bluuebunny/crossref_metadata_2025 huggingface dataset:
Conditions for stress corrosion cracking to occur from crevice corrosion sites and related electrochemical features
Authors: Wang S.
Published: December 2004

The occurrence of stress corrosion cracking (SCC) from crevice corrosion sites was studied using a kind of occluded U‐bend specimen of Type 316L (UNS S31603) stainless steel. It was done in 0.5 M NaCl solution at room temperature and 50°C. The galvanostatic and potentiostatic polarization methods were adopted. It was found that a tight crevice and high polarization current were the necessary conditions for SCC to occur relative rapidly from crevice corrosion sites. Meanwhile, if there was obvious SCC developing from a crevice corrosion site, the IR drop (or solution resistance) in the crevice path would increase. The increase of IR was attributed to the corrosion product deposition and/or hydrogen bubbles evolved from the cracks. On the other hand, the usually high aspect ratio of stress corrosion cracks, i.e. the inhibited dissolution on the crack walls, might be explained as due to the existence of high IR drops in them.
Impact of wear debris on striated muscle‐ a comparativein‐vivostudy with titanium and stainless steel
Authors: Kraft C.N. , Burian B. , Kunze J. , Diedrich O. , Pennekamp P. , Wimmer M.A.
Published: December 2004

Wear debris and corrosion products of metal implants induce biological events that may have severe consequences for skeletal muscle microcirculation. We therefore studied in vivo leukocyte‐endothelial cell interaction and leukocyte transmigration in skeletal muscle after confrontation with characterised titanium and stainless steel fretting corrosion particles, and compared these results with those of the bulk materials. Using the hamster dorsal skinfold chamber preparation and intravital microscopy, we could demonstrate in 30 animals that stainless steel induces a more pronounced inflammatory answer in contrast to the implant material titanium. However we were not able to show a general benefit of bulk vs. debris. Overall the study suggests that not only the bulk properties of orthopaedic implants but also the microcirculatory implications of inevitable wear debris may play a role in determining biocompatibility and ultimately longlivety of an implant. The skinfold chamber is a feasible and versatile model for observation of the dynamic process of microvascular response after foreign‐body implantation, and offers much perspective. With a minimum of adverse host reaction, our results indicate that titanium still represents the gold standard in metallic implant material, even in the case of generated wear debris, which shows a comparatively low inflammatory potential.
Controlled release of gentamicin from biomimetic calcium phosphate in vitro. Comparison of four different incorporation methods
Authors: Tadic D. , Welzel T. , Seidel P. , Wüst E. , Dingeldein E. , Epple M.
Published: December 2004

Cylinders of biomimetic (nanocrystalline) calcium phosphate were loaded with gentamicin by four different methods: 1) dip‐coating, 2) impregnation followed by cold‐isostatic pressing, 3) co‐precipitation followed by cold‐isostatic pressing, and 4) coating of co‐precipitated particles with a biodegradable polymer PDLLA (poly‐D,L‐lactide), followed by uniaxial pressing. The release kinetics were studied in vitro over 10 days. The incorporation by methods 2), 3) and 4) showed a significantly higher long‐term release of active gentamicin than dip‐coating, although there was an initial burst during the first two days with all four methods. With method 4), there was an increase of the released gentamicin after 7 days, and the long‐term release was the highest of these four methods. The results are of considerable interest for the preparation of biodegradable bone implants which are loaded with biologically active substances.
Allergic reactions to metal implants
Authors: Thomas P. , Maier S. , Summer B.
Published: December 2004

Upon surgery only transient inflammatory response may be observed in contrast to some developing immune response to metal implants as result of material characteristics or individual reagibility. This is predominantly a macrophage‐driven foreign body like response to particulate debris. Metal implant allergy may develop as result of preexisting allergy or upon newly induced lymphocyte sensitisation. Clinical manifestations encompass eczema, recurrent swelling, seroma formation and impaired wound healing. Allergy‐dependent implant loosening is also suspected. We discuss more detailed clinical‐allergological testing, the analysis of periimplantar immune reaction and report about an interdisciplinary data collection (metal implant allergy register).
Mutant torsinA, which causes early‐onset primary torsion dystonia, is redistributed to membranous structures enriched in vesicular monoamine transporter in cultured human SH‐SY5Y cells
Authors: Misbahuddin Anjum , Placzek Mark R. , Taanman Jan‐Willem , Gschmeissner Steve , Schiavo Giampietro , Cooper J. Mark , Warner Thomas T.
Published: December 2004

A single GAG deletion in the DYT1 gene causes primary early‐onset, generalized torsion dystonia. The DYT1 protein product, torsinA, belongs to the AAA+ family of proteins. When overexpressed, wild‐type torsinA localizes mainly to the endoplasmic reticulum, whereas the mutant forms inclusions of unclear biogenetic origin. In this study, overexpressed wild‐type torsinA in human neuroblastoma (SH‐SY5Y) cell lines was distributed throughout the cell body and colocalized with a marker for the endoplasmic reticulum, confirming it is an endoplasmic reticulum protein. However, mutant torsinA showed perinuclear staining and formed distinct globular inclusions, which did not colocalize with endoplasmic reticulum markers. Immunoelectron microscopy of the mutant torsinA inclusions revealed membrane whorls staining for torsinA, as well as labeling of lamellae, isolated bilayers, and perinuclear membranes. This finding shows that mutant torsinA redistributes to specific membranous structures, which may represent different stages of maturation of the intracellular inclusions. The mutant torsinA‐containing bodies were immunoreactive for vesicular monoamine transporter 2 (VMAT2). VMAT2 expression is important for the exocytosis of bioactive monoamines in neurons. Abnormal processing, transport, or entrapment of VMAT2 within the mutant torsinA membranous inclusions, therefore, may affect cellular dopamine release, providing a potential pathogenic mechanism for the DYT1‐dependent dystonia. © 2004 Movement Disorder Society
Role of liver transplantation in the treatment of unresectable liver cancer
Authors: Pichlmayr Rudolf , Weimann Arved , Oldhafer Karl J. , Schlitt Hans J. , Klempnauer Jürgen , Bornscheuer Albrecht , Chavan Ajay , Schmoll Ekkehard , Lang Hauke , Tusch Günter , Ringe Burckhardt
Published: December 2004

Resection remains the treatment of choice in liver cancer. In order to avoid liver transplantation in conventionally unresectable tumors ex‐situ (“bench” procedure), in‐situ and ante‐situm resection technique should be prefered whenever feasible. Despite the deficiency of donor organs, a single center experience with 198 patients reveals that liver transplantation continues its role as a therapeutic option for selected patients. At present “favorable” indications for transplantation are International Union against Cancer (UICC)‐stage II hepatocellular carcinoma as well as the subtype fibrolamellar carcinoma, uncommon tumors such as epitheloid hemangioendothelioma, hepatoblastoma, and liver metastases from neuroendocrine tumors. Due to unsatisfying results, intrahepatic bile duct‐, stage III and IV hepatocellular carcinoma, hemangiosarcoma, and liver metastases from nonendocrine primaries should be excluded from liver transplantation alone. For these advanced tumors, especially in cases of extrahepatic involvement, a combination of liver transplantation and multivisceral resection has been proven feasible. However, a significant improvement in patient survival may only be expected by currently investigated multimodality treatment protocols which will require further randomized studies.
Cavernous hemangiomas of the liver: Are there any indications for resection
Authors: Farges Olivier , Daradkeh Salam , Bismuth Henri
Published: December 2004

A total of 163 patients with cavernous hemangiomas of the liver were managed at Paul Brousse Hospital between 1970 and 1992. The tumor was smaller than 4 cm in 54 patients and larger than 10 cm in 38 patients. The diagnostic sensitivities of the imaging procedures were as follows: ultrasonography 61%; angio‐computed tomography scanning 77%; angiography 85%; magnetic resonance imaging 92%. The tumor was diagnosed during the evaluation of abdominal pain in 87 patients. Forty‐seven patients had associated disorders that proved to be responsible for the symptoms. Fourteen patients with incapacitating symptoms underwent specific treatment of their tumor: resection (n=8), embolization (n=5), or hepatic artery ligation (n=1). Seven of these patients are still symptomatic, indicating that the hemangioma was in fact not responsible for their symptoms. Twenty‐five patients were given oral analgesic medications; in 21 the symptoms diminished or became infrequent. Unresected hemangiomas did not significantly increase in size, nor have they become complicated or symptomatic. These results indicate that resection of liver hemangiomas is rarely required, and such treatment should be carefully balanced against the risk inherent in liver surgery.
Surgical treatment of hepatocellular carcinomas in noncirrhotic liver: Experience with 68 liver resections
Authors: Bismuth Henri , Chiche Laurence , Castaing Denis
Published: December 2004

Hepatocellular carcinoma (HCC), although generally associated with cirrhosis, can also develop in a noncirrhotic liver. To study HCCs in noncirrhotic liver, their surgical management and prognosis, 68 patients with partial hepatectomy for this disease were analyzed. The liver, in all cases, appeared normal macroscopically at laparotomy, but in 13 cases (19%) it presented some slight histologic modifications, such as steatosis or portal fibrosis. Five patients had a fibrolamellar carcinoma. The mean diameter of the tumors was 8.8 cm. Sixteen patients (23.5%) were treated preoperatively by embolization or chemoembolization. Surgical procedures consisted in a major hepatectomy (three segments or more) in 72% of the cases. Operative mortality and morbidity were, respectively, 2.9% and 19.0%. The 1‐, 3‐, 5‐, and 10‐year survivals and the survivals without recurrence were 74%, 52%, 40%, and 26% and 69%, 43%, 33%, and 19%, respectively. Recurrence, which was in most cases intrahepatic, occurred in 39 of the 66 survivors (59%) and was treated by rehepatectomy in 12 cases, providing long survivals. These data justify extensive, aggressive surgery for HCCs in noncirrhotic liver and show the need for long‐term follow‐up to defect late recurrence, as surgery for recurrent disease prolongs survival.
Treatment of unresectable primary liver cancer: With reference to cytoreduction and sequential resection
Authors: Tang Zhao‐You , Yu Ye‐Qin , Zhou Xin‐Da , Ma Zeng‐Chen , Yang Bing‐Hui , Lin Zhi‐Ying , Lu Ji‐Zhen , Liu Kang‐Da , Fan Zeng , Zeng Zhao‐Chong
Published: December 2004

Unquestionably, progress has been made in the early detection and early treatment of primary liver cancers (PLCs), although most remain unresectable, mainly because the cancer is advanced and coexists with liver cirrhosis, particularly in Oriental patients. Thanks to the progress of regional cancer therapy, a multidisciplinary approach, and changing concepts about surgical oncology, it has been proved that some unresectable but not far advanced PLCs are potentially convertible to being resectable, particularly those cancers confined to the right lobe of a cirrhotic liver. A retrospective analysis of 571 unresectable PLCs revealed the following: (1) There was an increase in 5‐year survivals in the series, from 0% during the 1960s (n=61), to 4.8% during the 1970s (n=163), to 21.2% during the 1980s (n=347). It might be a result of the increase in double‐ or triple‐modality treatments in these series (from 9.8%, to 19.6%, to 70.3%, respectively) and in the sequential resection rate after cytoreduction (from 0%, to 2.5%, to 14.7%). (2) The combination of hepatic artery ligation, hepatic artery cannulation and infusion, and intrahepatic arterial radioimmunotherapy has resulted in better shrinkage of the tumor, a higher sequential resection rate, and a higher 5‐year survival (28.2%). (3) Of the 55 patients who had initially unresectable PLCs and yielded “cytoreduction and sequential resection”, the 5‐year survival was 58.5%. It is concluded that cytoreduction and sequential resection might be an important approach to improving the prognosis of patients with unresectable PLCs.
Liver transplantation for hepatocellular carcinoma
Authors: Selby Rick , Kadry Zakiyah , Cari Brian , Tzakis Andreas , Madariaga Juan R. , Iwatsuki Shunzaburo
Published: December 2004

Total hepatectomy plus liver transplantation was performed on 105 patients considered unsuitable for liver resection. Postoperative 5‐year actuarial survivals correlated with the pathologic stage of the tumor: stage I 75%, stage II 68%, stage III 52,1%, and stage IVA 11%. The overall 5‐year survival for all patients was 36%. Nodal disease, bilobar tumor, and macroscopic venous invasion were significant poor‐prognosis features. In addition, 12 patients with pT4N1M0 lesions (also stage IVA) had hepatectomy plus more extensive en bloc regional resection (Whipple procedure or cluster resection) plus transplantation in an effort to prevent local recurrence. Only 2 of these 12 patients (16.7%) are alive and free of disease after 2 years. Seven patients (58%) have died from tumor recurrence usually originating from distant metastases an average of 10.6 months after transplantation. Successful transplantation for hepatoma depends on screening programs to identify early stage disease. Successful outcome of transplantation for late stage disease, which includes most of the patients in our series, awaits the development of neoadjuvant therapy to control distant microscopic metastases, which are almost certainly present though not apparent at the time of transplantation.
Resection of colorectal liver metastases
Authors: Scheele Johannes , Stang Richard , Altendorf‐Hofmann Annelore , Paul Martin
Published: December 2004

From 1960 to 1992 a total of 1718 patients with liver metastases from colorectal carcinoma were recorded. Of these patients, 469 (27.3%) underwent hepatic resection, which was performed with curative intent in 434 patients (25.3%). Operative mortality in this group was 4.4%, being 1.8% (2 of 114) during the last 3 years. Significant morbidity was observed in 16% of patients with a decrease to 5% (6 of 112) for the last 3 years. A 99.8% follow‐up until November 1, 1993 was achieved. Excluding operative mortality, there are 350 patients with “potentially curative” resection and 65 corresponding patients with minimal macroscopic (n=19) or microscopic (n=46) residual disease. The latter group demonstrated a poor prognosis, with median and maximum survival times of 14.4 and 56.0 months, respectively. Among the 350 patients having potentially curative resection, the actuarial 5‐, 10‐, and 20‐year survivals were 39.3%, 23.6%, and 17.7%, respectively. Tumor‐free survival was 33.6% at 5 years. In the univariate analysis, the following factors were associated with decreased crude survival: presence and extent of mesenteric lymph node involvement (p=0.0001); grade III/IV primary tumor (p=0.013); synchronous diagnosis of metastases (p=0.014); satellite metastases (p=0.00001); metastasis diameter of>5 cm (p=0.003); preoperative carcinoembryonic antigen (CEA) elevation (p=0.03); limited resection margins (p=0.009); extrahepatic disease (p=0.009); and nonanatomic procedures (p=0.008). With respect to disease‐free survival, extrahepatic disease (p=0.09) failed to achieve statistical significance, whereas patients with primary tumors in the colon did significantly better than those with rectal cancer (p=0.04). The presence of five or more independent metastases adversely affected resectability (p<0.05). However, once a radical excision of all detectable disease was achieved, no significant predictive value of an increasing number of metastases (1–3 versus≥4) on either overall (p=0.40) or disease‐free (p=0.64) survival was found. Using Cox's multivariate regression analysis, the presence of satellite metastases, primary tumor grade, the time of metastasis diagnosis diameter of the largest metastasis, anatomic versus nnanatomic approach, year of resection, and mesenteric lymph node involvement each independently affected both crude and tumor‐free survival.
Surgical treatment of cholangiocellular carcinoma
Authors: Pichlmayl Rudolf , Lamesch Peter , Weimann Arved , Tusch Günter , Ringe Burkhardt
Published: December 2004

Intrahepatic cholangiocellular carcinoma (CCC) is known to be associated with severe symptoms and a particularly poor prognosis. Nonsurgical methods have failed to change this situation up to now. Surgical therapy, so far, is the only chance for effective treatment, but it has had limited success. The relative infrequency of this tumor does not allow extensive statistics and limits our present knowledge. In this contribution the outcome of 50 patients who underwent liver resection or liver transplantation in our institution is reported. Their courses have been reevaluated according to pathohistologic classification and TNM tumor staging. The median survival rates were 12.8 months in the group of patients after liver resection (n=32) and 5.0 months after liver transplantation (n=18). Liver transplantation, however, was performed only in patients with unresectable tumors. The longest survival after transplantation was 25 months; after resection four patients survived more than 5 years. In the resection group and the transplantation group survival rates correlated with tumor size and tumor stages according to TNM, although the differences were not statistically significant. Liver resection thus has its place in resectable situations. Liver transplantation for unresectable lesions of this tumor type—always deemed critically in the past—seems not to be indicated with our present stage of knowledge, unless adjuvant protocols appear promising and are tested.
Temporary abdominal wall closure in trauma patients: Indications, technique, and results
Authors: Howdieshell Thomas R. , Yeh Karen A. , Hawkins Michael L. , Cué Jorge I.
Published: December 2004

From 1988 to 1992 more than 5300 patients were admitted to a level I trauma center, with 36 of these patients requiring Silastic abdominal closure. Patients ages ranged from 13 to 75 years with a mean Injury Severity Score (ISS) of 30 (range 13–50). Nineteen patients (53%) suffered penetrating injuries, and 17 (47%) were victims of blunt trauma. Silastic closure was performed at admission laparotomy in 15 patients (42%) due to inability to close the fascia primarily. Twenty‐one patients (58%) underwent Silastic closure at reexploration for inability to close primarily (12 patients), elevated intraabdominal pressure with deteriorating renal function (6 patients), and wound sepsis with fascial necrosis (3 patients). Twenty‐six patients (72%) survived and 10 patients (28%) expired. The causes of death were multiple organ failure (9 patients) and exsanguination (1 patient). Of the 26 survivors, 8 patients (31%) underwent fascial closure at initial hospitalization, and 18 patients (69%) required split‐thickness skin grafting to visceral granulation tissue. Of theses 18 patients, 13 (72%) have already undergone ventral herniorrhaphy at subsequent admission. No patient developed a complication attributable to the technique.
Molecular biology of breast carcinoma
Authors: El‐Ashry Dorraya , Lippman Marc E.
Published: December 2004

During the last several years basic research has resulted in the identification of many of the factors involved in signal transduction pathways, leading us to a greater understanding of the mechanisms of growth control in breast cancer cells. Many of these factors are the products of proto‐oncogenes or suppressor genes. This review describes the role of some of these factors in breast cancer development, progression, and metastasis and discusses implications for future directions.
Evaluation and management of high risk and premalignant lesions of the breast
Authors: Page David L. , Jensen Roy A.
Published: December 2004

Specific, combined histologic and cytologic patterns of atypical epithelial hyperplasia (AH) in the breast indicate a medically relevant risk of breast cancer development in 5% to 10% of women with otherwise benign biopsies. This risk is four to five times that of similar women without such lesions, that is, women of the same age and at risk for the same period of time. These relative risks are not stable and fall 10 to 15 years after detection, more closely approximating the risks of women of comparable age. Proliferative disease without atypia, no matter how extensive or complex, predicts only a slight elevation of risk, which approaches double that of the reference population. There is a strong interaction of AH with family history of breast cancer in at least a first degree relative. This risk doubles the risk of AH alone and is approximately 20% at 10 to 15 years after biopsy, particularly for women in their forties and early fifties. These considerations are of less clinical importance in women over age 60. Low replacement doses of conjugated estrogen after the menopause do not further elevate risk beyond that identified by histologic patterns. Noncomedo ductal carcinoma in situ may be considered a true precursor lesions; however, it differs significantly in many ways from the more advanced lesion recognized as the comedo type of ductal carcinoma in situ. Small examples of noncomedo ductal carcinoma in situ can eventuate in invasive carcinoma after 6 to 10 years. They may be treated by wide local excision without radiation, with no recurrence up to 8 to 10 years in all likelihood. Ductal carcinoma in situ lesions can be extensive within the breast, and this conservative posture should be reserved for smaller lesions.
Patient selection criteria for conservation surgery versus mastectomy: Memorial hospital breast service experience
Authors: Moore Michael P. , Kinne David W.
Published: December 2004

Breast cancer remains the most common noncutaneous malignancy of women. Although the incidence of the disease continues to rise, most women now present with early (stage I or II) disease. Breast conservation has been demonstrated to be equal in efficacy to mastectomy in such patients in six modern‐day randomized trials. The utilization of breast conservation has been slow throughout the United States. At Memorial Hospital the utilization of breast conservation almost equals that of modified mastectomy in the treatment of 950+annual primary operable cancers. Excellent local‐regional control can be obtained with a defined surgical approach to the primary tumor and axillary nodes, radiotherapy to the breast with a boost to the primary site, and finally patient selection.
Conservation approaches for the management of stage I/II carcinoma of the breast: Milan Cancer Institute Trials
Authors: Veronesi Umberto , Luini Alberto , Galimberti Viviana , Zurrida Stefano
Published: December 2004

The most recent analysis of the results of three major trials on breast conservation carried out at the Milan Cancer Institute between 1973 and 1988 showed that breast conservation consisting of a wide breast resection (quadrantectomy) plus radiotherapy is a safe procedure, and that there are no differences in long‐term survival (up to 19 years) compared with women who have undergone Halsted's mastectomy. The studies also showed that reducing the extent of surgery from quadrantectomy to lumpectomy increases the risk of local recurrence by nearly three times, as does withdrawing radiotherapy. However, in women older than 55 years, quadrantectomy alone (without radiotherapy) may yield good results. Among the risk factors for local recurrence, a young age and the presence of an extensive intraductal component are the most significant.
Management of locally advanced breast cancer
Authors: Borgen Patrick Ivan
Published: December 2004

The management of locally advanced breast cancer with single modality therapy has been associated with a high rate of systemic failure. A multimodality treatment strategy that includes induction cytotoxic chemotherapy, surgery, radiation therapy, and, possibly, hormonal ablation therapy is the current preferred management approach. As our knowledge and understanding of the mechanisms involved in mitogenic signal transduction improve, it is likely that less toxic, more effications agents will emerge.
Effects of highly selective vagotomy and additional procedures on gastric emptying in patients with obstructing duodenal ulcer
Authors: Wang Chia‐Siu , Tzen Kai‐Yuan , Chen Pang‐Chi , Chen Miin‐Fu
Published: December 2004

A solid gastric emptying study was conducted on 46 patients more than 1 year after highly selective vagotomy (HSV) and additional procedures for obstructing duodenal ulcer and on 21 patients after HSV alone for uncomplicated duodenal ulcer. The additional procedures included dilatation (n=14; HSV+D group), Holle pyloroplasty (n=14; HSV+P group), and Jaboulay gastroduodenostomy (n=18; HSV+GD group). The test meal consisted of two eggs labeled with99mTc sulfur colloid, two slices of white bread toast, and 300 ml of organge juice (total 322 kcal). Gastric emptying curves and emptying parameters (t1/2, half emptying time; lag phase, TLAG; emptying rate, k; and β value) were compared with those of 17 healthy volunteers, the normal control group. The patients after HSV alone had an almost normal gastric emptying. The HSV+D group showed a significant delay from minute 45 to the end of the emptying curve, corresponding to a longer t1/2(p=0.02), and a slower emptying rate (p=0.029). The HSV+P group approached a nearly normal emptying curve, corresponding to an insignificant difference in emptying parameters. The HSV+GD group had significantly faster emptying from minute 15 to the end of the emptying curve, corresponding to a faster t1/2(p=0.0005), a shorter lag phase (p=0.027), and a faster emptying rate (p=0.021). Recurrent ulcerations were noted in one patient (4.8%) of the HSV alone group, five (35.7%) of the HSV+D group, one (7.1%) of the HSV+P group, and one (5.6%) of the HSV+GD group. This study indicates that HSV plus dilatation is not an adequate operation because of the high incidence of delayed gastric emptying and recurrence. Drainage is necessary for prevention of post‐operative delayed gastric emptying after HSV treatment for an obstructing duodenal ulcer. To achieve nearly normal gastric emptying, Holle pyloroplasty is the first choice for drainage. Because of a rare dumping syndrome in our patients, Jaboulay gastroduodenostomy is another choice, if the stenosis cannot be managed easily by Holle pyloroplasty.
Doppler analysis of hepatic blood flow predicts liver dysfunction after major hepatectomy
Authors: Kin Yukoh , Nimura Yuji , Hayakawa Naokazu , Kamiya Junichi , Kondo Satoshi , Nagino Masato , Miyachi Masahiko , Kanai Michio
Published: December 2004

In 17 consecutive patients who underwent major hepatic resection, 9 of whom with combined resection of the gastrointestinal tract or the pancreatic head (or both), postoperative hepatic blood flow was investigated. In this study, the patients were classified into two groups according to their postoperative serum total bilirubin level: Group A comprised 7 patients with the level higher than 7 mg/dl for more than 1 week postoperatively, and group B comprised 10 patients who did not meet this criterion. For 2 weeks after surgery, the portal blood flow velocity, the hepatic artery resistive index (RI) calculated from the changes in Doppler frequency shifts, and the hepatic venous blood flow velocity were measured intermittently using color Doppler ultrasonography. Liver volume was assessed by computed tomography to provide the restoration. Significant differences in portal blood flow velocity and hepatic artery RI were noted between the two groups from the third postoperative day. In group A the portal blood flow velocity decreased below the preoperative value, and the hepatic artery RI increased above 0.75. In contrast, group B showed high portal blood flow velocity and low hepatic artery RI. In both groups the RI correlated significantly with the total bilirubin level (r=0.74; p<0.0001), and the growth rate of the remnant liver was proportional to the mean postoperative portal blood flow velocity (r=0.70; p=0.016). We concluded that measurement of the portal blood flow velocity and hepatic artery RI can be useful for predicting postoperative liver dysfunction and liver regeneration after major hepatic resection.
Continuous hyperthermic peritoneal perfusion for the prevention of peritoneal recurrence of gastric cancer: Randomized controlled study
Authors: Fujimura Takashi , Yonemura Yutaka , Muraoka Keiichi , Takamura Hiroyuki , Hirono Yasuo , Sahara Hiroyuki , Ninomiya Itasu , Matsumoto Hisashi , Tsugawa Kouichiro , Nishimura Gen‐ichi , Sugiyama Kazuo , Miwa Kouichi , Miyazaki Itsuo
Published: December 2004

We performed continuous hyperthermic peritoneal perfusion (CHPP) or continuous normothermic peritoneal perfusion (CNPP) combined with cisplatin (CDDP) 300 mg/kg and mitomycin C (MMC) 30 mg/kg in an attempt to prevent peritoneal recurrence after surgery for gastric cancer. Twenty‐two patients were treated with perfusion using about 10 liters of saline heated to 41° to 42°C (CHPP group); 18 patients were treated with saline heated to 37° to 38°C (CNPP group); and 18 patients underwent only gastric surgery without perfusion (control group) in a randomized control study. There were two deaths (9%) due to peritoneal recurrence in the CHPP group, four (22%) in the CNPP group, and four (22%) in the control group. The 1‐, 2‐, and 3‐year survival rates were 95%, 89%, and 68%, in the CHPP group; 81%, 75%, and 51%, in the CNPP group; and 43%, 23%, and 23%, in the control group, respectively. There was a significant difference between the three survival curves by the log‐rank test (p<0.01). This difference showed that CNPP and CHPP are both effective procedures for preventing peritoneal recurrence. The maximum concentrations in the perfusate of total and free CDDP with 300 mg administration were 12.2 and 10.1 μg/ml, respectively, at the end of the perfusion, and the maximum concentrations of total and free CDDP in plasma were 2.1 and 1.0 μg/ml, respectively. The maximum concentrations of MMC in perfusate and plasma with 30 mg administration were 1.00 and 0.05 μg/ml, respectively, which are intraperitoneally cytotoxic but systemically safe concentrations.
Towards integrated optimal configuration of platform products, manufacturing processes, and supply chains
Authors: Huang George Q. , Zhang X.Y. , Liang L.
Published: December 2004

This paper seeks to address the challenge of designing effective supply chain systems that integrate platform product decisions, manufacturing process decisions, and supply sourcing decisions. Specifically, this paper considers the specific scenario of optimizing the configuration of the supply chain system given commonality among platform products. The paper uses and extends the concept of Generic Bills of Materials (GBOM) of a product family as a unified framework for qualitatively capturing and representing the structure of its supply chain. This qualitative model is then enhanced by a mathematical model developed to quantify the relationships among various design decisions. Endeavoring to solve the mathematical model more efficiently, we propose an effective heuristic method using Genetic Algorithm (GA). Although GA generally does not guarantee the optimal solution, the best heuristic solutions obtained in this study are consistent with the optimal solutions obtained using Dynamic Programming. The resulting mathematical model and solution algorithm are then used to investigate the mutual impact between the design decisions of platform products and of processes in the supply chain through sensitivity analyses. Several useful managerial insights are generated and discussed.
Habitual Risk Factors for Head and Neck Cancer
Authors: Goldenberg David , Lee Juna , Koch Wayne M. , Kim Michael M. , Trink Barry , Sidransky David , Moon Chul‐So
Published: December 2004

Chronic tobacco smoking and alcohol consumption are well‐established risk factors for the development of squamous cell carcinoma (SCC) of the head and neck. There are, however, a variety of other habitual and culturally based activities that are less commonly seen in the Western world and that are also risks factors for the development of this type of cancer. In this era of globalization, many of these habits have now crossed borders and appear in various areas throughout the world. This article reviews habitual and social risk factors for cancer of the head and neck, excluding smoking and alcohol consumption. These factors include chewing tobacco and snuff, areca nut in its various forms, Khat leaves, and the drinking of Maté. EBM rating: D. (Otolaryngol Head Neck Surg 2004;131: 986–93.)
Functional Outcomes Following Chemoradiotherapy for Head and Neck Cancer
Authors: Akst Lee M. , Chan James , Elson Paul , Saxton Jerrold , Strome Marshall , Adelstein David
Published: December 2004

OBJECTIVE

To study functional outcomes following concurrent chemoradiotherapy of head and neck cancer.

METHODS

A retrospective chart review assessed diet, feeding tube use, and tracheotomy pretreatment and 3, 6, 12, and 24 months posttreatment.

RESULTS

Of 196 patients who underwent chemoradiotherapy between 1990 and 2002, 148 (76%) required feeding tubes immediately posttreatment; 150 (77%) required nutritional support at 3 months. By 12 months, 92% were tube‐free and 83% resumed near‐normal diet. Of 17 patients (9%) with tracheotomy posttreatment, 71% were decannulated by 6 months. Stage IV disease strongly predicted prolonged feeding tube use and slow recovery of diet; age ≥60 also predicted slow recovery. Primary site, gender, and radiotherapy schedule did not predict functional recovery after adjusting for stage and age.

CONCLUSION

Few patients required tracheotomy before or during chemoradiotherapy. Many patients required feeding tubes and nutritional support for several months following therapy, but most were tube‐free and eating near‐normal diets within 1 year. EBM rating: C.
Phase 1 Clinical Trial Results of the Envoy System: A Totally Implantable Middle Ear Device for Sensorineural Hearing Loss
Authors: Chen Douglas A. , Backous Douglas D. , Arriaga Moisés A. , Garvin Renee , Kobylek Deborah , Littman Thomas , Walgren Sue , Lura David
Published: December 2004

OBJECTIVES

This report will present the results of the USA Phase 1 clinical trials for the Envoy System (St. Croix Medical): A totally implantable middle ear hearing system for sensorineural loss.

STUDY DESIGN

A prospective, single‐subject, repeated‐measures, multicenter study was performed to evaluate safety and functionality of the Envoy System. Data collected included Abbreviated Profile of Hearing Aid Benefit, bone conduction threshold, speech reception threshold, functional gain, word recognition, and adverse events. Testing was performed unaided, with the patient's best‐fit hearing aid, and post device activation at 2 (trial endpoint) and 4 months.

RESULTS

Five of 7 patients at the 2‐month postactivation period had working systems. All 5 patients perceived benefit increases with the Envoy System over their best‐fit hearing aid, including communication in high background noise levels. Word recognition was improved over hearing aids. Functional gain and speech reception thresholds were similar for the Envoy device and hearing aids.

CONCLUSIONS

The feasibility trial has shown the Envoy device, a totally implantable middle ear device, can safely sense and drive the ossicular chain. EBM rating: B‐2.
Bacterial Tracheitis Reexamined: Is There a Less Severe Manifestation?
Authors: Salamone Frank N. , Bobbitt D. Bradley , Myer Charles M. , Rutter Michael J. , Greinwald John H.
Published: December 2004

OBJECTIVE

Bacterial tracheitis (BT) is a condition that can cause fatal airway obstruction. We evaluated our experience with BT over a 10‐year period.

STUDY DESIGN

Retrospective review of patients treated for BT between 1991 and 2001. RESULTS: Ninety‐four cases were evaluated. The mean patient age was 7.9 years. At presentation, 60% were afebrile, and the mean WBC count was 10.8 × 103/mm3. Only 53% of patients required intubation. Younger children were more likely to require this intervention. S. aureus was the most commonly cultured bacteria, while isolation of M. catarrhalis was associated with a higher intubation rate. A pathologic virus was isolated in 64% of the 34 cultures performed. Only 9 patients were described as “toxic,” and 6 presented in respiratory extremis. There were no deaths.

CONCLUSION AND SIGNIFICANCE

A subset of patients with tracheal membranes has a less severe clinical appearance. Nonetheless, these patients require debridement and aggressive medical treatment. We propose that the term “exudative tracheitis” (ET) better describes this entity. Older patients who are less systemically ill and rapidly respond to local and systemic therapy are characteristic of ET. EBM rating: C.
Can History and Physical Examination Reliably Diagnose Pediatric Obstructive Sleep Apnea/Hypopnea Syndrome? A Systematic Review of the Literature
Authors: Brietzke Scott E. , Katz Eliot S. , Roberson David W.
Published: December 2004

OBJECTIVE

Using an evidence‐based technique, systematically review the literature to evaluate the accuracy of routine clinical history and physical examination in the diagnosis of obstructive sleep apnea/hypopnea syndrome (OSAHS) in the pediatric patient.

STUDY DESIGN AND SETTING

The biomedical literature was systematically reviewed. Articles comparing the results of clinical evaluation to polysomnography (PSG) were selected. The level of evidence was assessed using established evidence‐based medicine (EBM) guidelines.

RESULTS

Twelve articles were identified using the search criteria. Eleven of 12 articles concluded that clinical evaluation is inaccurate in the diagnosis of OSAHS. The level of evidence was good to very good (Grade B/B+).

CONCLUSION/SIGNIFICANCE

Clinical history and physical examination are not reliable for diagnosing OSAHS compared with overnight PSG. Complicating the interpretation of this work is the lack of a validated PSG threshold of clinically significant disease. There is an urgent need for the development of adequate screening tests with validated clinical outcomes. EBM rating: B‐3.
Complications of Neonatal Tracheostomy: A 5‐Year Review
Authors: Pereira Kevin D. , Macgregor Allison R. , Mitchell Ron B.
Published: December 2004

OBJECTIVE

Study the complication rate of tracheostomy in premature infants and identify contributing factors.

SETTING

Two university‐based tertiary care children's hospitals.

METHODS

The charts of 55 neonates who underwent tracheostomy between January 1997 and December 2002 were reviewed. Group 1 included 32 infants born weighing < 1000 grams. Group 2 included 23 infants born weighing ≥ 1000 grams.

RESULTS

Group 1 infants had a higher incidence of comorbidities related to prematurity. Thirty‐eight infants underwent tracheostomy due to ventilatory dependence, 13 for airway obstruction, and 4 for neurologic debilitation. Sixteen infants (29%) had a complication related to tracheostomy. There was no tracheostomy‐related mortality.

CONCLUSIONS

Tracheostomy in the preterm infant has the potential for significant morbidity. Meticulous technique, surgeon experience and specialized care may play a role in reducing the complication rate. Complications are usually minor and do not require additional surgical intervention. EBM rating: C.
Lamina Propria Replacement Therapy with Cultured Autologous Fibroblasts for Vocal Fold Scars
Authors: Chhetri Dinesh K. , Head Christian , Revazova Elena , Hart Stephen , Bhuta Sunita , Berke Gerald S.
Published: December 2004

OBJECTIVES

To develop a canine model of vocal fold scar and to evaluate its treatment with lamina propria replacement therapy using autologous cultured fibroblasts.

MATERIALS AND METHODS

Full thickness of the lamina propria layer in canine vocal folds was injured with a laser. Fibroblasts were cultured and expanded in the laboratory from a buccal mucosal biopsy. The scarred vocal folds were treated with 3 weekly injections of fourth, fifth, and sixth passage autologous fibroblasts. Mucosal waves and acoustic parameters were measured at baseline, after scarification, and several months after injection therapy. Histologic evaluation of the vocal folds for fibroblasts, collagen, elastin, reticulin, and hyaluronic acid was performed.

RESULTS

Nine beagle dogs were used, and 1 animal served as control. Vocal fold scarring resulted in absent or severely limited mucosal waves and significantly worse acoustic parameters. Significant improvements in mucosal waves and acoustic parameters were obtained after lamina propria replacement therapy. After therapy, mucosal waves became normal in 4 animals and near normal in the other 4. No statistical difference was found in mucosal waves between baseline and post‐therapy. All animals tolerated therapy without complications. The treated vocal folds demonstrated an increased density of fibroblasts, collagen, and reticulin, a decreased density of elastin, and no change in hyaluronic acid.

CONCLUSIONS AND SIGNIFICANCE

Therapeutic options for vocal fold scars are limited. Lamina propria replacement therapy in the form of autologous cultured fibroblasts improves mucosal pliability and returns normal or near normal mucosal waves in experimentally scarred vocal folds. This novel therapeutic modality may hold new promise for treating vocal fold scars.
Esophageal Incisions Repair by CO2 Laser Soldering
Authors: Nageris Ben I. , Zilker Zeev , Zilker Maya , Kariv Noam , Feinmesser Rafael , Katzir Abraham
Published: December 2004

PURPOSE

This study evaluated the feasibility of fiberoptic CO2 laser soldering for the repair of esophageal injuries under tight temperature feedback control in an animal model. Healing was compared to conventional suture closure.

MATERIALS AND METHODS

A CO2 soldering system equipped with infrared transmitting silver halide fibers was used. The soldered tissue temperature was monitored continuously, and laser power was adjusted to provide constant temperature. The procedure was done with 50% bovine serum albumin solder. Longitudinal incisions measuring 8 to 10 mm were made under general anesthesia in the cervical esophagus of 25 rats. Twenty rats (group I) underwent laser tissue bonding; 8 of which were tested in a preliminary study to determine optimal laser parameters. In the remaining 5 rats (group II, controls), closure was performed with 1 layer of 6/0 Vicryl sutures. The rats were sacrificed 2, 3, 4, and 6 weeks postoperatively, and the esophagus was examined histologically.

RESULTS

Optimal temperature was found to be 65 to 70° C and optimal exposure time, 150 to 200 seconds. Laser soldering was successful in 9 of the 12 rats (75%) treated under optimal settings; suturing was successful in 4 of the 5 control rats (80%). There were no significant differences between the groups in healing or complication rates.

CONCLUSIONS

These results indicate that the CO2 laser soldering technique is a valid option for the correction of esophageal tears or incisions in rats. The confirmation and extension of these findings in further studies with larger animals may ultimately lead to the routine in vivo use of temperature‐controlled laser repair for the esophagus and other organs. This method lends itself to endoscopic bonding of tissues.
Post‐Tonsillectomy Hemorrhage: Cold versus Hot Dissection
Authors: Lee Michael S. W. , Montague Mary‐Louise , Musheer Hussain S. S.
Published: December 2004

OBJECTIVE

The aim of our study was to assess the rate of reactionary and secondary posttonsillectomy hemorrhage using “cold” dissection and bipolar diathermy and to determine whether there was any difference in the postoperative hemorrhage rate between the 2 methods.

METHODS

This was a prospective study of all patients undergoing tonsillectomy between November 8, 1999 and November 7, 2000 in a tertiary medical centre. The data collected included patient identity, age, gender, date of surgery, method of operation, and complications (if any). The timing of reactionary or secondary posttonsillectomy hemorrhage and the treatment were recorded. We hypothesized no difference in posttonsillectomy hemorrhage rates using the 2 methods. X 2 test was used for statistical analysis.

RESULTS

A total of 349 patients underwent tonsillectomy in the period (134 males, 215 females, mean age was 16.7 years). Of these, 337 were bilateral procedures, 145 patients had tonsillectomy using cold dissection, and 192 patients had bipolar diathermy. Reactionary hemorrhage occurred in 1 patient (0.3%) and 31 patients (9.2%) developed secondary hemorrhage. The hemorrhage rates using cold dissection (n = 8) and bipolar diathermy (n = 24) were 5.5% and 12.5%, respectively (P < 0.05).

CONCLUSIONS

The primary and secondary posttonsillectomy hemorrhage rates were 0.3 and 9.2%, respectively. Tonsillectomy using bipolar diathermy has a statistically significant higher secondary hemorrhage rate than using cold dissection (12.5% vs. 5.5%, P < 0.05). (Otolaryngol Head Neck Surg 2004;131:833–6.)
Randomized Double‐Blinded, Placebo‐Controlled Clinical Trial of Famciclovir for Reduction of Ménière's Disease Symptoms
Authors: Derebery M. Jennifer , Fisher Laurel M. , Iqbal Zarina
Published: December 2004

OBJECTIVE

To conduct a clinical trial of famciclovir for symptom control in Ménière's disease.

STUDY DESIGN AND SETTING

Randomized, double‐blinded placebo‐controlled clinical trial in a tertiary referral center, with 12 subjects in the active treatment arm and 11 subjects in the placebo arm.

RESULTS

There were no serious adverse events. Twenty‐five percent of the famciclovir group and 18% of the placebo group showed a reduction in number of vertigo spells, the primary efficacy endpoint. This difference was not statistically significant. All subjects improved in dizziness and health‐related quality of life. There was a trend for the famciclovir arm to have less fluctuation in hearing relative to the placebo arm.

CONCLUSION

No dramatic effects of famciclovir were found on vertigo or dizziness. Some promising effects on reduction of the fluctuation in hearing were observed.

SIGNIFICANCE

Famciclovir may suppress the fluctuation of hearing in Ménière's disease, but had a minimal effect on vertigo or dizziness symptoms in this study. The probable multifactorial etiology in Ménière's disease requires that further studies be conducted to determine the effects of antiviral medications. EBM rating: A.