bluuebunny/crossref_metadata_2025 huggingface dataset:
News Notes
Authors: Duncan Charles T.
Published: July 2017

News for inclusion in this section … activities of schools and departments of journalism, staff appointments and changes, curricular developments and the like … should be sent to Professor Duncan, School of Journalism, University of Oregon, Eugene, Ore. Notes for the next issue should reach him by January 1.
Toward an Understanding of News-Reading Behavior
Authors: Kay Herbert
Published: July 2017

Under the guidance of Dr. Chilton R. Bush, director of the Institute for Journalistic Studies at Stanford University, this study takes a fresh approach to the problem of determining why people read certain items and ignore others. It suggests that anxiety is a “pervasive determinant of news-reading behavior.”
Effect of Newscast item Leads upon Listener Interpretation
Authors: Tannenbaum Percy H. , Kerrick Jean S.
Published: July 2017

An earlier study by the senior author showed that headlines have a significant effect upon the interpretation of newspaper stories. An experiment with newscast “leads” produced similar results. Dr. Tannenbaum is director of research in television at Michigan State; Mrs. Kerrick is a research assistant at Illinois.
Small-City Daily Newspapermen: Their Abilities and Interests
Authors: Jones Robert L. , Swanson Charles E.
Published: July 2017

Editorial-side workers from nine small-city dailies in Minnesota were given a battery of standardized ability and interest tests. The results are compared here with norms for other groups on these same tests and with the showing made by metropolitan newspapermen in an earlier Minnesota personnel study.
Economies in Cross Channel Affiliation of Media
Authors: Levin Harvey J.
Published: July 2017

The chief advantages of owning two different kinds of media appear to lie in promotion and “hedging” against the unknown, rather than in lower costs. Dr. Levin is assistant professor of economics at Pennsylvania State University and research consultant in the Bureau of Applied Social Research at Columbia.
Journalism Opportunities in the Armed Forces
Authors: Haskins Jack B.
Published: July 2017

Since one out of three male graduates of journalism schools now goes directly into military service, opportunities for the use of journalistic training are of great interest to students and their advisers. The author made this study while on leave from the Minnesota faculty as an officer in the U. S. Navy.
San Francisco Newspapers’ Campaign Coverage: 1896, 1952
Authors: Batlin Robert
Published: July 2017

Three San Francisco newspapers gave more nearly equal news treatment to the two major parties in the 1952 presidential campaign than did three San Francisco papers in 1896, but still gave the party each supported editorially an advantage. The study was made for an M.A. thesis at Stanford University.
Correspondents of U. S. Media in the United Kingdom
Authors: Kruglak Theodore E.
Published: July 2017

American newspapers have fewer staff correspondents in London now than in 1932, but other media have increased their coverage. So Professor Kruglak finds in this analysis of the composition of the newspaper correspondents’ corps, and of problems encountered in their reporting of the British scene.
The Egyptian Press and Its Current Problems
Authors: Smith Henry Ladd
Published: July 2017

Egyptian newspapers are striving to overcome handicaps of illiteracy, lack of access to news, censorship and an inadequate economic base. Dr. Smith, journalism professor at Wisconsin, spent the 1952-53 academic year in Egypt as a Fulbright lecturer at Cairo University and the American University at Cairo.
An Analysis of Degree and Rank: 1947-1953
Authors: Vernon Dodd
Published: July 2017

A study of the 1947 and 1953 journalism teachers’ directories shows an increase in number of teachers listed despite student enrollment declines, and an increase in the number of teachers holding doctor's degrees. The author is assistant professor of journalism at Texas Technological College.
A Selected Bibliography from Foreign Journals
Authors:   Assisted, Haiderer F. , Alisky Marvin
Published: July 2017

During the last three months the short life of the London Daily Recorder was discussed and analyzed. At the end of March it changed back to weekly appearance and had to be sold some weeks later.

The General Assembly of the International Press Institute met for the third time (in Vienna). Freedom of the press and the internal organization of the institute were main topics. In Bordeaux the International Federation of Journalists met for the second time.

Lord Camrose (Berry), one of the British “Press Lords,” died in June.
A Method for Analyzing Newspaper Campaign Coverage
Authors: Price Granville
Published: July 2017

The new chairman for courses in journalism at the University of Idaho reports on a plan for measuring the intensity of a paper's political leanings in several areas of news performance. Done as research for his Ph.D. thesis at Missouri, Dr. Price's work is a pilot study for a large-scale analysis of election news.
Recent Trends in the Weekly Newspaper Field
Authors: Barnhart Thomas F.
Published: July 2017

Despite a decline in the number of papers, the weekly field is stronger than ever before. This conclusion is based on a study of trends and on personal visits to more than 450 weekly newspaper offices. The author is professor of journalism at Minnesota and author of three books on weekly journalism.
The Influence of Italy's Communist-Bloc Dailies
Authors: Porter William E.
Published: July 2017

Contributing to the strength of the Communist movement in Italy are party and fellow-traveling daily newspapers, which are described in the article below. The author, an assistant professor in the School of Journalism, State University of Iowa, was a Fulbright lecturer at the Istituto di Pubblicismo in Rome.
Intrauterine Fetal Death With Vanishing Gastroschisis and Post Mortem Examination Findings
Authors: Jolley Alexandra Frances , Beare Elizabeth Jane , Granger Jeremy , Cord-Udy Catherine Lucy , Muller Peter , Moore Lynette
Published: July 2017

We present a severe case of vanishing gastroschisis resulting in intrauterine death with post mortem examination findings. Gastroschisis is defined as a full thickness paraumbilical abdominal wall defect associated with evisceration of fetal intestine. It is almost always right-sided. Vanishing gastroschisis is an extremely rare form of gastroschisis that results in short bowel syndrome due to exteriorized bowel disconnected from the lumen of the rest of the bowel proximally as well as distally in association with partial or complete closure of the abdominal wall. This case is only the second published case of vanishing gastroschisis resulting in intrauterine fetal death including post mortem examination findings. It highlights the importance of being aware of this rare form of gastroschisis and provides insights regarding pathogenesis, ultrasound surveillance, and antenatal counseling.
Clinical, Pathologic, and Genetic Features of Wilms Tumors With WTX Gene Mutation
Authors: Alexandrescu Sanda , Akhavanfard Sara , Harris Marian H , Vargas Sara O
Published: July 2017

Clinical and pathologic features of patients with WTX-mutated Wilms tumor (WT) have not been studied in detail. We characterize the clinical and pathologic findings in WT with WTX abnormalities and provide comparison with WT without WTX mutation. Clinical, gross, and microscopic features in 35 patients with WT were examined. Karyotype was examined in a subset of cases. All cases had been previously analyzed for WTX, WT1, and CTNNB1 aberrations via array comparative genomic hybridization; OncoMap 4 high throughput genotyping was performed on 18 cases. Eleven tumors had WTX abnormality. No significant differences were identified between patients with mutated versus nonmutated WTX with respect to gender (45% versus 33% male), age (mean 3.9 versus 4.1 years), tumor size (mean 12.7 cm versus 12.8 cm), anaplasia (9% versus 12%), rhabdomyoblastic differentiation (18% versus 8%), cartilage differentiation (9% versus 4%), mucinous epithelial differentiation (9% versus 4%), nephrogenic rests (28% versus 21%), or relapse rate (11% versus 25%). Mutations in KRAS, MYC, and PIK3R1 were restricted to WTX-mutated WT, mutations in AKT, CKDN2A, EFGR, HRAS, MET, and RET were restricted to WT without WTX mutation, and mutations in BRAF, CTTNB1, NRAS, PDGFRA, and STK11 were seen in both groups. Our study revealed no clinical or pathologic distinctions between WT with and without WTX abnormality. This similarity lends support to the concept of a common tumorigenic pathway between WT with aberrant WTX and those without.
Fatal Vernix Caseosa Aspiration Associated With Persistent Pulmonary Hypertension of the Newborn
Authors: Nakwan Narongsak , Kamolvisit Wuttichart , Napapongsuriya Charoen , Chaiwiriyawong Pornpreenun , Charoenlap Cheep
Published: July 2017

Vernix caseosa aspiration is an extremely rare condition resulting in high mortality if complicated by persistent hypertension of the newborn (PPHN). Herein we offer the first case report of PPHN due to massive vernix caseosa aspiration documented by histopathological examination. This case report is presented to provide a synopsis of the pathoetiology of PPHN related to vernix caseosa aspiration syndrome as likely to be encountered by neonatologists and general pediatricians involved with neonatal care.
Adrenal Histologic Stress-related Changes in Third Trimester Stillbirth
Authors: Jacques Suzanne M , Qureshi Faisal
Published: July 2017

Adrenal histologic changes, including compact cell change (CCC), cystic change (CYC), and adrenal hemorrhage (AH), and their clinical correlations have only infrequently been investigated in stillbirth. We evaluated 75 third trimester singleton stillborns with complete autopsies (30 term and 45 preterm). A total of 58 had unexplained stillbirth and 17 had clinical placental abruption. The mothers were predominantly African-American (89%). CCC and CYC were diagnosed as cytoplasmic eosinophilia and cystic cavities in the definitive cortex, respectively. Adrenal changes were correlated with acute thymic involution (ATI), thymic petechiae, and clinical features, including abruption. CCC, CYC, and AH were present in 58 (77%), 51 (68%), and 15 (20%) of the 75 stillborns, respectively. CCC and CYC were frequently seen together ( P < .001). CCC and CYC were associated with higher ATI grade ( P < .001 and P = .010, respectively). The presence of CCC, but not CYC, was associated with absence of thymic petechiae ( P = .013) and was more frequent with unexplained stillbirth compared to abruption ( P = .017). AH was associated with lower ATI grade ( P = .002), with thymic petechiae ( P < .001), and with abruption ( P = .004). CYC was associated with diabetes ( P = .015). Overall, CCC and CYC were frequent findings and correlated with higher ATI grade, suggesting similar causes and time frames. CCC, but not CYC, correlated with unexplained stillbirth compared to abruption, but its high frequency in both groups limits its usefulness in their separation. AH was more frequent in the abruption group and correlated with lower ATI grade and thymic petechiae, supporting an association with sudden asphyxial death.
Obtaining consent for an operation: A choice of words or numerical probabilities?
Authors: Earlam Richard , Rizwan-Hasib Mostafa , Tross Samantha , Morris Gareth
Published: July 2017

Questionnaires were administered to 105 consultants, junior medical staff and students at the Royal London Hospital in a study which aimed to find how the respondents would associate 46 words with percentage numbers. The words ‘certain’ and ‘never’ had a mean of 96 and 5, and a median of 100 and 0. The addition of the adjective ‘almost’ changed the median figures to 95 and 1. ‘Probable’ had a mean of 64, a median of 75 but a range of 50–80. ‘Possible’ had a mean of 32 and a median of 30, but a range of 15–50. The variation and range of all the other 46 words was even more variable and extensive, with no accurate prediction of the numerical value. However inadequate words are in communicating risk, they must still be used as a ‘discourse opener’, backed up by numerical figures. It is suggested that risk has been communicated using words and numbers. The patient may actually be more interested in what the surgeon is going to do about reducing the incidence of those risks than in the actual meaning of words.
Identifying risks using a new assessment tool: The missing piece of the jigsaw in medical device risk assessment
Authors: Brown Anthony S
Published: July 2017

Introduction

There is an increasing expectation for the NHS to deliver a constantly up-to-date health service that is both safe and patient-oriented. This paper outlines the findings of a new risk assessment tool implemented across the organization targeted specifically to medical devices.

Method

The process employs a new medical devices risk assessment tool (MeDRa) to collect quantitative data relating to the contributory factors and control measures associated with medical devices used in the clinical setting. The tool utilises the responses from healthcare professionals as the ‘real experts’ in assessing risk to compute risk ratings for each device. Consequently the risk assessments are validated through the professional judgement of the clinical staff.

Results

As the data is inputted, the software tool computes the individual risk profiles for device categories in the particular clinical setting. A macro perspective of medical device risk is produced through statistical analysis and mathematical modelling using cross-tabulations. Risk perceptions are influenced by the differences in professional roles of nursing and medical staff. The outcome of the analysis is a report on medical device risks across the organization and an associated action plan, which identifies ways of mitigating those risks.

Conclusions

This approach efficiently produced risk assessments for each clinical area across the whole Trust in a matter of weeks. The MeDRa tool collated evidence to satisfy many of the criteria necessary for the external assurance framework. The subsequent statistical analysis and mathematical modelling highlighted a number of issues across the Trust that required interventions.
The Nuffield Council on Bioethics Report — Critical care decisions in fetal and neonatal medicine: Ethical issues
Authors: Winyard Anne
Published: July 2017

Anne Winyard, a member of the Working Party, summarises the main findings of the Report which examines the ethical, social and legal issues which may be raised in critical care decision-making and makes practical recommendations for future policy and practice. The Report provides guidelines to help parents and professionals make decisions about instituting intensive care for extremely premature and seriously ill babies.
Negligent prescribing of long-term antipsychotic over 12 years
Authors: Collier Spencer , Collins John , Sayer William Latimer , Harris Mark , Dolan Bridget
Published: July 2017

General damages: £35,000;June 2006;

Total Award: £150,000

Negligent prescribing of long-term antipsychotic Depixol over a period of 12 years leading to tardive dyskinesia, marked sedation and cognitive blunting.
The Arizona Telemedicine Program business model
Authors: Barker Gail P , Krupinski Elizabeth A , Mcneely Richard A , Holcomb Michael J , Lopez Ana Maria , Weinstein Ronald S
Published: July 2017

summary

The Arizona Telemedicine Program (ATP) was established in 1996 when state funding was provided to implement eight telemedicine sites. Since then the ATP has expanded to connect 55 health-care organizations through a membership programme formalized through legal contracts. The ATP's membership model is based on an application service provider (ASP) concept, whereby organizations can share services at lower cost; that is, the ATP acts as a broker for services. The membership fee schedule is flexible, allowing clients to purchase only those services desired. An annual membership fee is paid by every user, based on the services requested. The membership programme income has provided a steady revenue stream for the ATP. The membership-derived revenue represented 30% of the ATP's $2.6 million total income during fiscal year 2003/04.
The Collections of Sir John Lubbock, the First Lord Avebury (1834–1913) ‘An Open Book?’
Authors: Owen Janet
Published: July 2017

Does the collection of archaeological and ethnographic material created by Sir John Lubbock shed light on the nature of late 19th-century English society, and Lubbock's role within it? I am currently undertaking research1 into this very question, exploring the depths of potential meaning held by a selection of artefacts now housed at Bromley Museum2 and the British Museum. This article proposes a methodology for carrying out such a collection analysis, as a form of discourse analysis, and summarizes a few of the conclusions and ideas that are beginning to emerge from its application.
Trauma Scoring
Authors: Champion H. R.
Published: July 2017

Severity scales to characterize the nature and extent of injury are important adjuncts to trauma care systems, trauma research and many of the elements of a complete public health approach to injury. This article provides a brief overview of severity scale development over the past 30 years during which the science to support such initiatives has matured substantially.

Anatomical, physiological, intensive care, composite and complex scales and models now abound and are being applied to a variety of tasks with increasing precision. Trauma registries enable the meaningful aggregation of data for the development and testing of models. Future challenges are identified as are potentially fruitful avenues of research.
Initial Management of the Poly-Trauma Patient: A Practical Approach in an Australian Major Trauma Service
Authors: D'Amours S. K. , Sugrue M. , Deane S. A.
Published: July 2017

The initial management of the poly-trauma patient is of vital importance to minimizing both patient morbidity and mortality. We present a practical approach to the early management of a severely injured patient as practiced at Liverpool Hospital in Sydney, Australia. Specific attention is paid to innovations in care and specific controversies in early management as well as local solutions to challenging problems.
Peripheral Vascular Disease as Predictor of Outcome after Coronary Artery Bypass Grafting
Authors: Loponen P. , Taskinen P. , Laakkonen E. , Nissinen J. , Peltola T. , Wistbacka J-O. , Luther M.
Published: July 2017

Background and Aims:

Understanding and objective assessment of risks is crucial in cardiac surgery. The aim of this study was to assess the influence of peripheral vascular disease (PVD) on morbidity, mortality and outcome in coronary artery bypass grafting (CABG) patients.

Material and Methods:

The ankle-brachial pressure index (ABPI) was used as indicator of PVD and was measured in 178 CABG patients. Two groups were established: 1. normal ABPI (0.9–1.3) (n = 136) and 2. lowered ABPI (< 0.9) (n = 35). The mean follow-up was 26 months.

Results:

The presence of PVD was 20.5 %. Patients with PVD were older (p < 0.05), more often of female sex (p < 0.05), had higher Higgins's risk score (p = 0.001) and more often intermittent claudication (IC) (p < 0.001). PVD significantly predicted atrial fibrillation (FA) (p < 0.05) and relatively postoperative myocardial infarction (MI) (p = 0.058).

Conclusions:

The presence of PVD is relatively high in CABG patients and increases with age. PVD predicts some morbidity but seems to have fairly little influence on short-term or middle-term outcome of CABG patients. ABPI may be of only limited value in identifying patients with high operative risk in CABG.
Prognosis of Primary Melanoma
Authors: Ilmonen S. , Asko-Seljavaara S. , Kariniemi A-L. , Jeskanen L. , Pyrhönen S. , Muhonen T.
Published: July 2017

Materials and Methods:

To investigate the prognosis of primary melanoma, we studied a Finnish population of 298 primary melanoma patients, the majority with stage I or II tumours. The median clinical follow-up (4.8 years) was acquired from the patients' records, and the overall survival thereafter was collected from patient registries. The median follow-up for overall survival was 9.5 years.

Results:

The overall survival rate was 66.8 %. 24.5 % developed metastasis, 17.8 % died of melanoma, and 15.4 % died of some other cause. Surgical margins had no effect on survival. In univariate analysis the most significant prognostic factors for disease-free and overall survival were stage of tumour (p < 0.0001), thickness of tumour (p < 0.0001), depth of tumour invasion (p < 0.0001) and tumour ulceration (p = 0.0005, p < 0.0002). Ulceration was an unfavorable prognostic marker. Younger patients had better survival outcomes than older ones (p = 0.04). Accordingly, in the multivariate Cox model the independent prognostic factors for both disease-free and overall survival were stage of tumour and thickness of tumour. Tumour location on trunk was an independent adverse prognosticator for overall survival.

Conclusion:

We conclude that the prognosis of primary melanoma has improved in Finland in the last decades being in line with a global tendency.
Staging of Rectal Carcinoma with Transrectal Ultrasonography
Authors: Nesbakken A. , Løvig T. , Lunde O. C. , Nygaard K.
Published: July 2017

Background and Aims:

Transrectal ultrasonography (TRUS) has proven useful for loco-regional staging of rectal carcinoma in specialised centres, but the investigation is not widely used. The aim of this study was to audit the introduction of TRUS performed by surgeons without previous experience with ultrasonography.

Material and Methods:

All patients admitted with rectal carcinoma in the period 1996–2002 entered this prospective, comparative study. TRUS with a stiff endorectal probe was performed preoperatively in 118 consecutive patients, 91 of whom subsequently had rectal resection without preoperative radiotherapy (PRT), and seven who had rectal resection after PRT. Twenty patients did not have resection. The main outcome measures was the feasibility of TRUS in staging of rectal cancer, and the accuracy of T- and N-staging, comparing TRUS with the histopathological examination of resected specimens.

Results:

TRUS was successful in 81/91 patients who underwent rectal resection without PRT. The accuracy of T-staging was 74 % overall; 40 % in five pT1 tumours, 81 % in 26 pT2 tumours, 80 % in 45 pT3 tumours and 25 % in four pT4-tumours. With regard to perirectal tissue invasion, the sensitivity and specificity of TRUS was 82 % and 84 %, respectively, and the positive and negative predictive values were 89 and 71 %, respectively. The accuracy of TRUS for N-staging was 65 %. The sensitivity for detection of lymph node metastases was 41 % and the specificity 68 %. TRUS was unsuccessful in 21/118 patients, in 12/98 who had rectal resection, and in 9/20 who did not have resection, because of stenosis or high location of the tumour precluding correct placing of the probe.

Conclusions:

TRUS is often unsuccessful in patients with advanced tumours, especially when the tumour is located in the upper rectum. The predictive values for perirectal tumour invasion were acceptable, but the sensitivity for detection of lymph node metastases was low. These results were obtained by surgeons without previous experience with ultrasonographic examinations.
Ankle Brachial Index Measurements in Critical Leg Ischaemia — The Influence of Experience on Reproducibility
Authors: Mätzke S. , Franckena M. , Albäck A. , Railo M. , Lepäntalo M.
Published: July 2017

Background and Aims:

While the use of ankle brachial indices (ABI) in the screening for peripheral arterial obstructive disease is widely accepted, the applicability of ABI in the identification of critical leg ischaemia (CLI) is far from settled. The aim was to assess inter-observer variability of ABI measurements in patients with CLI.

Material and Methods:

The study was conducted in two parts. In both parts a handheld 9.5 MHz Doppler device was used.

Part A:

ABI was measured by 7 measurers with variable measurement experience in 22 limbs of patients admitted to the surgical ward because of CLI. The agreement between the measurements was assessed.

Part B:

Inter-observer agreement in measuring ABI was assessed between 2 trained vascular technicians measuring 33 limbs in patients with CLI on the vascular outpatient clinic.

Results and Conclusions:

Part A: 16 % of the ABI-values differed 0.15 or more from the median and the mean coefficient of variation was 56.1. Part B: The difference between measurements did not exceed 0.14 with a mean coefficient of variation of 3.2. To obtain reproducible and quantitative measurement values the measurements have to be performed by trained personnel. Measurements performed by untrained personnel can only be regarded as qualitative.
Surgical Treatment of Gynecomastia: Liposuction Combined with Subcutaneous Mastectomy
Authors: Boljanovic S. , Axelsson C. K. , Elberg J. J.
Published: July 2017

The purpose of the present work has been to evaluate surgical treatment of gynecomastia performed by liposuction combined with subcutaneous mastectomy. It was designed as a prospective consecutive registration of 21 patients (28 breasts) operated in a four month period. Treatment was done in local anaesthesia in the out-patient clinic. Treatment was in one patient complicated with a haematoma. In 86 % of cases the patients were satisfied with the postoperative result. Liposuction combined with surgical excision of the gland performed as an out-patient treatment in local anaesthesia is followed by few complications and good cosmetic results.
Dissemination of Bacteria in Multiple Organs Associated with Apoptosis and Macrophage Activity in Different Stages of Experimental Sepsis
Authors: Tapfer H. , Liigant A. , Simovart H. E. , Põldoja E. , Kokk K. , Naaber P. , Talvik R.
Published: July 2017

Background:

Gram negative sepsis is reported to induce massive translocation of bacteria into tissues, which associates with decreased macrophage function and increased macrophage apoptosis.

Aims:

The objective of this study was to detect the translocation of bacteria into different organs and to evaluate macrophage activity and the apoptosis of macrophages in the liver during different stages of sepsis and to correlate these parameters.

Material:

Wistar rats (n = 43) were inoculated intraperitoneally with an E. coli and divided into 5 groups, which were killed at different times.

Methods:

Counts of translocated bacteria in tissues were evaluated by using morphological and bacteriological methods. Macrophage activity and apoptotic cells in the liver were studied by applying immunohistochemical methods.

Results:

The counts of E. coli were the highest in the organs and blood 6 h after the onset of sepsis, being in correlation with the highest counts of apoptotic cells in the liver and the falling counts of activated macrophages. The counts of microbes show new wave of elevation in tissues by 120th h.

Conclusions:

The massive penetration of bacteria, the depressed macrophage response in early sepsis following the increased rate of apoptotic macrophages, the different rate of bacterial multiplication in tissues and blood and the second wave of the multiplication of bacteria in tissues in late sepsis all refer to the significance of developing immune dysfunction.
Immediate Breast Reconstruction
Authors: Jahkola T. , Asko-Seljavaara S. , von Smitten K.
Published: July 2017

Immediate breast reconstruction (IBR) in conjunction with mastectomy for cancer or high risk of breast cancer is safe from an oncological point of view. The cosmetic outcome can be excellent, especially when performing mastectomy by sparing the skin of the breast and reconstructing the breast mound with autogenous tissue.

The majority of women at their working age are willing to have their breast reconstructed. Patients with newly diagnosed cancer undergoing major surgery need extra support compared with those undergoing late reconstructions. Immediate reconstructions with one operation, one hospital stay and one sick leave are economically favourable by diminishing the demand of delayed reconstructions. Preference in patient selection for IBR should be in patients with good prognoses like those with diffuse noninvasive cancer and those with a considerable risk to develop breast cancer. Women with axillary-node negative invasive cancer and women with late local recurrences in breast earlier conservatively treated are also suitable for IBR. If needed, oncological treatments can be given after IBR, although radiotherapy after pure implant reconstructions is not recommended.

In order to give all eligible patients an equal opportunity to have IBR, treatment of breast patients should be centralised to hospitals with a team comprising breast cancer surgeons, pathologists, radiologists, and plastic surgeons.
Primary Hyperparathyroidism: Intraoperative Pth-Measurements
Authors: Rolighed L. , Heickendorff L. , Hessov I. , Garne J. P. , Rodt S. Å. , Christiansen P.
Published: July 2017

Background:

With the development of rapid assays and intraoperative measurement of intact parathyroid hormone (PTH), new strategies in the handling of patients with primary hyperparathyroidism (pHPT) have evolved.

Aim:

The aim of our study was to illustrate the performance of the intraoperative PTH measurement as a predictor of successful cure.

Material and Methods:

From September 1999 to April 2002 143 patients with pHPT underwent a parathyroid operation (bilateral neck exploration with identification of all parathyroid glands) with intraoperative measurements of plasma PTH (immediately prior to surgery (T0) and 5 minutes after gland excision (T5)). A positive test result was defined as plasma PTH values at T5 below 20 % of T0 or a value in the normal range below 7.6 pmol/l. Hence T5 values above 20 % of T0 and above 7.6 pmol/l were considered test negative.

Results:

122 patients (85 %) were test positive and cured, 11 patients (8 %) were test negative but cured, and 10 patients (7 %) were test negative and not cured by the primary operation. Consequently, the sensitivity of the test was 0.92 and the specificity 1.00.

Conclusions:

The rapid PTH test used is a reliable predictor of a successful outcome in pHPT patients undergoing parathyroid surgery.
Surgical Treatment of Popliteal Artery Aneurysms
Authors: Laxdal E. , Amundsen S. R. , Dregelid E. , Pedersen G. , Aune S.
Published: July 2017

Objectives:

To report the results of surgical treatment of popliteal aneurysms with respect to symptoms and aneurysm size.

Design:

A retrospective study based on prospectively registered data, in a single vascular unit.

Patients and Methods:

Forty-nine patients were subjected to 57 operations from May 1974 to June 2000. Patency and limb salvage rates are compared for limbs with and without symptoms of ischaemia, and for small (2 cm or less) and large (> 2 cm) aneurysms. The long-term survival rate was calculated and compared with that of an age and sex-matched population.

Results:

The overall 5 year graft patency was 60 %. It was 83 % for asymptomatic limbs and 49 % for limbs with ischaemic symptoms. This difference was significant (p < 0,05). The overall 5 year limb salvage rate was 76 %. It was 100 % for asymptomatic and 64 for symptomatic limbs and this difference was significant (p < 0,05). Twenty-one of the aneurysms were 2 cm or less in diameter and 85 % of these caused symptoms of ischemia. The operative mortality was 4 %. The 5-year survival rate was 57 % and significantly lower than that of a demographically matched population.

Conclusion:

The results of prophylactic operations for popliteal aneurysms on asymptomatic limbs are significantly better than those of operations done on limbs with ischaemic symptoms. The aneurysm size at which to recommend surgery is still not settled.
Combined Abdominal Aortic Aneurysmectomy and other Abdominal Operations
Authors: Georgopoulos S. , Pikoulis E. , Bacoyiannis C. , Tsigris C. , Felekouras E. , Leppäniemi A. , Papalambros E. , Bastounis E.
Published: July 2017

Background and Aim:

Co-existence of intra-abdominal non-vascular disease with an abdominal aortic aneurysm (AAA) poses a difficult surgical challenge.

Material and Methods:

Review of hospital records of 602 patients undergoing elective surgery for AAA during a 9-year period identified 61 (10.3 %) patients with a co-existent intra-abdominal non-vascular disease requiring surgery.

Results:

The concomitant operations were 26 cholecystectomies, 11 inguinal hernia repairs, 2 small bowel resections, 5 left and 5 right hemicolectomies and 1 low anterior resection for colorectal carcinoma, 1 gastrectomy for gastric carcinoma, 5 nephrectomies, one salvage cystectomy for renal carcinoma and 1 left liver lobectomy for hepatrocellular carcinoma. Additional procedures for benign diseases prolonged the operative time by a mean of 35 (range 20–105) minutes and the major operations for malignancy by 120 (range 60–225) minutes. The overall hospital mortality and morbidity rates in the whole series of AAA (n = 602) remained as low as 0.66 % and 13.6 % respectively. There was no mortality and only two complications occurred in patients undergoing the combined procedure (n = 61). During a follow up period of 4–70 months, no graft infections were detected.

Conclusion:

In selected patients, the one stage approach is safe and effective. Attention should be given to the technical details and the rules of antisepsis. In elderly patients with AAA, a co-existent malignancy should be actively excluded.
Cast vs External Fixation: A Comparative Study in Elderly Osteoporotic Distal Radial Fracture Patients
Authors: Moroni A. , Vannini F. , Faldini C. , Pegreffi F. , Giannini S.
Published: July 2017

Aim:

This study compared fracture treatment with plaster cast vs external fixation.

Methods:

Forty elderly female osteoporotic wrist fracture patients were randomized to be treated with either plaster cast (Group A) or external fixation (Group B). Bone mineral density less than −2.5 T-score was among the inclusion criteria.

Results:

In Group A, four redisplacements occurred, whereas in Group B there were none (p = 0.005). Horesh score was higher in Group B (p < 0.006) than in Group A. Volar angle deformity (p < 0.0005) and radial angle deformity (p = 0.008) were lower in Group B.

Conclusions:

This study shows that external fixation improves stability in elderly osteoporotic wrist fracture patients.
Glove Perforations in Open and Laparoscopic Abdominal Surgery: The Feasibility of Double Gloving
Authors: Laine T. , Kaipia A. , Santavirta J. , Aarnio P.
Published: July 2017

Background and Aims:

According to the traditional view, the glove protects the patient from the bacterial growth of the surgeons' hands and doing so prevents infections. Today, with growing incidences of HIV and Hepatitis B and C, surgical gloves are also important as protection for the surgeon. We compared the safety of double indicator gloves to standard single surgical gloves by investigating how often surgical gloves are punctured in laparoscopic and open gastrointestinal surgery.

Study:

As study material we gathered all gloves that had been used in gastrointestinal surgery in Satakunta Central Hospital during two months. 814 gloves from 274 operations were tested by using standardized water filling test method.

Results:

In open surgery 67 gloves out of 694 had been punctured (9.6 per cent). Puncture occurred in 22.5 per cent of operations (53 out of 236). During open surgery 24 holes out of 35 were undetected with single gloves (69 per cent). With double indicator gloves, only 3 out of 31 holes were unnoticed (10 per cent). Long duration of operation increased the risk of puncture. In laparoscopic operations 4 gloves out of 120 had been perforated (3.3 per cent).

Conclusion:

Double surgical gloves give markedly better protection in surgery. This is important especially in high risk operations.
Primary Cartilage Lesions of the Knee Joint in Young Male Adults. Overweight as a Predisposing Factor. An Arthroscopic Study
Authors: Eskelinen A. P. , Visuri T. , Larni H. M. , Ritsilä V.
Published: July 2017

Background and Aims:

This study was undertaken to evaluate the relationship between overweight and severity of arthroscopically confirmed primary cartilage lesions of the knee.

Material and Methods:

The hospital records of 88 young male adults (98 knees), who underwent arthroscopy of the knee and were diagnosed of primary cartilage lesion during 1997–98, were reviewed. The depth of the lesions was graded according to Beguin and Locker classification.

Results:

73.5 % of the lesions were patellar and 12.0 % in the medial condyle of the femur. 74.5 % of the patients had superficial (grade I—II) and 25.5 % deep (grade III—IV) lesions. Patients with deep lesions had a significantly higher body mass index (BMI 25.3 vs. 22.9, p < 0.001) and they were older (20.8 vs. 19.7 years, p = 0.023) than other patients. Similarly, patients with overweight (BMI ≥ 25.0) had significantly more often deep lesions than other patients (50 % vs. 10.4 %, p < 0.001).

Conclusions:

These results suggest, that overweight may predispose young patients to more severe cartilage lesions independent of other etiologic factors, and support the hypothesis of the cumulative effect of overweight on cartilage injuries during early adult life.
Medullary Thyroid Carcinoma
Authors: Brauckhoff M. , Lorenz K. , Ukkat J. , Brauckhoff K. , Gimm O. , Dralle H.
Published: July 2017

Medullary thyroid carcinoma (MTC) is subdivided into sporadic (75%) and hereditary (25%) forms. Several germline mutations in the RET proto-oncogene are the source of distinct clinical phenotypes in hereditary MTC including familial MTC (FMTC) and multiple endocrine neoplasia 2A (MEN 2A) and 2B (MEN 2B). The higher the penetrance of the MEN 2 phenotype the earlier the progression of MTC which forms the basis for the currently recommended codon-related concept of prophylactic thyroidectomy. In patients with sporadic MTC, routine calcitonin (CT) measurement in nodular goiter patients has been shown to reduce the frequency of advanced tumor stages. Patients with CT levels over 100 pg/ml after pentagastrin stimulation are recommended for total thyroidectomy. In patients with unexpected sporadic MTC after histological examination, completion thyroidectomy is currently only recommended when CT levels remain elevated. The extent of lymph node dissection in patients with MTC is controversial. However, with respect to lymphonodal micrometastases, systematic compartment-oriented microdissection has been shown to reduce the frequency of lymphonodal recurrence. On the other hand, to avoid unnecessary lymph node dissection, a more individualized concept is required in the future. New chemotherapeutic agents (tyrosine kinase inhibitors), therapeutic nuclids (90Yttrium-labeled octreotide), and chemoembolization of liver metastases are currently the most promising therapeutical concepts in patients with distant metastases.
Anaplastic Giant Cell Thyroid Carcinoma
Authors: Wallin G. , Lundell G. , Tennvall J.
Published: July 2017

Anaplastic (giant cell) thyroid carcinoma (ATC), is one of the most aggressive malignancies in humans with a median survival time after diagnosis of 3–6 months. Death from ATC was earlier seen because of local growth and suffocation. ATC is uncommon, accounting for less than 5% of all thyroid carcinomas. The diagnosis can be established by means of multiple fine needle aspiration biopsies, which are neither harmful nor troublesome for the patient. The cytological diagnosis of this high-grade malignant tumour is usually not difficult for a well trained cytologist. The intention to treat patients with ATC is cure, although only few of them survive. The majority of the patients are older than 60 years and treatment must be influenced by their high age. We have by using a combined modality regimen succeeded in achieving local control in most patients. Every effort should be made to control the primary tumour and thereby improve the quality of remaining life and it is important for patients, relatives and the personnel to know that cure is not impossible.

Different treatment combinations have been used since 30 years including radiotherapy, cytostatic drugs and surgery, when feasible. In our latest combined regimen, 22 patients were treated with hyper fractionated radiotherapy 1.6Gy × 2 to a total target dose of 46 Gy given preoperatively, 20 mg doxorubicin was administered intravenously once weekly and surgery was carried out 2–3 weeks after the radiotherapy. 17 of these 22 patients were operated upon and none of these 17 patients got a local recurrence. In the future we are awaiting the development of new therapeutic approaches to this aggressive type of carcinoma. Inhibitors of angiogenesis might be useful. Combretastatin has displayed cytotoxicity against ATC cell lines and has had a positive effect on ATC in a patient. Sodium iodide symporter (NIS) genetherapy is also being currently considered for dedifferentiated thyroid carcinomas with the ultimate aim of making radioiodine therapy possible.
Adrenal Incidentaloma
Authors: Zarco-González J. A. , Herrera M. F.
Published: July 2017

Adrenal incidentalomas are tumors that are serendipitously found by radiological examination. The incidence of adrenal incidentalomas in patients undergoing abdominal CT approaches 1%. The evaluation of a patient with an adrenal incidentaloma requires, in addition to a clinical history and physical examination, a focused biochemical evaluation to investigate if there is excess secretion of catecholamines, glucocorticoids, or aldosterone. Some tumors have specific features on imaging that identify them as benign or malignant. The recommendations for management of adrenal incidentalomas include resection of all functioning tumors regardless of size, preferably by the laparoscopic approach. Large, non-functional tumors should also be removed. Biochemical and radiological surveillance is recommended for at least one year, if a tumor is left in place.
Genetics of Pancreatitis
Authors: Keim V.
Published: July 2017

There was some recent progress in the understanding of genetic risk factors in chronic pancreatitis. Due to this progress some of the traditional views of the subject will change. Today, genetic risk factors are attributed a much more important role that in the past. The frequency and strength of mutations were higher than expected. Strong variants were the rare autosomal-dominant mutations N29I and R122H of PRSS1 (cationic trypsinogen) and homozygous N34S of SPINK1 (pancreatic secretory trypsin inhibitor). Other mutations (heterozygous N34S, CFTR) were of lower relevance but still mediate a higher risk than alcohol consumption. The course of genetically determined pancreatitis is rather mild. In the long term pancreas cancer was found in some patients but apart from non-smoking no adequate prophylactic strategy is available up to now.
Algorithm for the Diagnosis and Treatment of Acute Biliary Pancreatitis
Authors: Alexakis N. , Neoptolemos J. P.
Published: July 2017

Gallstones are the commonest cause of acute pancreatitis in developed countries. There is now a considerable evidence base consolidated by a series of systematic reviews, metaanalyses and guidelines that has established a clear algorithm for diagnosis and management. In the majority of patients the combination of ultrasonography and serum alanine transaminase <60 iu/l >48 hours of symptoms will identify gallstones as the cause. The simplest method of severity assessment is a high level of serum C-reactive protein (> 150 mg/l up to 72 hours after symptoms). In mild disease, all fit patients must undergo laparoscopic cholecystectomy with intraoperative cholangiography or if not fit for surgery then endoscopic sphincterotomy during the same admission to prevent further attacks. All patients with severe disease should undergo endoscopic sphincterotomy in less than 72 hours. Patients with >30% necrosis should undergo fine needle aspiration for bacteriology. Necrosectomy is indicated for infected necrosis or sterile necrosis if there are persisting clinically significant symptoms. There is increasing evidence for the use of minimally invasive pancreatic necrosectomy. Enteral nutrition should be instituted whenever possible but antibiotics should be reserved for patients with proven sepsis. The presence of fungal infection requires active anti-fungal therapy. Patients with severe disease should undergo cholecystectomy at a later stage. Patients who have undergone necrosectomy require long-term follow-up because of delayed complications.
Surgery in the Treatment of Acute Pancreatitis — Open Pancreatic Necrosectomy
Authors: Werner J. , Hartwig W. , Hackert T. , Büchler M. W.
Published: July 2017

Management of acute necrotizing pancreatitis has changed significantly over the past years. Early management is non-surgically and solely supportive. Today, more patients survive the early phase of severe pancreatitis due to improvements of intensive-care-medicine. Pancreatic infection is the major risk factor with regard to morbidity and mortality in the late phase of severe acute pancreatitis. Whereas early surgery and surgery for sterile necrosis can only be recommended in selected cases, pancreatic infection is a well accepted indication for surgical treatment. Surgery should ideally be postponed until four weeks after the onset of symptoms as necrosis is well demarcated at that time. Four surgical techniques can be performed with comparable results regarding mortality: necrosectomy combined with (1) open packing, (2) planned staged relaparotomies with repeated lavage, (3) closed continuous lavage of the retroperitoneum, and (4) closed packing. However, closed continuous lavage of the retroperitoneum, and closed packing seem to be associated with a lower morbidity compared to the other two approaches. Advances in radiologic imaging, new developments of interventional radiology and other minimal access interventions have revolutionized the management of many surgical conditions over the past decades. However, minimal invasive surgery and interventional therapy for infected necrosis should be limited to specific indications in patients who are critically ill and otherwise unfit for conventional surgery. Open surgical debridement is the “gold standard” for treatment of infected pancreatic and peripancreatic necrosis.
Customized Surgical Strategy in Chronic Pancreatitis
Authors: Mann O. , Izbicki J. R.
Published: July 2017

Despite major advances in the management of patients with chronic pancreatitis, yet the disease remains an enigmatic process of uncertain pathogenesis, unpredictable clinical course, and unclear treatment. In most of the cases intractable pain is the main indication for surgical intervention. Furthermore complications related to adjacent organs, endoscopically not permanently controlled pancreatic pseudocysts, ductal pathology, conservatively intractable internal pancreatic fistula or suspected malignancy also require surgery. The ideal surgical approach should address all these problems — tailoring the various therapeutic options to meet the individual patient's needs. In our opinion, the ideal procedure for chronic pancreatitis is the duodenum preserving pancreatic head resection in terms of an extended drainage procedure, were the extent of the pancreatic head resection may be tailored to the morphology of the pancreatic gland, thus allowing a tailored concept (to resect and/or drain as much as necessary but as little as possible). Looking at the present data, there is no need to transsect the pancreatic axis above the portal vein. If portal vein thrombosis is present, an extended drainage procedure is mandatory without transsection of the neck of the pancreas.