bluuebunny/crossref_metadata_2025 huggingface dataset:
Laparoscopic total mesorectal excision with autonomic nerve preservation
Authors: Weiser Martin R. , Milsom Jeffrey W.
Published: August 2002

Laparoscopy has greatly influenced abdominal surgery. We hypothesize that the benefits of minimally invasive surgery are applicable to rectal cancer. A cadaver model of laparoscopic rectal resection with total mesorectal excision (TME) and autonomic nerve preservation was utilized to explore this hypothesis. The principles of TME were followed, including high vascular ligation, sharp mesorectal dissection, and identification and preservation of the autonomic pelvic nerves. After proving feasibility in the cadaver model, a clinical study was performed on patients with mid to low rectal cancers. We observed acceptable morbidity with this minimally invasive technique of rectal resection and TME. We conclude that there is growing evidence that laparoscopic methods can be applied to patients with rectal cancer. Semin. Surg. Oncol. 19:396–403, 2000. © 2000 Wiley‐Liss, Inc.
Chronic treatment with imipramine or mirtazapine antagonizes stress‐ and FG7142‐induced increase in cortical norepinephrine output in freely moving rats
Authors: Dazzi Laura , Ladu Stefania , Spiga Francesca , Vacca Giada , Rivano Antonella , Pira Luigi , Biggio Giovanni
Published: August 2002

The effect of repeated administration of imipramine or mirtazapine, two antidepressant drugs with different mechanisms of action, was studied on the stress‐induced increase in the extracellular concentration of norepinephrine in the prefrontal cortex of freely moving rats. Exposure to footshock in control rats induced a marked increase in extracellular norepinephrine concentrations in the prefrontal cortex (+120%). Long‐term administration with imipramine or mirtazapine (10 mg/kg, i.p., twice or once a day, respectively, for 14 days) reduced (+50%) the effect of stress on basal norepinephrine output. Acute administration of FG7142 (30 mg/kg, i.p.), an anxiogenic benzodiazepine receptor inverse agonist, induced a marked increase in norepinephrine output (+90%) in control rats. In rats chronically treated with imipramine or mirtazapine this effect was completely antagonized. On the contrary, acute administration of these antidepressant drugs failed to reduce stress‐ and FG7142‐induced increase in norepinephrine output. The plastic changes in the sensitivity of norepinephrine neurons to footshock stress and drug‐induced anxiogenic stimuli may reveal a new important neuronal mechanism involved in the long‐term modulation of emotional state. This action might be relevant for the anxiolytic and antidepressant effect of antidepressant drugs. Synapse 43:70–77, 2002. © 2001 Wiley‐Liss, Inc.
Enhancement of presynaptic performance in transgenic Drosophila overexpressing heat shock protein Hsp70
Authors: Karunanithi Shanker , Barclay Jeffrey W. , Brown Ian R. , Robertson R. Meldrum , Atwood Harold L.
Published: August 2002

Prior heat shock confers protection to Drosophila synapses during subsequent heat stress by stabilizing quantal size and reducing the decline of quantal emission at individual synaptic boutons. The major heat shock protein Hsp70, which is strongly induced by high temperatures in Drosophila, may be responsible for this synaptic protection. To test this hypothesis, we investigated synaptic protection and stabilization at larval neuromuscular junctions of transgenic Drosophila which produce more than the normal amount of Hsp70 in response to heat shock. Overexpression of Hsp70 coincides with enhanced protection of presynaptic performance, assayed by measuring mean quantal content and percentage success of transmission. Quantal size was not selectively altered, indicating no effects of overexpression on postsynaptic performance. Thus, presynaptic mechanisms can be protected by manipulating levels of Hsp70, which would provide stability to neural circuits otherwise susceptible to heat stress. Synapse 44:8–14, 2002. © 2002 Wiley‐Liss, Inc.
Loss of metabolites from monkey striatum during PET with FDOPA
Authors: Cumming Paul , Munk Ole Lajord , Doudet Doris
Published: August 2002

The decarboxylation of 6‐[18F]fluorodopa (FDOPA) and retention of the product [18F]fluorodopamine within vesicles of catecholamine fibers results in the labeling of dopamine‐rich brain regions during FDOPA/PET studies. However, this metabolic trapping is not irreversible due to the eventual diffusion of [18F]fluorodopamine metabolites from brain. Consequently, time–radioactivity recordings of striatum are progressively influenced by metabolite loss. In linear analyses, the net blood–brain clearance of FDOPA (K, ml g−1 min−1) can be corrected for this loss by the elimination rate constant k (min−1). Similarly, the DOPA decarboxylation rate constant (k, min−1) calculated by compartmental analysis can also be corrected for metabolite loss by the elimination rate constant k (min−1). To compare the two methods, we calculated the two elimination rate constants using data recorded during 240 min of FDOPA circulation in normal monkeys and in monkeys with unilateral 1‐methyl‐4‐phenyl‐1,2,3,6‐tetrahydropyridine (MPTP) lesions. Use of the extended models increased the magnitudes of K and k in striatum; in the case of k, variance of the estimate was substantially improved upon correction for metabolite loss. The rate constants for metabolite loss were higher in MPTP‐lesioned monkey striatum than in normal striatum. The high correlation between individual estimates of k and k suggests that both rate constants reveal loss of decarboxylated metabolites from brain. Synapse 41:212–218, 2001. © 2001 Wiley‐Liss, Inc.
GABAergic neurons in prepositus hypoglossi regulate REM sleep by its action on locus coeruleus in freely moving rats
Authors: Kaur Satvinder , Saxena R.N. , Mallick Birendra N.
Published: August 2002

GABA in locus coeruleus modulates REM sleep. Apart from the presence of interneurons, locus coeruleus also receives GABAergic inputs from prepositus hypoglossi in the medulla, where the presence of REM‐ON‐like neurons have been reported. Therefore, it was hypothesized that GABAergic projections from prepositus hypoglossi to locus coeruleus may modulate REM sleep. The experiments were conducted on chronic rats prepared for recording EEG, EOG, and EMG in freely moving conditions. Bipolar stimulating electrodes were implanted in prepositus hypoglossi bilaterally, while chemitrodes were implanted bilaterally in locus coeruleus. The prepositus hypoglossi were bilaterally stimulated (3 Hz, 250 μsec, 100 μA) for 8 h in the presence and absence of picrotoxin (0.25 μg/250 nl) microinjection bilaterally in locus coeruleus, followed by poststimulation recording for 4 h. It was observed that stimulation of prepositus hypoglossi alone significantly increased REM sleep primarily by increasing the REM sleep duration per episode. However, when it was stimulated in the presence of picrotoxin in LC, REM sleep decreased, predominantly due to decreased REM sleep duration per episode. The results of this study suggest that GABAergic inputs from prepositus hypoglossi act on locus coeruleus and regulate REM sleep, possibly by inhibition of REM‐OFF neurons. Synapse 42:141–150, 2001. © 2001 Wiley‐Liss, Inc.
Energy appproach in peformance‐based seismic design of steel moment resisting frames for basic safety objective
Authors: Akbas B. , Shen J. , Hao H.
Published: August 2002

This study presents an energy approach to the performance‐based seismic design of steel moment resisting frames for the basic safety objective. The seismic demand is expressed in terms of hysteresis energy and its distribution along the height of the frame, based on an associated study. The resistance of a steel moment‐resisting frame to such demand is presented in the form of energy dissipation capacities of critical members, based on the previous experimental studies on full‐scale moment‐connections. An energy‐based design methodology is proposed for performance‐based earthquake resistant design. The proposed design method is examined using design examples and the results are discussed. Copyright © 2001 John Wiley & Sons, Ltd.
Cytotoxic and genotoxic effects of As, MMA, and DMA on leukocytes and stimulated human lymphocytes
Authors: Sordo Monserrat , Herrera Luis A. , Ostrosky‐Wegman Patricia , Rojas Emilio
Published: August 2002

Inorganic arsenic is a human carcinogen associated with different types of cancer. Arsenic metabolism produces two methylated species: monomethylarsonic and dimethylarsinic acids. Although this metabolic route has been involved in arsenic detoxification, it is still not clear whether these methylated metabolites participate in the carcinogenic process. In this work, we studied the cytotoxic and genotoxic effects of arsenic and its metabolites. Cytotoxicity was evaluated in cultured lymphocytes from three donors. Mitotic and replication indices were the parameters analyzed. The results indicate a clear cytotoxic effect by sodium arsenite but not by its metabolites. Genotoxicity was assessed by the single cell gel electrophoresis assay. Sodium arsenite increased DNA migration in stimulated lymphocytes only at doses greater than 5 × 10–6 M; meanwhile in leukocytes a weak response was observed. Monomethylarsonic acid produced in leukocytes a weak induction of DNA damage, while in stimulated lymphocytes, a dose‐increase in DNA migration was observed. The injury caused by dimethylarsinic acid was more evident than that observed in cultures treated with sodium arsenite and monomethylarsonic acid in stimulated lymphocytes, although in leukocytes no effect on DNA migration was found. In conclusion, only sodium arsenite had the capacity to alter mitotic and replication indices, while sodium arsenite and its metabolites were capable of inducing single strand DNA breaks on stimulated human lymphocytes treated in vitro for 24 h; however, the differences observed were between individual responses, one donor being more susceptible even at the lower doses. This individual susceptibility to arsenic compounds has been repeatedly observed for different end‐points and should be studied further. Teratogenesis Carcinog. Mutagen. 21:249–260, 2001. © 2001 Wiley‐Liss, Inc.
Protective effect of Picroliv, the active constituent of Picrorhiza kurroa, against chemical carcinogenesis in mice
Authors: Rajeshkumar N.V. , Kuttan Ramadasan
Published: August 2002

Cancer chemoprevention of chemically induced tumours by Picroliv, an iridoid glycoside mixture purified from Picrorhiza kurroa, was studied on 20‐methylcholanthrene (20‐MC)‐induced sarcoma model and 7,12‐dimethylbenz[a]anthracene (DMBA)‐initiated papilloma formation in BALB/c mice. Administration of Picroliv (100 and 200 mg/kg, p.o) inhibited the sarcoma development by 47 and 53% as estimated on day 200 after 20‐MC administration. Control animals started dying of tumour burden 76 days after 20‐MC administration and all animals were dead by day 170, while 60 and 66% of the animals survived in the Picroliv treated group, 100 and 200 mg/kg, respectively. Picroliv exhibited anti‐tumour‐promoting activity on a two‐stage carcinogenesis test on mouse skin using DMBA as an initiator and croton oil as a promoter. Topical application of Picroliv (1 and 5 mg/mouse) 30 minutes prior to that of croton oil application resulted in a 50 and 60% reduction in the number of animals that developed papillomas, and 48 and 64% reduction in the number of papillomas per mouse. There was also a delay in the onset of first skin tumour in the group of animals treated with Picroliv. Oral administration of Picroliv (150 mg/kg, p.o.) prior to DMBA application delayed the onset of papillomas and the percent of mice (60%) with tumours indicates that Picroliv inhibited the tumour initiation induced by DMBA. Picroliv administration was also found to increase the life span of transplanted Dalton’s Lymphoma Ascites (DLA) and Ehrlich Ascites Carcinoma (EAC) harboring mice and reduced the volume of transplanted solid tumours. Teratogenesis Carcinog. Mutagen. 21:303–313, 2001. © 2001 Wiley‐Liss, Inc.
The science/technology interaction: Implications for science literacy
Authors: Cajas Fernando
Published: August 2002

Science literacy includes understanding technology. This raises questions about the role of technology in science education as well as in general education. To explore these questions, this article begins with a brief history of technology education as it relates to science education and discusses how new conceptions of science and technological literacy are moving beyond the dichotomies that formerly characterized the relationship between science and technology education. It describes how Benchmarks for Science Literacy, the National Science Education Standards, and the Standards for Technological Literacy have been making a case for introducing technology studies into general education. Examples of specific technological concepts fundamental for science literacy are provided. Using one example from the design of structures, the article examines how understanding about design (i. e., understanding constraints, trade‐offs, and failures) is relevant to science literacy. This example also raises teaching and learning issues, including the extent to which technology‐based activities can address scientific and technological concepts. The article also examines how research can provide guides for potential interactions between science and technology and concludes with reflections on the changes needed, such as the creation of curriculum models that establish fruitful interactions between science and technology education, for students to attain an understanding of technology. © 2001 John Wiley & Sons, Inc. J Res Sci Teach 38: 715–729, 2001
Update on new developments in the study of human teratogens
Authors: Shepard T.H. , Brent R.L. , Friedman J.M. , Jones K.L. , Miller R.K. , Moore C.A. , Polifka J.E.
Published: August 2002

Background and Methods

The purpose of this annual article is to highlight and briefly review new and significant information on agents that may be teratogenic in pregnant women. Various sources of on‐line and printed information are given.

Results

The following topics have been discussed: 1) lithium medication: decreased estimate of risk; 2) cigarette smoking and genotype as contributors to oral‐facial clefts and clubfoot; 3) trimethoprim; 4) methimazole syndrome?; 5) glucocorticoids and oral‐facial clefts; 6) binge drinking; 7) fetal valproate syndrome; and 8) carbamazepine.

Conclusions

We have highlighted several maternal exposures during pregnancy that are associated with small but increased rates of birth defects, generally only a few cases per 1,000 infants. These exposures include cigarette smoking, and treatment with lithium, trimethoprim, methimazole, or corticosteroids. This weak teratogenic effect was usually identified by the linkage of an uncommon treatment with an unusual birth defect outcome. The use of modern epidemiologic techniques, especially prospective multicenter studies that provide increased numbers, has helped to strengthen the evidence for these associations. We discuss how teratogenic risks that are small in comparison to the background risk can be presented to at‐risk women and their doctors. We have briefly listed some elements that might be used in prioritizing further studies of suspected teratogenic exposures. Various existing methods for expressing the strength of evidence for human teratogenicity are also given. Teratology 65:153–161, 2002. © 2002 Wiley‐Liss, Inc.
Hypercompetition and the future of global management in the twenty‐first century
Authors: Harvey Michael , Novicevic Milorad M. , Kiessling Timothy
Published: August 2002

In today's hypercompetitive landscape, organizations are moving from being multinational to being global
in the strategic intent. There are a number of “drivers” of this globalization process, but it would
be difficult to argue that globalization is not going to be an enduring phenomena. The consequences of this
modification in the strategic orientation of organizations have implications for most every element in an
organization. To gain an insight into the future of global organizations in the twenty‐first century, a
market‐based perspective is utilized. In addition, the importance of organizational boundary spanners is
also explored as a means to effectively compete in the global competitive arena. Inpatriation is viewed as a
means to gain tacit knowledge at the headquarters level to ensure adaptation of corporate standard operating
policies to effectively compete as a global network, yet with the flexibility to meet local competitor
strategies and consumer demands. © 2001 John Wiley & Sons, Inc.
Transforming the scholarly process through information technology
Authors: Hannum Wallace
Published: August 2002

This chapter focuses on the influence of computers and communications technology on the scholarly process. Examples of this influence on all aspects of scholarship, from formulating ideas and gathering data to collaborating and publishing results, are discussed.
Student‐faculty collaborations, undergraduate research, and collaboration as an administrative model
Authors: Dotterer Ronald L.
Published: August 2002

Collaborative inquiry‐based education (undergraduate research, scholarship, and creative activity) and collaborative administrative models are this chapter’s topics. Both mentoring undergraduate research projects and collaborative administrative action point to new ways of incorporating research and learning into a single integrated process.
Toxicity of different industrial effluents in Taiwan: A comparison of the sensitivity of Daphnia similis and Microtox®
Authors: Liu M. C. , Chen C.‐M. , Cheng H. Y. , Chen H. Y. , Su Y. C. , Hung T. Y.
Published: August 2002

Industrial effluents are known to exhibit toxicity toward different aquatic organisms. In Taiwan management of these discharges still relies on chemical and physical characteristics of water, although various standard methods for assessing aquatic toxicity have been proposed by the Taiwan Environmental Protection Administration. In this study we examined the toxicity and compared the sensitivity of different types of industrial effluents using two proposed toxicity tests: the Daphnia similis acute toxicity test and the Microtox® acute assay (Vibrio fischeri). Results showed that electroplating effluents were the most toxic of all the effluents tested, followed by acrylonitrile manufacturing, pulp/paper, and tannery effluents. The EC50 of an electroplating effluent for D. similis and V. fischeri (15 min) was as low as, respectively, 2.9% and 3.9% of the whole effluent. The other effluents were not acutely toxic to either organism tested. However, the tests exhibited different sensitivity toward various discharges. Only the electroplating and acrylonitrile manufacturing effluents had effects on both organisms. These results indicate the importance of the incorporation of aquatic toxicity tests into the management scheme for treated wastewaters. © 2002 Wiley Periodicals, Inc. Environ Toxicol 17: 93–97, 2002; Published online in Wiley InterScience (www.interscience.wiley.com). DOI 10.1002/tox.10036
Mutation of the homologue of GDP‐mannose pyrophosphorylase alters cell wall structure, protein glycosylation and secretion in Hansenula polymorpha
Authors: Agaphonov Michael O. , Packeiser Anna N. , Chechenova Maria B. , Choi Eui‐Sung , Ter‐Avanesyan Michael D.
Published: August 2002

A Hansenula polymorpha mutant with enhanced ability to secrete a heterologous protein has been isolated. The mutation defines a gene, designated OPU24, which encodes a protein highly homologous to GDP‐mannose pyrophosphorylase Psa1p/Srb1p/Vig9p of Saccharomyces cerevisiae and CaSrb1p of Candida albicans. The opu24 mutant manifests phenotypes similar to those of S. cerevisiae mutants depleted for GDP‐mannose, such as cell wall fragility and defects in N‐ and O‐glycosylation of secreted proteins. The influence of the opu24 mutation on endoplasmic reticulum‐associated protein degradation is discussed. The GenBank Accession No. for the OPU24 sequence is AF234177. Copyright © 2001 John Wiley & Sons, Ltd.
Joint degeneration following meniscal allograft transplantation in a canine model: mechanical properties and semiquantitative histology of articular cartilage
Authors: Elliott Dawn M. , Jones Relief , Setton Lori A. , Scully Sean P. , Vail Parker T. , Guilak Farshid
Published: August 2002

This study examined the hypothesis that meniscal allograft transplantation serves a “chondroprotective” role and prevents the histological and biomechanical changes of the articular cartilage following meniscectomy. Skeletally mature mongrel dogs underwent total medial meniscectomy and received either a fresh meniscal allograft (n=10) or no further treatment (n=10). Semiquantitative histology and biomechanical analysis of the femoral articular cartilage was used to assess cartilage pathology 12 weeks following surgery. Histological analysis showed significant changes in cartilage structure that did not differ between the meniscectomy and allograft transplantation groups. Similarly, the tensile modulus of the surface zone cartilage was significantly lower than that in unoperated controls following either meniscectomy or allograft transplantation. A significant correlation was observed between the biomechanical and histological changes, suggesting that degenerative changes in cartilage structure and mechanical function are interrelated. Our findings do not support the hypothesis that meniscal allograft transplantation provides chondroprotection of the femoral condyle and also suggest that it does not lead to increased degenerative changes.
Influence of Gases on Intraperitoneal Immunity during Laparoscopy in Tumor‐bearing Rats
Authors: Neuhaus Susan J. , Watson David I. , Ellis Tanya , Rofe Allan M. , Mathew George , Jamieson Glyn G.
Published: August 2002

Laparoscopy has been associated with metastases to abdominal wall wounds. In addition, many recent experimental studies suggest that laparoscopy is associated with increased tumor dissemination. It is possible that immune or metabolic disturbances due to the use of a pneumoperitoneum could contribute to this problem. To investigate this possibility, we studied the effect of two insufflation gases and gasless laparoscopy on in vivo peritoneal macrophage function and intraperitoneal pH in an experimental model. A carcinoma was implanted into the flank of 32 experimental rats that underwent laparoscopic surgery in one of four treatment groups: anesthesia alone, gasless laparoscopy, helium insufflation, and CO2 insufflation. Intraperitoneal pH was monitored during surgery, and peritoneal macrophage function was determined 3 days after surgery by harvesting peritoneal macrophages and then examining their ability to produce tumour necrosis factor‐α (TNF‐α). CO2 insufflation was associated with a consistent fall in intraperitoneal pH and a significant reduction in TNFα production. These findings did not occur in the other study groups. The results of this study demonstrate that CO2 insufflation results in depressed intraperitoneal macrophage activity. It is possible that it is mediated by pH changes. In addition, it could be a contributing factor to the development of port‐site metastases. Further studies are needed to determine whether the factors identified act during clinical surgery.
Relation between Gastroduodenal Interdigestive Migrating Motor Complex and Postoperative Gastrointestinal Symptoms before and after Cisapride Therapy following Distal Gastrectomy for Early Gastric Cancer
Authors: Tomita Ryouichi , Tanjoh Katsuhisa , Fujisaki Shigeru , Fukuzawa Masahiro
Published: August 2002

A total of 30 patients (18 men, 12 women; 43–79 years, mean 58.9 years) 1.0 to 1.5 years (mean 1.25 years) after distal gastrectomy for early gastric cancer (Billorth I, D2 lymph node dissection, curability A) were divided into two groups based on the occurrence of interdigestive migrating motor complex (IMMC) phase III (pIII) from the duodenum and their postoperative gastrointestinal symptoms. They were compared before and after cisapride therapy (at an oral dose of 7.5 mg/day for 3 months). Results were as follows. Before cisapride therapy: (1) Patients in the IMMC‐pIII‐positive group (n= 20) had more appetite and ate more food with less decrease in body weight than those in the IMMC‐pIII‐negative group (n= 10); (2) patients in the IMMC‐pIII‐positive group clearly had fewer symptoms, such as early dumping (systemic) symptoms, symptoms of reflux esophagitis (e.g., heartburn, feeling of regurgitation, difficult swallowing), nausea, abdominal pain, diarrhea, abdominal distension, and borborygmus, than the IMMC‐pIII‐negative group. After cisapride therapy: eight patients (80%) in the IMMC‐pIII‐negative group became IMMC‐pIII‐positive, and their appetite and food consumption were obviously improved; body weight increased in six patients (60%), with alleviation of other abdominal symptoms and disappearance of the early dumping syndrome. These results showed a more satisfactory condition in regard to gastrointestinal symptoms in the IMMC‐pIII‐positive group than in the IMMC‐pIII‐negative group. It is concluded that cisapride therapy results in the occurrence of IMMC‐pIII and subsequently alleviates various abdominal symptoms, contributing to the improved postoperative gastrointestinal condition of patients after gastrectomy.
Upper Airway Obstruction in Patients with Goiter Studied by Flow Volume Loops and Effect of Thyroidectomy
Authors: Krishan Thusoo Tej , Gupta Umesh , Kochhar Kapil , Singh Hira Harmanjit
Published: August 2002

The patient with goiter and his or her physician frequently overlook symptoms of upper respiratory obstruction. Conventional radiology is the accepted method for detecting upper airway obstruction in these patients. Flow volume loops provide additional information on airflow dynamics. Twenty‐five patients of goiter undergoing surgery were evaluated for upper airway obstruction by symptomatology, conventional radiology, and flow volume loops. Flow volume loops were repeated 1 month after surgery. Ten (40%) patients had mild symptoms on direct questioning. Tracheal deviation, compression, or both were noted in eight (32%) patients on radiology. Flow volume loops detected upper airway obstruction in 15 (60%) patients. Surgery resulted in normalization of all preoperative abnormal curves. The flow volume loop is a simple noninvasive method for detecting upper airway obstruction in patients with goiter. Abnormal upper airway dynamics are present in more patients with goiter than previously recognized, and relief of this obstruction should be an important aspect of thyroid surgery.
Comparison of Coagulation Parameters for Healthy Subjects and Behçet Disease Patients with and without Vascular Involvement
Authors: Şengül Neriman , Demirer Seher , Yerdel M. Ali , Terzioğlu Gökay , Akin Bariş , Gürler Aysel , Tüzüner Altan
Published: August 2002

Behçet disease (BD) is an inflammatory illness that may attack several systems. Vascular involvement with thrombosis is one of the basic characteristics of this disease. The etiology of thrombosis tendency in BD has not been understood well. In this study, the role of primary coagulation parameters in patients with BD who have thromboembolic events was evaluated. In addition, the relation between the clinical activity of the disease and these parameters was compared. A total of 96 patients with a diagnosis of BD were studied at Ankara University, Medical School, Department of General Surgery and Behçet Center. BD patients were separated into two groups with respect to vascular involvement. Group A contained 22 patients with vascular attacks, and group B contained 74 patients without vascular attacks. In addition, 25 healthy persons comprised the control group (group C). The coagulation parameters assessed included protein C, protein S, antithrombin III activity, fibrinogen level, prothrombin time (PT), and partial thromboplastin time (PTT). There were no differences among the three groups with respect to protein C, protein S, fibrinogen, PT, and PTT values (p > 0.05). The antithrombin III value was found to be high in BD patients compared to those in the control group (p= 0.011). There was no difference regarding the antithrombin III value between BD patients with or without vascular attacks (p= 0.954). There was no correlation between the activity of disease and coagulation parameters (p > 0.05), but a positive correlation was seen between the duration of illness and vascular involvement. Fifty percent of patients who had had BD more than 8 years had vascular involvement (p= 0.002). We could not determine a specific pathology in relation to coagulation parameters that could explain the etiology of thrombosis in patients with BD. The elevated antithrombin III levels in patients with BD (compared to controls) may be due to a compensatory defense mechanism against increased procoagulant activity. There was a correlation between the duration of illness and vascular involvement.
Treatment of Malignant Mesothelioma
Authors: Jaklitsch Michael T. , Grondin Sean C. , Sugarbaker David J.
Published: August 2002

Malignant pleural mesothelioma (MPM) is a rare tumor that predominantly afflicts men over 50 years of age. Nearly 3000 MPMs are reported annually in the United States with the incidence expected to rise into the new millenium. Over the past 40 years, MPM has been unequivocally linked to asbestos exposure worldwide. Recently, however, a new theory on the carcinogenesis of this tumor has been proposed with the isolation of a simian virus (SV 40)‐like gene sequence in mesothelioma tumor cells. The clinical presentation of MPM is variable, although most patients typically present with dyspnea, chest pain, or pleural effusion. Obtaining a diagnosis of MPM has been greatly assisted by video‐assisted surgery and the use of immunohistochemistry and electron microscopic techniques, which help distinguish MPM from other tumor pathologies such as adenocarcinoma. Computed tomography and magnetic resonance imaging have been also useful for determining tumor burden and resectability. Traditionally, strategies for the treatment of MPM have included supportive care, surgery, radiotherapy, and chemotherapy. Survival with supportive care alone ranges between 4 and 12 months. Single‐modality therapy using traditional approaches (surgery, radiotherapy, chemotherapy) alone has failed to improve patient survival significantly. Recently, results using a multimodality approach have been favorable. In particular, cytoreductive surgery (pleuropneumonectomy) followed by sequential chemotherapy and radiotherapy have demonstrated improved survival, especially for patients with epithelial histology, negative resection margins, and no metastases to extrapleural lymph nodes. Innovative therapies such as the use of photodynamic, targeted cytokines and gene therapy are currently being investigated for management of MPM.
Fiberoptic Bronchoscopy of Intubated Patients with Life‐threatening Hemoptysis
Authors: Düpree Hans‐J. , Lewejohann Jan‐C. , Gleiss Joachim , Muhl Elke , Bruch Hans‐P.
Published: August 2002

Bleeding in the tracheobronchial tree in intubated patients on an intensive care unit is a potentially life‐threatening incident. The antecedent state of disease and frequent respiratory failure require immediate and effective therapeutic measures to avoid further respiratory and cardiocirculatory depression. We present our bronchoscopic management of endobronchial bleeding. Cardiorespiratory function must be maintained by modification of the mechanical ventilation and drug therapy owing to the patient's condition. Seven consecutive patients with acute endobronchial bleeding were treated with fiberoptic bronchoscopy and instillation of cold epinephrine‐saline solution (1:10,000–100,000) during the period of July 1997 to December 1997. Control of bleeding was achieved after 1 to 20 (mean ± SEM: 5.86 ± 0.93) bronchoscopic interventions during a period of 0.5 hours to 10 days. One control bronchoscopy was performed additionally in every patient. Cardiocirculatory instability was observed in five patients. Six patients survived; one patient died of uncontrolled bleeding caused by severe pulmonary aspergillosis. Fiberoptic endobronchial epinephrine instillation is an effective therapy for life‐threatening hemoptysis in critically ill patients. Widespread use of flexible bronchoscopy makes this procedure immediately applicable in critical situations. Intubated and mechanically ventilated patients with life‐threatening hemoptysis especially benefit from this rapidly feasible procedure.
Total Pancreatectomy for Cancer of the Pancreas: Is It Appropriate?
Authors: Ihse Ingemar , Anderson Harald , Andrén‐Sandberg Åke
Published: August 2002

During the late 1960s total pancreatectomy was advocated on theoretic grounds as an operation superior to subtotal (Whipple) resection in patients with pancreatic cancer. There are, however, no prospective randomized studies and only few institutional comparisons between the two operations. The aim of the present paper was to report the clinical outcome of total and subtotal pancreatectomy, respectively, in a consecutive series of patients with exocrine pancreatic cancer. The short‐ and long‐term results of 89 consecutive patients who underwent total pancreatectomy (1959–1984) for pancreatic cancer were retrospectively compared with a similar group of 36 patients who had a subtotal pancreatectomy (1985–1992) for the same diagnosis. The clinical characteristics were on the whole similar in the two groups. Postoperative mortality and morbidity, the amount of intraoperative bleeding, operation time, reoperation rate, postoperative days in the intensive care unit, and duration of hospital stay were statistically significantly increased after total pancreatectomy. The 5‐year survival rate was lower after total pancreatectomy when hospital deaths were included in the analysis. At multivariate analysis total pancreatectomy adversely influenced long‐term survival compared to subtotal resection, as did positive lymph nodes and poor histologic differentiation. Better early and long‐term results were found after subtotal than after total pancreatectomy in patients with exocrine pancreatic cancer. Although the two operations were done during different time periods, we believe the results suggest that total pancreatectomy cannot be recommended as a routine treatment for this patient group.
Update on the Mechanisms of Immune Suppression of Injury and Immune Modulation
Authors: Faist E. , Schinkel C. , Zimmer S.
Published: August 2002

Major trauma results in massive impairment of immunologic reactivity, the clinical consequence of which consists in the high susceptibility of the traumatized individual toward serious infection. Whereas parts of the immune system are stimulated within a systemic, nondiscriminant, excessive whole‐body inflammation, other functions within the complex of cell‐mediated immunity (CMI) are dramatically paralyzed. Immune abnormalities in the aftermath of trauma occur in a sequence of states of cellular activation and within a complex order of events that is not yet well understood. Traumatic stress is causing disintegration of the intact monocyte (Mφ)–T cell interaction, which is associated with profound changes in Mφ forward‐regulatory capacities and substantial depression of T cell function. Extensive tissue destruction results in the generation of numerous stimuli, such as phagocytosis, immune complexes, complement split products, and endo‐ and exotoxins, all of which contribute to excessive Mφ activation. Mφ then rapidly produce and release prostaglandin E2 (PGE2), a powerful endogenous immune suppressant. PGE2 is an inhibitor of T cell mitogenesis, interleukin 2 (IL‐2) production, and IL‐2 receptor expression; and it has a massive impact on the quality of B cell antibody synthesis. Most importantly, PGE2 represents an important cofactor for the induction of T‐helper lymphocyte (TH) activity toward the TH2 direction. TH2 cells are associated with the synthesis of immunosuppressive cytokines, such as IL‐4 and IL‐10. Although immunosuppressive substrates are inhibitory for TH1 cells—the functional carriers of CMI—they support TH2 activity, which predisposes the host to develop infection. The endogenous ability of the organism to survive overwhelming trauma is insufficient and requires major exogenous support. Immune modulatory interventions, depending on the immune abnormalities seen in the traumatized host, should be started as early as possible after trauma in a preventive fashion to protect against organ tissue destruction. Ideally, it should protect all cellular host defense compartments from hyperactivation as well as from exhaustion. We do believe that only a combination of drugs can effectively control the posttraumatic dyshomeostasis of the various cell systems.
Endovascular Technology and Its Impact on the Relationships among Vascular Surgeons, Interventional Radiologists, and Other Specialists
Authors: Veith Frank J. , Marin Michael L.
Published: August 2002

Endovascular treatment methods that are largely catheter/guidewire‐based permit treatment of a variety of vascular lesions from remote access sites in a minimally invasive manner. Because these endovascular technologies have intrinsic appeal to patients and physicians, they may, if proved safe and effective, replace a substantial proportion of current vascular surgical procedures. This change will have a substantial impact on the specialties involved in their development and use, that is, vascular surgery and interventional radiology (which in this discussion includes other interventional specialists devoted to peripheral vascular disease management). The relationship between these previously distinct specialties must also be influenced greatly by the introduction of endovascular technologies, the use of which requires skills that overlap the specialties. This paper considers several possible approaches for dealing with the altered interspecialty relationships that will result if new endovascular treatment methods prove to be safe and effective. Because the development and use of these endovascular technologies require the skills and talents of vascular surgeons and interventional radiologists (or other interventionalists), a collaborative, multispecialty approach to the use of endovascular technologies is recommended as the most reasonable and optimal for patient care. Although this approach may not be applicable for every environment, it is the one most likely to minimize costs and turf battles, particularly if interspecialty conflict can be minimized by collaboration and compromises developed by a conjoint executive committee representing the leadership of the involved specialty societies.
Mortality following Lower Limb Ischemia‐Reperfusion: A Systemic Inflammatory Response?
Authors: Yassin Magdi M.I. , Barros D’Sa Aires A.B. , Parks George , Abdulkadir Aminu S. , Halliday Isla , Rowlands Brian J.
Published: August 2002

Restoration of blood flow to an acutely ischemic lower limb may paradoxically result in systemic complications and unexpected mortality. It has been suggested that lower limb ischemia reperfusion alters gut permeability. In this study, using a rat model, we determined the effect of acute lower limb ischemia‐reperfusion on mortality rate, bowel morphology, and circulating concentrations of endotoxin and the proinflammatory cytokine interleukin‐6. Survival rate was compared in two groups of adult Wistar rats: (1) control group (n= 10); and (2) animals subjected to 3 hours of bilateral hind limb ischemia followed by reperfusion (n= 10). Both groups were observed under standard conditions for 4 days. In a second experiment three groups of animals were studied: (I) control (n= 12); (II) 3 hours of bilateral hind limb ischemia alone (n= 12); and (III) 3 hours of bilateral hind limb ischemia followed by 2 hours of reperfusion (n= 12). Animals subjected to bilateral hind limb ischemia followed by reperfusion had a significantly higher mortality rate (70%) than controls (0%) (p< 0.005). Morphometric assessment of the small bowel showed a significant decrease in mean mucosal thickness in the ischemia‐reperfusion group compared with that in the group of controls and the ischemia‐alone group (p< 0.05). Bilateral hind limb ischemia followed by reperfusion was associated with significantly increased plasma concentrations of endotoxin (p< 0.05) and interleukin‐6 (p< 0.0001) compared with that of controls and ischemia alone. These results indicate that reperfusion of the acutely ischemic lower limb is accompanied by structural changes in the gut mucosa associated with increased systemic endotoxin concentrations and cytokine activation. Mortality following reperfusion of the acutely ischemic limb may be related to a systemic inflammatory response triggered by endotoxin of gut origin.
Laparoscopic Cholecystectomy for Acute Cholecystitis in the Elderly
Authors: Lo Chung‐Mau , Lai Edward C.S. , Fan Sheung‐Tat , Liu Chi‐Leung , Wong John
Published: August 2002

This study reviewed the results of laparoscopic cholecystectomy for acute cholecystitis in the elderly. Among 557 patients who underwent laparoscopic cholecystectomy, 70 (12.6%) had a clinical diagnosis of acute cholecystitis confirmed by ultrasonography. There were 28 men and 42 women with a mean age of 59.9 years (range 20–87 years). Thirty patients ≥ 65 years of age were compared to 40 patients < 65 years old. Elderly patients had a higher female predominance (p< 0.05), a higher incidence of intercurrent diseases (p< 0.05), and a higher serum urea level (p< 0.001). The proportions of patients who underwent early or delayed surgery were comparable. There was no difference in operation time, postoperative analgesic requirements, or complications. Elderly patients, however, had a significantly higher conversion rate (23.3% versus 2.5%;p< 0.05). Even after successful laparoscopic cholecystectomy, there was a longer delay before ambulation (p< 0.05) and resumption of normal diet (p= 0.08) with resulting prolonged postoperative (p= 0.08) and total hospital stay (p< 0.05). Laparoscopic cholecystectomy is a safe, effective treatment for acute cholecystitis in the elderly. When compared to younger patients, elderly patients are at greater risk for conversion, delayed recovery, and prolonged hospital stay.
Effect of Supplemental l‐Arginine in a Chemical‐Induced Model of Colorectal Cancer
Authors: Ma Qingyong , Hoper Margaret , Anderson Neil , Rowlands Brian J.
Published: August 2002

l‐Arginine inhibits the development of spontaneous, transplantable solid tumors and chemically induced mammary tumors. The aim of the present study was to investigate the effect of l‐arginine on chemically induced colorectal cancer in male Wistar rats. Colorectal cancer was induced in all animals by weekly subcutaneous injections of the colonic procarcinogen 1,2‐dimethyhydrazine (DMH) at a dosage of 20 mg/kg body weight. Arginine was given in a 1% solution of drinking water. Group I was the DMH control; group II, arginine for 22 weeks; group III, arginine for the first 10 weeks only. Lymphocyte function was evaluated by measuring the thymic lymphocyte proliferative response to the T cell mitogen phytohemagglutinin. The results show that tumor incidence and tumor burden (tumors/rat and tumors/tumor‐bearing rat) were significantly reduced in both groups of animals receiving arginine compared to DMH controls (p< 0.05). The tumor areas and volumes were also reduced in both arginine groups (p< 0.05). Thymic lymphocyte stimulation indices were significantly increased by arginine supplementation (p< 0.05). These results would be in keeping with the reduction in colorectal tumor production due to a “nonspecific” stimulation of the host immune system by l‐arginine.
Clinical Development of Human Polymerized Hemoglobin as a Blood Substitute
Authors: Gould Steven A. , Moss Gerald S.
Published: August 2002

Although the efficacy of hemoglobin‐based oxygen carriers was established more than 60 years ago, all prior clinical trials have demonstrated significant toxicity characterized by renal dysfunction, gastrointestinal distress, and systemic vasoconstriction. The mechanisms of these toxicities now appear to be understood. Tetrameric forms of the hemoglobin molecule extravasate from the circulation and interact with endothelium‐derived relaxing factor, leading to unopposed vasoconstriction. Although numerous efforts are under way to chemically modify the native tetramer, it is likely that all tetrameric forms of the hemoglobin molecule will continue to extravasate. We have focused on developing a polymerized form of hemoglobin that is virtually free of unreacted tetramer. The development and characterization of this polymerized pyridoxylated hemoglobin solution (Poly SFH‐P) is described. Clinical trials have been completed successfully in volunteers and are now under way to assess the safety and efficacy of Poly SFH‐P as a clinically useful red blood cell substitute for treatment of acute blood loss in the setting of trauma and surgery.
Overview on Compression Anastomoses: Biofragmentable Anastomosis Ring Multicenter Prospective Trial of 1666 Anastomoses
Authors: Thiede A. , Geiger D. , Dietz U.A. , Debus E.S. , Engemann R. , Lexer G.C. , Lünstedt B. , Mokros W.
Published: August 2002

This study represents a European prospective clinical multicenter trial and was undertaken to evaluate the applicability of the biofragmentable anastomosis ring (BAR) as a routine anastomotic tool in teaching hospitals. The trial results analyzed consisted of 1666 BAR anastomoses performed in 1360 patients from March 1989 to May 1996 in the upper (1042 anastomoses) and lower (624 anastomoses) gastrointestinal (GI) tract. Only patients selected for elective procedures and having previously undergone orthograde bowel cleansing were entered into the trial. In the upper GI tract six anastomoses (0.58%) developed clinically relevant and radiologically detectable leaks with indications for reoperation. In the lower GI tract 42 (6.73%) anastomoses showed a radiologically detectable leak with clinical manifestations in 28 cases (4.48%). Reoperation was performed in 18 cases (2.80%). The overall leakage rate with clinical relevance was 2.04%. Three gastrojejunostomy episodes of bleeding were observed (0.18%) at the BAR anastomotic site. During the early postoperative course there was no ileus due to obstruction of a BAR anastomosis. Reintroduction of diet after the operation was not delayed. In two centers a follow‐up evaluation reported no BAR‐related late anastomotic stenoses. There were no intraoperative deaths, but 54 patients died postoperatively. Peritonitis following anastomotic leakage was responsible for postoperative deaths in four cases; three of them were related to BAR anastomoses. In conclusion, the BAR anastomotic procedure is an established, rapid, simple to learn, highly standardized, safe technique with the advantage of no persistent foreign material in the anastomotic region and therefore no induction of stenosis. At present, the application of anastomoses in various segments of the GI tract, from the stomach to the middle third of the rectum, can be recommended.
Quality of Life of Patients with Inflammatory Bowel Disease after Surgery
Authors: McLeod Robin S. , Baxter Nancy N.
Published: August 2002

Quality of life is an important outcome measure following surgery for ulcerative colitis. Quality of life incorporates not only the physical or functional outcome; it also considers the emotional and social well‐being of patients. Quality of life may be measured using disease‐specific or generic quality of life measures or by utility measurement. Although the pelvic pouch procedure is preferred by most patients, there are data to suggest that the quality of life is excellent irrespective of the procedure, possibly because physical well‐being is improved and is the main determinant of outcome. Those who have a pelvic pouch may be less restricted in some activities. Compared to medically treated patients, quality of life is usually superior in surgical patients, although it varies depending on the activity of the disease and the surgical outcome. Despite more publications on this topic in recent years, there is a need for further studies comparing quality of life in patients receiving medical and surgical treatment as well as assessing outcome following the various surgical procedures.