bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predictors for outcomes and readmission rates following double balloon enteroscopy: a tertiary care experience
Authors: Shelnut Danielle , Sims Omar , Zaibaq Jenine , Oh Hyejung , Venkata Krishna , Peter Shajan 
Published: June 2018

Abstract
Aim The objectives of this study are to examine clinical characteristics of patients undergoing anterograde and retrograde double balloon enteroscopy (DBE) and to assess factors predicting positive diagnostic yield, therapeutic yield, and readmission.
Methods We conducted a retrospective cohort study of patients (n = 420) who underwent DBE at a tertiary care center between 2012 and 2016 at a tertiary referral center. Measures of central tendency and frequency distributions were used for univariate analysis. Chi-square and t-test analyses were used to compare patient characteristics. Logistic regression was used to predict outcomes of interest.
Results Of patients included in the study, 59 % were male with a mean age of 61.49 (SD = 15.15) Altered anatomy was noted in 14 %, while 5 % and 13 % of patients had end stage renal disease (ESRD) and current use of anticoagulation, respectively. The most common indication for DBE was obscure gastrointestinal bleed (OGIB) (33 %). Forty-nine patients had obscure and overt gastrointestinal bleeding (GIB) and 22 % had occult GIB with iron deficiency. The cohort’s rate of positive diagnostic yield was 73 % and 35 % for therapeutic yield. The 30-day and 6-month readmission rates were both 11 %. A higher proportion of those readmitted were male (75 % vs 57 %, P = 0.027) and had longer procedural time (38.68 vs 46.57, P = 0.011). Likewise, occult GIB with iron deficiency anemia and iron deficiency alone (OR = 2.45, CI: 1.233 – 4.859, P = 0.011), inpatient status (OR 2.42, CI 1.344 – 4.346, P = 0.003), and longer procedural time (OR = 1.02, CI: 1.004 – 1.029, P = 0.008) were associated positively with readmission. There were no statistically significant predictors of positive diagnostic yield, however procedural time (OR = 1.01, CI: 1.03 – 1.026; P = .0017) and older age (OR = 1.03, CI: 1.009 – 1.045, P = 0.003) were positively associated with therapeutic yield. Retrograde procedure (OR = 0.230, CI 0.125 – 0.422, P = 0.000) was negatively associated with therapeutic yield.
Conclusion DBE procedures have relevant efficacy for both diagnostic and therapeutic yield while evaluating small bowel disease. Readmission rates are low and more in those with GI bleed and iron deficiency with longer index procedural times.
Skull Base Dural Thickness and Relationship to Demographic Features: A Postmortem Study and Literature Review
Authors: Fam Maged , Potash Andrea , Potash Martin , Robinson Robert , Karnell Lucy , O'Brien Erin , Greenlee Jeremy 
Published: June 2018

AbstractDural membrane is an important anatomic structure that surrounds and protects the entire central nervous system. Physical properties of the dura have many pathophysiological and therapeutic implications in cranial surgery, especially skull base disorders. The aim of this study is to investigate variation in skull base dural thickness and correlation with different demographic parameters. At the time of autopsy, the petrous apex dura with the underlying bone of 20 cadavers was harvested. Dural thickness was independently measured by two pathologists at the thinnest and thickest segments in the specimen. Correlational analyses were then performed to compare dural thickness with gender, age, neck circumference, height, weight, and body mass index (BMI). Mean, minimum, and maximum skull base dural thickness in our study was 0.36, 0.27, and 0.46 mm, respectively. Age demonstrated a negative correlation with dural thickness with significantly thinner dura in the older subjects, p = 0.01. There was a trend toward thinner dura in females that approached statistical significance, p = 0.06. No strong correlation could be found with body weight, height, neck circumference, or BMI. Our findings show a considerable intersubject and intrasubject variability in skull base dural thickness. Some demographic parameters also seem to impact dural thickness. Additional histological studies are needed for better understanding of the pathophysiological mechanisms pertaining to the tensile properties of the dural membrane.
Fracture of the Body's Hamate Bone: Open Reduction Internal Fixation by Double Approach—A Case Report
Authors: Salvador Marín Jorge , Brotons Baile Antonia , Cardona Vives Nuria , Vargas Prieto Jaime , Pérez Alba José , Martínez López José 
Published: June 2018

AbstractHamate fractures are rare. Their treatment depends on the displacement and type of fracture. We present the case and surgical technique of a 33-year-old male patient, who is a manual worker, with a displaced fracture of the body of the hamate bone associated with dislocation of the fourth and fifth metacarpal (MC) bones. The patient was operated on with a double palmar and dorsal approach directly over the hamate and the body hook, respectively, which was performed to improve the control reduction and avoid damaging the neighboring vascular and nerve structures. The open reduction internal fixation (ORIF) was performed by inserting mini-screws in a dorsal to palmar direction. Later, the dislocations were reduced and fixed with Kirschner wires between the fourth and fifth MC bases, and between the fourth MC base and the capitate bone. The patient was discharged 2.5 months after the fracture. The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire outcome measure was 5 points at 6 months postsurgery.
Emerging Technologies for the Diagnosis of Perihilar Cholangiocarcinoma
Authors: Ilyas Sumera I , Eaton John , Yang Ju Dong , Chandrasekhara Vinay , Gores Gregory J. 
Published: June 2018

AbstractThe diagnosis of malignant biliary strictures remains problematic, especially in the perihilar region and in primary sclerosing cholangitis (PSC). Conventional cytology obtained during endoscopic retrograde cholangiography (ERC)-guided brushings of biliary strictures is suboptimal due to limited sensitivity, albeit it remains the gold standard with a high specificity. Emerging technologies are being developed and validated to address this pressing unmet patient need. Such technologies include enhanced visualization of the biliary tree by cholangioscopy, intraductal ultrasound, and confocal laser endomicroscopy. Conventional cytology can be aided by employing complementary and advanced cytologic techniques such as fluorescent in situ hybridization (FISH), and this technique should be widely adapted. Interrogation of bile and serum by examining extracellular vesicle number and cargo, and exploiting next-generation sequencing and proteomic technologies, is also being explored. Examination of circulating cell-free deoxyribonucleic acid (cfDNA) for differentially methylated regions is a promising test which is being rigorously validated. The special expertise required for these analyses has to date hampered their validation and adaptation. Herein, we will review these emerging technologies to inform the reader of the progress made and encourage further studies, as well as adaptation of validated approaches.
The Thromboplastinogen activity time (TAT) Test
Authors: Quick Armand J. 
Published: June 2018

SummaryThe thromboplastinogen activity time (TAT) test is described. The method is based on the finding that rabbit brain extract heated to 60° C loses its holo-thromboplastin activity but retains the properties of platelet extract and can, therefore, be used as a substitute for platelet extract in the prothrombin consumption test. The application of the test to differentiate hemophilia from thrombocytopenia and thrombasthenia is illustrated by case reports. The use of the test for the differential diagnosis of hemophilia and PTC deficiency is outlined and examples of its application given.
Platelet cothromboplastin: a platelet factor(s) related to the blood clotting mechanisms
Authors: Lee Pyung-Hee , Johnson Shirley A. , Seegers Walter H. 
Published: June 2018

SummaryBovine Platelets contain a factor(s) that greatly enhances the capacity of lung extract thromboplastin to conver purified prothrombin to biothrombin. It also may function with Russell’s viper venom in the activation of prothrombin The activity is destroyed below pH 4 or above pH 11 or at temperatures above 52° C. Concentrates of the activity have been obtained in a fraction of platelets that consists predominately of carbohydrate and protein.
The Challenge of cerebral vascular diseases
Authors: Wright Irving S. 
Published: June 2018

SummaryCerebral vascular diseases are of major importance but unfortunately their study has been greatly neglected until recent years.There are serious gaps in our basic knowledge regarding their pathogenesis and therapy. The differential diagnoses of thrombosis, embolism, hemorrhage and tumor have been outlined. Intermittent neurological signs due to cerebral vascular diseases have been discussed. The distinctions between intermittent and permanent occlusion of the basilar artery, carotid artery and cerebral artery have been elaborated.Long term anticoagulant therapy is of value in the prevention of recurrent thromboses and emboli wherever they may occur in the carotid, basilar or cerebral arterial tree.Anticoagulants are indicated as a prophylactic measure before mitral com-misurotomy when the patient has had previous emboli or when his heart is in atrial fibrillation. They should also be continued after this surgery. The question whether the patient should be carried through the operation at therapeutic levels of anticoagulant therapy is at present under study in several clinics, but the evidence suggests that this is feasible and improves the chances of avoiding emboli.It appears logical to use anticoagulants in the treatment of acute episodes of thrombosis and embolism but this is under further study at present.Other forms of therapy including the stellate sympathetic ganglion block, and the inhalation of CO2 have been evaluated. Thus far the evidence suggests that while the inhalation of CO2 may be helpful theoretically the others are of doubtful value.This is a challenging field which should attract the attention of many workers during the next several decades.
Versuche zur chemischen Identifikation und Synthese von Gerinnungsfaktoren
Authors: Hecht E , Shapiro D 
Published: June 2018

Zusammenfassung1. Mit Hilfe einer ausführlichen Einleitung wurde versucht, die Grundlage zum müheloseren Verständnis der vorliegenden Untersuchung zu schaffen.2. Die Resultate einer Studie mit fünf verschiedenen synthetischen Kephalinen waren:a) Die synthetischen Kephaline sind im Gegensatz zu den lipoiden Aktivatoren und dem von Paul s sen untersuchten Lipoidextrakt aus den Blutplättchen gegenüber Hühnerplasma und menschlichem Plasma inaktiv.b) Ebensowenig können die Kephaline die Rolle der sub a) genannten Substanzen im Rahmen der Sphingosinreaktionen übernehmen.c) Die Kephaline sind nicht imstand im Thrombokinasebildungstest die Funktion der Thrombozyten zu erfüllen, wozu die Lipoidextrakte aus denselben und ebenso die lipoiden Aktivatoren befähigt sind.d) Alle synthetischen Kephaline geben anläßlich ihrer papierchromatographi-schen Untersuchung andere Ninhydrin-positive Reaktionen wie Lipoidextrakte aus den Blutplättchen und die lipoiden Aktivatoren.3. Die sub 2 genannten Befunde werden als weitere Argumente gegen die Auffassung von der Identität des lipoiden Aktivators mit dem Kephalin klassischer Prägung gedeutet.4. Die typischen Reaktionen des aus physiologischem Material isolierten Inhibitors Sphingosin werden in noch stärkerem Maß von der synthetisch bereiteten Verbindung gegeben.5. Die Untersuchung von 8 synthetischen Derivaten, Isomeren und Homologen des Sphingosins zeigte, daß zum Erhalt der maximalen Sphingosinreaktionen sowohl die Doppelbindung als auch die freien OH- und NH2-Gruppen erforderlich sind.
The Haemostatic Balance))
Authors: Astrup Tage 
Published: June 2018

SummaryThe roles played by the blood clotting system and by fibrinolysis in the haemostatic balance are discussed. The significance of the tissue thromboplastin and the tissue activator of plasminogen for local haemostasis is emphasized, and their relation to anticoagulant therapy considered. Problems specific for coronary thrombosis, cerebral thrombosis and cerebral haemorrhage have been mentioned.
Long Term Treatment with Anticoagulants in Coronary Artery Disease
Authors: Owren P. A 
Published: June 2018

Summary347 patients with angina pectoris and 222 patients who had survived an attack of myocardial infarction for at least 8 weeks have been under long-term treatment with dicumarol or phenylindanedione. The annual mortality-rate was reduced to 5% in both groups. Patients with angina pectoris show improvement in 47.7% of the cases, if the disease is not older than 1 year before the start of treatment. Improvement was found in only 25% of the cases when the disease was older than 4 years. It was clearly evidenced that anticoagulant treatment of angina pectoris is only useful when the disease is not older than 2 to 3 years before starting treatment.
Chronic Antithrombinaemia (Antithrombin V) with Haemorrhagic Diathesis in a Case of Rheumatoid Arthritis with Hypergammaglobulinaemia
Authors: Loeliger A , Hers J. F. Ph 
Published: June 2018

SummaryA report is represented on a 44-year-old patient suffering, since 1938, from very slowly progressive rheumatoid arthritis. Haemorrhagic manifestations have been seen since 1951 (large cutaneous and muscular haemorrhages, microhaematuria and macrohaematuria, possibly also articular haemorrhages). In addition to an extremely marked increase in γ-globulins to values above 8 g/100 ml (γ-globulins with a normal sedimentation constant S 7) a circulating anticoagulant was demonstrable, which is held responsible for the marked increase in clotting time, “prothrombin” time and thrombin time. The hypothesis is forwarded that this is a physiological anticoagulant showing a marked increase. Since it is different from the four antithrombins described by Seegers it is referred to as antithrombin-V. Antithrombin-V occurs both in the plasma and in the serum and appears to be bound to the (ß)γ-fraction. It is a thrombin inhibitor which, unlike antithrombin-II, has no direct effect on thromboplastin and thrombin formation. Antithrombin-V cannot be neutralized by protamine sulphate; it is heat-stable, not dialysable and not adsorbed onto BaSO4. Thrombelastography made it possible clearly to demonstrate that an increase in antithrombin-V is associated with a marked increase in clotting time but causes no pathological course of clot formation.Therapeutic results obtained with ACTH and cortisone are favourable: the activity of antithrombin-V decreases parallel with a decrease in γ-globulin values, and the clotting time is normalized. The patient has received, during the past 16 months, oral cortisone treatment (25 mg thrice daily), and is at present free of complaints, although clinical and laboratory findings show a gradual increase in symptoms respectively γ-globulin values with a slight increase in clotting time.The possible significance of the antithrombin-V activity in the protection against thrombo-embolism is briefly mentioned.
Probleme der Antikoagulantienbehandlung
Authors: Deutsch E , Benda L , Zischka W 
Published: June 2018

ZusammenfassungDie Antikoagulantien beeinflussen neben der Blutgerinnung auch die Zellteilung, das Wachstum von Fibroblastenkulturen und die Bindegewebsbildung. Da diese Vorgänge die Heilung bei Myokardinfarkten ungünstig beeinflussen könnten, wurde das histologische Bild der Abheilungsvorgänge experimenteller Myokardinfarkte bei Hunden mit und ohne Behandlung mit Marcoumar oder Heparin verfolgt. Es zeigte sich, daß bei den Kontrolltieren nach 14 Tagen bereits ein junges, faserreiches Bindegewebe im Bereich des Infarktes nachweisbar ist, während unter Marcoumar noch Nekrosen, reichlich Fibroblasten, aber noch keine Bindegewebsfasern nachgewiesen werden können. Erst nach 4 Wochen ist die Bindegewebsbildung so weit fortgeschritten wie bei den Kontrolltieren nach 14 Tagen. Unter Heparin ist die Proliferation der Fibroblasten besonders ausgeprägt. Die Konsequenzen für die Antikoagulantienbehandlung der Myokardinfarkte werden diskutiert.
Augentrauma im Kindesalter
Authors: Meier P. 
Published: June 2018

ZusammenfassungUnglücklicherweise erleiden immer wieder Kinder Augenunfälle. Wir können dabei zwischen direkten und indirekten Traumata unterscheiden und klassifizieren direkte Augenunfälle in offene und geschlossene Bulbusverletzungen, zu letzteren gehören Verätzungen und Verbrennungen.Kinder verunfallen vorzugsweise zu Hause beim unbeaufsichtigten Spielen. Wichtig ist die Kenntnis des jeweiligen Unfallherganges. Oftmals haben wir jedoch keine oder auch falsche Informationen, manchmal ist die Glaubwürdigkeit der Angaben fraglich und die Kinder sind nicht kooperativ. Primäres Ziel der Untersuchung sollte eine klare Diagnose der Augenverletzung sein, damit eine optimale Versorgung ohne Verzögerung eingeleitet werden kann. Dazu ist bei der Mehrzahl der kindlichen Augenverletzungen eine gute Zusammenarbeit zwischen Pädiatern, Augenärzten, Radiologen und anderen Fachgebieten notwendig.Eine notfallmäßige Intervention ist bei Verätzungen und Verbrennungen der Augen erforderlich, wichtigste Sofortmaßnahme ist ein unverzügliches intensives Spülen der Augenoberfläche, da jede Verzögerung eine Verschlechterung der Prognose bedeutet.
Diagnose „Konnatale Hypothyreose” – früh stellen und dranbleiben!
Authors: Kiess W. , Pfäffle R. , Körner A. , Stoltze A. 
Published: June 2018

ZusammenfassungSchwere mentale und körperliche Retardierung sind bekannte Folgen einer nicht behandelten primären Hypothyreose. Seit Einführung des erweiterten Neugeborenenscreenings in Deutschland sehen wir das gesamte Ausmaß dieser Folgeerscheinungen erfreulicherweise kaum noch. Wir berichten hier über ein Mädchen, welches trotz gestellter Diagnose im Neugeborenenscreening und umgehend eingeleiteter Behandlung mit initialer Normalisierung der Serumparameter unter extremem Kleinwuchs sowie weiteren Auswirkungen einer manifesten Hypothyreose litt.
Prepectoral implant placement in plastic-reconstructive breast surgery – a contribution to the discussion
Authors: Paepke Stefan , Ohlinger Ralf , Klein Evelyn , Thill Marc 
Published: June 2018

AbstractImplant-based breast reconstruction has gained a high and increasing level of importance both nationally and internationally in recent years and covers a wide spectrum of reconstruction techniques. The standard procedure in nipple-sparing subcutaneous mastectomies is currently performed by placing the implant into a subpectoral pocket beneath the pectoralis muscle. The use of implant-based reconstructive techniques with the need for internal support to reconstruct the inframammary fold, to cover the implant at the lower pole and to provide a stable but flexible implant position has become relevant and led to the introduction of heterologous materials such as acellular dermal matrices and synthetic meshes. Although the safety and aesthetics of this approach have produced good results, prepectoral techniques add a whole new dimension with the development of the next generation of acellular dermal matrices and, especially, titanised implant pockets created specifically for prepectoral implant placement 1 have brought about a renaissance in muscle-sparing reconstructive techniques. These preserve the natural anatomy, thereby avoiding the adverse effects associated with submuscular reconstruction, including preservation of full shoulder function, minimising postoperative pain and the risk of bleeding and haematoma, and animation deformities such as “jumping breast phenomenon”. A new method of implant-based breast reconstruction is therefore available and must be analysed regarding indications and benefits.
EUS-FNA versus ERCP for tissue diagnosis of suspect malignant biliary strictures: a prospective comparative study
Authors: Moura Diogo , de Moura Eduardo , Matuguma Sergio , dos Santos Marcos , Moura Eduardo , Baracat Felipe , Artifon Everson , Cheng Spencer , Bernardo Wanderley , Chacon Danielle , Tanigawa Ryan , Jukemura José 
Published: June 2018

Abstract
Background and study aims Biliary strictures are frequently a challenging clinical scenario and the anatomopathological diagnosis is essential in the therapeutic management, whether for curative or palliative purposes. The acquisition of specimens is necessary since many benign diseases mimic biliopancreatic neoplasms. Endscopic retrograde cholangiopancreatography (ERCP) is the traditionally used method despite the low sensitivity of biliary brush cytology and forceps biopsy. On the other hand, several studies reported good accuracy rates using endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). The aim of this prospective study was to compare, the accuracy of EUS-FNA and ERCP for tissue sampling of biliary strictures.
Patients and methods After performing the sample size calculation, 50 consecutive patients with indeterminate biliary strictures were included to undergo ERCP and EUS on the same sedation.The gold-standard was surgery or 6 months’ follow-up. Evaluation of the diagnostic indices (sensitivity, specificity, positive and negative predictive value, positive and negative likelihood ratio), concordance and adverse events among the methods were performed. Also, subtype analyses of the techniques, anatomical localization and size of the lesion were included.
Results The final diagnoses reported in 50 patients were 47 malignant, 1 suspicious and 2 benign lesions. 31 lesions were extraductal and 19 intraductal, 35 were distal and 15 proximal strictures. In the intention-to-treat analysis, the sensitivity and accuracy of EUS-FNA were superior than ERCP tissue sampling (93,8 %, 94 % vs. 60,4 %, 62 %, respectively) (P = 0.034), with similar adverse events. There was no concordance between the methods and combining both methods improved the sensitivity and accuracy for 97.9 % and 98 %, respectively. In the subtype analyses, the EUS-FNA was superior, with a higher accuracy than ERCP tissue sampling in evaluating extraductal lesions (100 % vs. 54.8 %, P = 0.019) and in those larger than 1.5 cm (95.8 % vs. 61.9 %, P = 0.031), but were similar in evaluating intraductal lesions and lesions smaller than 1.5 cm. There was no significant difference between the methods in the analyzes of proximal, distal and pancreatic lesions.
Conclusion EUS-FNA is better than ERCP with brush cytology and intraductal forceps biopsy in diagnosing malignant biliary strictures, mainly in the assessment of extraductal lesions and in those larger than 1.5 cm. Combining ERCP with tissue sampling and EUS-FNA is feasible, the techniques have similar complication rates, and the combination greatly improves diagnostic accuracy.