bluuebunny/crossref_metadata_2025 huggingface dataset:
Rapid analysis of controlled substances using desorption electrospray ionization mass spectrometry
Authors: Rodriguez‐Cruz Sandra E.
Published: November 2005

The recently developed technique of desorption electrospray ionization (DESI) has been applied to the rapid analysis of controlled substances. Experiments have been performed using a commercial ThermoFinnigan LCQ Advantage MAX ion‐trap mass spectrometer with limited modifications. Results from the ambient sampling of licit and illicit tablets demonstrate the ability of the DESI technique to detect the main active ingredient(s) or controlled substance(s), even in the presence of other higher‐concentration components. Full‐scan mass spectrometry data provide preliminary identification by molecular weight determination, while rapid analysis using the tandem mass spectrometry (MS/MS) mode provides fragmentation data which, when compared to the laboratory‐generated ESI‐MS/MS spectral library, provide structural information and final identification of the active ingredient(s). The consecutive analysis of tablets containing different active components indicates there is no cross‐contamination or interference from tablet to tablet, demonstrating the reliability of the DESI technique for rapid sampling (one tablet/min or better). Active ingredients have been detected for tablets in which the active component represents less than 1% of the total tablet weight, demonstrating the sensitivity of the technique. The real‐time sampling of cannabis plant material is also presented. Published in 2005 by John Wiley & Sons, Ltd.
A longitudinal study of ethanol and acetaldehyde in the exhaled breath of healthy volunteers using selected‐ion flow‐tube mass spectrometry
Authors: Turner Claire , Španěl Patrik , Smith David
Published: November 2005

Selected‐ion flow‐tube mass spectrometry (SIFT‐MS) has been used to monitor the volatile compounds in the exhaled breath of 30 volunteers (19 male, 11 female) over a 6‐month period. Volunteers provided breath samples each week between 8:45 and 13:00 (before lunch), and the concentrations of several trace compounds were obtained. In this paper the focus is on ethanol and acetaldehyde, which were simultaneously quantified by SIFT‐MS using H3O+ precursor ions. The mean ethanol level for all samples was 196 parts‐per‐billion (ppb) with a standard deviation of 244 ppb, and the range of values for breath samples analysed is 0 to 1663 ppb. The mean acetaldehyde level for all samples was 24 ppb with a standard deviation of 17 ppb, and the range of values for breath samples analysed is 0 to 104 ppb. Background (ambient air) levels of ethanol were around 50 ppb, whereas any background acetaldehyde was usually undetectable. Increased ethanol levels were observed if sweet drink/food had been consumed within the 2 h prior to providing the breath samples, but no increase was apparent when alcohol had been consumed the previous evening. The measured endogenous breath ethanol and acetaldehyde levels were not correlated. These data relating to healthy individuals are a prelude to using breath analysis for clinical diagnosis, for example, the recognition of bacterial overload in the gut (ethanol) or the possibly of detecting tumours in the body (acetaldehyde). Copyright © 2005 John Wiley & Sons, Ltd.
Exponential estimates for neutral time delay systems with multiple delays
Authors: Kharitonov Vladimir , Collado Joaquín , Mondié Sabine
Published: November 2005

Exponential estimates and sufficient conditions for the exponential stability of linear neutral time delay for systems with multiple delays are given. The case of systems with uncertainties, including uncertainties in the difference operator, is considered. The proofs follows from new results on non‐homogeneous difference equations evolving in continuous time combined with the Lyapunov–Krasovskii functionals approach. The conditions are expressed in terms of linear matrix inequalities. The particular case of neutral time delay systems with commensurate delays, which leads to less restrictive exponential estimates, is also addressed. Copyright © 2005 John Wiley & Sons, Ltd.
Finding blocks and other patterns in a random coloring of ℤ
Authors: Matzinger Heinrich , Rolles Silke W.W.
Published: November 2005

Let ξ = (ξk)k∈ℤ be i.i.d. with P(ξk = 0) = P(ξk = 1) = 1/2, and let S: = (Sk) be a symmetric random walk with holding on ℤ, independent of ξ. We consider the scenery ξ observed along the random walk path S, namely, the process (χk := ξ). With high probability, we reconstruct the color and the length of blockn, a block in ξ of length ≥ n close to the origin, given only the observations (χk). We find stopping times that stop the random walker with high probability at particular places of the scenery, namely on blockn and in the interval [−3n,3n]. Moreover, we reconstruct with high probability a piece of ξ of length of the order 3 around blockn, given only 3 observations collected by the random walker starting on the boundary of blockn. © 2005 Wiley Periodicals, Inc. Random Struct. Alg., 2006
Directed Fabrication of Radially Stacked Multifunctional Oxide Heterostructures Using Soft Electron‐Beam Lithography
Authors: Pan Zixiao , Donthu Suresh K. , Wu Nianqiang , Li Shuyou , Dravid Vinayak P.
Published: November 2005

A versatile patterning approach based on electron‐beam lithography (eBL) and solution deposition, termed soft‐eBL, has been developed to fabricate radially stacked heterostructures of multifunctional oxides from their sol precursors. Well‐defined nanorings of lead zirconate titanate (PZT) are fabricated on a variety of substrates such as noble metals (e.g., Au), semiconductors (e.g., Si), and oxide single crystals (e.g., SrTiO3), which were previously functionalized with appropriate self‐assembled monolayers (SAMs). The undercut in the double‐layer eBL resist and substrate functionalization with the SAM treatment play a vital role in the formation of the ring structures. The nanorings are then used as building block “containers” and ring‐reservoirs are filled with a second sol (e.g., CoFe2O4) to form radially stacked composite ceramic heterostructures. The approach presented here does not require either feature alignment to realize heterostructures or the etching of ceramics, and is amenable to a variety of radially stacked composite heterostructures.
What lies behind graphicacy? Relating students' results on a test of graphically represented quantitative information to formal academic achievement
Authors: Åberg‐Bengtsson Lisbeth , Ottosson Torgny
Published: November 2005

Based on studies carried out on qualitative data an instrument was constructed for investigating how larger numbers of students handle graphics. This test, consisting of 18 pages, each with its own graphic display(s) and a set of tasks, was distributed to 363 students, 15–16 years of age, from five different schools. The format of the questions varied, as did the format of the graphics. As students' performance was expected to be multidimensional, confirmatory factor analysis was carried out with a structural equation modeling technique. In addition to the identification of a general graphicacy‐test factor (Gen) and an end‐of‐test effect (End′), a narrative dimension (Narr′) was vaguely indicated. This model was then related to a six‐factor model of students' formal academic achievement measured by their leaving certificates from compulsory education. The strongest correlation obtained was between the general graphicacy‐test dimension (Gen) and a mathematic/science factor (MathSc′) in the grades model. In addition, substantial relationships were detected between the Gen factor and both an overall school achievement factor (SchAch) and a language factor (Lang′) in the grades model. © 2005 Wiley Periodicals, Inc. J Res Sci Teach 43: 43–62, 2006
Inscriptional practices in two inquiry‐based classrooms: A case study of seventh graders' use of data tables and graphs
Authors: Wu Hsin‐Kai , Krajcik Joseph S.
Published: November 2005

This case study characterizes the inscriptional practices demonstrated by seventh graders, particularly their use of data tables and graphs, in an inquiry‐based learning environment. Using a naturalistic approach, we collected multiple sources of data during an 8‐month instructional unit that emphasized water quality and relevant concepts. The analyses show that constructing and interpreting graphs and tables provided students with opportunities to discuss, review, and clarify questions about concepts and the inquiry process. At the end of the unit on water quality, students were capable of fully participating in designing a more complicated inscription and interpreting new inscriptions. The findings suggest that four features of the learning environment promoted the development of inscriptional practices: (1) embedding the use of inscriptions in students' science inquiry; (2) providing scaffolds to support students' inquiry process; (3) sequencing tasks and the inquiry process; and (4) engaging students in science inquiry in an iterated manner. This study provides insight into the design of a learning environment in which students can develop competent scientific practices. © 2005 Wiley Periodicals, Inc. J Res Sci Teach 43: 63–95, 2006
Relationship between achievement and students' acceptance of evolution or creation in an upper‐level evolution course
Authors: Ingram Ella L. , Nelson Craig E.
Published: November 2005

Students often hold strong attitudes regarding topics they encounter during their studies, and many instructors feel that these attitudes can have strong effects on students' performance. We characterized students' attitudes toward evolution and investigated the influence of students' attitudes (pre‐course and post‐course) regarding evolution on their performance in an evolution course, measured as their final grade. We found our students to hold positive attitudes toward evolution; these attitudes became more positive following the course. The most significant change in attitude occurred in the group of students initially undecided toward evolution. We also found that attitudes prior to the course had little influence on later achievement; however, at the end of the course, students' attitudes were positively related to final grades, although the effect was small. We argue that pedagogical techniques directly addressing students' attitudes help reduce the influence of attitudes (especially prior attitudes) on achievement. © 2005 Wiley Periodicals, Inc. J Res Sci Teach 43: 7–24, 2006
“It isn't no slang that can be said about this stuff”: Language, identity, and appropriating science discourse
Authors: Brown Bryan A.
Published: November 2005

This investigation explores how underrepresented urban students made sense of their first experience with high school science. The study sought to identify how students' assimilation into the science classroom reflected their interpretation of science itself in relation to their academic identities. The primary objectives were to examine students' responses to the epistemic, behavioral, and discursive norms of the science classroom. At the completion of the academic year, 29 students were interviewed regarding their experiences in a ninth and tenth‐grade life science course. The results indicate that students experienced relative ease in appropriating the epistemic and cultural behaviors of science, whereas they expressed a great deal of difficulty in appropriating the discursive practices of science. The implications of these findings reflect the broader need to place greater emphasis on the relationship between students' identity and their scientific literacy development. © 2005 Wiley Periodicals, Inc. J Res Sci Teach 43: 96–126, 2006
Offshore wind climatology over the Mediterranean basin
Authors: Lavagnini A. , Sempreviva Anna M. , Transerici C. , Accadia C. , Casaioli M. , Mariani S. , Speranza A.
Published: November 2005

To obtain the offshore wind climatology over the whole Mediterranean region, European Centre for Medium‐range Weather Forecasts (ECMWF) 6‐hourly wind data over a grid resolution of 0·5° × 0·5° for a period of 24 years have been retrieved. Data sets at 850 and 700 hPa pressure levels and 10 m above the surface were downloaded. For each grid point, mean wind speeds and Weibull probability density function parameters have been computed. As the wind field of ECMWF at 10 m is less accurate near the coast and in narrow basins, e.g. the Adriatic Sea, owing to the size of the mesh and land–sea mask smoothness, these statistics have been corrected, for each grid point, with the statistics produced using 2 year runs of a limited‐area model with a grid size of 10 km. Results have been compared with experimental data from buoys, islands and ships in various regions of the basin. Maps of mean wind speeds and Weibull parameters are shown here for the whole Mediterranean Sea to illustrate these results. Copyright © 2005 John Wiley & Sons, Ltd.
Modelling and ride‐through capability of variable speed wind turbines with permanent magnet generators
Authors: Akhmatov Vladislav
Published: November 2005

A model for a variable speed wind turbine with a permanent magnet, multipole, synchronous generator is developed and implemented in the simulation tool PSS/E as a user‐written model. The model contains representations of the permanent magnet generator, the frequency converter system with control, the aerodynamic rotor and a lumped mass representation of the shaft system. This model complexity is needed for investigations of the short‐term voltage stability and ride‐through capability of such wind turbines. Ride‐through capability is a major issue and, for the given concept, can be achieved by applying blocking and restart sequences to the frequency converter at the voltage drop in the power grid. Copyright © 2005 John Wiley & Sons, Ltd.
Study on synchronization phenomena of fixed speed wind turbines with an induction generator in a wind farm
Authors: Nanahara Toshiya , Katayama Norihide , Takata Go , Miyake Masatoshi
Published: November 2005

Synchronization of rotor angles of fixed speed wind energy converters with an induction generator has been reported in several wind farms. In terms of impacts on a power system, the synchronization could worsen the voltage flicker problems. Although many articles have examined this synchronization, there remains considerable room in the physical interpretation of the phenomena. This article discusses the physical context of the synchronization phenomena of wind turbines in a wind farm. After analysing interaction among electric power output, voltage, generator slip and rotor angle, differential equations describing the phenomena are presented. The synchronization phenomena are examined through a study on equilibria of the equations and their stability. Fundamental characteristics of the phenomena such as pull‐in force, speed of synchronization and the impact of discrepancies among generator characteristics are discussed for two‐ and three‐machine systems. The results show that synchronization tends to occur in wind energy converters with large 3p components and a low power factor, which are interconnected into a grid with large short‐circuit impedance of high X/R ratio. Copyright © 2005 John Wiley & Sons, Ltd.
Incidental Parathyroidectomy during Thyroid Surgery: An Underappreciated Complication of Thyroidectomy
Authors: Sakorafas George H. , Stafyla Vania , Bramis Constantinos , Kotsifopoulos Nikolaos , Kolettis Theophilos , Kassaras George
Published: November 2005

The aim of this study was to investigate the incidence, risk factors, and clinical relevance of incidental parathyroidectomy during thyroid surgery. Prospective analysis of data in patients following thyroidectomy, specifically regarding the presence of parathyroid parenchyma in the thyroidectomy specimens, the underlying thyroid pathology, and the presence of postoperative hypocalcemia (biochemical/clinical). The clinical records of 158 patients who underwent thyroid surgery during a 2‐year period were reviewed. Pathology reports were carefully reviewed for the nature of the underlying thyroid disease, the presence, number, and size of incidentally resected parathyroid gland(s), their location, and possible parathyroid pathology. Serum calcium levels were measured preoperatively, on the day of surgery, and on postoperative days 1, 2, and 7 or even later as needed. Two groups of patients were studied: a group with incidental parathyroidectomy following thyroidectomy (group A) and a group without incidental parathyroidectomy after thyroidectomy (group B). Total/near‐total thyroidectomy was the procedure of choice and was performed in 154 patients; total lobectomy and contralateral subtotal lobectomy was performed in the other 4 patients. Elective central neck lymph node dissection was performed in four patients with neck lymphadenopathy. Inadvertently removed parathyroid tissue was found in 28 cases (17.7 %); in 6 of these patients (21%) the parathyroid tissue was intrathyroidal. The percentage of women in group A was significantly higher than in group B (93% vs. 58.5%, P = 0.0002). There was no statistically significant difference between the two groups (A and B) regarding the preoperative (presumed) diagnosis, the histologic diagnosis of thyroid disease (benign versus malignant), the type/extent of surgery, or the presence of thyroiditis. Biochemical and clinical hypocalcemia was observed in 6 (21%) and 2 (7%) patients in group A, respectively, and in 30 (23%) and 8 (6%) patients of group B, respectively. There was no statistically significant difference regarding the occurrence of postoperative hypocalcemia (clinical/biochemical) between the two groups (P = 0.33). Incidental parathyroidectomy is not uncommon following thyroidectomy and in a significant percentage of cases it may be due to the intrathyroidal location of the parathyroid glands. Incidental parathyroidectomy was not found to be associated with postoperative hypocalcemia (biochemical/clinical). Incidental parathyroidectomy may be considered as a potentially preventable but clinically minor complication of thyroid surgery.
Comparison of Resected and Non‐resected Intraductal Papillary Mucinous Neoplasms of the Pancreas
Authors: Wang Shin‐E , Shyr Yi‐Ming , Chen Tien‐Hua , Su Cheng‐Hsi , Hwang Tsann‐Long , Jeng Kuo‐Shyang , Chen Jui‐Hao , Wu Chew‐Wun , Lui Wing‐Yiu
Published: November 2005

By comparing the clinicopathological features and survivals between the resected and non‐resected intraductal papillary mucinous neoplasms (IPMNs) of the pancreas, this study tried to clarify the natural history of IPMNs, to provide a strategy for treatment, and to determine the justification of not performing resection for some patients. A total of 57 patients with IPMN, including 39 resected and 18 non‐resected IPMNs, were recruited for study. Data on demographics, clinical presentations, diagnostic work‐up, treatment modality, clinical course, and outcomes were evaluated and compared between the resected and non‐resected IPMNs. The most common clinical presentation was abdominal pain (57% in total IPMNs, 67% in resected, 33% in non‐resected), followed by body weight loss (32% in total IPMNs, 33% in resected, 28% in non‐resected). The sensitivity in the diagnosis of IPMN was highest by magnetic resonance cholangiopancreatography (MRCP) (88%), followed by endoscopic retrograde cholangiopancreatography (ERCP) (68%), and computed tomography scan (CT scan) (42%) and sonography (10%). The median survival was 21.5 months for patients with resected IPMNs, ranging from 2 to 124 months, and 14 months in non‐resected IPMN patients, ranging from 5.5 to 70 months. There is no significant survival difference between the resected and non‐resected groups, with a 5‐year survival of 69.8% in resected IPMNs and 59.8% in non‐resected IPMNs, P = 0.347. The survival outcome of the unresectable non‐resected IPMNs was much inferior to the resected IPMNs, P = 0.002 and resectable non‐resected IPMNs, P = 0.001. Thus, the prime prognostic factor in predicting the survival outcome of IPMNs is resectability, instead of resection itself. Long‐term survival could also be expected in resectable IPMNs without resection. No resection for the IPMN may be justified for patients with high surgical risks, especially for those who are asymptomatic and very aged.
Outcome in Right Living Related Liver Transplantation with Branch‐Patch Arterial Reconstruction
Authors: Di Benedetto F. , Lauro A. , Masetti M. , Cautero N. , Quintini C. , De Ruvo N. , Romano A. , Guerrini G. , Dazzi A. , Molteni G. , Siniscalchi A. , Bertani H. , Miller C.M. , Pinna A.D.
Published: November 2005

cRight lobe living liver transplantation is being performed worldwide with increased frequency. Difficult arterial reconstructions are often encountered because of small diameter or discrepancy between arterial stumps. The risk of arterial thrombosis is reported as high as 26%: microsurgical techniques have reduced this rate below 2%, increasing warm ischemia time. We have developed a new branch patch technique in living related liver transplantation using the donor cystic artery to create an enlarged patch anastomosis that enables increase in the vessel’s diameter and therefore greater inflow to the liver. We have followed 8 patients treated with this technique. After more than 1 year (mean follow‐up: 636 days) we did not observe any arterial thrombosis by Doppler ultrasound performed every 3 months. The mean resistance index was 0.68 (0.57–0.83–). Three patients died with functional graft without signs of thrombosis. We believe that the cystic artery branch patch technique is feasible in all cases. It is fast (mean time: 6.2 min), it allows a shorter warm ischemia time, and there is no increased risk of thrombosis.
Results of Surgical, Laparoscopic, and Percutaneous Treatment for Hydatid Disease of the Liver: 10 Years Experience with 355 Patients
Authors: Yagci Gokhan , Ustunsoz Bahri , Kaymakcioglu Nihat , Bozlar Ugur , Gorgulu Semih , Simsek Abdurrahman , Akdeniz Ali , Cetiner Sadettin , Tufan Turgut
Published: November 2005

Selection of the most appropriate treatment to obtain the best results with the lowest rate of recurrence and minimal morbidity and mortality is mandatory for the management of hepatic hydatid disease. The surgical approach is the mainstay of treatment, and there has been a tendency toward laparoscopic surgery and, more recently, percutaneous treatment (PT), which has become increasingly popular with revolutions in techniques. We aimed to evaluate the results of current therapeutic methods in the context of a 10‐year single‐institution experience. Between 1992 and 2003, 355 patients with 510 hydatid cysts of the liver were treated by open operation, laparoscopic surgery, or PT. The series included 128 females and 227 males ranging in age from 10 years to 73 years. Preferred treatment modalities, perioperative complications, interventions, recurrences, and length of hospital stay were retrospectively analyzed. There were two postoperative deaths (1.08%) in the open surgery group. Biliary leakage was observed in 28 patients treated with open surgery, in 10 patients after PT, and in 2 after laparoscopic treatment. Recurrence rates were 16.2%, 3.3%, and 3.5% after open surgery, laparoscopic surgery, and percutaneous treatment, respectively. Characteristics of the cyst, presence of cystobiliary communications, and the availability of a multidisciplinary team are the factors that we believe directly affect the results. Radical surgery can be done safely for suitable cases; conventional procedures are associated with greater morbidity. Laparoscopic surgery seems effective and safe, with low morbidity and recurrence rates for type I–III cysts in accessible localizations. Our experience with PAIR (puncture, aspiration, injection, and reaspiration) and catheterization provides evidence that the procedure is an effective and safe option.
Antibody Response of Autogenous Splenic Tissue Implanted in the Abdominal Cavity of Mice
Authors: Nunes Sérgio I. , Rezende Alice B. , Teixeira Francisco M. , Ferreira Ana Paula , Alves Márcio M.J. , Jamel Nelson , Assis Raimunda V.C. , Teixeira Henrique C.
Published: November 2005

There is still controversy about the immunologic function of autotransplanted splenic tissue. In this study, splenic autotransplantation was performed in the abdominal cavity of mice, and the plaque‐forming cell (PFC) assay was used to investigate the frequency of antibody‐forming cells in response to sheep red blood cell (SRBC) immunization. BALB/c mice were divided into four groups according to the location of the autogenous graft: intraomental (IO), free peritoneal splenosis (FPS), retroperitoneal (RP), and nongrafted control (CT). Thirty days after surgery the mice were immunized intraperitoneally with SRBCs, and 4 days later splenic immunoglobulin M anti‐SRBC‐secreting cells were determined by counting the number of PFCs. All the immunized mice showed increased numbers of PFCs that were about 2 logs higher than those in the the nonimmunized controls (P < 0.005). The frequencies of anti‐SRBC‐producing cells in the tissues grafted in various sites of the abdominal cavity (IO, FPS, RP), in the normal spleen from nonoperated controls (CT), or in the sham‐operated control group (SCT) were not notably different (5582 ± 2475 PFC/107 cells for IO; 4849 ± 1856 for FPS; 6604 ± 2903 for RP; 5940 ± 5029 for CT; and 6172 ± 2203 for SCT). Similar histology with small architectural variations was observed in all implants; less white pulp was involved, and there was more congestion in the red pulp, with extensive sinusoids and reticular fiber proliferation. This study shows that the T cell‐dependent antibody response in implanted splenic tissues is as efficient as in the intact spleen, with no difference between the graft sites studied. This immune response does not depend on the slight architectural variations observed in the splenic implants.
Gender Differences in Quality of Life of Patients with Rectal Cancer. A Five‐Year Prospective Study
Authors: Schmidt Christian E. , Bestmann Beate , Küchler Thomas , Longo Walter E. , Rohde Volker , Kremer Bernd
Published: November 2005

To determine how quality of life changes over time and to assess gender‐related differences in quality of life of rectal cancer patients we conducted a 5‐year study. Little is known about how quality of life (QoL) changes over time in patients after surgery for rectal cancer, and whether gender of the patients is associated with a different perception of QoL. The aim of this study was to assess prospectively, changes in quality of life after surgery for rectal cancer, with a focus on gender related differences. Over a 5‐year period, the EORTC‐QLQ‐C‐30 and a tumor‐specific module were prospectively administered to patients before surgery, at discharge, 3, 6, 12, and 24 months postoperatively. Comparisons were made between female and male patients. A total of 519 patients participated in the study, 264 men and 255 women. The two groups were comparable in terms of surgical procedures, adjuvant treatment, tumor stage, and histology. Most QoL scores dropped significantly below baseline in the early postoperative period. From the third month onward, global health, emotional and physical functioning, improved. Female gender was associated with significantly worse global health and physical functioning and with higher scores on treatment strain and fatigue. Men reported difficulties with sexual enjoyment; furthermore, over time, sexual problems created high levels of strain in men, worse than baseline levels in the early postoperative period. These problems tended to continue over the course of time. The findings in this study confirm that QoL changes after surgery and differs between men and women. Women appear to be affected by impaired physical functioning and global health. Female gender is associated with significantly higher fatigue levels and increased strain values after surgery. Through impaired sexual enjoyment, men are put more under strain than woman.
Prognostic Significance of Vascular Endothelial Growth Factor D in Gastric Carcinoma
Authors: Shida Atsuo , Fujioka Shuichi , Ishibashi Yoshio , Kobayashi Katsutoshi , Nimura Hiroshi , Mitsumori Norio , Suzuki Yutaka , Kawakami Makio , Urashima Mitsuyoshi , Yanaga Katsuhiko
Published: November 2005

The angiogenic factor called vascular endothelial growth factor (VEGF)‐D is a ligand for VEGF receptor‐2 (VEGFR‐2/KDR) and receptor‐3 (VEGFR‐3/Flt‐4). It is implicated in the development of lymphatic vessels and promotion of lymphatic metastasis. The purpose of this study was to investigate the prognostic significance of VEGF‐D expression in patients with gastric carcinoma. We assessed the expression of VEGF‐D in gastric carcinoma by immunohistochemistry on 143 consecutive patients’ stored sections and evaluated the lymphatic vessel count (LVC) in tumors using the novel selective lymphatic endothelium marker D2‐40. VEGF‐D expression was observed in 55 (39%) tumor sections. The expression of VEGF‐D correlated significantly with tumor size, T of the TNM classification, lymphatic and venous system invasion, LVC, lymph node metastasis, M of TNM, and pTNM stage. Multivariate analysis indicated that VEGF‐D expression was an independent prognostic factor for both relapse‐free survival (RFS) and overall survival (OS). Our data indicate the involvement of VEGF‐D in tumor progression via lymphoangiogenic pathways. Practically, VEGF‐D expression can be useful for predicting RFS and OS in patients with gastric carcinoma.
Needle Tract Implantation of Papillary Thyroid Carcinoma after Fine‐needle Aspiration Biopsy
Authors: Ito Yasuhiro , Tomoda Chisato , Uruno Takashi , Takamura Yuuki , Miya Akihiro , Kobayashi Kaoru , Matsuzuka Fumio , Kuma Kanji , Miyauchi Akira
Published: November 2005

Although fine‐needle aspiration biopsy (FNAB) is a useful tool for diagnosing thyroid carcinoma, there are some risks of complications. In this study, we investigated tumor implantation by FNAB of papillary carcinoma. We compared the characteristics of the main tumors and implanted tumors of patients showing FNAB implantations. Between 1990 and 2002, 4912 patients underwent FNAB and were diagnosed as having papillary carcinoma. We encountered 7 cases of needle tract implantation, which account only for 0.14%. We reviewed these 7 cases as well as 3 other patients who underwent FNAB in other hospitals. The intervals between FNAB and detection of the implanted tumor ranged from 2 to 131 months. For these 10 patients, the main tumors in 6 were diagnosed as poorly differentiated carcinoma, and 7 showed extrathyroid extension. Five showed the development of implanted tumor after comparatively shorter intervals (2–68 months), and we classified these as the short interval group. The remaining 5 were classified as the long interval group, because tumor development occurred after 87–131 months. All 5 cases in the short interval group involved preoperatively detectable lymph node metastasis; those in the long interval group did not. The MIB‐1 labeling index of the implanted tumor was high in 4 cases in the short interval group, but it was low in all cases in the long interval group. The implanted tumors could be surgically removed without recurrence at the focal sites. These findings indicate that, although high growth activity in the metastatic lesions may be a risk factor of FNAB, inducing the growth of implanted tumors along the needle tract within a short interval after the procedure, FNAB remains the most useful technique for diagnosing thyroid carcinoma. The incidence of implantation was low, and when it did occur, the tumors could be surgically removed without recurrence.
Navigational Maxillofacial Surgery Using Virtual Models
Authors: Hohlweg‐Majert B. , Schön Ralf , Schmelzeisen Rainer , Gellrich Nils‐Claudius , Schramm Alexander
Published: November 2005

Ablative tumor surgery and orbital and midface reconstruction, as much as orthognathic surgery, requires detailed planning using computed tomography (CT) or magnetic resonance imaging (MRI). These techniques also allow simulation of complex surgeries preoperatively. Proper reconstruction depends on reliable information to choose the correct type of grafts and to predict the outcome. This study evaluates the benefit and indications of computer‐assisted surgery in the treatment of 107 patients who underwent craniomaxillofacial surgery. Based on a CT or MRI data set, an optical navigation system was used for preoperative planning, intraoperative navigation, and postoperative control. Surgery could be preoperatively planned and intraoperatively navigated. Preoperatively, it required that soft and hard tissues were measured using the mirrored data set of the unaffected side; the size and location of the graft were chosen virtually. Intraoperatively contours of transplanted tissues were navigated to the preoperatively simulated reconstructive result. Computer‐assisted treatment was successfully completed in all 107 cases. Preoperatively outlined safety margins could be exactly controlled during tumor resection. Reconstruction was designed and performed precisely as virtually planned. Image‐guided treatment improves preoperative planning by visualizing the individual anatomy, outlining the intended reconstructive outcome, and by objectifying the effect of adjuvant therapy. Intraoperative navigation makes tumor and reconstructive surgery more reliable by showing the safety margins, saving vital structures, and leading the reconstruction to preoperatively planned objectives.
Mirizzi Syndrome: Ten Years Experience from a Teaching Hospital in Riyadh
Authors: Al‐Akeely Mohammed H.A. , Alam Mohammed K. , Bismar Hayan Abdulrahman , Khalid Kamran , Al‐Teimi Ibrahim , Al‐Dossary Nasser Faleh
Published: November 2005

Objective

Mirizzi syndrome (MS) is an uncommon presentation of cholelithiasis. This study aims to find the incidence and analyze the outcome of management of this condition at Riyadh Medical Complex (RMC) with particular reference to diagnostic methods and outcome of surgical treatment.

Methods

Retrospective study on 17 consecutive patients of MS diagnosed and managed at RMC over ten year period. The records were reviewed for demography, clinical presentation, diagnostic methods, operative procedures, postoperative complication and follow up.

Results

The incidence of MS syndrome was 0.7% of 2415 cholecystectomies. There was preponderance of Type I variety (58.8%). Ultrasonography was able to diagnose 82% cases. ERCP suggested the diagnosis in all cases and helped further in classifying and management of these patients. All Type I cases were managed with partial cholecystectomy, two underwent laparoscopic surgery. Three Type II patients were managed by partial cholecystectomy alone. Three patients with Type III variety had choledochoplasty whereas one remaining patient with Type IV variety underwent hepatico‐jejunostomy. All patients had complete recovery with 17.6% procedure‐related morbidity and no hospital mortality. All patients are doing well over a mean follow up 6.5 years.

Conclusion

Preoperative diagnosis of Mirizzi syndrome by ultrasound and ERCP is essential to prevent serious complications during surgery. Partial cholecystectomy is an adequate procedure for Types I & II MS. Choledochoplasty provides an effective surgical repair in Type III cases. Although laparoscopic cholecystectomy in MS may be hazardous, it may still be tried in preoperatively diagnosed type I cases, provided the surgeon is experienced and keeps a low threshold for conversion open surgery.
Liver Regeneration and Splenic Enlargement in Donors after Living‐Donor Liver Transplantation
Authors: Ibrahim Salleh , Chen Chao‐Long , Wang Chih‐Chi , Wang Shih‐Ho , Lin Chih‐Che , Liu Yeuh‐Wei , Yang Chin‐Hsiang , Yong Chee‐Chien , Concejero Allan , Cheng Yu‐Fan
Published: November 2005

Liver regeneration after donor hepactectomy offers a unique insight into the process of liver regeneration in normal livers. As the liver restores itself, concurrent splenic enlargement occurs. There are many theories about why this phenomenon takes place: some investigators have proposed a relative portal hypertension that leads to splenic congestion or, perhaps, the presence of a common growth factor that induces both the liver and spleen to enlarge. Between the months of June 2001 and May 2004, 112 live donor liver transplants (LDLTs) were performed in Chang Gung Memorial Hospital, Kaohsiung, Taiwan. The total number of donor hepatectomies performed during this period was 113, however, because one of the cases required dual donors. Of our 113 donors, we eventually analyzed the data of 109; 4 patients were lost to follow‐up 6 months later and were excluded from our study. The average age of our donor population was 32.32 ± 8.48 years. The mean liver volume at donation was noted to be 1207.72 ± 219.95 cm3, and 6 months later, it was 1027.18 ± 202.41 cm3. Expressed as a percentage of the original volume, the mean liver volume 6 months after hepatectomy was 90.70% ± 12.47% in this series. For right graft donors, mean liver volume after 6 months was 89.68% ± 12.37% of the original liver volume, whereas that for left graft donors was 91.99% ± 12.6%. Only 26 of the 109 (23.85%) donors were able to achieve full regeneration 6 months post‐donation. Notably, liver function profiles of all donors were normal when measured 6 months after operation. The average splenic volume at donation as measured by computed tomography (CT) volumetry was 159 ± 58 cm3, and the splenic volume 6 months post‐donation was 213 ± 85 cm3. There was a mean increment in splenic volume of 35% ± 28% 6 months after donation. The blood profiles of the donors were monitored; particular attention was given to platelet levels and liver function tests, and these were found to be within normal limits 6 months after operation. Of note, splenic enlargement was significantly greater among right‐sided donors than their left‐sided counterparts. Greater splenic enlargement was also observed in those donors who achieved full liver regeneration at their evaluation 6 months postoperatively than in those who did not. Although original liver volume was not re‐established in most patients 6 months after liver donation, there seemed to have been no untoward effects to the donor. The factors that affect liver regeneration are complex and myriad. Although there is splenic enlargement at 6 months post‐donation in donors of LDLT, there are no untoward effects of this enlargement.
One‐stage Transthoracic Operation for the Treatment of Right Lung and Liver Hydatid Cysts
Authors: Erdogan Abdullah , Ayten Arife , Kabukcu Hanife , Demircan Abid
Published: November 2005

In this study we reviewed our experience of hydatid disease of the lung and the liver and discussed the safety and the follow‐up results of the one‐stage operation. Between 1990 and 2004, 142 patients with pulmonary hydatid disease underwent operation in our clinic. Of these, 27 (19%) patients had cysts located on the dome of the liver, treated with phrenotomy through a right thoracotomy. Hydatid cysts located in the lungs were managed by means of cystotomy. For liver cysts, cystotomy and the inversion of the cavity with sutures was the surgical method of choice, and a drain was left in place. The pulmonary cysts of 12 (8.4%) patients were bilateral and 5 (3.5%) patients had prior surgical treatment of hepatic (n = 1) or pulmonary (n = 4) hydatid cysts. The liver cysts were approached transdiaphragmatically after the lung cysts were excised in 27 (19%) patients. In patients with pulmonary cysts, cystotomy, with or without capitonnage was performed on 123 (86.6%) patients, and wedge resection was performed on 11 (7.7%), segmentectomy was performed on 6 patients (4.2%), and lobectomy was performed on 2 (1.4%) patients. There was no mortality, and only a small number of complications were encountered: empyema in 3, excessive biliary drainage in 2, and bronchopleural fistula in only 1. We suggest that the extraction of pulmonary and hepatic cysts simultaneously through the transthoracic route is a useful and safe surgical technique. This technique also prevents the need for a second operation.
Pancreatic Anastomoses after Pancreaticoduodenectomy: Do We Need Further Studies?
Authors: Shrikhande Shailesh V. , Qureshi Sajid S. , Rajneesh Nanda , Shukla Parul J.
Published: November 2005

Pancreatic anastomotic leak is the single most important factor responsible for the considerable morbidity and mortality associated with pancreaticoduodenectomy. Management of the pancreatic remnant is controversially discussed, reflecting the complexity of anastomosing a pancreas of different textures to the digestive tract. A number of studies evaluating diverse options have often provided conflicting conclusions. This information is confusing particularly to those surgeons outside of large‐volume centers with broad experience and to general surgeons who perform pancreatic surgery. A PubMed search with the key words pancreaticoduodenectomy, pancreatic anastomosis, pancreaticojejunostomy, pancreaticogastrostomy, and pancreatic fistula was performed. Major series of pancreatic anastomosis published between 1990 and 2002 were studied from diverse centers worldwide. Their results with regard to pancreatic fistula, morbidity, and mortality were documented. Nine series of pancreaticojejunostomy and seven series of pancreaticogastrostomy were evaluated. Eight comparative studies evaluating the two techniques were also analyzed. A single randomized controlled trial was identified among these comparative studies. Equally good results were observed with the two techniques. Other uncommon methods of management of the pancreatic remnant (duct occlusion and ligation) were also evaluated. Pancreaticojejunostomy followed by pancreaticogastrostomy are the most favored techniques. A duct‐to‐mucosa anastomosis is preferred over other methods. Fistula rates of less than 5%–10% should be the standard irrespective of the technique used. Unlike in the past, mortality can be reduced even in the event of an anastomotic dehiscence, and this aspect is primarily dependent on a meticulous anastomosis based on sound surgical principles rather than the method per se. Based on the information accumulated, adherence to these specific principles could ensure a safe and reliable pancreatic anastomosis with mimimal morbidity and mortality after pancreaticoduodenectomy, even in the hands of general surgeons operating outside high‐volume centers.
Laparoscopy‐assisted Gastrectomy for Early Gastric Cancer in Young and Elderly Patients
Authors: Mochiki Erito , Ohno Testsurou , Kamiyama Youichi , Aihara Rusuke , Nakabayashi Toshihiro , Asao Takayuki , Kuwano Hiroyuki
Published: November 2005

Open gastric surgery in elderly patients is associated with higher morbidity and mortality rates than those reported among younger individuals. Therefore, minimally invasive surgery may have a larger impact on the elderly compared to the younger age group. The objective of this study was to evaluate the experience of laparoscopy‐assisted distal gastrectomy (LADG) in patients with early gastric cancer and compare the results in patients 70 years of age and older to those in patients younger than 70 years of age. From January 1998 to October 2004, a total of 103 patients underwent LADG. Of these patients, 30 who were older than 70 years were compared with 73 who were younger. Preoperative co‐morbidity, operative results, postoperative outcomes, and survival were analyzed. Furthermore, as a standard control of this study, we reviewed 54 distal gastrectomy cases with open surgery (open distal gastrectomy; ODG) in the same term with the same background factors, categorized into elder (n = 16) and younger (n = 38). The mean age of the elderly patients was 75 years in the LADG group. A significantly higher proportion of elderly patients had concurrent diseases in both groups. Blood loss was significantly less in the elderly than in younger patients undergoing LADG, and it was less in the LADG group than in the ODG group. The overall 5‐year survival rates in the LADG group were not significantly different between elderly and younger patients. Laparoscopy‐assisted distal gastrectomy is a safe and effective treatment for early gastric cancer in the elderly. Therefore, chronological age alone should not be considered a contraindication in selecting patients for LADG.
Proximal Gastrectomy Reconstructed by Jejunal Pouch Interposition for Upper Third Gastric Cancer: Prospective Randomized Study
Authors: Yoo Chang Hak , Sohn Byung Ho , Han Won Kon , Pae Won Kil
Published: November 2005

Proximal gastrectomy with jejunal pouch interposition (PGJP) has been advocated as an alternative operation for upper third gastric cancer. However, there has been no prospective randomized trial comparing PGJP with total gastrectomy with Roux‐en‐Y esophagojejunostomy (TGRY). The aim of this study was to compare the short‐ and medium‐term results of PGJP and TGRY in a randomized clinical trial. Fifty‐one patients with upper third gastric cancer were randomized to either PGJP (n = 25) or TGRY (n = 26). Outcome measures were postoperative complications, nutritional status assessed by serum nutritional parameters, and postgastrectomy symptoms. There were no significant differences in operating time, hospital stay, and postoperative complications. Blood loss was significantly less in the PGJP group (P = 0.036). Nineteen patients (73%) in the TGRY group had one or more postgastrectomy symptoms, which was significantly more frequent than in the PGJP group (32%; P = 0.012). There were also significant differences between the two groups with regard to food intake, weight recovery, hemoglobin, and serum vitamin B12 levels in favor of PGJP. In conclusion, proximal gastrectomy with jejunal pouch interposition for upper third gastric cancer is safe, and is associated with a greater reduction in postgastrectomy symptoms and better nutritional status compared with conventional total gastrectomy.
Escin: Inhibiting Inflammation and Promoting Gastrointestinal Transit to Attenuate Formation of Postoperative Adhesions
Authors: Fu Fenghua , Hou Yuezhi , Jiang Wanglin , Wang Ronghua , Liu Ke
Published: November 2005

Postoperative peritoneal adhesions are common, serious complications of general abdominal and gynecologic surgery that can lead to chronic abdominal pain, intestinal obstruction, and infertility. As yet, there are no ideal drugs that may be prescribed for patients to prevent adhesion formation effectively. In this study the effects of escin, a natural drug, on the various steps of adhesion formation were investigated. The effects of escin on increased vascular permeability induced by acetic acid in a mouse model of acute inflammation, granuloma formation in a subchronic inflammatory rat model, gastrointestinal transit in rats with intestinal paralysis, intestinal motility in postoperative patients, and postoperative adhesion formation in a rat model were observed. It was shown that escin could inhibit acute inflammation and granuloma formation, cause acceleration of gastrointestinal transit, help recover intestinal motility, and attenuate the formation of postoperative adhesions. The findings suggest that escin attenuates the formation of postoperative adhesions by inhibiting inflammation and promoting gastrointestinal transit. Thus it may be concluded that both inhibition of inflammation and increased gastrointestinal motility during the early postoperative period have a positive effect on decreasing the formation of adhesions.