bluuebunny/crossref_metadata_2025_split huggingface dataset:
Incidental Pancreatic Cystic Lesions
Authors: Edirimanne Senarath , Connor Saxon J. 
Published: June 2008

AbstractIntroductionIncidental pancreatic cystic lesions (IPCL) are becoming an increasingly frequent clinical entity. Within this review, the differential diagnosis, investigation, and management are discussed.MethodsA MEDLINE search was performed for IPCL.ResultsIncidence of IPCL varies from 0.2–0.7%, and 30–47% are premalignant or malignant. Pancreatic pseudocysts (PC), serous cystic neoplasms (SCN), intraductal papillary mucinous neoplasms (IPMN), and mucinous cystic neoplasms (MCN) are the most common pathological entities of IPCL. The use of combined modalities, including clinical characteristics, serum tumor markers, cross‐sectional imaging, and endoscopic ultrasound (EUS) with cyst fluid analysis should all be used to establish an accurate preoperative diagnosis if possible. Modern multidetector computed tomography (MDCT) and magnetic resonance pancreatography (MRP) allow detailed characterization of IPCL, including size, septation, calcifications, mural nodules, and communication with main pancreatic duct. The best available cyst fluid markers of mucinous neoplasm are viscosity ≥1.6 and carcinoembryonic antigen >192 ng/ml. Although surgery is indicated for MCN or main or mixed duct IPMN, recent advances in the understanding of the natural history and increasingly accurate preoperative diagnosis allow a nonoperative approach to be undertaken for the majority of IPCL. For those treated nonoperatively, the ideal follow‐up has yet to be determined.ConclusionsEmerging evidence supports selective nonoperative management for the majority of patients who have IPCL when investigated by a multimodal approach. For those in whom a suspicion of malignancy remains, surgery is indicated.
The Right Small‐for‐Size Graft Results in Better Outcomes than the Left Small‐for‐Size Graft in Adult‐to‐Adult Living Donor Liver Transplantation
Authors: Yi Nam‐Joon , Suh Kyung‐Suk , Cho Yong Beom , Lee Hae Won , Cho Eung‐Ho , Cho Jai Young , Shin Woo Young , Kim Joohyun , Lee Kuhn Uk 
Published: June 2008

AbstractBackgroundThe recent outcome of adult‐to‐adult living donor liver transplantation (ALDLT) using small‐for‐size grafts (SFSGs; GRWR <0.8%) has been excellent after right grafts were exclusively used in large‐volume ALDLT centers.MethodsWe compared the outcome of ALDLTs using 11 right SFSGs (group R) with that using 18 left SFSGs (group L) of our center. The dysfunction of graft was defined dysfunction as hyperbilirubinemia (>5 mg/dl), prolonged prothrombin time (>2 INR), or uncontrolled ascites (>1,000 ml/day) on 3 consecutive days in posttransplant 7 days, and the dysfunction score (DS; the sum of points given per each sign) of the graft was used to describe the SFSG dysfunction severity.ResultsThe pretransplant recipient status was similar between the groups, but the 1‐year mortality rate was 0% in group R and 33.3% (n = 6) in group L (p = 0.038). The ICU stay was longer in group L (20 days) than in group R (11 days; p = 0.004). Hyperbilirubinemia in group R vs. L was noted in 54.5% vs. 50%, prolonged prothrombin time in 18.2% vs. 50%, and uncontrolled ascites in 54.5% vs. 100%. The DS was lower in group R than in group L (1.3 vs. 2; p = 0.007). The DS was zero in four right liver recipients. On multivariate analysis, the only factor affecting DS was the graft side.ConclusionThe clinical signs of SFSG dysfunction were less arduous and there was no 1‐year mortality in cases in group R. Therefore, the right SFSG may be used for ALDLT in the future base on the transplant center’s experience.
Predictors of Technical Skill Acquisition Among Resident Trainees in a Laparoscopic Skills Education Program
Authors: Van Hove Corey , Perry Kyle A. , Spight Donn H. , Wheeler‐Mcinvaille Krissy , Diggs Brian S. , Sheppard Brett C. , Jobe Blair A. , O’Rourke Robert W. 
Published: June 2008

AbstractBackgroundAdministrative and financial pressures on surgical education have created a need for efficient training curricula. Predictors of innate technical ability, which would guide the optimization of such a curriculum, are not well described. The goal of this study was to identify student characteristics predictive of innate pretraining skill level and response to training during the course of a four‐week laparoscopic skills development program.MethodsLaparoscopic skills in 35 first‐year surgical residents were assessed with the McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS) before and after a four‐week skills training program and after an interval of approximately 1 year. The correlation between trainee characteristics, including age, sex, designated surgical specialty, and laparoscopic skill level was assessed by using Pearson’s correlation and paired t‐test studies.ResultsIntake MISTELS scores showed no significant correlation to age, sex, or designated field. Interns designated for the general surgery training program had significantly higher final scores than those entering other fields (p = 0.02). There was a negative correlation between trainee age and both degree of improvement during training and final scores (p = 0.02 and 0.05). A history of video game use correlated with significantly higher initial scores and better skills retention (p = 0.03 and 0.04).ConclusionsA laparoscopic technical curriculum can achieve basic proficiency even when taught to a diverse group of trainees. Older residents beginning their surgical careers may be slower to develop technical skills. Choice of subspecialty seems to predict higher level of proficiency after completion of a skills training program among resident students.
Fundus Rotation Gastroplasty vs. Kirschner‐Akiyama Gastric Tube in Esophageal Resection: Comparison of Perioperative and Long‐Term Results
Authors: Hartwig Werner , Strobel Oliver , Schneider Lutz , Hackert Thilo , Hesse Christine , Büchler Markus W. , Werner Jens 
Published: June 2008

AbstractBackgroundImproved tube length and low anastomotic leakage rates have been demonstrated for fundus rotation gastroplasty (FRG) after esophageal resection. The aim of the present study was to compare the safety of FRG vs. the conventional Kirschner‐Akiyama gastric tube in a large prospective clinical series.MethodsAll patients with primary esophageal cancer who were to undergo esophageal resection at the authors’ department were prospectively assessed. The subgroup of patients in whom FRG or the Kirschner‐Akiyama reconstruction with either intrathoracic or cervical anastomosis was performed between October 2001 and November 2005 was analyzed for perioperative surgical and nonsurgical complications and for long‐term survival.ResultsFRG was performed in 57 patients and Akiyama reconstruction was performed in 54 patients with potentially curative resectable carcinoma. The patients had a mean age of 60.3 years. Tumor type was squamous cell carcinoma in 51 patients and adenocarcinoma (AEG types I and II) in 60 patients. There were no differences between the reconstruction groups with respect to age, gender, tumor type, neoadjuvant treatment, and tumor stage. Duration of surgery, blood loss, resection margins, extent of lymphadenectomy, ICU stay, and hospital stay also did not show any significant differences. Overall leakage rate, including tube ischemia, was 9.9% and mortality was 2.7%. Compared with the Akiyama reconstruction, FRG was performed significantly more often in combination with cervical anastomosis (4 vs. 22, respectively, p = 0.0001). Uni‐ and multivariate analyses excluded the reconstruction type as a possible parameter for insufficiency. Furthermore, neither hospital mortality nor long‐term survival was significantly different between the two groups.ConclusionThis clinical series is the first to compare FRG and conventional gastric tube reconstruction after esophagectomy in esophageal cancer. With comparable perioperative and long‐term results of either technique, the increased length of the FRG tube may have advantages for reconstruction with cervical anastomosis.
Liver Transplantation: The Last Measure in the Treatment of Bile Duct Injuries
Authors: de Santibañes Eduardo , Ardiles Victoria , Gadano Adrian , Palavecino Martin , Pekolj Juan , Ciardullo Miguel 
Published: June 2008

AbstractBackgroundBile duct injury (BDI) is a severe complication that may arise during the surgical treatment of a benign disease. A significant proportion of cases develop end‐stage liver disease and a liver transplant is required. The aim of this study was to analyze the indications and results of liver transplantation as treatment for BDI.MethodsBetween January 1988 and May 2007, 20 patients with end‐stage liver disease secondary to BDI were included on the liver transplant waiting list. Retrospective charts were analyzed and survival was estimated by the Kaplan–Meier test.ResultsFour patients died while on the waiting list and 16 received a transplant. Injury to the bile duct occurred during a cholecystectomy in 13 of 16 patients, with the main cause of the lesion being duct division in six patients and resection in four. All patients had received some surgical treatment (median = 2 procedures) before being considered for a transplant. The liver transplant came from a cadaveric donor for all patients and the median time between BDI and liver transplant was 60 months. Two patients died in the postoperative period and nine had complications. Three patients died in the late postoperative period. Median follow‐up was 62 (range = 24–152) months. One‐, three‐, and five‐year survival rates were 81, 75, and 75%, respectively.ConclusionComplex bile duct injuries and bile duct injuries with previous repair attempts can result in end‐stage liver disease. In these cases, liver transplantation provides long‐term survival.
Endoscopic Evaluation of the Quality of the Anastomosis After Esophagectomy with Gastric Tube Reconstruction
Authors: Kim Hyun Koo , Choi Young Ho , Shim Jae Hoon , Cho Yang Hyun , Baek Man‐Jong , Sohn Young‐Sang , Kim Hark Jei 
Published: June 2008

AbstractBackgroundThe morbidity and mortality of anastomotic complications after esophagectomy have gradually decreased in recent years. However, swallowing difficulties and reflux continue to burden patients jeopardizing their quality of life. In the present study we performed endoscopic evaluation of the outcomes of esophagogastrostomy by analyzing the presence of anastomotic stenosis and reflux esophagitis.MethodsA retrospective analysis was carried out on 74 patients who underwent esophagogastrostomy after esophagectomy by one surgeon between January 1995 and December 2004. Fifty‐three patients had an endoscopic examination during follow‐up (29 ± 23.6 months, range = 5–111 months). Reflux esophagitis and stenosis at the anastomostic site were analyzed according to the surgical technique used and the location of the esophagogastrostomy.ResultsThe mean age at the time of repair was 60.3 ± 8.87 (range = 39–81) years. Cervical anastomosis was performed in 26 patients and intrathoracic anastomosis in 27 patients. No significant statistical difference in the frequency of anastomotic stenosis was observed between the two groups (p = 0.829); reflux esophagitis was noted in three patients in the cervical anastomosis group and in 14 patients in the intrathoracic anastomosis group (p = 0.041). For all patients, 23 received a hand‐sewn esophagogastric anastomosis and 30 a circular stapled one. There was no significant statistical difference in anastomotic stenosis (p = 0.689) and reflux esophagitis (p = 0.879) in comparisons between the two groups.ConclusionCervical anastomosis resulted in a better outcome for esophagogastrostomy by lowering the risk of reflux esophagitis; this outcome might improve the patient’s quality of life.
Acute Care Nurse Practitioner: An Advanced Practice Role for RN First Assistants
Authors: Schroeder Janice L. 
Published: June 2008

ABSTRACTACUTE CARE NURSE PRACTITIONERS (ACNPs) are advanced practice RNs who are educationally prepared to provide advanced nursing care to patients with complex acute, critical, and chronic illness.THE EDUCATION of advanced practice nurses should prepare them for the setting in which they practice; ACNPs are well prepared for hospital and specialty practice, particularly if they have experience as RN first assistants (RNFAs).THIS ARTICLE PROVIDES a brief overview of the ACNP opportunity for RNFAs and the importance of additional training for ACNPs without OR experience who may be first assisting. AORN J 87 (June 2008) 1205‐1215. © AORN, Inc, 2008.
Assessment of physical activity in daily life in patients with musculoskeletal pain
Authors: Verbunt Jeanine A. , Huijnen Ivan P.J. , Köke Albere 
Published: June 2008

ABSTRACTPatients with musculoskeletal pain often report limitations in daily functioning due to pain. Recently, the World Health Organisation (WHO) recommended in their International Classification of Functioning, Disability and Health (ICF) to accentuate patients remaining possibilities in functioning instead of focussing on restrictions. In patients with musculoskeletal pain, this would imply that a person's “daily activity level” rather than his/her “disability level” has to be focussed upon. At this moment, broad consensus about how to measure physical activity in daily life in patients with pain has not been established. The objectives of this study were twofold, firstly to identify instruments assessing the level of physical activity in daily life in patients with musculoskeletal pain and secondly to review psychometric properties of the instruments identified. In all, 42 articles derived from the literature on musculoskeletal pain were included in the review. Thirty four assessment instruments for physical activity were identified; fourteen questionnaires, ten diaries and ten instruments based on movement registration. Only, 10 out of these 34 instruments contained full or partial information regarding pain specific psychometric properties. At this moment, for quantitative assessment of physical activity, movement registration seems to be favoured based on its higher degree of objectivity in comparison with self report. Taken together more research is needed to evaluate psychometric properties of instruments measuring physical activity in musculoskeletal pain.
Pentoxifylline attenuates nociceptive sensitization and cytokine expression in a tibia fracture rat model of complex regional pain syndrome
Authors: Wei Tzuping , Sabsovich Ilya , Guo Tian‐Zhi , Shi Xiaoyou , Zhao Rong , Li Wenwu , Geis Christian , Sommer Claudia , Kingery Wade S. , Clark David J. 
Published: June 2008

ABSTRACTBackground: Tibia fracture in rats evokes chronic hindpaw warmth, edema, allodynia, and regional osteopenia, a syndrome resembling complex regional pain syndrome (CRPS). Previous studies suggest that the pathogenesis of some of these changes involves an exaggerated regional inflammatory response to injury and we postulated that inflammatory cytokines contribute to the development of CRPS‐like changes after fracture.Methods: The distal tibia was fractured and the hindlimb casted for 4 weeks. The rats were given drinking water with or without the cytokine inhibitor pentoxifylline (PTX) starting the day before fracture and continuing for 4 weeks, after which time the cast was removed and multiple assays were performed in the hindpaw. PCR and immunoassays were used to evaluate changes in cytokine expression. Bilateral hindpaw thickness, temperature, and nociceptive thresholds were determined, and bone microarchitecture was measured by microcomputed tomography (μCT).Results: Tibia fracture chronically up‐regulated TNFα, IL‐1β and IL‐6 mRNA and protein levels in hindpaw skin and PTX treatment significantly reduced the mRNA expression and cytokine protein levels for all these cytokines. PTX inhibited the nociceptive sensitization and some vascular changes, but had insignificant effects on most of the bone‐related parameters measured in these studies. Immunostaining of hindpaw skin was negative for immunocyte infiltration at 4 weeks post‐fracture.Conclusions: These results suggest that pro‐inflammatory cytokines contribute to the nociceptive and vascular sequelae of fracture and that PTX treatment can reverse these CRPS‐like changes.
Chronic otitis media and immunoglobulin E–mediated hypersensitivity in adults: Is it a contributor of cholesteatoma?
Authors: Hong Sang Duk , Cho Yang‐Sun , Hong Sung Hwa , Chung Won‐Ho , Chung Kyu‐Whan 
Published: June 2008

ObjectivesThe aim of this study was to determine the relationship between chronic otitis media (COM) and immunoglobulin E (IgE)‐mediated hypersensitivity in adults.Study DesignA prospective comparative study.Subjects and MethodsOne hundred seventeen patients with COM from July 2005 to April 2007 were enrolled. All subjects had a questionnaire on allergic rhinitis symptoms and performed allergy tests that included a total IgE and the multiple radioallergosorbent chemiluminescence assay to check the presence of IgE‐mediated hypersensitivity.ResultsThe prevalence of IgE‐mediated hypersensitivity and allergic rhinitis were 22.2% and 7.7% in patients with COM, respectively. The mean total IgE was 157.2 ranging from 3 to 1833. The prevalence of IgE‐mediated hypersensitivity was similar with regard to the recurrence or bilaterality. However, patients with cholesteatoma had a higher prevalence of IgE‐mediated hypersensitivity than patients without that condition.ConclusionThe prevalence of IgE‐mediated hypersensitivity and allergic rhinitis in adults with COM appeared to be higher than in the general population. Allergy might contribute to COM especially in cases with a cholesteatoma.
Transoral laser microsurgery for recurrent laryngeal and pharyngeal cancer
Authors: Grant David G. , Salassa John R. , Hinni Michael L. , Pearson Bruce W. , Hayden Richard E. , Perry William C. 
Published: June 2008

Study Design and SettingA two‐center prospective case series analysis.PatientsOne hundred fourteen patients with previously treated laryngeal or pharyngeal squamous cell carcinoma who underwent salvage transoral laser microsurgery (TLM).InterventionsTLM in 114 patients, neck dissection in 22 (19%) patients, adjuvant radiotherapy in 12 (11%) patients.ResultsNinety‐one (80%) patients had recurrent primary tumors whereas 23 (20%) patients had second primary tumors occur within a previously irradiated field. The minimum follow‐up was 1 year (median, 3 years). The distribution of tumor location was oropharynx 52 (46%), glottic and subglottic larynx 44 (39%), supraglottic larynx 11 (10%), and pyriform/hypopharynx 7 (6%). Overall, three‐year local and locoregional control estimates were 70 percent and 67 percent, respectively; and three‐year survival and disease‐free survival estimates were 62 percent and 64 percent, respectively. The average duration of hospitalization was 2.3 days. Four (3.5%) patients had significant postoperative bleeding. Two (<2%) patients had treatment‐related deaths.ConclusionsTransoral laser microsurgery offers select patients an attractive alternative salvage surgical therapy to the recurrent and second primary tumor site.
External auditory exostoses: Evaluation and treatment
Authors: House John W. , Wilkinson Eric P. 
Published: June 2008

ObjectiveTo determine (1) if external auditory exostosis (EAE) severity in a surgical exostosis population differs between ears and (2) the incidence of complications from postauricular canalplasty for EAE.Study DesignA retrospective review.Subjects and MethodsThree hundred twenty‐seven patients (401 ears) underwent drill canalplasty for EAE from 1990 to 2006. EAE severity was graded, and air and bone thresholds were used to evaluate hearing changes.ResultsThere were no significant differences in surgery rate or severity between right and left ears (71% grade 3 in both ears), with 95 percent grade 3 in operated ears. Prolonged healing occurred in 4.5 percent, with 1 TM perforation (0.2%). Sensorineural hearing at 4 kHz worsened slightly (mean change = 3.7 dB, P ≤ 0.001), with 4.8 percent worsening > 15 dB (maximum 30 dB), but sensorineural bone average was unchanged (mean = 0.2 dB). EAE recurred in 8 of 91 ears with long‐term follow‐up, occurring up to 15 years postsurgery.ConclusionsEAE severity in surgical patients does not differ between right and left ears. Drill canalplasty via the postauricular approach minimizes complications.
Building a cathedral for your soul: Generosity as a virtue and a practice
Authors: Enright William G. , Miyamoto Richard T. 
Published: June 2008

ObjectiveTo evaluate the virtue of generosity as it relates to how we are what we are.Study DesignSystematic review of the literature.ResultsGenerosity has to do with our very being and our behaving, with our living as caring, respectful, courteous, grace‐giving people. Authentic generosity is rooted in our unique sense of calling. Generosity is an interactive, interpersonal two‐way relationship of trust and respect between doctor and patient, student and teacher. How do we nurture generosity? Generous people are reflective people who take inventory of their souls.ConlusionBuilding a cathedral for your soul has to do wth tomorrow as well as with today, with how we choose to be remembered, and with the kind of spiritual legacy that we are crafting by the way we live.
Late Holocene fire impact and post-fire regeneration from the Bereket Basin, Taurus Mountains, southwest Turkey
Authors: Kaniewski David , Paulissen Etienne , De Laet Véronique , Waelkens Marc 
Published: June 2008

AbstractThe 800 cm long sequence from the Bereket provides the first detailed fire history in the western Taurus Mountains for the last three millennia. The main disturbances occurred during the Beyşehir Occupation Phase (BO Phase), a period of intensive polyculture and dated at Bereket from ca. 2230 to 1550 cal yr BP. Four phases of local and extra-local fire periods have been recorded at 2320–2240, 1985–1970, 1865–1820 cal yr BP and post-AD 1950. The fire history established for the BO Phase is complex, with fire periods alternating with periods without local fires, as is the case for the late BO Phase from 1820 until 1550 cal yr BP. It is suggested that the past agricultural practices including fires cause a higher soil erodibility than agricultural practices without fires. A climatic shift towards aridity during Roman times may have triggered the observed change in fire regime but local processes, mainly human disturbances, appear to be the proximal cause of all recorded changes. In the Bereket surroundings, fires led to a simplification of the vegetation structure, favouring soil erosion, pastures and intensive cultivation.