bluuebunny/crossref_metadata_2025 huggingface dataset:
Toxicity evaluation of metal plating wastewater employing the Microtox® assay: A comparison with cladocerans and fish
Authors: Choi Kyungho , Meier Peter G.
Published: August 2002

The relative sensitivity of the Microtox assay is closely related to the type of toxicant, and hence its utility in biomonitoring effluents is better evaluated on a case‐by‐case basis. The Microtox® assay, employing the marine bacterium Vibrio fischeri, was evaluated for its applicability in monitoring metal plating wastewater for toxicity. The results of the Microtox assay after 5, 15, and 30 min of exposure, were compared with data obtained from conventional whole effluent toxicity testing (WET) methods that employed Daphnia magna, Ceriodaphnia dubia, and the fathead minnow (Pimephales promelas). The Microtox assay produced notably comparable EC50 values to the LC50 values of the acute fathead minnow toxicity test (<0.5 order of difference). The Spearman's rank correlation analyses showed that the bacterial assay, regardless of exposure duration, correlated better with the acute fish than the daphnid results (p<0.05). These observations were consistent to other studies conducted with inorganic contaminants. The relative sensitivity of the 30‐min Microtox assay was within the range of the two frequently used acute daphnid/fish toxicity tests. In conclusion, the Microtox assay correlated well with the acute fathead minnow data and is well suited for toxicity monitoring for these types of industrial wastes. © 2001 John Wiley & Sons, Inc. Environ Toxicol 16: 136–141, 2001
Saccharomyces cerevisiae cell wall chitin, the Kluyveromyces lactis zymocin receptor
Authors: Jablonowski Daniel , Fichtner Lars , Martin Vera J. , Klassen Roland , Meinhardt Friedhelm , Stark Michael J. R. , Schaffrath Raffael
Published: August 2002

The exozymocin secreted by Kluyveromyces lactis causes sensitive yeast cells, including Saccharomyces cerevisiae, to arrest growth in the G1 phase of the cell cycle. Despite its heterotrimeric (αβγ) structure, intracellular expression of its smallest subunit, the γ‐toxin, is alone responsible for the G1 arrest. The α subunit, however, has a chitinase activity that is essential for holozymocin action from the cell exterior. Here we show that sensitive yeast cells can be rescued from zymocin treatment by exogenously applying crude chitin preparations, supporting the idea that chitin polymers can compete for binding to zymocin with chitin present on the surface of sensitive yeast cells. Consistent with this, holozymocin can be purified by way of affinity chromatography using an immobilized chitin matrix. PCR‐mediated deletions of chitin synthesis (CHS) genes show that most, if not all, genetic scenarios that lead to complete loss (chs3Δ), blocked export (chs7Δ) or reduced activation (chs4Δ), combined with mislocalization (chs4Δchs5Δ; chs4Δchs6Δ; chs4Δchs5Δchs6Δ) of chitin synthase III activity (CSIII), render cells refractory to the inhibitory effects of exozymocin. In contrast, deletions in CHS1 and CHS2, which code for CSI and CSII, respectively, have no effect on zymocin sensitivity. Thus, CSIII‐polymerized chitin, which amounts to almost 90% of the cell's chitin resources, appears to be the carbohydrate receptor required for the initial interaction of zymocin with sensitive cells. Copyright © 2001 John Wiley & Sons, Ltd.
Molecular and functional analysis of a MIG1 homologue from the yeast Schwanniomyces occidentalis
Authors: Carmona Teresa A. , Barrado Patricia , Jiménez Antonio , Fernández Lobato María
Published: August 2002

A putative glucose repressor MIG1‐homologue (SoMIG1) was isolated from the amylolytic yeast Schwanniomyces occidentalis. Degenerate primers were designed from the conserved zinc finger regions of Mig1 and CreA proteins from different organisms. PCR using these primers and S. occidentalis genomic DNA as template yielded a single 128 bp product. This fragment was used as a DNA probe to screen a S. occidentalis genomic library. Analysis of the positive clones led to the isolation by PCR of a DNA fragment, which contained an open reading frame (ORF) that would encode a 458 amino acid polypeptide. The DNA binding and effector domains of this putative protein showed an identity of 71% and 15%, respectively, to those of the Mig1 protein from Saccharomyces cerevisiae. The SoMIG1 gene complemented a mig1 mutant of this yeast, which suggests that in S. occidentalis SoMIG1 is a glucose repressor. The Accession No. is AJ417892. Copyright © 2002 John Wiley & Sons, Ltd.
Reproductive steroid hormones and ovarian activity in felids of the Leopardus genus
Authors: Moreira N. , Monteiro‐Filho E.L.A. , Moraes W. , Swanson W.F. , Graham L.H. , Pasquali O.L. , Gomes M.L.F. , Morais R.N. , Wildt D.E. , Brown J.L.
Published: August 2002

Reproductive endocrine patterns were characterized in female ocelots (Leopardus pardalis; n = 3), tigrinas (Leopardus tigrinus; n = 2), and margays (Leopardus wiedii; n = 2) housed in captivity in southern Brazil. Females were maintained as singletons and exposed to natural fluctuations in photoperiod. Cyclic changes in ovarian steroids were monitored by analyzing estrogen and progestogen metabolites in fecal samples collected five times weekly for 14 to 18 months. Based on intervals between fecal estrogen peaks, mean (± SEM) duration of the estrous cycle was 18.4 ± 1.6 days for the ocelots (range, 7–31 days; n = 75 cycles), 16.7 ± 1.3 days for the tigrinas (range, 11–27 days; n = 23 cycles), and 17.6 ± 1.5 days for the margays (range, 11–25 days; n = 32 cycles). Fecal progestogen analyses combined with two laparoscopic observations of the ovaries confirmed that ocelots and tigrinas did not ovulate spontaneously. In contrast, non‐mating–induced luteal phases of 40.1 ± 6.3 days in duration (range, 30–60 days) were observed frequently in both margays. There was no evidence of gonadal seasonality in margays in either follicular or luteal activity. In ocelots, cyclic changes in estrogen excretion were observed during each month of the year; however, only one female cycled continuously. In the other two ocelots, periods of acyclicity of several months’ duration were observed. It was not possible to conclude whether tigrinas were aseasonal because estrous cyclicity was observed in only one of two individuals. In the female that cycled, a 3‐month period of acyclicity was observed in the late fall/early winter. These data demonstrate similarities among three felid species of the genus Leopardus, including evidence they are polyestrous but experience unexplained periods of ovarian inactivity. Only the margays differed by exhibiting occasional spontaneous, non‐mating–induced ovulations. Historically, these species have not bred well in captivity. However, it is hoped that understanding the biological similarities and differences among them could lead to improved management strategies that may one day result in increased reproductive success. Zoo Biol 20:103–116, 2001. © 2001 Wiley‐Liss, Inc.
Prognostic Significance of Metastatic Lymph Node Ratio in T3Gastric Cancer
Authors: Hyung Woo Jin , Noh Sung Hoon , Yoo Chang Hak , Huh Ji Hun , Shin Dong Woo , Lah Ki Hyeok , Lee Jun Ho , Choi Seung Ho , Min Jin Sik
Published: August 2002

The fifth International Union Against Cancer tumor node metastasis (UICC TNM) classification, basedon the number of metastatic lymph nodes (LN), has proved to be areliable and objective method for predicting the prognosis of patientswith gastric cancer. However, the prognosis of patients with T3 gastriccancer is still heterogeneous. This study was carried out toinvestigate the validity of metastatic LN ratio as a prognostic factorin T3 gastric cancer. A retrospective analysis was performed on a totalof 833 patients that had either T3N1M0 (n = 504) orT3N2M0 (n = 329) gastric cancer by the fifth UICCclassification. A preliminary analysis revealed the cutoff values forT3N1M0 to be 10% and for T3N2M0 to be 25%. The mean metastatic LNratio was 9.0% for T3N1M0 cancer and 26.9% for T3N2M0 cancer. For theT3N1M0 stage, the patients who showed less than 10% of the metastaticLN ratio were grouped as N1‐low with the others grouped as N1‐high. Forthe T3N2M0 stage group, those who had less than 25% of the metastaticLN ratio were grouped as N2‐low, the remainder as N2‐high. Themetastatic LN ratio decreased in proportion to the extent oflymphadenectomy and it increased in relation to the increasing scale ofthe fourth N classification. The rates of recurrence were significantlydifferent according to the metastatic LN ratio in N1 and N2classification of the fifth UICC classification (p < 0.05). The5‐year survival rates after gastrectomy decreased significantly byincreasing the metastatic LN ratio in both T3N1M0 cancers (p =0.0026) and T3N2M0 cancers (p = 0.0057). The metastatic LN ratiowas an independent risk factor for recurrence and poor prognosis. Ourdata suggest that the metastatic LN ratio is a significant prognosticfactor for T3 gastric cancer. Furthermore, the application of themetastatic LN ratio can provide information not only about the extentof LN metastasis but also about the extent of lymphadenectomy in T3gastric cancer.
Surgeon Scientist
Authors: Murray Joseph E.
Published: August 2002

The origins and development of the renal transplant program at the Peter Bent Brigham Hospital (now the Brigham and Women's Hospital) from the late 1940s to the present are reviewed. The program was initiated as a effort to understand hypertension as a cause of renal failure. The initial transplants were unmodified allogeneic grafts placed in the thigh, followed by extensive laboratory experiments on dogs. This research culminated with the first successful human transplant of a kidney between identical twins in 1954. In 1959 the first successful fraternal allogeneic graft was accomplished as part of a protocol utilizing total body irradiation and bone marrow replacement. Finally, with the development of immunosuppressive drugs, we were able to transplant a cadaveric kidney successfully in 1962. This was a major impetus in the study of organ transplantation worldwide, which currently involves kidneys, liver, heart, pancreas, heart/lung, and bone marrow.
Tolerance and Its Clinical Significance
Authors: Brent Leslie Baruch
Published: August 2002

Several aspects of fetally or neonatally induced tolerance are briefly considered, and a variety of strategies for the induction of specific tolerance in adult animals or patients are discussed. They include the following: (1) augmentation of organ transplantation with donor‐specific bone marrow; (2) the “prope” tolerance postulated by R.Y. Calne following treatment of kidney transplant recipients with a powerful monoclonal antibody; (3) linked epitope suppression, a form of specific tolerance for fully allogeneic haplotypes that can be induced in adult animals with a single major histocompatibility complex (MHC) epitope provided it is presented on the same antigen‐presenting cells as the other MHC antigens; (4) allogeneic mixed chimerism, induced in experimental animals by the inoculation of allogeneic bone marrow into adult animals that had been subjected to a nonmyelosuppressive regimen, avoiding whole body irradiation; (5) several other approaches, viz., total lymphoid irradiation with bone marrow infusion, intrathymically induced tolerance, and the still rather mysterious case of the maternally noninherited HLA antigens of siblings. All or some of these strategies may yet come into their own in clinical transplantation, as the induction of specific tolerance must still be regarded as the most satisfactory solution to the problems of allogeneic, and perhaps xenogeneic, transplantation.
Molecular Genetics of Thyroid Tumors and Surgical Decision‐making
Authors: Learoyd Diana L. , Messina Marinella , Zedenius Jan , Robinson Bruce G.
Published: August 2002

The study of thyroid tumor genetics has great relevance to surgeons and facilitates understanding tumor pathogenesis, prediction of tumor behavior, and management decisions. The genes implicated can be broadly categorized as oncogenes or tumor‐suppressor genes. The RET oncogene has well established roles in the development of both papillary (PTC) and medullary (MTC) thyroid carcinoma. Genetic screening for germline RET mutations in members of multiple endocrine neoplasia type II (MEN‐II) families is now widely performed, and prophylactic thyroidectomy in gene carriers is advisable at an early age. Patients with apparently sporadic MTC can also be screened to rule out familial disease. The demonstration of a RET rearrangement in a patient's PTC may have prognostic significance, but as yet there are no management implications. The thyrotropin receptor (TSH‐R) and Gsα become oncogenic through point mutation and are associated with the development of toxic thyroid adenomas. The ras oncogene is implicated in the early stages of development of several thyroid tumor types. Tumor‐suppressor genes also have a role in thyroid tumor formation. The p53 gene appears to be involved in the process of transformation to the anaplastic phenotype and the PTEN gene in the development of follicular adenomas but not carcinomas. There is still limited evidence for the so called adenoma–carcinoma sequence of the thyroid follicular cell. Loss of heterozygosity studies have enabled identification of tumor‐suppressor genes, and their findings suggests differences in the pathogenesis of PTCs compared with follicular cancers. Surgical decision‐making will benefit from these basic molecular advances, which rapidly translates into improved patient management.
Occult Micro Medullary Thyroid Carcinoma: Therapeutic Strategy and Follow‐up
Authors: Peix Jean Louis , Braun Petra , Saadat Masood , Berger Nicole , El Khazen Mansour , Mancini Frédérique
Published: August 2002

Twenty micro medullary thyroid carcinomas (MTCs) were found in histologic specimens of 19 patients in our department from 1990 to 1998. There were 14 women and 5 men, with a median age of 63 years. The indication for surgery was goiter in 12 patients and a solitary nodule in 7 patients (three differentiated cancers). Altogether, 18 patients had unifocal micro‐MTCs with a median diameter of 3.6 mm. One patient had a bilateral MTC (3 and 5 mm, respectively). Surgical procedures consisted of 9 total thyroidectomies and 10 lobectomies or subtotal thyroidectomies. Of these 10 patients, 4 underwent reoperation (totalization). One was operated on 48 months after a positive pentagastrin test: There was no thyroid residual tumor but three lymph node micrometastases. Among the six patients in whom thyroid tissue was left, a 91‐year‐old woman died of unrelated cause and the five others remain disease‐free without biologic abnormalities at follow‐ups of 18 to 70 months. Considering the aggressiveness of MTCs, total thyroidectomy with central compartment dissection is theoretically indicated. However, among the nine total thyroidectomies and four secondary totalizations associated with at least central compartment dissection, no other thyroid lesion was observed and only one case of lymph node microinvasion was found. Because of the morbidity associated with reoperation and neck dissection, we propose that it is indicated only for microcarcinomas > 5 mm in diameter, in cases of an abnormal response to pentagastrin, or when it is difficult to ensure prolonged follow‐up of the patient.
Method for Dissection of Mesenteric Metastases in Mid‐gut Carcinoid Tumors
Authors: Öhrvall Ulf , Eriksson Barbro , Juhlin Claes , Karacagil Sadettin , Rastad Jonas , Hellman Per , Åkerström Göran
Published: August 2002

With adequate medical management the midgut carcinoid tumor generally is an indolent malignancy associated with substantial life expectancy and appreciable life quality, even in the presence of liver metastases and significant tumor burden. Abdominal complications may occur in this entity of carcinoids owing to entrapment of intestines and encasement of mesenteric vessels by mesenteric metastases and associated marked mesenteric fibrosis. This may be the cause of abdominal pain, disabling diarrhea, weight loss to the extent of malnutrition, and eventually the risk of death with acute or chronic intestinal obstruction or intestinal gangrene. Operative removal of the mesentericointestinal lesion is often indicated to prevent or treat these complications but may be technically difficult when mesenteric metastases extend in the vicinity of major vessels in the mesenteric root. At laparotomy 56 patients with advanced midgut carcinoids underwent removal of the mesenteric tumor with a method for preserving the mesenteric vessels. This was feasible by mobilizing and releasing the right colon and mesenteric root from posterior adhesions, identifying the mesenteric artery below the pancreas, and free‐dissecting this artery on the tumor capsule in the mobilized mesentery. Dissection was successful even with tumors initially judged inoperable unless tumor growth completely surrounded the mesenteric vessels or extended retroperitoneally. One patient was subjected to distal intestinal artery bypass. Symptom relief was been substantial and often of long duration after mesenteric tumor removal in patients who prior to surgery often had threatening intestinal ischemia. Patients with advanced midgut carcinoids may benefit markedly from dissectional removal of mesenteric tumors, which (conceivably better than conventional wedge resection) preserves the length of the remaining intestine.
Clinical Characteristics and Prognosis of Patients with Hepatoblastoma
Authors: Jung Sung‐Eun , Kim Ki‐Hong , Kim Min‐Young , Kim Dae‐Yeon , Lee Seong‐Cheol , Park Kwi‐Won , Kim Woo‐Ki
Published: August 2002

Hepatoblastoma is a rare pediatric malignancy that frequently appears in an advanced unresectable stage. Improved resectability and survival rate have been reported with the help of neoadjuvant chemotherapy. Between January 1987 and June 1995 a series of 20 patients were managed with a diagnosis of hepatoblastoma. The median age at diagnosis was 13 months (2 months to 7 years 10 months) with a male/female ratio of 13:7. Chemotherapy effectively reduced the tumor volume (with statistical significance: p= 0.008) and was able to convert seven of nine initially unresectable tumors (78%) to resectable ones. Altogether, 14 operations were done, 12 radical and 2 palliative, with or without adjuvant chemotherapy. The whole population was followed for a median duration of 33 months; and the median survival for the whole group was 26 months. The curative resection group displayed a 5‐year survival rate of 61.1%, but none in the noncurative group survived more than 13 months (p= 0.0001). In the univariate analysis for prognostic factors, large tumor size at diagnosis and the absence of thrombocytopenia were associated with poor survival, but these differences were not statistically significant. Pure fetal histology was not associated with better prognosis. In this new era of neoadjuvant chemotherapy, the optimal management strategy for hepatoblastoma is still debated, with radical surgical resection at the earliest possible time being the final goal. For now an individualized approach appears to be the protocol of choice.
Use of Intraoperative Ultrasonography during Hepatolithectomy
Authors: Zhang Wei , Niu Hai‐Ou , Zhao Guang‐Wu , Su Ke‐Jun , Wei Hong‐Chen , Su Zi‐Xia , Huai Jian‐Cun
Published: August 2002

Complete clearance of intrahepatic stones has long been a major surgical challenge. To reduce the incidence of residual stones, we used intraoperative ultrasonography (IOUS) to localize them and guide lithectomy in 38 patients with hepatolithiasis between July 1988 and December 1993. All patients had multiple intrahepatic stones; 24 had accompanying extrahepatic calculi. Hepatic stones were confined to the left intrahepatic biliary tract in 13 patients, to the right in 9, and in both lobes in 16. Twenty‐three patients underwent common bile duct exploration followed by T‐tube drainage, 8 had transhepatic lithotomy with or without choledocholithotomy, 3 had choledocolithotomy and Roux‐en‐Y side‐to‐side choledochojejunostomy, and 2 had hepaticojejunostomy, left lobectomy was performed in the remainder. In 35 patients cholecystectomy was performed at the same time. Complete clearance of the stones was achieved in 36 patients (94.7%). The incidence of retained stone was decreased to 5.3%. No associated complications occurred. IOUS can accurately localize intrahepatic calculi, directly orient lithotomy instruments to approach the stones, demonstrate the spatial relation between stone and intrahepatic critical structure, and thereby choose an optical route for transhepatic lithotomy. Imaging can be repeated at any time with no radiation exposure to the patient or the medical staff.
Papillary Thyroid Carcinoma in Mexican Patients: Clinical Aspects and Prognostic Factors
Authors: Herrera Miguel F. , López‐Graniel Carlos M. , Saldaña Jorge , Gamboa‐Domínguez Armando , Richaud‐Patín Yvonne , Vargas‐Vorackova Florencia , Angeles‐Angeles Arturo , Llorente Luis , Castillo Cecilia , Pérez Bernardo , Rivera Raúl , González Ofelia , Rull Juan
Published: August 2002

The present study characterizes papillary thyroid carcinoma (PTC) in a Mexican patient sample and evaluates potential prognostic factors for recurrence. Clinical records of 229 patients with PTC were analyzed. Surgical specimens were rereviewed and DNA ploidy determined. Cox logistic regression was used to explore prognostic factors. Mean age ± SD of the patients was 42 ± 16 years, with a male/female ratio of 24:205. A thyroid mass was the initial manifestation in 99%. Extrathyroid invasion occurred in 45% and nodal metastases in 38%. Mean size ± SD of the tumors was 3 ± 2 cm. By flow cytometry 88% of the tumors were DNA euploid and 12% aneuploid. Complete tumor resection was achieved in 83% with an operative mortality of 0.4%. Postoperative hormone suppression was administered in 65% and remnant 131I thyroid ablation in 84%. The 10‐year recurrence‐free survival was 85%. In the group of patients with tumors totally removed and without distant metastases, none of the 14 evaluated variables demonstrated statistical significance as an independent prognostic factor for recurrence. However, the group of patients in whom a combination of the following factors was present—age ≥ 40 years, tumor size ≥ 3 cm, local invasion, and lymph node metastases—showed a higher incidence of tumor recurrence.
Mediators of Injury and Inflammation
Authors: Schlag G. , Redl H.
Published: August 2002

Mediators play a key role in the development of systemic inflammatory response syndrome (SIRS), multiple organ dysfunction syndrome, and multiple organ failure of vital organs. In this short review, we update our knowledge on these mediator networks. First, we summarize the stimuli that occur during severe trauma (intraoperative stress), including polymorphonuclear neutrophil‐derived tissue‐damaging substances, complement activation products, and adherence molecules such as selectins. The gut in shock is discussed as an important intermediate step in the transition from noninfectious to infectious SIRS. Second, we describe the mediators, including cytokines, nitric oxide, phospholipase A2, platelet‐activating factor, and procoagulatory substances, that are released during sepsis. The release of mediators depends primarily on the severity of the trauma, shock, or sepsis and secondarily on the activation of the various cascades of mediators during posttraumatic/postoperative complications. The mediators are thus of decisive importance regarding the intensity of organ damage and the outcome.
Hematologic Problems and Organ Transplantation
Authors: Dmitrewski Jan , Russell Scott , Vijeyasingham Rajasingam , McMaster Paul
Published: August 2002

Disturbances in blood coagulation profiles combined with intraoperative technical problems may lead to hemorrhage and significant blood loss. During the postoperative period hematologic changes may result from the use of immunosuppressive drugs, so careful monitoring and review are essential parts of management. The two major aspects of hematologic change are reviewed.
Safe Hemoglobin or Hematocrit Levels in Surgical Patients
Authors: Lundsgaard‐Hansen Per
Published: August 2002

The terminology and fundamental aspects of the delivery, consumption, and deficits of oxygen are recalled. In chronic and acute, nonseptic states, red blood cell (RBC) transfusion is capable of increasing oxygen consumption (VO2). In acute septic states, the response of VO2 to RBC transfusion is variable and unpredictable, but attempts to increase oxygen delivery (DO2) should be made if the clinical picture raises the suspicion of a potentially lethal oxygen deficit. Therapeutic interventions raising the cardiac index to “supranormal” values in critically ill patients improve their chances of survival; and maintenance of hemoglobin or hematocrit values around 11 g/dl or 33%, respectively, is one part of such interventions. Opinions differ on the general tolerance of anemia, as witnessed by postulated “critical levels” of the hemoglobin concentration between approximately 11 and 4 to 5 g/dl or hematocrit values between 33% and 12% to 15%, respectively. The common denominator underlying these vastly different opinions is the variable behavior of several “non‐Hb variables,” which influence the venous oxygen tensions apart from the hemoglobin or hematocrit. Abnormalities of these non‐Hb variables—typically encountered in the critically ill—increase the dependence of patients on hemoglobin or hematocrit levels that suffice to protect them against an oxygen deficit. For this reason, the “critical” hemoglobin or hematocrit is anindividualvalue, and a generally valid “transfusion trigger” doesnotexist. Finally, the entity now known as silent myocardial ischemia (SMI) is a decisive factor for the tolerance of anemia. Solid clinical evidence is now available to support the concept that patients over age 40 should not, as an elective procedure, be subjected to levels < 10 g/dl or < 30%, respectively, without prior exclusion of SMI by appropriate investigations.
Recombinant Blood Components: Clinical Administration Today and Tomorrow
Authors: Growe Gershon H.
Published: August 2002

Improvements in the technology of whole blood fractionation have resulted in the development of many subfractions that allow more specific management of clotting deficiencies, such as the hemophilias. Infective disasters have occurred in recent years, which has led to concern regarding the use of human blood components. There has been great interest in the search for alternatives, such as synthetic volume expanders, antifibrinolytic drugs, and hormones to stimulate bone marrow production. Recombinant technology has developed rapidly over the past 15 years, and several products are now available for use, including recombinant factor VIII and recombinant factor VIIa for the treatment of hemophilia and recombinant erythropoietin to stimulate red blood cell production. As these recombinant proteins are complex, they require mammalian cell lines as their substrate. Recombinant processes have the potential to produce sufficient quantities of these products for the treatment of patients around the world independent of a human plasma source. The introduction of all of the new recombinant products has been done in an orderly fashion through clinical trials. Erythropoietin was extensively reviewed initially for its effect in chronic renal failure patients and appears to have other applications. Recombinant factor VIII has now become a mainstay of treatment for many patients with hemophilia A, and recombinant factor VIIa has a major role to play in the management of patients with inhibitors to factors VIII and IX. We anticipate the availability of other recombinant blood proteins soon.
Value of Mass Screening for Thyroid Cancer
Authors: Miki Hitoshi , Inoue Hiroyuki , Komaki Kansei , Uyama Tadashi , Morimoto Tadaoki , Monden Yasumasa
Published: August 2002

This study aims to clarify the presently uncertain value of mass screening for thyroid cancer, which has been performed by physical examination along with mass screening for breast cancer in Zentsuji, Japan since 1983. Among 18,619 subjects, 36 individuals with thyroid cancer (0.19%) were found. The detection rate was 0.40% at the initial screening and 0.10% during subsequent periodic screening. All thyroid cancers were confirmed histologically as well differentiated carcinoma. The tumor size in the mass‐screening group (14 ± 6 mm) was significantly smaller than in patients presenting at an outpatient clinic during the same period (19 ± 13 mm) (p < 0.05). The incidence of nodal metastases in the mass‐screening group (38%) was significantly lower than in the outpatient group (68%) (p < 0.05). Thus mass screening seemed to find thyroid cancers in a relatively early stage. Mass screening for thyroid cancer was economic in this instance because it was performed together with screening for other cancers, such as breast cancer. Thyroid cancer screening required less than one additional minute per subject. The ultimate aim of mass screening is to reduce mortality. No improvement in prognosis from enforced mass screening for thyroid cancer was detected in this study. It cannot be demonstrated that there is sufficient value of mass screening for thyroid cancer to perform it independently despite early cancer detection.
Surgical Triumvirate of Theodor Kocher, Harvey Cushing, and William Halsted
Authors: Modlin Irvin M.
Published: August 2002

It is difficult to evaluate precisely the effects of one individual on an entire discipline such as surgery. Indeed, it is impossible to do so when such a discipline spans so vast a country as the United States of America. Nevertheless, as a mountain peak can be seen from afar, so may one perceive the influence of man of Kocher's stature. His connection with Halsted and especially Cushing provided a direct link between the grandeur of Kocher's achievements and their lineal translation to a generation of evolving American surgeons. Both individuals, by personal example and professional endeavor, transmitted the precepts of Kocher to the nascent surgical fellowship of America. Thus the icon of Swiss surgery, recognized by a Nobel laureate and esteemed by his European colleagues, became a profound influence on American surgery. The triumvirate of Kocher, Cushing, and Halsted may thus be acknowledged as of vital consequence to the establishment of American surgery during the twentieth century.
Roles of Nitric Oxide in Surgical Infection and Sepsis
Authors: Johnson Mark L. , Billiar Timothy R.
Published: August 2002

Recent advances in nitric oxide (NO) research have begun to elucidate the roles of NO in sepsis and infection. Although adequate levels of NO production are necessary to preserve perfusion and carry out cytoprotective functions in sepsis, overproduction appears to contribute to hemodynamic instability and tissue damage. These observations have led to the development of strategies to inhibit NO synthesis or scavenge excess NO in patients with septic shock. Local expression of the inducible NO synthase also has antimicrobial functions. The combination of NO with superoxide forms peroxynitrite which participates in bacterial killing in the peritoneal cavity. The capacity of red blood cells and hemoglobin to remove NO most likely accounts for the adjuvant effect of blood in peritonitis.

This review will summarize the pathobiology of NO in surgical sepsis and infection.
Management of Hyperparathyroidism in an Endemic Goiter Area
Authors: Klingler P.J. , Strolz S. , Profanter C. , Klingler A. , Kendler D. , Lhotta K. , Bodner E. , Riccabona G.
Published: August 2002

In an endemic goiter area patients with hyperparathyroidism (HPTH) frequently also have thyroid abnormalities. In a retrospective study of 95 patients with HPTH we assessed the diagnostic accuracy of imaging techniques (ultrasonography or radionuclide scanning) for preoperative localization of parathyroid adenomas. Altogether 86% of our patients had goiter, requiring thyroid resections in 37%. For 19 patients the parathyroid exploration was the second or third cervical operation, most of them due to goiter. We found that the overall rate of transient and permanent recurrent nerve paralysis is considerably increased in patients with previous neck surgery (26% vs. 7%). The combination of ultrasonography and radionuclide scanning can lead surgeons to the site of parathyroid lesions responsible for HPTH in 85% of cases, although frequent nodular goiters can produce pitfalls for correct imaging in iodine‐deficient countries. In endemic goiter areas preoperative localization studies can be recommended in patients with primary HPTH—for evaluation of thyroid pathology possibly leading to resection or its accuracy in localizing parathyroid adenomas. These studies also seem justified in patients with previously unsuccessful neck explorations for HPTH.
Laparoscopy for Inflammatory Bowel Disease: Pros and Cons
Authors: Sardinha T. Cristina , Wexner Steven D.
Published: August 2002

The role of laparoscopic surgery in the treatment of colorectal malignancies is still under investigation, although it can offer significant benefits to many patients with inflammatory bowel disease (IBD). The aim of this study was to assess the pros and cons of the laparoscopic management of IBD. Data were obtained from a review of the literature published since 1992, when the first report of laparoscopic surgery for IBD appeared in print. From 1992 to 1997 several series of laparoscopic colorectal surgery for the management of IBD have been reported. A close evaluation of these studies revealed that laparoscopy in patients with terminal ileal Crohn's disease or anal Crohn's disease in need of fecal diversion offers significant advantages compared to laparotomy, including decreased pain, length of hospitalization, and disability. An additional bonus is improved cosmesis and a reduction in symptomatic postoperative adhesions. These many benefits can be achieved without any increase in morbidity or expense. Conversely, the use of this technology for restorative proctocolectomy in patients with mucosal ulcerative colitis is associated with a longer operative time and an increased incidence of both intra‐ and postoperative complications compared to laparotomy. Laparoscopic colorectal surgery can thus be advantageous for treatment of terminal ileal Crohn's disease but cannot be routinely justified for the treatment of mucosal ulcerative colitis.
Prevalence of Thyroid Cancer in Hyperthyroid Patients Treated by Surgery
Authors: Zanella Everardo , Rulli Francesco , Muzi Marco , Sianesi Mario , Danese Daniele , Sciacchitano Salvatore , Pontecorvi Alfredo
Published: August 2002

A retrospective study has been carried out to evaluate the prevalence of malignant thyroid tumors in 202 patients submitted to surgery for hyperthyroidism. Thyroid cancer was diagnosed in 12 cases (5.9%); the final histologic examination revealed nine papillary carcinomas, one follicular carcinoma, and two Hürthle cell carcinomas. Concurrence of hyperthyroidism and thyroid cancer was more frequent in patients with single toxic adenomas than in those with toxic diffuse or multinodular goiters. In five cases thyroid malignancy was detected in the context of the hyperthyroid lesion (three toxic adenomas and two diffuse goiters). In eight patients the malignant lesion showed a maximum diameter of less than 1 cm, although in five of these cases unfavorable histologic features, such as minimal capsular invasion or multifocality, were present. All patients presenting with thyroid cancer are currently alive and apparently free of residual disease. It is concluded that hyperthyroid patients, particularly those with single toxic adenomas, should be carefully evaluated to exclude the presence of an associated malignancy and to plan the most appropriate therapeutic options.
Tension‐free Laparoscopic and Open Hernia Repair: Randomized Controlled Trial of Early Results
Authors: Picchio Marcello , Lombardi Assunta , Zolovkins Aleksejs , Mihelsons Maris , La Torre Giuseppe
Published: August 2002

The aim of the study was prospectively to compare the early results and outcome in 105 patients randomly allocated to undergo tension‐free laparoscopic hernia repair (LHR) with transabdominal preperitoneal technique (53 patients) or open hernia repair (OHR) with mesh apposition (52 patients). The mean (SD) operation time was longer in the LHR group than in the OHR group: 49.6 (5.4) versus 33.9 (6.2) minutes; p < 0.001. One laparoscopic case was converted to open repair to deal with a hemorrhage from an aberrant obturatory artery at the level of Cooper's ligament. Groin discomfort or pain was the most common complication after both procedures. The patients requiring none, one, two, or more than two doses of intramuscular diclofenac were, respectively, 40.4%, 40.4%, 15.4%, and 3.8% after LHR and 50.0%, 30.8%, 17.3%, and 1.9% after OHR (p= 0.69; NS). The mean ± SEM (range) postoperative visual analog scale score, ranging from 0 (no pain) to 10 (worst pain imaginable), was 3.1 ± 0.2 (1–7) in the LHR subset and 2.7 ± 0.2 (1–5) in the OHR group (p= 0.14; NS); on the second postoperative day the score was 2.3 ± 0.2 (1–6) and 1.8 ± 0.1 (1–4), respectively (p < 0.03). The time ± SEM (range) of resumption of pain‐free normal activities and work was faster in OHR group: 6.1 ± 0.2 (4–8) weeks versus 6.5 ± 0.1 (4–8) weeks; p < 0.03. Our results showed that tension‐free open hernia repair is superior to LHR in terms of postoperative pain with no important differences in recovery.
Decision Analysis for the Surgeon
Authors: Kucey Daryl S.
Published: August 2002

Surgical practice, by nature, is full of important decision making scenarios. Surgeons have begun to utilize the decision sciences as a methodology of approaching clinically relevant surgical problems. This article provides a brief overview of some of the important concepts of the decision sciences as they apply to practicing surgeons. Concepts discussed include the basic principles behind decision trees, valuing outcomes, and Markov modeling as well as the pros and cons of the decision analytic approach. Decision analysis is a valuable aid in determining answers to clinical scenarios, and understanding the principles behind this methodology is an important addition to the armamentarium of all practicing surgeons.
Recipient Factors as Determinants of Mortality after Adult Liver Transplantation
Authors: Palma Fermin , Jimenez Carlos , Moreno Enrique , Loinaz Carmelo , Garcia Ignacio , Palomo Juan Carlos , Hernandez Diego , Gonzalez‐Chamorro Antonio
Published: August 2002

The factors that can influence the outcome of orthotopic liver transplantation (OLT) are numerous. The purpose of this study was to determine the effects of recipient preoperative factors on patient mortality. Between April 1986 and April 1998 a total of 600 OLTs were performed in our institution. We retrospectively reviewed our first 203 consecutive primary adult OLTs with at least 4 years of follow‐up. A case‐control comparison was performed between survivors and nonsurvivors, and differences in recipient variables were studied for their correlation with patient mortality. A logistic regression analysis was also performed. Mortality was significantly increased among those with fulminant hepatic failure (FHF) (66.6%, p= 0.003), primary cancer (63.1%, p= 0.018), females (46.1%, p= 0.043), encephalopathy grade IV (72.7%, p= 0.012), recipients under respiratory support (69.2%, p= 0.031), and ABO‐incompatible transplants (80%, p= 0.05). FHF, primary cancer, and female gender were the only variables that had a significant association with mortality in the logistic regression analysis. A higher incidence of prolonged respiratory support, bacterial and fungal infections, pneumonia, and chronic rejection contributed to the lower outcome observed in females. These results stress the need for continuous evaluation of the selection criteria of candidates for OLT suffering from primary cancer and FHF. The impact of recipient gender on mortality warrants further analysis but suggests that in the future more attention must be paid to the influence of this factor on the final outcome of OLT.
Tauroursodeoxycholate and Cholestyramine Enhance Biliary Carcinogenesis in Hamsters
Authors: Ikematsu Yoshito , Tomioka Tsutomu , Kitajima Tomoo , Inoue Keiji , Tajima Yoshitsugu , Kanematsu Takashi
Published: August 2002

The aim of this study was to examine whether tauroursodeoxycholate (TUDC) and cholestyramine resin (CR) enhance biliary carcinogenesis in the hamster model. A cholecystoduodenostomy with dissection of the extrahepatic bile duct on the distal end of the common duct was performed on Syrian hamsters. The hamsters were then divided randomly into 3 groups: control group, TUDC‐treated group, and CR‐treated group. All animals received N‐nitrosobis(2‐oxopropyl)amine (BOP) to initiate pancreaticobiliary cancer. The experiment was terminated at week 16 and the number of neoplastic lesions was counted microscopically. In the TUDC group, the intrahepatic biliary carcinogenesis was more accelerated than that observed in the control group, but no promoting effect was seen in the pancreas, gallbladder, or extrahepatic bile duct. In the CR group, both the intrahepatic biliary and the gallbladder carcinogenesis were inhibited compared with that observed in the control group and the TUDC group. TUDC enhanced the intrahepatic bile duct carcinogenesis, whereas CR inhibited both the intrahepatic bile duct and the gallbladder carcinoma. Bile acids were suggested to promote biliary carcinoma in the hamster model.
Fate of the Rectum and Ileal Recurrence Rates after Total Colectomy for Crohn's Disease
Authors: Yamamoto Takayuki , Keighley Michael R.B.
Published: August 2002

The aim of this study was to examine the fate of the rectum and ileal recurrence rates after total colectomy for Crohn's disease. One hundred thirty patients who underwent total colectomy between 1970 and 1997 were reviewed; 65 patients underwent end ileostomy with an oversewn rectal stump (TC+I) and 65 had ileorectal anastomosis (IRA). Patients treated by TC+I had significantly more rectal involvement (93%) than those having IRA (43%) (p < 0.0001). The incidence of ileal disease at the time of colectomy was similar (TC+I 34% versus IRA 32%; p = 0.99). Rectal recurrence requiring proctectomy was significantly more common after TC+I (51%) than after IRA (26%) (p= 0.01), whereas ileal recurrence requiring resection was significantly more common after IRA (45%) than after TC+I (18%) (p= 0.002). Using Kaplan‐Meier methods, the 10‐year cumulative probability of proctectomy was significantly higher after TC+I than IRA (58% versus 22%; p= 0.0001), whereas the 10‐year cumulative probability of ileal resection was significantly higher after IRA than TC+I (37% versus 18%; p= 0.03). In conclusion, the proctectomy rate is higher after colectomy and ileostomy probably due to a higher incidence of preoperative rectal involvement. By contrast, the ileal recurrence rate is higher after colectomy and IRA.
Efficacy of Endoscopic Pure Ethanol Injection Method for Gastrointestinal Ulcer Bleeding
Authors: Asaki Shigeru
Published: August 2002

We reviewed endoscopic hemostatic effects of the pure ethanol injection (PEI) method for reducting emergency operations and deaths due to gastroduodenal ulcer bleeding. During 17 years beginning in June 1979 in Tohoku University Hospital, 331 patients underwent endoscopic hemostasis by the PEI method. Initial hemostasis was successfully obtained in all cases. Rebleeding occurred in about 4% of the patients, and rehemostasis was obtained successfully in all of them. Complete hemostasis was obtained in 330 of 331 patients (99.7%) using the PEI method; there were no deaths. Only one patient required emergency operation after hemostasis because of repeated neogenetic bleeding complicated with a perforation and another because of an unidentifiable neogenetic ulcer bleeding located just above the Vater papilla. None required other endoscopic hemostasis or interventional radiology. Moreover, after introduction of “second‐look” endoscopy, the rebleeding rate decreased to about 1% with PEI hemostasis. Based on these excellent hemostatic effects of the PEI method, we believe that a comparative study with other hemostatic methods is not needed.
Postoperative Hepatic Catabolic Stress Response in Patients with Cirrhosis and Chronic Hepatitis
Authors: Lausten Susanne B. , El‐Sefi Talaat , Marwan Ibrahim , Ibrahim Tarek M. , Jensen Lone S. , Grøfte Thorbjørn , Andreasen Frederik , Vilstrup Hendrik , Raouf Ahmed A. , Helmy Amr , Jensen Steen L.
Published: August 2002

Open (OC) or laparoscopic (LC) cholecystectomy is considered a relative contraindication in patients with liver cirrhosis. The effect of LC and OC on the hepatic catabolic stress response was studied in patients with postnecrotic liver cirrhosis and chronic hepatitis to define the most suitable procedure from a metabolic point of view. Altogether 14 patients with cirrhosis and 14 with chronic hepatitis were randomized to LC or OC (n= 7 in each group). The increase in the functional hepatic nitrogen clearance (FHNC) was quantified. Changes in glucose, insulin, glucagon, cortisol, epinephrine, norepinephrine, and prostaglandin E2 (PGE2) were observed. There was no difference in FHNC between LC and OC in any of the patients. Among cirrhotic patients OC caused a 132% increase in FHNC (p < 0.05) and among the hepatitis patients a 69% increase (p < 0.05). In contrast, there was no significant increase following LC in any of the patients. OC increased fasting glucose and insulin in the hepatitis patients (p < 0.01 and p < 0.001, respectively) and in the cirrhosis group (p < 0.01 and p < 0.05, respectively). Alanine stimulation increased glucose in hepatitis patients after OC (p < 0.05) and after LC (p < 0.01). Stimulated glucagon increased after OC in the hepatitis group (p < 0.05). During stimulation cortisol was higher following LC in hepatitis patients (p < 0.01) and cirrhotic patients (p < 0.05). Fasting PGE2 was down‐regulated after LC in hepatitis patients (p < 0.05) and cirrhotic patients (p < 0.01) and after OC in the hepatitis group (p < 0.001). FHNC is similar after LC and OC. Thus from a metabolic point of view, LC has no advantage over OC.
Initiators and Propagators of the Metabolic Response to Injury
Authors: Hill Andrew G.
Published: August 2002

Injury produces tissue hypoperfusion and subsequent reperfusion, afferent neural activity, and immune and vascular endothelial activation. These, in turn, set up a cascade of events coordinated by the central nervous system and at the level of individual tissues such as the liver, gut, and skeletal muscle. They are mediated by a complex array of neutrophil and macrophage products. The changes result in hypermetabolism, lypolysis, lysis of skeletal muscle and visceral protein, and expanded extracellular fluid with consequent organ failure.