bluuebunny/crossref_metadata_2025_split huggingface dataset:
Is laparoscopically assisted radical vaginal hysterectomy for cervical carcinoma safe? A case control study with follow up
Authors: Morgan DJ , Hunter DC , McCracken G , McClelland HR , Price JH , Dobbs SP 
Published: March 2007

Objective  To compare a new surgical approach, laparoscopically assisted radical vaginal hysterectomy (LARVH) with open radical hysterectomy in women with cervical cancer. Can selected women benefit from the minimally invasive approach without compromising safety (recurrence rate) and morbidity (complications)?Design  Retrospective case control study.Setting  A tertiary referral unit for gynaecological malignancies.Population  Thirty women undergoing LARVH were included and compared with 30 women undergoing open radical surgery. The control group was matched for age, body mass index and disease stage.Methods  Retrospective collection of data from patient files and follow up.Main outcome measures  Recurrence rate, complication rate, hospital stay, nodal counts, blood loss, operating time.Results  Recurrence rates were equal (6.7%). There was one death, in the LARVH group. Follow up was mean 31 months in the LARVH group and 30.9 months in the open group. Blood loss as measured by mean drop in haemoglobin was greater in the open group (2.03 versus 3.01 g/dl, P= 0.02). Transfusions were given in 40% of women in the open group and 16.7% in the LARVH group. Hospital stay was significantly less in the LARVH group (5.9 versus 7.8 nights, P= 0.003). Mean operating time was longer in the LARVH group (131 versus 187 minutes P= 0.0001). Mean nodal counts did not differ significantly (17.4 in open vs 14.8 in LARVH, P > 0.05). There were seven perioperative complications in the open group and four in the LARVH group. There have been two recurrences in each group (6.67%) at mean follow up of 31 (LARVH) and 30.9 (open) months.Conclusions  The first 30 LARVH procedures performed in this unit are comparable in terms of safety (recurrence rate and complication rate) and economic factors (shorter hospital stay mitigating longer operating time). Further development of this technique is warranted.
Randomized controlled trial for the efficacy of hepatic arterial occlusion during radiofrequency ablation for small hepatocellular carcinoma – direct ablative effects and a long‐term outcome
Authors: Kobayashi Masahiro , Ikeda Kenji , Kawamura Yusuke , Hosaka Tetsuya , Sezaki Hitomi , Yatsuji Hiromi , Akuta Norio , Suzuki Fumitaka , Suzuki Yoshiyuki , Arase Yasuji , Kumada Hiromitsu 
Published: March 2007

AbstractObjective: To evaluate the efficacy of temporary balloon arterial occlusion during radiofrequency ablation (RFA), randomized controlled trial was performed.Methods: Twenty patients with hypervascular hepatocellular carcinoma measuring ≤30 mm were randomly treated with RFA combined with arterial occlusion (group A), or RFA alone (group B). Tumour ablation was performed in both groups using our ‘stepwise hook extension technique.’Results: Median diameters of the longer and shorter axis of RF‐induced area measured on computer tomography were 38 mm (range, 31–52) and 36 mm (25–40) in group A, and 34 mm (26–45) and 26 mm (22–32) in group B respectively. Although the longer axis was not statistically significant, the shorter axis of group A was significantly larger than in group B (P=0.003). The median volume of the ablated lesion was 25.3 cm3 (15.6–48.7) in group A and 16.1 cm3 (9.3–23.8) in group B. The lesion volume was significantly larger in group A than in group B (P=0.005). The time and energy requirement of RFA of both groups were not significantly different. In addition, no serious adverse effects were observed in both groups. Intrasubsegmental tumour recurrence was found in 0% in group A and 30% in group B at the end of the third year (P=0.082).Conclusions: Hepatic arterial balloon occlusion during RFA is useful for extending the area of ablation in RF‐induced lesions, and the procedure tended to decrease tumour recurrence from the same subsegment of ablated tumour.
Decreased portal flow volume increases the area of necrosis caused by radio frequency ablation in pigs
Authors: Yoshimoto Tsuyoshi , Kotoh Kazuhiro , Horikawa Yuki , Kohjima Motoyuki , Morizono Shusuke , Yamashita Shinsaku , Enjoji Munechika , Nakamuta Makoto 
Published: March 2007

AbstractBackground/aims: Although radio frequency ablation (RFA) has been widely accepted as an effective treatment for hepatocellular carcinoma (HCC), severe complications are not uncommon. Major complications seem to occur as a result of over‐ablation beyond the intended area. As most patients with HCC have underlying cirrhosis, we speculated that decreased portal flow might cause the necrosis associated with RFA. To confirm this hypothesis, we examined the area of necrosis resulting from RFA under varying conditions of portal flow in a porcine model.Methods: RFA was performed using ultrasonographic guidance in anesthetized pigs. During the RFA procedure, portal flow was regulated by a balloon catheter, which was set in a portal trunk. The necrosis area was measured after sacrifice and was compared with the hyperechoic area that appeared during ablation. In another session, RFA was performed close to the hepatic vein and endothelial damage was examined.Results: The necrosis area caused by RFA was significantly larger when the portal flow volume was decreased by 50% or more. The hyperechoic lesion was always larger than the area of pathological necrosis regardless of portal flow volume. Under conditions of decreased portal flow, the vessel endothelium near the ablated area was more readily damaged.Conclusion: Decreased portal flow volume resulted in enlargement of the area of necrosis caused by RFA. Our results indicate that over‐ablation could easily occur in patients with advanced cirrhosis, and that this could lead to major complications. Ultrasonographic guidance may be helpful for avoiding over‐ablation.
Efficacy and Tolerability of Levetiracetam in Children Younger than 4 Years: A Retrospective Review
Authors: Perry M. Scott , Benatar Michael 
Published: March 2007

Summary:  Purpose: To review our experience of the efficacy and tolerability of levetiracetam (LEV) in children younger than 4 years. Methods: We used retrospective chart review to identify 122 children with seizures who were younger than 4 years and followed for ≥6 months. Efficacy was evaluated on the basis of the occurrence and durability of seizure remission. Tolerability was based on parent‐ and patient‐reported side effects. Results: Seventy (57%) subjects achieved seizure remission, and 52 (43%) did not. In univariate analysis, those achieving seizure remission were more likely to have partial epilepsy, require lower maintenance doses of LEV, and have fewer than two seizures per month at initiation of the medication. Only seizure frequency at initiation of LEV remained significant in multivariate analysis. The median duration of seizure freedom (8.9 months) was not influenced by age, epilepsy type, gender, or pretreatment seizure frequency. The dose of LEV was the only significant predictor of the duration of seizure remission, with longer duration of seizure remission seen in those taking <30 mg/kg/day compared with those taking >30 mg/kg/d (median, 12.8 months vs. 3 months; p < 0.0001). Side effects of LEV occurred in 34% of subjects but required discontinuation in only 16%, most commonly because of behavioral disturbances. Conclusions: LEV is an effective medication in children younger than 4 years and at doses lower than previously reported. It is also well tolerated, suggesting that it represents an important option for the treatment of epilepsy in this age group.
Founder Effect with Variable Age at Onset in Arab Families with Lafora Disease and EPM2A Mutation
Authors: Gomez‐Abad Cristina , Afawi Zaid , Korczyn Amos D. , Misk Adel , Shalev Stavit A. , Spiegel Ronen , Lerman‐Sagie Tally , Lev Dorit , Kron Katherine L. , Gómez‐Garre Pilar , Serratosa Jose M. , Berkovic Samuel F. 
Published: March 2007

Summary:  Purpose: We observed three apparently unrelated and geographically separate Arab families with Lafora disease in Israel and the Palestinian territories. Methods: We clinically evaluated the families and analyzed their DNA for EPM2A mutations. Results: Of seven individuals with Lafora disease, the clinical onset varied from 13 to 20 years. All three families shared the same novel homozygous deletion in EPM2A. Haplotype analysis around the deletion showed that the families shared a common homozygous haplotype. The boundaries of this haplotype varied between families and even within one family. Conclusions: We conclude that considerable variability in the age at onset of Lafora disease can occur within families. Identical mutations can be associated with the classic adolescent presentation, as well as late‐onset cases. Haplotype analysis suggests that this EPM2A mutation arose many generations previously, so it may be of importance for cases distributed more widely in the Middle East.
Epilepsy and Language Development: The Continuous Spike‐Waves during Slow Sleep Syndrome
Authors: Debiais Séverine , Tuller Laurie , Barthez Marie‐Anne , Monjauze Cécile , Khomsi Amedh , Praline Julien , De Toffol Bertrand , Autret Alain , Barthelemy Catherine , Hommet Caroline 
Published: March 2007

Summary: Background:Continuous spike‐waves during slow sleep syndrome (CSWSS) is a rare epileptic syndrome occurring in children, which is characterized by the association of epilepsy, neuropsychological disorders, and abnormal paroxysmal electroencephalographic (EEG) discharges activated by sleep. Language can be affected but, to date, language disorders and their long‐term outcome have been documented only rarely.Purposes:Description of language impairment in patients with the CSWSS.Methods:We performed a detailed language testing in 10 right‐handed children and adolescents with the CSWSS. Their pragmatic performance was compared to that of a control population of 36 children aged 6—10 years.Results:Patients with CSWSS had lower scores in tests measuring their lexical, morphosyntactic, and pragmatic skills compared to controls. Comprehension remains unaffected. In addition, language impairment was found to be just as severe in patients in remission as those still in an active phase.Conclusions:We found severe language impairments in lexical and syntactic skills. The language profile is different from that observed in the Landau–Kleffner syndrome. Moreover patients in remission and those in an active phase of the CSWSS have the same language impairment profiles. This confirms the poor long‐term neuropsychological prognosis. Our results raise points about the relationship between epileptic activity and language development. This pilot study underscores the need to assess language, and especially pragmatic skills, and to study long‐term outcome in such childhood epileptic syndromes.
Social Functioning and Psychological Well‐Being of 347 Young Adults with Epilepsy Only—Population‐Based, Controlled Study from Finland
Authors: Koponen Anne , Seppälä Ullamaija , Eriksson Kai , Nieminen Pirkko , Uutela Antti , Sillanpää Matti , Hyvärinen Leena , Kälviäinen Reetta 
Published: March 2007

Summary:  Purpose: To explore social functioning and psychological well‐being in a population‐based cohort of epilepsy patients compared to matched controls. Methods: A random sample of patients with epilepsy (N = 347) and a healthy control group (N = 430) matched for age, gender and domicile were identified through National Registry of Social Insurance Institution in Finland. The data were collected by postal questionnaire assessing various factors related to social and psychological well‐being and were analyzed by using linear regression analysis to compare the study and control groups. Results: The age at onset of epilepsy was significantly associated with the level of further education and the level of seizure control with the employment status. The patients with epilepsy and lower level of basic education had also significantly lower level of further education, employment, and fewer social relations. Some differences in psychological well‐being were also seen in those with matriculation examination when compared to matched controls. Conclusions: In young adults with well‐controlled epilepsy and successful basic education, social functioning is comparable with healthy peers. The importance of all social and educational support during the time of basic education may be crucial to favorable intellectual, functional, and social development later in life. Both professional and informal support is needed in adjunct to conventional treament of epilepsy, which is emphasized.
Fetal Exposure to GABA‐Acting Antiepileptic Drugs Generates Hippocampal and Cortical Dysplasias
Authors: Manent Jean‐Bernard , Jorquera Isabel , Mazzucchelli Iolanda , Depaulis Antoine , Perucca Emilio , Ben‐Ari Yehezkel , Represa Alfonso 
Published: March 2007

Summary:  Purpose: The management of epilepsy during pregnancy entails a number of concerns. While seizures may affect adversely maternal and fetal outcome, antiepileptic drugs (AEDs) may increase the incidence of congenital abnormalities and possibly affect postnatal cognitive development in the offspring. Experimental animal studies can aid in assessing teratogenic features associated with individual AEDs and/or with seizures, and to identify the mechanisms involved. The purpose of this study was to investigate the consequences of prenatal exposure to (a) different AEDs and (b) maternal seizures on brain maturational processes in rats. Methods: Pregnant rats received from embryonic days 14 to 19 intraperitoneal injections of carbamazepine (20 mg/kg/day), vigabatrin (200 mgkg/day), and valproate (100 mg/kg/day) at doses not widely different from those used clinically. Pups exposed to AEDs in utero were analyzed postnatally. Animals born to “kindled” pregnant animals that had experienced one generalized convulsive seizure per day during the same gestational period were analyzed in parallel. Results: Prenatal exposure to vigabatrin and valproate, which act on GABA signaling, induced hippocampal and cortical dysplasias, which were likely to result from a neuronal migration defect and neuronal death. By contrast, offspring of rats exposed to carbamazepine (which at the dose used produced low plasma concentrations) or to generalized convulsive seizures showed no clear‐cut evidence of dysplasias. Conclusions: We suggest that AEDs that increase the extracellular concentration of GABA might induce severe neuronal migration disorders. Drugs acting through other molecular targets would also perturb cortical maturation. The potential clinical relevance of these results should be a subject of future research.
Electrophysiological Differences of the Spontaneous Onset of Paroxysmal and Persistent Atrial Fibrillation
Authors: WEBER STEFAN , NDREPEPA GJIN , SCHNEIDER MICHAEL , DEISENHOFER ISABEL , ZRENNER BERNHARD , SCHMITT CLAUS 
Published: March 2007

Background: Information about the spatiotemporal organization of atrial activity at the onset of atrial fibrillation (AF) is still limited.
Methods: AF mapping was performed in 30 patients with AF (mean age 53 ± 9 years, 26 males) by deploying a noncontact mapping balloon in the left atrium (LA). Twenty‐four patients had paroxysmal AF and six patients had persistent AF. Three types of AF episodes were analyzed: nonsustained AF (lasting ≤ 30 seconds), sustained AF (lasting > 30 seconds, with spontaneous conversion or requiring internal cardioversion and subsequent stable sinus rhythm), and persistent AF episodes (stable sinus rhythm lasting ≤ 1 minute after cardioversion).
Results: A total of 101 spontaneous AF onset episodes were analyzed. Analysis of AF onset showed that there was a progressive shortening of the initial cycle lengths from nonsustained episodes to sustained episodes and to persistent AF episodes. There was an earlier and more rapid reduction in the cycle lengths from persistent episodes to sustained episodes and to nonsustained episodes of AF (P < 0.05 for persistent vs sustained and for sustained vs nonsustained episodes). The development of multiwavelet activity and disorganization of conduction occurred earlier in persistent and sustained episodes than in nonsustained AF episodes. LA size was greater in patients with persistent AF episodes compared with patients with sustained or nonsustained AF episodes.
Conclusions: Electrophysiological events that develop at the onset of AF seem to be different in different types of AF. A more rapid degeneration into the fibrillatory activity was observed in persistent and sustained AF than in nonsustained AF episodes.
Tachycardia Circuit in Typical Atrial Flutter: The Role of a Posterolateral Line of Block in the Perpetuation of the Tachycardia
Authors: YAMABE HIROSHIGE , TANAKA YASUAKI , MORIHISA KENJI , UEMURA TAKASHI , KAWANO HIROAKI , NAGAYOSHI YASUHIRO , KOJIMA SUNAO , OGAWA HISAO 
Published: March 2007

Background: The essential boundaries in typical atrial flutter (AF) are unknown.
Methods: To examine the role of the tricuspid annulus (TA) and posterolateral line of block (LB) in maintaining AF, single extrastimuli were delivered during AF both around the LB and the TA in 29 patients. Single extrastimuli were delivered from the superior, middle, and inferior third of the anterior LB, superior, middle, and inferior third of the posterior LB, and the superior, lateral, inferior, and septal portions of the TA. The longest coupling interval (LCI) of single extrastimuli that reset AF and subsequent return cycle (RC) were analyzed.
Results: The resetting response showed two patterns (groups 1 and 2). The differences between the AF cycle length (AFCL) and the LCI (AFCL−LCI) at the superior, lateral, inferior, and septal portions of the TA were the shortest, and were significantly shorter than those at the other sites (P < 0.0001) in group 1. However, the AFCL−LCI at the superior, middle, and inferior third of the anterior LB, and the superior, lateral, inferior, and septal portions of the TA were the shortest, and were significantly shorter than those at the other sites (P < 0.0001) in group 2. The difference between the RC and the AFCL exhibited the same two patterns, similar to the AFCL−LCI. In group 1, a single extrastimulus produced an artificial conduction across the LB, but AF was not reset.
Conclusions: Two types of reentry circuits exist in AF; one has its essential reentry circuit confined to the TA and thus the LB acts as a bystander, while the LB and the TA are essential boundaries in the other one.
Thermal Mapping of Right Ventricular Outflow Tract Tachycardia
Authors: CLYNE CHRISTOPHER A. , ATHAR HARIS , SHAH ANUJ , KAHR ROSEMARIE , RENTAS ANGEL 
Published: March 2007

Background: Acute and long‐term success of catheter ablation of right ventricular outflow tract tachycardia (RVOT VT) may be limited by the inability to reproduce the arrhythmia at the time of activation (AM) and pace mapping (PM). We have observed early initiation of the clinical VT when subtherapeutic radiofrequency (RF) energy was applied to the target area (TA), defined as a 2‐cm2 area around a pace match. We describe a novel approach using thermal mapping (TM) to guide the ablation of RVOT VT.
Methods: Thirteen patients (10 female, mean age 46.2 ± 13.7 years) with symptomatic VT of left bundle branch block (LBBB) inferior axis morphology and no structural heart disease underwent standard electrophysiologic evaluation with PM (n = 13), AM (n = 13), and 3D noncontact mapping (n = 4). Thermal mapping was performed after standard techniques failed to induce stable sustained VT for mapping in all 13 patients: RF was applied for 5–10 seconds in the TA to achieve a tip temperature of 45–50°C. At sites where morphologically consistent with the clinical VT was induced, RF was applied at target temperature between 50 and 60°C for 30–60 seconds. TM was repeated before and after intravenous Isoproterenol infusion until no further VT could be induced by low temperature application.
Results: Noninducibility was achieved in all 13 patients. During a mean follow‐up of 29 months (9–69 months), all patients remain arrhythmia‐free, off antiarrhythmic medications.
Conclusion: Thermal mapping is a safe and effective adjunctive technique for the mapping and ablation of RVOT VT when sustained tolerated clinical VT cannot be induced.
Chronic Renal Insufficiency Is an Independent Predictor of Mortality in Implantable Cardioverter‐Defibrillator Recipients
Authors: CHEN‐SCARABELLI CAROL , SCARABELLI TIZIANO M. 
Published: March 2007

Background: Chronic renal insufficiency (CRI) has been associated with increased risk of cardiovascular morbidity and mortality. However, there is limited knowledge regarding this association and the effect of renal dysfunction on survival benefit in patients with implantable cardioverter‐defibrillators (ICDs).
Methods: We investigated whether there was an association between CRI (defined as serum creatinine levels ≥1.5 mg/dL) and increased risk of mortality in ICD recipients. We retrospectively studied all patients (n = 336) followed within our ICD clinic in a 2.5‐year period. CRI, ventricular tachycardia (VT), cardiomyopathy (CM), and mortality were recorded. Ischemic CM was defined as the presence of coronary artery disease (CAD) and left ventricular ejection fraction ≤ 30%.
Results: Despite no significant difference in CAD and VT occurrence between CRI and non‐CRI groups in the overall population, there was a significantly higher mortality rate in the CRI group (P < 0.0001).
Conclusion: CRI is a significant independent predictor of mortality in ICD recipients. Further investigation is needed to determine whether prevention, early detection, and more aggressive intervention in the treatment of CRI will reduce the incidence of mortality in this population.