bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.
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.
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.
Isolation and Identification of Paracetamol Metabolites
Authors: Andrews R S , Bond C C , Burnett J , Saunders A , Watson K 
Published: July 2017

A comparison has been made of the urinary metabolites of volunteers who had taken therapeutic doses of paracetamol with those of persons who had taken an overdose in an attempt to highlight the metabolic changes associated with massive doses. The main technique for examining urine samples was two-dimensional thin layer chromatography. Other chromatographic techniques were used for the isolation and purification of metabolites. The urinary metabolites after a therapeutic dose of paracetamol were identified as free paracetamol, paracetamol sulphate, 3-hydroxy-paracetamol-3-sulphate, 3-methoxy-paracetamol sulphate, paracetamol glucuronide, 3-methoxy-paracetamol glucuronide, paracetamol 3-cysteine conjugate and paracetamol 3-mercapturate. The same metabolites were also present in urine following overdosage but the proportions were quite different. There was particularly a big increase in the relative amounts of cysteine and mercapturic acid conjugates excreted. No new metabolites were found. The significance of these findings is briefly discussed in relation to the metabolism and toxicology of paracetamol.
A Theoretical Approach to the Management of Paracetamol Overdosage
Authors: Penn R G 
Published: July 2017

Possible ways of treating paracetamol hepatotoxicity are briefly reviewed. This toxicity appears to be due to an oxidation metabolite which is normally detoxified by conjugation with glutathione, but when in excess, as in paracetamol overdosage, binds covalently to hepatic proteins to cause liver necrosis. Depletion of hepatic glutathione may also lead to other contributory disorders of cellular metabolism. Physical methods of preventing this would appear to be of little value, and treatments are being developed which aim to lessen the production of the toxic metabolite, antagonize its attachment to hepatic tissue or to combat this toxicity via basic cellular mechanisms. At this moment the most effective substances appear to be glutathione precursors and other compounds which interfere with oxidation of paracetamol.
Net Shape Woven Fabrics—2D and 3D
Authors: Clarke Steven R. 
Published: July 2017

Weaving technology has been used for many years to weave net shape products to very tightly controlled dimensions. Numerous examples of narrow tapes, tubular fabrics, and multi-layer belting products can be found in the biomedical, automotive, and industrial fields. In more recent times 2D and 3D woven net shape products have expanded into polar or spiral woven fabrics, integrally stiffened skin panels, and tapered net shape airfoil components. This paper will review the manufacturing technologies used to produce these net shape textile products as well as show examples of the finished textile products and their applications.