bluuebunny/crossref_metadata_2025 huggingface dataset:
Function of “Nontrauma” Surgeons in Level I Trauma Centers in the United States
Authors: Pate James W.
Published: February 2006

Although the general “trauma” surgeon is usually the team leader in level I trauma centers, the use of
surgical subspecialists and nonsurgeons is frequently ill‐defined. This
study was done to gain data in regard to actual use of subspecialists
in busy centers. First, a survey of the patterns of staffing in 140 trauma centers was elicited by mail questionnaire, supplemented by
telephone calls. Second, records of 400 consecutive patients at the
Elvis Presley Trauma Center were reviewed to determine the use of
subspecialists during the first 24 hours of care of individual
patients. There were differences in the use of surgical subspecialists
and nonsurgeons at different centers: in receiving, admitting, operating, and critical care areas and in privileges for admission and
attending of inpatients. Consultation “guidelines” are used for
many specific injuries. At our center, a mean of 1.92 subspecialists, in addition to general surgeons, were involved in the early care of
each patient. Problems exist in many centers regarding the use of
subspecialists, especially for management of facial and chest injuries. In some centers nonsurgeons function in the intensive care unit, and as
admitting and attending physicians of trauma patients.
Predictive Factors for Conversion of Laparoscopic Cholecystectomy
Authors: Alponat Ahmet , Kum Cheng K. , Koh Bee C. , Rajnakova Andrea , Goh Peter M.Y.
Published: February 2006

Reliable predictive factors for conversion of laparoscopic cholecystectomy (LC) would be extremely useful in the preparation and planning of admission for patients with symptomatic cholelithiasis. Data from 783 patients in whom LC was attempted in a university clinic from June 1990 to December 1995 were retrospectively analyzed. The aim of this study was to determine preoperative indicators that can be useful for predicting conversion to open cholecystectomy (OC). Conversion was required in 58 (7.4%) patients, of which 48 (83%) were elective and 10 (17%) emergency. Factors evaluated were age, sex, obesity, duration of gallstone disease, co‐morbid factors, indication for surgery, previous abdominal surgery, fever, physical examination findings, white blood cell (WBC)
count, liver function tests, ultrasound findings, and the experience of the surgeon. Acute cholecystitis, rigidity in the right upper abdomen, fever, thickened gallbladder wall on ultrasonography, elevated alkaline phosphatase (ALP), liver transaminases and the WBC count were significant predictors of conversion in the univariate analysis. Multivariate logistic regression analysis on these significant predictors showed that acute cholecystitis [odds ratio (OR) = 3.12], thickened gallbladder wall on ultrasonography (OR = 3.75), elevated ALP (OR = 2.23), and WBC count (OR = 3.69) were jointly significant.
Antibiotic Administration in Patients Undergoing Common Surgical Procedures in a Community Teaching Hospital: The Chaos Continues
Authors: Gorecki Piotr , Schein Moshe , Rucinski James C. , Wise Leslie
Published: February 2006

The influence of recently published guidelines by the Surgical Infection Society (SIS) on current surgical practice are not well documented. The appropriateness of antibiotic administration in a cohort of surgical patients undergoing elective and emergency surgery in a department of surgery in an urban, community‐based, private, 560‐bed teaching hospital was retrospectively reviewed. The following were the criteria defining administration as appropriate as modified from SIS guidelines: Prophylactic use: (1) started prior to operation; (2) spectrum appropriate to the specific operation; (3) duration ≤ 24 hours. Therapeutic use: (1) started prior to operation; (2) spectrum appropriate to pathology; (3) Duration ≤ 24 hours for contamination or “resectable” infection and ≤ 5 days for established infection in the absence of clinical evidence of persisting infection. Any switchover from an appropriate agent to another appropriate or inappropriate agent in the same patient in the absence of microbiologic or clinical indication was considered inappropriate administration. We reviewed the charts of 211 randomly selected patients who underwent elective (n= 132) or emergency (n= 79) procedures during 1996. The operations included gastrectomy (n= 22), appendectomy (n= 27), open (n= 5) or laparoscopic (n= 27) cholecystectomy, colectomy (n= 28), hysterectomy (n= 8), laparotomy for intestinal obstruction (n= 11), mastectomy (n= 26), and ventral hernia repair (n= 37). A total of 17 antibiotics were used for prophylaxis and 21 for therapy. In 156 patients (74%) the administration was considered inappropriate. Eight patients in the inappropriate group developed diarrhea (two cases of Clostridium difficile‐induced colitis) compared to two cases of diarrhea in the appropriate group (nonsignificant). The average duration of administration after elective and emergency operations was 3.3 and 5.7 days, respectively. The total expense for excessive duration of administration was $18,533. Many surgeons are not familiar with the spectrum of antimicrobials and often do not distinguish between prophylactic and therapeutic administration. Antibiotic usage in current surgical practice is often inappropriate, excessive, and chaotic.
Management of Nonpalpable, Mammographically Detectable Breast Lesions
Authors: Markopoulos Christos , Kakisis John , Kouskos Stratos , Kontzoglou Konstantinos , Koufopoulos Konstantinos , Gogas John
Published: February 2006

A series of 151 women underwent 156 preoperative localizations of nonpalpable, mammographically detected breast lesions. Indications for biopsy were (1) a cluster of more than five fine microcalcifications; (2) a solid lump found by ultrasound investigation; and (3) a radiologic abnormality of the breast parenchyma. The lesions were localized preoperatively using the hook‐wire method (Frank needle), and all biopsies were performed under general anesthesia. Carcinoma was discovered in 34 (21.8%) cases; in 22 (64.7%) it was a noninvasive cancer (9 with microinvasions) and in 12 (35.3%) an invasive carcinoma with a mean tumor diameter of 0.8 cm. The highest malignancy rate was found among those with microcalcifications (21 of 81 cancers, or 25.9%). Lymph node involvement was seen in 25% of patients with invasive carcinomas. In conclusion, the needle localization of nonpalpable breast lesions is a simple, accurate method for early detection of small cancers with favorable prognosis.
Expression of Pepsinogen C in Gynecomastias and Male Breast Carcinomas
Authors: Serra Díaz Carlos , Vizoso Francisco , Rodríguez Juan C. , Merino Antonio M. , González Luis O. , Baltasar Aniceto , Pérez‐Vázquez María T. , Medrano Justo
Published: February 2006

Pepsinogen C is a proteolytic enzyme involved in the digestion of proteins in the stomach; it is also synthesized by a significant percentage of female breast carcinomas. In addition, it has been demonstrated that pepsinogen C is one of the few proteins induced by androgens in breast carcinoma cells. Here we evaluate the expression of pepsinogen C by immunoperoxidase staining in normal breast tissue from 3 male patients, 15 gynecomastia tissues, 2 male in situ breast carcinomas, and 68 male invasive breast carcinomas. Pepsinogen C immunostaining values were quantified in male breast tumors using the HSCORE system, which considers both the intensity and the percentage of cells staining at each intensity. The results indicated positive immunohistochemical staining for pepsinogen C in all gynecomastia tissues, the two in situ ductal carcinomas, and 52 of 68 invasive breast carcinomas (76.4%). The three normal breast tissues analyzed showed negative staining for pepsinogen C, whereas invasive tumors showed clear differences among them with regard to the intensity and percentage of staining cells. In addition, pepsinogen C scores were significantly higher in well‐differentiated (grade I, 188.7) and moderately differentiated (grade II, 145.8) tumors than in poorly differentiated (grade III, 98.5) tumors (p= 0.032). Similarly, significant differences in pepsinogen C content were found between estrogen receptor (ER)‐positive tumors and ER‐negative tumors (158.5 vs. 44.3, respectively; p= 0.009). Patients with pepsinogen C‐positive tumors reached longer relapse‐free and overall survival periods than did those with tumors with negative staining, but no statistical differences were observed between survival curves calculated for these two groups of patients. This results demonstrate expression of pepsinogen C by gynecomastias and by a high percentage of male breast carcinomas and may indicate an important role of pepsinogen C in the pathophysiology of male breast diseases.
Hypocaloric Support in the Critically Ill
Authors: Patiño José Félix , de Pimiento Sonia Echeverri , Vergara Arturo , Savino Patricia , Rodríguez Mario , Escallón Jaime
Published: February 2006

The critically ill patient exhibits a well defined endocrine and metabolic adaptive response to stressor agents, characterized by incremented resting energy expenditure (hypermetabolism, which is believed to signify increased energy requirements), accelerated whole‐body proteolysis (hypercatabolism), and lipolysis. These phenomena occur in the acute stage, which is also characterized by hyperglycemia, typically accompanied by a hyperdynamic cardiovascular reaction manifested by high cardiac output, increased oxygen consumption, high body temperature, and decrease peripheral vascular resistance. High provisions of glucose‐derived calories tend to accentuate these reactions and increase the degree of hyperglycemia. We have adopted a hypocaloric‐hyperproteic regimen which is provided only during the first days of the flow phase of the adaptive response to injury, sepsis, or critical illness. Our regimen includes a daily supply of 100 to 200 g of glucose and 1.5 to 2.0 g of protein (synthetic amino acids) per kilogram of ideal body weight. We have analyzed the data on 107 critically ill patients, 70 men and 37 women, who were admitted to the surgical intensive care unit and who received nutritional support by the TPN hypocaloric modality for a minimum of 3 days. We found that the high caloric loads contained in TPN regimens results in additional metabolic stress, with consequent hyperdynamic cardiorespiratory repercussion, high CO2 production, and frequently hepatic steatosis. In contrast, our hypocaloric‐hyperproteic approach has resulted in a more physiologic clinical course and considerable reduction in cost. The infusion of high glucose loads, such as those used in hypercaloric TPN, does not seem to suppress the excessive endogenous production of glucose but instead markedly exacerbates the hyperglycemia of the postinjury and acute stress condition. We believe that the hypocaloric‐hyperproteic regimen we utilize during the first few days of the stress situation is more in accordance with the inflammatory and hormonal mediator climate of the initial stages of the flow phase and thus appears to be beneficial vis‐à‐vis the hypercaloric loads that many use as routine metabolic support in critically ill patients.
Catheter‐related Bloodstream Infections
Authors: Sitges‐Serra Antonio , Girvent Meritxell
Published: February 2006

Catheter‐related bloodstream infections (CBIs) rank among the most frequent and potentially lethal nosocomial infections. Intravascular devices become contaminated on the outer surface during nonaseptic insertion or maintenance of the catheter exit site or endoluminally during hub manipulation. CBI is heralded by spiking fever, malaise and rigors and should be promptly diagnosed to prevent endocarditis and septic metastasis. In about two‐thirds of the cases the offending organisms are coagulase‐negative staphylococci; Staphylococcus aureus, gram‐negative bacilli, and Candida sp. are responsible for one‐third of these infections and carry a worse prognosis. Diagnosis of CBI relies on proper bacteriologic techniques, some of which can be performed in situ avoiding withdrawal of the device. Prevention strategies should aim at avoiding extra‐ and endoluminal contamination and should be based on three main pillars: maximal aseptic barriers at insertion, appropriate site maintenance, and junctional (hub) care and protection. Treatment includes catheter withdrawal and appropriate antibiotic coverage. For long‐term cuffed catheters, local treatment with intraluminal administration of antibiotics is effective and can save a significant number of catheters, particularly those colonized by coagulase‐negative staphylococci.
Jejunostomy: Techniques, Indications, and Complications
Authors: Tapia Jesus , Murguia Ricardo , Garcia Gabriel , de los Monteros Pedro Espinoza , Oñate Edgardo
Published: February 2006

Jejunostomy is a surgical procedure by which a tube is situated in the lumen of the proximal jejunum, primarily to administer nutrition. There are many techniques used for jejunostomy: longitudinal Witzel, transverse Witzel, open gastrojejunostomy, needle catheter technique, percutaneous endoscopy, and laparoscopy. The principal indication for a jejunostomy is as an additional procedure during major surgery of the upper digestive tract, where irrespective of the pathology or surgical procedures of the esophagus, stomach, duodenum, pancreas, liver, and biliary tracts, nutrition can be infused at the level of the jejunum. It is also used in laparotomy patients in whom a complicated postoperatory recovery is expected, those with a prolonged fasting period, those in a hypercatabolic state, or those who will subsequently need chemotherapy or radiotherapy. As a sole procedure it is advised for neurologic and congenital illnesses, in geriatric patients who pose difficult care demands, and for patients with tumors of the head and neck. The complications seen with jejunostomy can be mechanical, infectious, gastrointestinal, or metabolic. The rate of technical complications of the Witzel longitudinal technique is 2.1%, for the transverse Witzel up to 6.6%, for the Roux‐en‐Y 21%, for open gastrojejunostomy from 2%, and for the needle catheter technique from 1.5% with 0.14% mortality. The percutaneous endoscopic procedures have as much as a 12% complication rate; no figures exist for laparoscopy. The complications are moderate and severe: tube dislocation, obstruction or migration of the tube, cutaneous or intraabdominal abscesses, enterocutaneous fistulas, pneumatosis, occlusion, and intestinal ischemia. The infectious complications are aspiration pneumonia and contamination of the diet. The gastrointestinal complications are diarrhea 2.3% to 6.8%, abdominal distension, colic, constipation, nausea, and vomiting. The metabolic complications are hyperglycemia 29%, hypokalemia 50%, water and electrolyte imbalance, hypophosphatemia, and hypomagnesemia. These complications are secondary to inadequate selection of nutrition relative to the characteristics of the patient, to inadequate management of the mixture, and to deficient clinical care. The ideal jejunostomy technique depends on the material resources but more importantly on the experience of the surgeon. The benefits of jejunostomy justify the risks.
Tailoring Antireflux Surgery: A Randomized Clinical Trial
Authors: Rydberg Lars , Ruth Magnus , Abrahamsson Hasse , Lundell Lars
Published: February 2006

A hypothesis has been formulated that mandates the adjustment of antireflux surgery to either a total or a partial wrap depending on the motor function of the esophagus to avoid dysphagia and other obstructive complaints. This hypothesis has been tested in a randomized, clinical trial where 106 chronic gastroesophageal reflux patients were allocated to either a total Nissen‐Rossetti (n= 53) or a Toupet partial posterior (n= 53) fundoplication, irrespective of their preoperative esophageal motor function. All patients were followed at least 3 years, during which time none had a relapse of moderate to severe reflux symptoms. Motor dysfunctions defined as peristaltic amplitude ≤ 30 mmHg in the distal third and failed primary peristalsis with or without > 20% simultaneous contractions were noted in 67 patients preoperatively, but these patients did not have a specific symptom profile (e.g., dominated by obstructive symptoms) nor did seven patients with “aperistaltic esophagus.” The incidence of dysphagia decreased from 20% preoperatively to 8% (mild) at 3 years after the operation with no difference between the surgical procedures. We were unable to demonstrate a relation between preoperative manometric findings and postoperative symptoms when assessed in the total group or when subdivided by the type of fundoplication (r < 0.3). Flatulence occurred more frequently among those with a total fundic wrap (p < 0.01). When patients representing motor dysfunction (see above) were specifically analyzed, we again observed no difference in outcome between those having a total or a partial fundic wrap. In conclusion, the concept of tailoring antireflux surgery based on the preoperative motor function of the esophagus in patients with chronic gastroesophageal reflux disease was not supported by the results of this clinical trial.
Surgical Gloves: Current Problems
Authors: Osman Maher O. , Jensen Steen L.
Published: February 2006

One century ago surgical gloves were introduced to practice as part of the new antiseptic technique and originally to protect the hands of the surgeon and his assistants from the harmful dermatologic effects of powerful antiseptics (e.g., carbolic acid) in use at that time. Since then, the wearing of gloves during surgery has been standard practice. Furthermore, the protection value of surgical gloves in preventing cross‐infection has stood the test of time. Nevertheless, materials used in glove manufacturing have caused a succession of iatrogenic problems in surgical patients over the years. More recently, emergence of transmissible viruses, such as hepatitis B and C and human immunodeficiency virus, has led surgeons to consider their own safety with the frequent possibility of perforation of surgical gloves by sharp instruments. In this review we discuss the problems associated with surgical glove practice: glove powder‐induced peritonitis and adhesions, latex rubber‐associated hypersensitivity, and glove perforation.
Primary Retroperitoneal Soft Tissue Sarcomas: Results of Aggressive Surgical Treatment
Authors: Malerba Marina , Doglietto Giovanni Battista , Pacelli Fabio , Carriero Concetta , Caprino Paola , Piccioni Emanuele , Crucitti Pierfilippo , Crucitti Francesco
Published: February 2006

A retrospective study was undertaken to evaluate the results of surgical treatment in a series of patients with primary retroperitoneal sarcomas consecutively treated by the same surgical team. The hospital records of 42 patients with primary retroperitoneal sarcomas who underwent surgical exploration at our unit from 1984 to 1995 were reviewed. A univariate analysis was used to identify the main clinical, pathologic, and treatment‐related factors affecting long‐term survival. Twenty‐five patients (59.6%) underwent radical surgery. The 5‐year survival and 5‐year disease‐free survival after radical resection were 48.1% and 38.8%, respectively. According to the univariate analysis of survival tumor classification (T), stage and gross surgical margins significantly affected prognosis. The study indicates that even though there are predetermined and unmodifiable tumor‐related factors, such as tumor classification (T) and stage, that influence survival in patients with retroperitoneal sarcomas, wide surgical excision offers a concrete chance for long‐term survival.
Thoracoscopic Splanchnicectomy: Pilot Evaluation of a Simple Alternative for Chronic Pancreatic Pain Control
Authors: Moodley Jaynathan , Singh Bhugwan , Shaik Abdool Samad , Haffejee Aref , Rubin Joseph
Published: February 2006

Achieving adequate pain control in patients with chronic pancreatitis remains a surgical challenge. The quest for a procedure that retains all of the residual pancreatic tissue in the absence of ductal dilatation remains elusive. This study sought to evaluate the feasibility and efficacy of thoracoscopic splanchnicectomy and attempted to outline the surgical anatomy appropriate to an adequate denervation. Of 17 patients considered suitable for the procedure, 16 had a sucessful outcome, which was statistically significant (p < 0.001). The longest follow‐up of 30 months suggests that the procedure may be more enduring than percutaneous procedures. However, the surgical anatomy is not predictable owing to the racemose arrangement of the splanchnic fibers, and a long pleurotomy with transection of all medial fibers is necessary to effect denervation. Thoracoscopic splanchnicectomy may effect immediate pain relief with negligible morbidity and absent mortality. Although the follow‐up period is short, the patient with the longest follow‐up remains pain‐free at 30 months. This procedure warrants scrutiny for its role in long‐term pancreatic pain control.
Courbures et singularités réelles
Authors: Dutertre N.
Published: February 2006

Soit

f : \mathbb {R}^n \rightarrow \mathbb {R}

un polynôme tel que f(0)=0 et tel que 0 soit un point critique isolé de f. Etant donnée ft une déformation lisse à un paramètre de f, on relie la limite:¶¶

\lim\limits_{\varepsilon \rightarrow 0} \lim\limits_{t \rightarrow 0} \int_{C_{t}^{\varepsilon}} k dv_t,

¶¶ou

C_t^\varepsilon=f_t^{-1}(0)\cap B_\varepsilon^n

est la fibre de Milnor et k la courbure, à des degrés topologiques associés à f et à sa déformation.¶¶Abstract. Let

f : \mathbb {R}^n \rightarrow \mathbb {R}

be a polynomial such that f(0)=0 and such that 0 is an isolated critical point of f. Given ft a one-parameter smooth deformation of f, we relate the limit:

\lim\limits_{\varepsilon \rightarrow 0} \lim\limits_{t \rightarrow 0} \int_{C_{t}^{\varepsilon}} k dv_t,

where

C_t^\varepsilon=f_t^{-1}(0)\cap B_\varepsilon^n

is the Milnor fiber and k the curvature, to topological degrees associated with f and its deformation.
Isolated Vascular Perfusion of Human Colon with Adenocarcinoma
Authors: Pilati Pier Luigi , Rossi Carlo Riccardo , Mocellin Simone , Pozzobon Maurizia , Galeotti Fabrizio , Foletto Mirto , Scalerta Romano , Scagnet Barbara , Alaggio Rita , Lise Mario
Published: February 2006

2 183 (78–304) mmHg; arterial PCO2 36 (31–46) mmHg. No important signs of tissue damage were found at histology. Autonomous or stimulated peristalsis (or both) was present throughout the experiment. Mean O2 extraction was 7.9 ml/min/100 g (range 3.1–11.0). Mean glucose consumption was 229 mg/100 g (range 174–252). The model worked well and appears promising, particularly for future use in various pharmacokinetic and pharmacodynamic studies of antiblastic agents.
Clinically Significant, Isolated Metastatic Disease to the Thyroid Gland
Authors: Chen Herbert , Nicol Theresa L. , Udelsman Robert
Published: February 2006

n = 5), esophageal adenocarcinoma (n= 1), pulmonary squamous cell carcinoma (n= 1), gastric leiomyosarcoma (n= 1), lingual squamous cell carcinoma (n= 1), and parotid gland carcinoma (n= 1). Three patients underwent preoperative fine‐needle aspiration (FNA), all of which were suggestive of metastatic disease. The mean time from resection of the primary tumor to thyroid metastases was 3.5 ± 6.0 years (range 0–19.5 years). Total thyroidectomy (n= 5) or lobectomy (n= 5) was performed without morbidity or mortality. After a median follow‐up of 5.2 years six patients are alive and two are free of disease. Moreover, no patients have had recurrent disease in the neck. Thus carcinomas metastatic to the thyroid represent a rare cause of clinically significant thyroid disease, with RCCs comprising 50%. Most thyroid metastases (80%) present within 3 years of primary tumor resection, but with RCC they can occur as late as 19 years. The diagnosis of metastatic disease should be suspected in patients with even a remote history of cancer, especially RCC, and an FNA revealing clear cell or spindle cell carcinoma. Contrary to previous reports, long‐term survival can be achieved after resection of the metastatic tumor. Furthermore, thyroidectomy may also palliate/prevent the potential morbidity of tumor recurrence in the neck.
Feasibility of Laparoscopic Cholecystectomy with Miniaturized Instrumentation in 50 Consecutive Cases
Authors: Reardon Patrick R. , Kamelgard Joseph I. , Applebaum Bruce , Rossman Lucho , Brunicardi F. Charles
Published: February 2006

p = NS), and postoperative LOS for the mini‐LC and conventional LC were 1.5 ± 0.2 and 1.8 ± 0.4 days (mean ± SD), respectively, (p= NS). Of the 50 mini‐LC cases, 5 required conversion to conventional LC. One cystic duct leak was detected and successfully treated conservatively; no common bile duct injuries occurred; and no patients required conversion to open cholecystectomy. This study demonstrates the safety and efficacy of minilaparoscopic instruments for the performance of cholecystectomy. The data reveal that this new technique is comparable to conventional LC.
Noninvasive Evaluation of Blunt Abdominal Trauma: Prospective Study Using Diagnostic Algorithms to Minimize Nontherapeutic Laparotomy
Authors: Shih Hsin‐Chin , Wen Yi‐Su , Ko Tun‐Jen , Wu Jar‐Kan , Su Cheng‐Hsi , Lee Chen‐Hsen
Published: February 2006

p = 0.025). Hence following well designed algorithms, noninvasive evaluation of BAT can proceed with safety, and NTL is minimized.
Type‐oriented Intraoperative and Adjuvant Chemotherapy and Survival after Curative Resection of Advanced Gastric Cancer
Authors: Shimoyama Shouji , Shimizu Nobuyuki , Kaminishi Michio
Published: February 2006

n = 16); intraoperative chemotherapy and UFT 300 mg/day (P1 group, n= 13); or UFT 600 mg/day (P2 group, n= 17). Patients with an intestinal type of cancer were randomly assigned to one of three treatment groups: H0 (n= 17), H1 (n= 12), and H2 (n= 12); each group was subjected to the same protocols as the P0, P1, and P2 groups, respectively, except for the MMC administration route. MMC (10 mg/patient) was administered intraoperatively into the intraperitoneal cavity (P1 and P2 groups) or the portal vein (H1 and H2 groups). All patients underwent curative resection. Background factors did not differ significantly among the treatment groups. The overall survival rates were progressively worsened in the order of P2, P1, and P0 or H2, H1, and H0, respectively. The survival rate of the P2 group was statistically higher than that of the P0 group (p < 0.05). The intermediate‐term survival rate of the P2 group or H2 group was significantly higher than that of the P0 group (p < 0.05) or H0 group (p < 0.05), respectively. These results suggest the effectiveness of this therapy and the possible eradication of potential micrometastatic foci outside the surgical field by the direct administration of chemotherapeutic agents to the predicted recurrence site.
Effective Hepatic Cryoablation: Does It Enhance Tumor Dissemination?
Authors: El‐Shakhs Soliman A. , Shimi Sami A. , Cuschieri Alfred
Published: February 2006

n = 12) were sacrificed after induction of liver tumors at 4 and 6 weeks. The animals in the treatment group (n= 16) underwent cryosurgery 2 weeks after tumor induction and were allowed to recover before sacrifice 2 and 4 weeks later. Pulmonary metastases were identified in 9 of 12 (75%) control animals at postmortem examination (2 and 6 weeks after tumor inoculation) and in 6 of 16 (38%) rats in the treatment group at sacrifice 2 and 4 weeks after cryosurgery (p= 0.11, Fisher's test for unpaired analysis). Peritoneal deposits were observed in 5 of 12 (42%) control animals at postmortem examination and in 8 of 16 (50%) of the treated animals at the time of cryosurgery (p= 0.95, Fisher's test for unpaired analysis). Two other study animals developed deposits after cryosurgery. The prevalence of peritoneal deposits in the study group was not altered by cryosurgery (p= 0.5, McNemar's test for paired analysis). The importance of the final subzero temperature at the edge of the iceball during tumor ablation by cryosurgery was confirmed by the histologic findings. Complete ablation with no residual viable tumor was obtained only when the subzero temperature had reached −38°C or below. The results of this study do not support the suggestion that hepatic cryosurgery enhances tumor dissemination. The findings also confirm that a subzero temperature at the edge of the iceball of −38°C or lower is necessary to ensure complete ablation of tumor.
Revealing the Cues Within Community Places: Storiesof Identity, History, and Possibility
Authors: Nowell Branda L. , Berkowitz Shelby L. , Deacon Zermarie , Foster-Fishman Pennie
Published: February 2006

Place‐based approaches to community change have become increasingly popular strategies for addressing significant social problems. With their intentional focus on ‘place,’ most efforts have sought to gain greater understanding into how neighborhood contexts affect people. However, while both aggregate characteristics and social dynamics of neighborhoods have been subject to scrutiny in the literature, less attention has been paid to understanding how the environmental characteristics of neighborhoods and communities as places have meaning for residents. The present study used an innovative methodology called Photovoice to obtain a greater understanding of themeanings residents ascribe to the salient characteristics of their neighborhoods and communities. As part of a place‐based initiative, 29 adult and youth residents in seven distressed urban neighborhoods photographed and dialogued about the meaningful physical attributes of their community. According to participants, place characteristics provided cues about their personal histories as members of the community; communicated messages about the value and character of the community and its residents; defined social norms and behavior within the community; and provided markers that could remind residents of who they are and inspire a sense of possibility for who they could become. Implications for practice are discussed.
Methods for estimating understory light conditions using crown projection maps and topographic data
Authors: Takashima Atsushi , Kume Atsushi , Yoshida Shigejiro
Published: February 2006

Four types of indices of canopy characteristics were compared to estimate understory light conditions using crown projection maps and topographic data. Crown area (CA) was formulated from the crowns in a focal sub‐block (20 m×20 m). Canopy shade index (CSI) was formulated from the crowns in a focal sub‐block and the surrounding sub‐blocks with topographic effect. Site shade index (SSI) incorporated the shade of the slopes into CSI and represented the total physical closure of the site. Site light index (SLI) incorporated the azimuth of the site into SSI and evaluated the light condition of the understory. We tested the methods using the data on steep old‐growth Cryptomeria japonica forests on Yakushima Island and the three‐dimensional canopy structures of the forests were digitized on a geographic information system. The results were validated by the basic indices obtained by hemispherical photographs: canopy openness (CO) and gap light index (GLI). The three‐dimensional structure of the surrounding canopies and topography had significant effects on the understory light conditions. CA had no significant correlation with CO, whereas CSI and SSI had significant negative correlations with CO. Although SLI had the highest negative correlation with GLI (R2=0.69), CSI had practical utility in the estimation of GLI (R2= 0.65). Our method is applicable to past crown projection maps that have been recorded at many forest research sites, thus making it possible to reconstruct past understory light conditions and to compare them with present conditions.
An Automated Metrics System to Measure and Improve the Success of Laboratory Automation Implementation
Authors: Benn Neil , Turlais Fabrice , Clark Victoria , Jones Mike , Clulow Stephen
Published: February 2006

We describe a system for collecting usage metrics from widely distributed automation systems. An application that records and stores usage data centrally, calculates run times, and charts the data was developed. Data were collected over 20 months from at least 28 workstations. The application was used to plot bar charts of date versus run time for individual workstations, the automation in a specific laboratory, or automation of a specified type. The height of one bar represented the length of one run, and its position on the x-axis indicated the date the run started. Graphs were visually inspected and few bars on the graph(s) indicated infrequent use. Quantitative data were obtained by running custom SQL queries. Analyses showed that 90% of the automation was used frequently (>8 runs per week). Where usage was less, or limited to part of the day, the causes were investigated by interviewing users. We show that revised user training, redeployment of equipment, and running complimentary processes on one workstation can increase the average number of runs by up to 20-fold and run times by up to 450%. Active monitoring of usage leads to more effective use of automation. Usage data#could be used to determine whether purchasing particular automation was a good investment. (JALA 2006; 11: 16-22)
Inhibition of Xylella Fastidiosa Biofilm Formation via Metal Chelators
Authors: Toney Jeffrey H. , Koh Mipha L.
Published: February 2006

Xylella fastidiosa (Xf) is the causative agent of Pierce's disease in a variety of commercially important plants such as citrus, coffee, and grapes. By blocking the xylem, Xf disrupts water and nutrient transport. Xf is a gram-negative phytopathogen that can form biofilms. Twelve genes have been identified in Xf that can regulate exopolysaccharides, a major component of biofilms, including aconitase, which responds to intracellular iron levels. We have employed a quantitative assay for biofilm formation referred to as minimal biofilm elimination concentration (MBEC) assay that is amenable for highthroughput screening. Biofilm formation by Xf (Napa, CA) can be blocked using iron chelators such as lactoferrin (LF), ethylenediaminetetraacetic acid (EDTA), and S, S' ethylenediaminedisuccinic acid (EDDS). Incubation of Xf in the presence of LF at 1000 μg/mL for 3.5 days showed inhibition of biofilm formation (42%) as well as inhibition (32%) of planktonic growth (liquid-phase bacteria). EDTA at a concentration of 15 mg/mL inhibited 99.7% of biofilm formation and 98.9% of planktonic growth in a 24 h incubation. In contrast, EDDS at a concentration of 38.2 mg/mL showed 64.7% inhibition of biofilm formation and 33.6% inhibition of planktonic growth. Iron deprivation could serve as a first step toward eradication of Pierce's disease via blockage of biofilm formation.
Assay Optimization: A Statistical Design of Experiments Approach
Authors: Altekar Maneesha , Homon Carol A. , Kashem Mohammed A. , Mason Steven W. , Nelson Richard M. , Patnaude Lori A. , Yingling Jeffrey , Taylor Paul B.
Published: February 2006

With the transition from manual to robotic HTS in the last several years, assay optimization has become a significant bottleneck. Recent advances in robotic liquid handling have made it feasible to reduce assay optimization timelines with the application of statistically designed experiments. When implemented, they can efficiently optimize assays by rapidly identifying significant factors, complex interactions, and nonlinear responses. With the use of an integrated approach called automated assay optimization developed in collaboration with Beckman Coulter (Fullerton, CA), the process of conducting these experiments has been greatly facilitated. This approach imports an experimental design from a commercial statistical package and converts it into robotic methods. The data from these experiments are fed back into the statistical package and analyzed, resulting in empirical models for determining optimum assay conditions. The optimized assays are then progressed into HTS. This tutorial will focus on the use of statistically designed experiments in assay optimization.
Immunohistochemical detection of E-cadherin in certain types of salivary gland tumours
Authors: Andreadis D , Epivatianos A , Mireas G , Nomikos A , Poulopoulos A , Yiotakis J , Barbatis C
Published: February 2006

Objectives: To investigate the topography of E-cadherin and its possible correlation with the histological phenotype of salivary gland tumours.

Material and methods: Archival formalin-fixed, paraffin-embedded sections of 54 benign and 56 malignant tumours and 24 samples of normal and inflamed salivary gland tissue were studied immunohistochemically using an Envision/horseraddish peroxidase (HRP) technique.

Results: In normal and inflamed salivary gland samples, E-cadherin was expressed at the membrane of acinar, myoepithelial and ductal cells located at cell–cell contact points. Reduction and/or absence of E-cadherin was only observed in pleomorphic adenoma at the peripheral cells of the duct-like or island structures, or in the cells exhibiting plasmacytoid or stromal differentiation. Neoplastic epithelium in Warthin's tumours and in myoepithelial and oncocytic adenomas was strongly positive. Furthermore, a weak to moderate loss of expression which was related to tissue tumour subtype was seen in malignant tumours such as: adenoid cystic carcinomas; polymorphous low-grade adenocarcinomas; acinic cell carcinomas; and mucoepidermoid low-grade, epithelial-myoepithelial, lymphoepithelial and squamous low-grade carcinomas. Moderate to extreme loss or alternative cytoplasmic non-functional expression were observed in cases of salivary ductal carcinoma, carcinosarcoma, myoepithelial carcinoma, oncocytic adenocarcinoma, unspecified adenocarcinoma and squamous high-grade carcinomas.

Conclusion: This study suggests a direct association of E-cadherin expression with neoplastic histologic phenotype, which is lost in the more undifferentiated and invasive epithelial salivary gland tumours.
Ear, nose and voice problems in children with orofacial clefts
Authors: Hocevar-Boltezar I , Jarc A , Kozelj V
Published: February 2006

The purpose of this study was to compare the prevalence of ear, nose and particularly voice problems in groups of children with cleft palate (CP) and with unilateral cleft lip, alveolus and palate (UCLP). On the basis of history, regular otorhinolaryngological examinations and hearing tests, the prevalence of different pathologies was assessed in 80 CP children (35 boys and 45 girls) and 73 UCLP children (47 boys and 26 girls). Ear pathology was reported in 53.8 per cent of CP children and in 58.9 per cent of UCLP children. Nasal breathing was impaired in 14 CP (17.5 per cent) and 36 UCLP (49.3 per cent) children. Dysphonia was detected in 12.5 per cent of CP and 12.3 per cent of UCLP children. In 9.2 per cent of all cleft children, functional voice disorder caused a hoarse voice. Two-thirds of cleft children with functional dysphonia had protracted hearing loss. Therefore, ENT specialists must take an active role early in the treatment of children with clefts.
Giant sublingual epidermoid cyst: a report of two cases
Authors: Yılmaz Ismaıl , Yılmazer Cuneyt , Yavuz Haluk , Bal Nebıl , Ozluoglu Levent N
Published: February 2006

Epidermoid cysts are benign epithelial cysts that occur rarely in the neck. In contrast to dermoid cysts, epidermoid cysts do not include dermal attachments such as hair, hair follicles, sebaceous glands and sweat glands. They may be congenital or acquired. Acquired epidermoid cysts are either post-traumatic or iatrogenic. They rarely enlarge markedly.

This study discusses epidermoid cysts in a 34-year-old woman and a 35-year-old man, both of which were giant epidermoid cysts in the sublingual space. Both patients were admitted for difficulty swallowing and cosmetic problems. The cysts of both patients had an aetiology of trauma and were documented by pathology sections and pre-operative magnetic resonance images. Both cysts were excised completely, one intraorally and one externally. Such cysts are benign and ought to be borne in mind in the differential diagnosis of oral cavity and neck cystic masses.
Nevermind The Beatles, here's Exile 61 and Nico: ‘The top 100 records of all time’ – a canon of pop and rock albums from a sociological and an aesthetic perspective
Authors: VON APPEN RALF , DOEHRING ANDRÉ
Published: February 2006

For this article the authors analysed thirty-eight lists of ‘The 100 greatest albums of all time’ type. As the findings demonstrate, a canon of popular music has evolved which shows strong tendencies towards stability in featuring albums from the late 1960s (especially those by The Beatles), while only a few albums from the 1990s have gained ‘classic’ status. The canon's contents and exclusions are explained by the social dispositions of the participants, predominantly white males aged twenty to forty. Influenced by efforts of the cultural industries, these actors also evaluate certain albums for the purposes of distinguishing themselves from the ‘mainstream’. Furthermore, aesthetic and artistic criteria underlying the esteem of the ‘masterworks’ are identified by analysing reviews. The authors suggest that future research on canonisation should interlock sociological and aesthetic perspectives. Findings from such an approach might initiate reflection among music fans about their own exclusions, and result in an opening up of the meaning and significance of the canon.
‘Loaded’: indie guitar rock, canonism, white masculinities
Authors: BANNISTER MATTHEW
Published: February 2006

Indie alternative rock in the 1980s is often presented as authentically autonomous, produced in local scenes, uncaptured by ideology, free of commercial pressures, but also of high culture elitism. In claiming that the music is avant-garde, postmodern and subversive, such accounts simplify indie's historical, social and cultural context. Indie did not simply arise organically out of developing postpunk music networks, but was shaped by media, and was not just collective, but also stratified, hierarchical and traditional. Canon (articulated through practices of archivalism and connoisseurship) is a key means of stratification within indie scenes, produced by and serving particular social and cultural needs for dominant social groups (journalists, scenemakers, tastemakers, etc.). These groups and individuals were mainly masculine, and thus gender in indie scenes is an important means for deconstructing the discourse of indie independence. I suggest re-envisioning indie as a history of record collectors, emphasising the importance of rock ‘tradition’, of male rock ‘intellectuals’, second-hand record shops, and of an alternative canon as a form of pedagogy. I also consider such activities as models of rational organisation and points of symbolic identification.
Snobs and quétaines: prestige and boundaries in popular music in Quebec
Authors: OLLIVIER MICHÈLE
Published: February 2006

This paper is a study of prestige and boundaries in Quebec French-language popular music. Based on interviews with artists, producers and critics conducted in the early 1990s, I argue that popular music in Quebec at that time remained divided along a symbolic boundary established in the 1960s between a highly prestigious group of songwriters/rock artists, who wrote and sang their own material, and a less prestigious group of interpreters/artistes populaires, who sang light pop songs or songs written by others. As predicted by Bourdieu, I show that artists in the most prestigious category were associated with privileged social groups and gained material and symbolic advantages from their prestige. They are more likely to receive honorific awards, to be invited to perform at special cultural events, to see their work recognised as ‘important’, and to persist over time. In opposition to Bourdieu, however, I argue that in the context of emerging nationalism, their songs were also perceived as providing collective benefits over and beyond class and gender divisions.
The design of a 2-dof novel flexible parallel robot
Authors: Zhao Yongjie , Huang Tian , Yang Zhiyong
Published: February 2006

This paper addresses the design of a 2-dof novel flexible parallel robot that maximizes the fundamental frequency of vibration under a specified total weight constraint. In order to enhance the natural frequency of the robot in the direction Z, structure modification of the robot is made based on the initial project. The proposed robot is suitable for the application that requires high-speed motion in a plane and step-by-step, or relatively low speed on the orthogonal direction.
The role of platinum-based therapy for HER-2-positive breast cancer
Authors: Joy A. A. , Mackey J. R.
Published: February 2006

Trastuzumab is a monoclonal antibody targeting the human epidermal growth factor receptor-2 (HER-2) protein, the mediator of an aggressive breast cancer phenotype. Trastuzumab has an important role in the treatment of metastatic breast cancer (MBC) where it improves multiple endpoints, including overall survival. More recently, striking activity is also seen in non-MBC, with substantial benefits seen in both the neoadjuvant and adjuvant settings. Experimental data has identified synergistic therapeutic effects of platinum containing chemotherapeutic regimens when combined with trastuzumab. We review the pre-clinical and rapidly evolving clinical evidence supporting platinum and trastuzumab combinations for HER-2-positive breast cancer.
Combined in situ and remote sensing of ionospheric ion outflow
Authors: Fuselier S. A. , Claflin E. S. , Mende S. B. , Carlson C. W. , Moore T. E.
Published: February 2006

Images of charge‐exchanged neutrals from ion outflow during a period of substorm recovery are supported by auroral oval images and simultaneous in situ ion outflow measurements. From these combined remote sensing and in situ measurements, the ion outflow is shown to consist of ion conics. The energy of these conics likely increases from <10 eV at 0.7 RE to >10 eV above this altitude. These first global images of the instantaneous outflow show that outflow occurs over nearly the entire dayside auroral oval at high latitudes, including the cusp. The broad local time extent of the outflow is observed for ∼2.5 hours. Outflow on the nightside may be weaker than on the dayside and/or may have different energy‐altitude dependence.
Emission of highly 13C‐depleted methane from an upland blanket mire
Authors: Bowes Helen L. , Hornibrook Edward R. C.
Published: February 2006

Rates and δ13C values of CH4 flux are reported from an upland blanket mire (Blaen Fign) situated in Wales UK. The δ13C values of CH4 flux were similar from Sphagnum and vascular flora dominated areas despite flux rates being an order of magnitude greater from the latter. Methane flux was 13C‐depleted relative to belowground CH4, indicating that transport occurred predominately via passive diffusion through vascular flora and that pore water diffusion and ebullition contributed little to CH4 flux. The strong influence of vascular flora abundance on CH4 flux strength suggests that any factors altering vegetation assemblages in blanket mires will likely impact CH4 emission rates. Methane flux from Blaen Fign was highly 13C‐depleted compared to emissions from minerotrophic wetlands, suggesting that δ13C values may be useful for tracing CH4 flux from blanket mires and other types of ombrogenous peatlands to the global CH4 budget.