. Although the literature on posttraumatic growth has recognized the possibility of wisdom as an outcome of adaptation, its role in the process of adaptation has been neglected. A theoretical framework is presented that conceptualizes three dimensions of wisdom as crucial to an understanding of the role it can play in posttraumatic positive adaptation. These dimensions are the recognition and management of uncertainty; the integration of affect and cognition; and the recognition and management of uncertainty; the integration of affect and cognition; and the recognition and acceptance of human limitation. The role of these dimensions in the process and outcome of traumatic adaptation is considered, together with limitations of the framework and directions for future research.
The Influence of Emotionally Relevant Context on the Evoked Cardiac Response Triggered by an Irrelevant Stimulus
Authors: Kuniecki Michal , Barry Robert , Kaiser Jan
Published: November 2003

Abstract The effect of stimulus valence was examined in the evoked cardiac response (ECR) elicited by the exposition of neutral and negative slides as well as by an innocuous auditory stimulus presented on the affective foregrounds generated by the slides. The exposition of the aversive slide produced prolonged cardiac deceleration in comparison with the neutral slide. Similar prolonged deceleration accompanied exposition of the neutral auditory stimulus on the negative visual foreground in comparison with the neutral foreground. We interpret these results as an autonomic correlate of extended stimulus processing associated with the affective stimulus. The initial deceleration response, covering two or three slower heart beats, may be prolonged for several seconds before HR reaches the baseline level again. In such a case the evoked cardiac deceleration can be functionally divided into two parts: the reflexive bradycardia (ECR1) elicited by neutral stimuli and a late decelerative component (LDC). We can speculate that the latter is associated with an additional voluntary continuation of processing of the stimulus. This must involve some cognitive aspect different from the mental task performance which leads to the accelerative ECR2, and we suggest that processing of a stimulus with negative valence is involved in generating the LDC.
Shall I Move My Right or My Left Hand?
Authors: Babiloni Claudio , Babiloni Fabio , Carducci Filippo , Cincotti Febo , Del Percio Claudio , Hallett Mark , Kelso AJ Scott , Moretti Davide Vito , Liepert Joachim , Rossini Paolo Maria
Published: November 2003

Abstract Event-related desynchronization/synchronization (ERD/ERS) at alpha (10Hz), beta (20Hz), and gamma (40Hz) bands and movement-related potentials (MRPs) were investigated in right-handed subjects who were “free” to decide the side of unilateral finger movements (“fixed” side as a control). As a novelty, this “multi-modal” EEG analysis was combined with the evaluation of involuntary mirror movements, taken as an index of “bimanual competition.” A main issue was whether the decision regarding the hand to be moved (“free” movements) could modulate ERD/ERS or MRPs overlying sensorimotor cortical areas typically involved in bimanual tasks. Compared to “fixed” movements, “free” movements induced the following effects: (1) more involuntary mirror movements discarded from EEG analysis; (2) stronger vertex MRPs (right motor acts); (3) a positive correlation between these potentials and the number of involuntary mirror movements; (4) gamma ERS over central areas; and (5) preponderance of postmovement beta ERS over left central area (dominant hemisphere). These results suggest that ERD/ERS and MRPs provide complementary information on the cortical processes belonging to a lateralized motor act. In this context, the results on vertex MRPs would indicate a key role of supplementary/cingulate motor areas not only for bimanual coordination but also for the control of “bimanual competition” and involuntary mirror movements.
The Independent Effects of Attention and Lead Stimulus Properties on the Acoustic Blink Reflex
Authors: Neumann David L. , Lipp Ottmar V.
Published: November 2003

Abstract The effects of attention to a lead stimulus and of its sensory properties on modulation of the acoustic blink reflex were investigated. Participants performed a reaction time task cued by an acoustic or a visual lead stimulus. In Experiment 1, half the participants were presented with sustained lead stimuli. For the remainder, the lead stimulus was discrete and consisted of two brief presentations that marked the onset and offset of a stimulus-free interval. In Experiment 2, sustained lead stimuli were presented at a low or high intensity. The attentional demands of the task enhanced blink latency and magnitude modulation during acoustic and visual lead stimuli, with blink modulation being largest at a late point during the lead stimulus. Independent of the attentional effects, blink latency and magnitude modulation were larger during sustained than during discrete acoustic lead stimuli, whereas there was no difference for visual lead stimuli. Increases in the intensity of the lead stimulus enhanced blink modulation regardless of lead stimulus modality. Attention to a lead stimulus and the properties of the lead stimulus appear to have independent effects on blink reflex modulation.
Gaseous Dynamics of the Rabbit Maxillary Sinus
Authors: Mikula Suzette K. , Gannon Patrick J. , Shapiro Jack , Lawson William
Published: November 2003

To better understand the mechanisms underlying maxillary sinus function, the gas composition of the sinus antrum in spontaneously breathing and tracheotomized rabbits (n = 17) was compared. The gas composition of samples (n = 117) obtained from rabbit maxillary sinuses was determined by gas chromatography. Results demonstrated significant differences (P<.005) in sinus gas composition between nasal breathing and tracheotomized animals for oxygen (O2) and carbon dioxide (CO2). In tracheotomized animals O2 levels decreased while CO2 levels increased markedly to suprasystemic levels. This unexpected finding may be due to reduced sinus blood flow and the effects of nasal versus tracheal respiration. We conclude that the gaseous dynamics and perhaps the function of the maxillary sinus vary under different respiratory conditions. A better understanding of these processes may lead to earlier diagnosis and the development of improved treatments for sinus disease.
Beta‐2 Transferrin
Authors: Levenson Mark J. , Desloge Rosemary B. , Parisier Simon C.
Published: November 2003

Beta‐2 transferrin is a protein marker that can be used in the clinical setting to reliably identify the presence of cerebrospinal fluid (CSF). Recent literature has suggested that beta‐2 transferrin can also be used as a clinical marker for perilymph. This study investigates the use of a beta‐2 transferrin assay as a method to identify the presence of perilymph. Twenty‐two patients were enrolled in the study. Fluid samples were obtained intraoperatively and tested for the presence of beta‐2 transferrin. As expected, four CSF samples collected were positive for beta‐2 transferrin; however, four known perilymph samples collected from patients undergoing cochlear implantation were negative for beta‐2 transferrin, seven of nine known perilymph samples obtained during stapedectomies were negative for beta‐2 transferrin, and four of five samples collected during middle ear explorations for fistula were negative for beta‐2 transferrin. With current methodology beta‐2 transferrin does not appear to be a reliable clinical marker for perilymph in the operative setting.
Angiography and Transcatheter Arterial Embolization of Vascular Injuries of the Face and Neck
Authors: Sclafani Anthony P. , Sclafani Salvatore J.A.
Published: November 2003

The condition of patients sustaining penetrating neck trauma often appears deceptively stable, even when major structures have been injured. The clinician must identify patients who require treatment and limit invasive procedures in those without significant injuries. Angiography is often used to search for vascular damage following penetration of the neck and face.

The charts of 401 hemodynamically stable patients with penetrating cervicofacial wounds who were evaluated by angiography followed, when necessary, by either transcatheter arterial embolization and observation or surgery were reviewed. One hundred twelve patients (27.9%) had 131 vascular injuries identified by angiography; 77 (68.8%) of these patients sustained injuries to zone III of the neck or the face.

The most commonly injured vessels were the internal carotid artery (ICA), the vertebral artery, and the external carotid artery (ECA) system. Multiple vessel injuries were seen in 17 (15.2%) of 112 patients and were more likely in patients with wounds in zone III or above than in those wounded in zone II or below (20.8% vs. 2.9%, respectively; P<.025). Injuries to the internal maxillary artery (IMA) (60%), ECA (53.3%), and the ICA (30.8%) were also significantly more likely to be accompanied by additional vascular injuries (P<.005). No clinically significant venous injuries were missed. Complications were noted in only 4 patients, and no deaths occurred as a result of angiography.

Angiography is a safe, effective modality in the head and neck trauma setting. Particular scrutiny should be given to patients with zone III or facial wounds, particularly those with documented ICA, IMA, and ECA injuries, since these patients have a higher incidence of multiple vascular injuries.
Vocal Cord Injection With Autogenous Fat
Authors: Brandenburg James H. , Unger June M. , Koschkee Danna
Published: November 2003

Since 1987, the senior author has injected autogenous fat into paralyzed or atrophic vocal cords as an alternative to alloplastic substances for vocal cord augmentation and medialization.

To determine the fate of the injected autogenous fat, the injected vocal cords of 10 patients were evaluated by laryngeal magnetic resonance imaging (MRI) in the sagittal, coronal, and axial planes. Imaging studies were performed as early as 17 hours after surgery to as long as 31 months after fat injection. In 9 patients, identification of a fat signal within the previously injected vocal cords was observed (including the 31‐month postoperative follow‐up). In 1 patient, no fat signal was identified 13 months after surgery, but the vocal cord was noted to have a bulging, enlarged contour.

The results of this imaging study provide further evidence that autogenous fat, which has not been damaged during harvesting or microinjection, can survive transplantation into the vocal cord. The bulk of the vocal cord is maintained by microlipocytes and fibrous connective tissue, both of which replace the damaged fat cells that are gradually being reabsorbed.