bluuebunny/crossref_metadata_2025_split huggingface dataset:
The impact of the implementation of work hour requirements on residents' career satisfaction, attitudes and emotions
Authors: Choi Dongseok , Dickey Jamie , Wessel Kristen , Girard Donald E 
Published: October 2006

Abstract

Background
To assess the impact of work hours' limitations required by the Accreditation Council for Graduate Medical Education (ACGME) on residents' career satisfaction, emotions and attitudes.

Methods
A validated survey instrument was used to assess residents' levels of career satisfaction, emotions and attitudes before and after the ACGME duty hour requirements were implemented. The "pre" implementation survey was distributed in December 2002 and the "post" implementation one in December 2004. Only the latter included work-hour related questions.

Results
The response rates were 56% for the 2002 and 72% for the 2004 surveys respectively. Although career satisfaction remained unchanged, numerous changes occurred in both emotions and attitudes. Compared to those residents who did not violate work-hour requirements, those who did were significantly more negative in attitudes and emotions.

Conclusion
With the implementation of the ACGME work hour limitations, the training experience became more negative for those residents who violated the work hour limits and had a small positive impact on those who did not violate them. Graduate medical education leaders must innovate to make the experiences for selected residents improved and still maintain compliance with the work hour requirements.
Phase II Trial of Erlotinib in Gastroesophageal Junction and Gastric Adenocarcinomas: SWOG 0127
Authors: Dragovich Tomislav , McCoy Sheryl , Fenoglio-Preiser Cecilia M. , Wang Jiang , Benedetti Jacqueline K. , Baker Amanda F. , Hackett Christopher B. , Urba Susan G. , Zaner Ken S. , Blanke Charles D. , Abbruzzese James L. 
Published: October 2006

Purpose A phase II trial of the oral epidermal growth factor receptor (EGFR) inhibitor erlotinib in patients with gastroesophageal adenocarcinomas stratified according to primary tumor location into two groups: gastroesophageal junction (GEJ)/cardia and distal gastric adenocarcinomas. Patients and Methods Patients with a histologically proven diagnosis of adenocarcinoma of the GEJ or stomach (ST) that was unresectable or metastatic; presence of measurable disease; no prior chemotherapy for advanced or metastatic cancer; Zubrod performance status (PS) of 0 to 1; and adequate renal, hepatic, and hematologic function were treated with erlotinib 150 mg/d orally. Patient characteristics were median age, GEJ—63 years, ST—64 years; sex, GEJ—84% male and 16% female, ST—60 male and 40 female; Zubrod PS, GEJ—25 had a PS of 0 and 18 had a PS 1, ST—13 had a PS of 0 and 12 had a PS of 1. Results Percentage of common toxicities were skin rash, 86% and 72%; fatigue, 51% and 44%; and AST/ALT elevation, 28% and 28%, respectively for GEJ and ST. There has been one confirmed complete response, three confirmed partial responses (PRs) and one unconfirmed PR for an overall response probability of 9% confirmed (95% CI, 3% to 22%), all occurring in GEJ stratum. No responses were observed in ST stratum. The median survival was 6.7 months in GEJ and 3.5 months in ST stratum. Neither intratumoral EGFR, transforming growth factor–alpha or phosphorylated Akt kinase expression nor plasma proteomic analyses were predictive of clinical outcome. No somatic mutations of the EGFR exons 18, 19, or 21 were detected and there was no gross amplification of EGFR by fluorescence in situ hybridization. Conclusion Erlotinib is active in patients with GEJ adenocarcinomas, but appears inactive in gastric cancers. The molecular correlates examined were not predictive of the patient therapeutic response.
Intravascular Ultrasound for Intracranial Angioplasty and Stent Placement: Technical Case Report
Authors: Christopher Wehman J. , Holmes David R. , Hanel Ricardo A. , Levy Elad I. , Hopkins L. Nelson 
Published: October 2006

Abstract

OBJECTIVE:
Intravascular ultrasound (IVUS) imaging has been used extensively in coronary artery interventions and has provided invaluable information for the understanding and treatment of coronary arterial disease. We present here the first description, to our knowledge, of IVUS-guided intracranial arterial interventions in the clinical setting.

CLINICAL PRESENTATION:
Two patients underwent intracranial angioplasty and stent placement with the assistance of IVUS for the evaluation of their lesions. One patient underwent stenting to treat an occlusive dissection of the left internal carotid artery that occurred during arteriovenous malformation embolization. Another patient underwent angioplasty and stenting for high-grade restenosis of a basilar artery atherosclerotic lesion.

RESULTS:
Both patients underwent successful revascularization procedures. The patient with the dissection had a small intraventricular and parenchymal hemorrhage documented by computed tomography 4 hours after treatment, but did not develop hydrocephalus or further hemorrhage. Both patients did well clinically and had no permanent neurological deficits. IVUS provided important information in terms of lesion evaluation, stent selection, and stent placement in each case.

CONCLUSION:
IVUS of the intracranial circulation may assist the performance of intracranial angioplasty and stenting. It provides useful information that can affect clinical decisions. It may prove to be a valuable tool in clinical use and enhance our understanding of vascular disease of the intracranial circulation, as it has in the coronary circulation.
Microsurgery in the Removal of a Large Cerebral Hydatid Cyst: Technical Case Report
Authors: Balak Naci , C¸avumirza Cengiz , Yıldırım Hu¨meyra , Ozdemir Sec¸il , Kınay Demet 
Published: October 2006

Abstract

OBJECTIVE:
Surgery is presently the mainstay in the treatment of cerebral hydatid cysts, but removal without perforation of the cyst wall is critical. The Dowling-Orlando technique has been the main surgical choice for the intact removal of intracranial hydatid cysts. Dowling described his technique in 1929, well before the introduction of the microscope in neurosurgery. Using the operating microscope has not been reported in the removal of a large hydatid cyst.

CLINICAL PRESENTATION:
The case of a 16-year-old male with a large, right parieto-occipital hydatid cyst is presented.

INTERVENTION:
In this case, surgery was greatly aided by the use of the microscope in the initial stage of the removal of the cyst. Cyst extraction during the delivery process was continued without the aid of the microscope. The cyst was successfully removed intact.

CONCLUSION:
The use of the magnification during the early part of the surgery of a hydatid cyst is extremely helpful because, at a crucial stage of the procedure, it prevents inadvertent damage of the very thin cyst wall and allows development of the critical surgical plane.
Coating the Wall of an Injured Intracranial Carotid Artery During Tumor Removal With N-Butyl-2-Cyanoacrylate: Technical Case Report
Authors: Requejo Flavio , Schumacher Martin , van Velthoven Vera 
Published: October 2006

AbstractOBJECTIVE:Carotid artery injury close to the clinoid process is difficult to repair, and is even more so when the vessel is firmly attached to a calcified tumor. We treated a patient with an intraoperative carotid lesion by coating the vessel wall with N-butyl-2-cyanoacrylate (NBCA).CLINICAL PRESENTATION:A 7-year-old boy was referred to our clinic with a 3-month history of somnolence, apathy, and headache. Neurological examination revealed bitemporal hemianopsia. The cranial magnetic resonance imaging and computed tomographic scans showed a sellar and suprasellar calcified mass with heterogeneous contrast enhancement, a cyst component in the upper part of the tumor displaced upward and back from the mesen-cephalic and diencephalic structures.INTERVENTION:The patient underwent a pterional craniotomy. Using a microsurgical technique, the suprasellar part of the craniopharyngioma was removed. In an attempt to dissect the calcified mass from the carotid artery on the right side, the vessel was unintentionally injured, followed by severe bleeding. Temporary occlusion and suturing of the vessel was impossible because of the overlying hard mass. To avoid a permanent occlusion, we decided to coat the injured artery wall with 100% NBCA. For this, 0.5 ml of NBCA was distributed on the surface of the injured segment and surrounding subarach-noid space by injection through a needle. An excellent hemostasis could be obtained immediately after coating. The patient woke up with no new neurological deficits. A digital cerebral angiogram obtained a few days after the procedure did not show vasospasm, stenosis, or pseudoaneurysm in the supraclinoidal segment of the carotid artery. A magnetic resonance angiogram obtained 3 years later showed a normal shape of the internal carotid artery and a stable residual tumor without inflammatory signs. The child is now attending school and is under hormonal therapy.CONCLUSION:For hemostatic purposes, the technique of coating an injured arterial wall with NBCA may be useful in cases in which a microsuture is impossible and a permanent artery occlusion is unwanted because of a risk of an ischemic stroke. It could serve as a transitory measure until a microsurgical bypass or the balloon test occlusion tolerance allow the trapping of the affected artery.
“Target Bypass”: A Method for Preoperative Targeting of A Recipient Artery in Superficial Temporal Artery-to-Middle Cerebral Artery Anastomoses
Authors: Kikuta Ken-ichiro , Takagi Yasushi , Fushimi Yasutaka , Ishizu Kouichi , Okada Tsutomu , Hanakawa Takashi , Miki Yukio , Fukuyama Hidenao , Nozaki Kazuhiko , Hashimoto Nobuo 
Published: October 2006

Abstract

OBJECTIVE:
To introduce a method for preoperative targeting of a proper recipient artery in superficial temporal artery-to-middle cerebral artery anastomosis.

METHODS:
Six operations for superficial temporal artery-to-middle cerebral artery anastomosis in four patients with moyamoya disease or moyamoya-like disease and two operations in two patients with atherosclerotic cerebrovascular occlusive disease accompanied by coronary artery stenosis were performed using our method. Before surgery, a 3-Tesla magnetic resonance imaging study was performed with axial T1-weighted three-dimensional magnetization-prepared rapid acquisition gradient-echo sequences and three-dimensional time-of-flight magnetic resonance angiography. Data on quantitative regional cerebral blood flow were obtained by iodine-123-labeled N-isopropyl-iodoamphetamine single-photon emission computed tomography or positron emission computed tomography. The magnetic resonance angiography and regional cerebral blood flow data sets were registered with the magnetization-prepared rapid acquisition gradient-echo data set by means of the coregistration function of the SPM2 software. We examined the arteries located on or near the cortex where the regional cerebral blood flow had significantly decreased and used the coregistered data set and MRIcro software to select the cortical artery with the largest diameter as the target recipient artery. At the surgery, the data sets were applied to the neuronavigation system and the actual site of the target was confirmed in the operation before scalp incision. The superficial temporal artery was anastomosed with the target through a small craniotomy.

RESULTS:
Successful bypass surgery to the target was confirmed in all cases. @@CONCLUSION:@@ The “target bypass” method might be effective for cases with moya-moya disease or for cases requiring surgery through a small craniotomy.
Stent Placement For Intracranial Cysts By Combined Stereotactic/Endoscopic Surgery
Authors: Berlis Ansgar , Vesper Jan , Ostertag Christoph 
Published: October 2006

Abstract

OBJECTIVE:
The treatment of space-occupying cystic lesions includes percutaneous cyst aspiration, marsupialization, percutaneous ventriculocystotomy, or Rickham catheter implantation. In some patients, the cysts tend to recur and repeated evacuations are necessary. The authors present a new treatment method with internal drainage of cysts into the ventricular system using a balloon-mounted vascular stent.

METHODS:
Six patients with cysts of low-grade gliomas, one with monocystic craniopharyngioma, and one with suprasellar arachnoid cyst were treated between September 2003 and May 2005. All patients were symptomatic after multiple previous treatments. Stent implantations were performed under local anesthesia in adults and under general anesthesia in children. In all patients, the stereotactic frame and computed tomographic and magnetic resonance fusion were used for an optimized approach. The treatment was performed in a compassionate manner and the patients were informed about the off-label use of the device.

RESULTS:
Stent placement was successful in all eight patients without procedure-related complications. Improvement of clinical symptoms was seen in seven out of eight patients. Seven out of eight cysts decreased in size within a follow-up period of up to 23 months (mean, 17 mo; median, 18 mo; range, 6-23 mo). The first patient showed recurrence of the tumor cyst 3 months after initial treatment with a Herkulink stent (5 × 18 mm), followed by retreatment with an Omnilink stent (6 × 28 mm; Guidant Corp., Santa Clara, CA). Stenting was ineffective in one patient. @@CONCLUSION:@@ Treatment of intracranial cystic lesions by internal drainage is possible with the use of stent-assisted ventriculocystostomy.
Complication Avoidance in Peripheral Nerve Surgery: Preoperative Evaluation of Nerve Injuries and Brachial Plexus Exploration—part 1
Authors: Russell Stephen M. , Kline David G. 
Published: October 2006

AbstractComplication avoidance during peripheral nerve surgery has received little attention in the neurosurgical literature. The goal of our two-part review is to discuss these possible complications, with this initial article highlighting the pitfalls associated with pre- and intraoperative assessment of nerve injuries, as well as the operative nuances used during brachial plexus exploration to minimize complications.
The Management of Vein of Galen Aneurysmal Malformations
Authors: Lasjaunias Pierre L. , Chng Soke M. , Sachet Marina , Alvarez Hortensia , Rodesch Georges , Garcia-Monaco Ricardo 
Published: October 2006

AbstractOBJECTIVE:The vein of Galen aneurysmal malformation (VGAM) is a choroidal type of arteriovenous malformation involving the vein of Galen forerunner. This is distinct from an arteriovenous malformation with venous drainage into a dilated, but already formed, vein of Galen. Reports of endovascular treatment of VGAM in the literature approach the disease from a purely technical viewpoint and often fail to provide satisfactory midterm results. To focus the therapeutic challenge to a strictly morphological goal overlooks the fundamental aspects of neonatal and infant anatomy and fluid physiology. During the past 20 years, our approach to VGAM has remained the same. Our experience, based on 317 patients with VGAM who were studied in Hospital Bicêtre between October 1981 and October 2002, allows us to describe the angioarchitecture, natural history, and management of VGAM in neonates, infants, and children.METHODS:Of our cohort of 317 patients, 233 patients were treated with endovascular embolization; of these, 216 patients were treated in our hospital. The treatment method of choice was a transfemoral arterial approach to deliver glue at the fistulous zone.RESULTS:Of 216 patients, 23 died despite or because of the embolization (10.6%). Twenty out of the 193 (10.4%) surviving patients were severely retarded, 30 (15.6%) were moderately retarded, and 143 (74%) were neurologically normal on follow-up.CONCLUSION:Our data demonstrate that most treated children survive and undergo normal neurological development; an understanding of the clinical, anatomical, and pathophysiological features of VGAM has, therefore, reversed the former poor prognosis. Our level of understanding about the lesion allows us to predict most situations and remedy them by applying a strict evaluation protocol and working within an optimal therapeutic window. Patient selection and timing remain the keys in the management of this condition. It is more important to restore normal growth conditions than a normal morphological appearance, with the primary therapeutic objective being normal development in a child without neurological deficit.
Current Status of Manpower Needs for Management of Cerebrovascular Disease
Authors: Zipfel Gregory J. , Derdeyn Colin P. , Dacey Ralph G. 
Published: October 2006

AbstractTHE CEREBROVASCULAR DISCIPLINE has undergone dramatic changes in recent years. The advent, development, and now widespread application of endovascular therapy for various cerebrovascular diseases has been the predominant influence behind many of these changes, but other factors (some scientific, others less so) have also contributed significantly. As our discipline evolves, it is critical to periodically examine how such changes have altered our manner of practice and to determine what impact such changes might have on manpower allocation and training for the future. This article is our attempt at providing such an assessment. First, we will critically review recent trends within the fields of intracranial aneurysms, arteriovenous malformations, carotid atherosclerotic occlusive disease, and ischemic stroke and how these trends have impacted our profession. Thereafter, we will provide a perspective on what the cerebrovascular manpower needs of the future might be and by whom these needs will be met. Finally, we will examine how the new generation of cerebrovascular specialists, including neurosurgeons, neuroradiologists, and some neurologists, will attain their requisite surgical or endovascular training and attempt to determine which careers, pathways, and opportunities will be available to these individuals in the future.
A Novel Technique and New Grading Scale for the Embolization of Cerebral Vascular Malformations
Authors: Amar Arun P. , Teitelbaum George P. , Larsen Donald W. 
Published: October 2006

Abstract

OBJECTIVE:
Effective transarterial embolization of a dural arteriovenous fistula or pial arteriovenous malformation (AVM) requires penetration of a durable occlusive agent into the fistula or AVM nidus. Cyanoacrylate glue often cannot traverse the tortuous vessels that typically supply such malformations, leading to proximal occlusion and recruitment of collateral flow. Other embolic agents, such as polyvinyl alcohol particles, achieve better penetration, but their effects are short lived, often leading to recanalization. The authors sought to overcome these obstacles by developing a technique to enhance glue penetration into the fistula or AVM nidus itself.

METHODS:
After placing a guide catheter in the proximal feeding artery, a microcatheter is advanced coaxially to its limit. As glue is injected through the microcatheter, a column of 5% dextrose in water (D5W) is pushed manually through the guide catheter lumen to propel the glue forward. This technique has been bench tested in a standard flow model of vascular malformations, using a pump capable of delivering various rates of D5W. It has also been validated in treating 17 patients with cerebral dural arteriovenous fistulae or AVMs, with real-time adjustment of D5W flow according to the extent of glue penetration.

RESULTS:
In the bench model, the extent of glue penetration, as graded by a new scale of liquid agent embolization proposed by the authors, correlated directly with the rate of D5W flow (P = 0.5, analysis of variance). In vivo, this technique has enhanced the penetration of glue into the fistula or AVM nidus, resulting in longstanding embolization of these malformations.

CONCLUSION:
Coaxial injection of D5W through the guide catheter can propel cyanoacrylate glue through tortuous feeding arteries and can enhance its penetration into dural fistulae and AVMs, leading to more effective endovascular treatment of these malformations.
Otolaryngologic manifestations of acute leukemia
Authors: Sklansky B. Donald , Jafek Bruce W. , Wiernik Peter H. 
Published: October 2006

AbstractThis report documents the principles of diagnosis and management of acute leukemia from an otolaryngologic standpoint, based on our experience with 273 patients at the Baltimore Cancer Research Center of the National Cancer Institute. Infection, hemorrhage, infiltration and chemo‐therapeutic complications are considered. The need for a high index of suspicion and an aggressive approach to these problems is stressed.
Electronystagmographic findings in motor neuron disease
Authors: Steinmetz Edward F. , Lebo Charles P. , Norris Forbes H. 
Published: October 2006

AbstractThe electronystagmogram (ENG) was abnormal in 94 percent of 88 consecutive patients with motor neuron disease (MND). The most common ENG abnormalities were dysrhythmic caloric responses (64 percent), active random eye movements with eyes closed (25 percent), caloric directional preponderance (24 percent), and caloric vestibular preponderance (20 percent). Torsional preponderance, poor fixation suppression (of induced vestibular nystagmus), spontaneous nystagmus, square waves, tracking and optokinetic abnormalities were also frequent. Most of these ENG findings are considered to be of central nervous system origin. Although these findings are not considered specific for MND, they appear to have clinical significance.
Bell's palsy and the chorda tympani nerve: A clinical and electron microscopic study
Authors: May Mark , Schlaepfer William W. 
Published: October 2006

AbstractThe chorda tympani nerve plays an important role in the pathogenesis of Bell's palsy. The chorda tympani nerve is altered early in the course of the disease, perhaps before involvement of the facial nerve occurs. This was demonstrated by studying the pathophysiologic alterations of the chorda tympani nerves of 15 patients with Bell's palsy. Fifty‐seven percent of the patients noted taste aberrations two days before the onset of the facial paralysis. In addition, chorda tympani nerve function, tested by electro‐gustometry and by determining submandibular salivary flow, was altered before the response to nerve excitability became reduced; further, the electron micrographic findings in two patients indicated that the involvement of the chorda tympani nerve preceded the time of onset of the facial paralysis.The study established a relationship between the pathologic involvement of the chorda tympani nerve and the facial nerve. There was a direct relationship between the severity of changes noted microscopically in the chorda tympani nerve specimens and the ultimate recovery of facial motor function.Examination of the chorda tympani nerve specimens was used to correlate the effectiveness of treatment. The results of steroid therapy and surgical decompression were compared. Steroids had no beneficial effect. Complete return of facial function was associated with surgical management when surgery was performed based on reduced salivary flow to 25 percent of normal and while the response to maximal stimulation was still normal.
Evaluation of tonsils and adenoids in sleep apnea syndrome
Authors: Richardson Mark A. , Seid Allan B. , Cotton Robin T. , Benton Corning , Kramer Milton 
Published: October 2006

AbstractPeripheral Sleep Apnea syndrome has been associated with enlarged tonsils and adenoids as well as other abnormalities which may cause upper airway obstruction in children. A multidisciplinary approach is used at the Sleep Disorder Center of Cincinnati General Hospital to evaluate the role of tonsils and adenoids in sleep apnea.Polysomnographic techniques combined with cine sleep studies of the upper airway document the degree, site and type of obstruction. This presentation highlights the entity of obstructive sleep apnea and provides a rational clinical approach in the management of these patients.