bluuebunny/crossref_metadata_2025_split huggingface dataset:
Total Esophagectomy versus Proximal Esophagectomy for Esophageal Cancer at the Cervicothoracic Junction
Authors: Fujita Hiromasa , Kakegawa Teruo , Yamana Hideaki , Sueyoshi Susumu , Hikita Shigeki , Mine Takashi , Tanaka Yuichi , Ishikawa Hiroto , Shirouzu Kazuo , Mori Kazunori , Inoue Yojiro , Tanabe Hiroko Yanaga , Kiyokawa Kensuke , Tai Yoshiaki , Inutsuka Hiroki 
Published: February 2006

Abstract.To investigate the adequate extent of esophagectomy and lymphadenectomy for an esophageal cancer localized at the cervicothoracic junction, the mortality and morbidity rates, survival rates, and patterns of recurrence were retrospectively analyzed in two groups—14 patients who underwent total esophagectomy with or without laryngectomy and 15 patients who underwent proximal esophagectomy with or without laryngectomy—at Kurume University Hospital from 1981 to 1996. Proximal esophagectomy with or without laryngectomy resulted in a lower hospital mortality rate and better overall survival for patients who underwent curative esophagectomy compared with total esophagectomy with or without laryngectomy. Multivariate analysis indicated that the extent of esophagectomy (total esophagectomy versus proximal esophagectomy) was not a prognostic factor. The incidence of recurrence was not different between the two groups. Lymph node metastasis or recurrence from such esophageal cancers was localized to the neck and upper mediastinum. For an esophageal cancer localized at the cervicothoracic junction, therefore, proximal esophagectomy with or without laryngectomy and with cervical and upper mediastinal lymphadenectomy could be better indicated for preselected patients.
Clinicopathologic Study of Gastric Cancer Based on Dukes' Classification
Authors: Adachi Yosuke , Suematsu Toshihiro , Yasuda Kazuhiro , Shiromizu Akio , Shiraishi Norio , Kitano Seigo 
Published: February 2006

Abstract.Dukes' classification is a useful staging system in patients with colorectal cancer. The aim of this study was to present clinicopathologic characteristics and survival of patients with gastric cancer based on Dukes' classification. A total of 273 patients with gastric cancer curatively treated by radical gastrectomy and lymph node dissection (D2, D3) were studied. With the modified Dukes' classification, A includes tumors limited to the mucosa, submucosa, or muscularis propria; B includes tumors extending into the subserosa or serosa; Ca includes tumors with one to six positive lymph nodes; and Cb includes tumors with seven or more positive lymph nodes. Dukes' classification modified by the number of positive lymph nodes well correlated with the tumor size (p < 0.01), depth of wall invasion (p < 0.01), level of lymph node metastasis (p < 0.01), and degree of lymphatic permeation (p < 0.01) and venous permeation (p< 0.01). The 5‐year survival rate was significantly different among Dukes' A (98%), Dukes' B (90%), Dukes' Ca (75%), and Dukes' Cb (44%) cases. The results indicate that Dukes' classification modified by the number of positive lymph nodes (Dukes' A, B, Ca, an Cb) significantly correlates with tumor progression and patient survival; and it may be a simple and useful staging system for gastric cancer.
Nutritional Depletion and Dietary Manipulation: Effects on the Immune Response
Authors: Hulsewé Karel W.E. , van Acker Bernadette A.C. , von Meyenfeldt Maarten F. , Soeters Peter B. 
Published: February 2006

Abstract.The association between nutritional depletion and the increased susceptibility for infectious diseases has been recognized for a long time. The complexity of the immune system, however, makes it difficult to unravel the underlying mechanisms. It appears that depletion adversely affects virtually all components of the immune system. This review provides an overview over the specific requirements of substrates by immune cells and the effects of nutritional depletion on various components of the immune response, with special attention to gut‐associated lymphoid tissue. The literature concerning effects of dietary interventions with specific nutrients on the immune response is also discussed. Finally, we offer a hypothesis with regard to the improvement of composition of “trauma” nutrition solutions.
Pancreatic Cancer as a Model: Inflammatory Mediators, Acute‐phase Response, and Cancer Cachexia
Authors: Fearon Kenneth C.H. , Barber Matthew D. , Falconer J.S. , McMillan Donald C. , Ross James A. , Preston Tom 
Published: February 2006

Abstract.Patients with pancreatic cancer frequently develop the syndrome of cancer cachexia. Pro‐inflammatory cytokines have been strongly implicated in the pathogenesis of this syndrome. In patients with pancreatic cancer an acute‐phase response (an index of pro‐inflammatory cytokine activity) is associated with accelerated weight loss, hypermetabolism, anorexia, and a shortened duration of survival. However, little is known about the primary significance of the acute‐phase response in terms of altered hepatic export protein synthesis rates and its potential impact on the body's nitrogen economy. In a recent series of studies on weight‐losing pancreatic cancer patients with hypoalbuminemia we have demonstrated albumin synthesis to be unaltered whereas fibrinogen synthesis is increased two‐ to threefold compared with healthy controls. Because of the mismatch in amino acid composition between the body's main labile amino acid reserve (skeletal muscle) and that of acute‐phase proteins, these results lend support to the concept that in pancreatic cancer the reprioritization of body protein metabolism during an acute‐phase response may well be a significant factor in the loss of lean tissue in these patients.
Comparison of Outcomes following Transhiatal or Ivor Lewis Esophagectomy for Esophageal Carcinoma
Authors: Gluch Laurence , Smith Ross C. , Bambach Christopher P. , Brown Alastair R. 
Published: February 2006

p = 0.05); if two surgeons operated concurrently, THO could be performed 40 minutes quicker than THO or ILO performed by a single surgeon (p= 0.018). The mean initial intensive care unit stay was 2.9 days for ILO versus 1.7 days for THO (p= 0.014). The 30‐day mortality was 5.1%; total in‐hospital mortality was 7.1% with no difference for operation type. There were similar morbidity rates for the procedures. Kaplan‐Meier survival analysis indicated no significant effect of surgical technique; there were no apparent advantages for either operation when patients were compared by tumor type or matched for stage. Hence THO is a valid alternative to ILO, particularly for stage II and III cancer.
Preoperative Transcatheter Arterial Chemoembolization and Prognosis of Patients with Hepatocellular Carcinomas: Retrospective Analysis of 120 Cases
Authors: Lu Cai‐De , Peng Shu‐You , Jiang Xien‐Chuan , Chiba Yukio , Tanigawa Nobuhiko 
Published: February 2006

1 (n= 24) and B1 (n= 57), and those with tumors > 8 cm were assigned to groups A2 (n= 20) and B2 (n= 19), respectively. Although no significant differences in survival between groups A1 and B1 were found, group A2 presented superior 1‐, 2‐, and 3‐year tumor‐free survival rates of 80%, 55%, and 32% and 1‐, 3‐, and 5‐year cumulative survival rates of 90%, 53%, and 42%. These figures are in comparison with the tumor‐free survival rates of 50%, 22%, and 11% (p= 0.06), and the cumulative survival rates of 72%, 33%, and 11% (p= 0.01) during the same periods for group B2, respectively. The Cox regression model revealed that for patients with tumors > 8 cm, the relative risk of preoperative TAE for overall survival was 0.38 (p= 0.017), indicating that preoperative TAE might benefit patients with tumors > 8 cm but not those with tumors 2 to 8 cm.
Ear protection as a treatment for disruptive snoring: do ear plugs really work?
Authors: Robertson S , Loughran S , MacKenzie K 
Published: February 2006

Background: In the absence of surgical treatments with demonstrable long-term efficacy, conservative treatments for snoring remain appropriate. Only limited evidence evaluating the use of ear protection by partners has been published.Methods: Eligible couples were invited to participate in a two-month trial, with each partner using custom-moulded ear plugs. Five questionnaires were completed by patients and their partners, at baseline and after two months: the snoring outcomes survey (SOS) or the spouse/bed partners survey (SBPS), the Epworth sleepiness scale (ESS), the general health questionnaire-12 (GHQ-12), the Nottingham health profile (NHP) and the Golombok–Rust inventory of marital status (GRIMS).Results: After two months, there was a significant improvement in the SOS score for patients (p = 0.005), the SBPS score for partners (p = 0.001) and the ESS for partners (p = 0.004).Conclusions: For selected couples, ear plugs represent an effective short-term treatment for some of the social effects of disruptive snoring, as determined by the SOS, SBPS and ESS questionnaires.
Patient perceptions of the otolaryngology ward round in a teaching hospital
Authors: Montague M-L , Hussain S S M 
Published: February 2006

Objective: This survey assesses patients' perceptions of a daily otolaryngology ward round in a teaching hospital.Methods: Initial, open-ended questionnaires generated themes from which a structured questionnaire was constructed. Patients' perceptions in a wide range of areas were examined by asking them to indicate on a Likert scale the extent to which they agreed or disagreed with a number of statements concerning various aspects of the ward round.Results: One hundred patients were surveyed. The response rate was 79 per cent. The findings showed overall patient satisfaction with the ward round, particularly in the areas of information-giving regarding diagnosis, treatment and follow-up arrangements. The large size of the ward round appeared to be intimidating and induced anxiety for approximately one-third of patients. Patients wished the roles of staff present to be better defined and to be informed of the presence of medical students. One-third of patients perceived staff to use language that was difficult to understand.Conclusions: The survey identified some improvement opportunities and will assist our department with its on-going endeavours to improve the ward round experience for both patients and staff.
Acute epiglottitis in adults: a recent experience with 10 cases
Authors: Hafidh M A , Sheahan P , Keogh I , Walsh R McConn 
Published: February 2006

Objectives: Our objective was to examine the presentation, clinical course and management of acute epiglottitis in a recent series of adult patients.Method: All consecutive adults with acute epiglottitis or supraglottitis admitted to a tertiary referral centre over a recent six-month period were included in this retrospective study. The diagnosis of epiglottitis or supraglottitis was established by flexible nasolaryngoscopy.Results: Ten patients were included. Two patients had concurrent acute tonsillitis and one had a peritonsillar abscess. Blood cultures were negative in all cases. Pathogens were isolated by throat swabs only in the two patients with acute tonsillitis. Two patients underwent intubation for management of airway obstruction. A combination of cefotaxime and metronidazole was the most common antibiotic regimen used.Conclusion: The rising incidence of acute epiglottitis in the adult population mandates vigilance on the part of the otolaryngologist. Selective airway intervention is recommended for patients with airway obstruction of more than 50 per cent.
Safe reduction in administration of naloxone to newborn infants: An observational study
Authors: Box Deborah , Cochran Dominic 
Published: February 2006

Abstract Background: Naloxone, a specific opiate antagonist, is widely used during neonatal resuscitation to reverse possible opiate‐induced respiratory depression. Aim: To determine the frequency with which naloxone is administered when resuscitation guidelines are conscientiously followed and to document any effect on respiratory morbidity. Methods: Perinatal data including naloxone administration and respiratory morbidity were collected retrospectively, and compared with prospectively collected data following the introduction of “Good Practice” guidelines. Results: There were 500 deliveries in the retrospective arm of the study and 1000 deliveries in the prospective arm. Although a similar proportion of women received opiates in labour in the two periods of study, there was a marked reduction in the use of naloxone when the guidelines were introduced (11% of opiate‐exposed deliveries compared to 0.2%). There was no significant effect on respiratory morbidity with the change in practice. Conclusion: Naloxone is rarely needed to reverse the effects of opiates in newborn infants, and its use can be curtailed by following current resuscitation guidelines without increasing respiratory morbidity.
Ex utero intrapartum treatment (EXIT) for congenital giant ranula
Authors: Chan Dorothy F. Y. , Lee Cheuk H. , Fung Tak Y. , Chan Daniel L. W. , Abdullah Victor , Ng Pak C. 
Published: February 2006

AbstractCongenital giant ranula causing life‐threatening upper airway obstruction is a rare condition. A well‐planned ex utero intrapartum treatment (EXIT) procedure for aspiration and decompression of the cystic lesion is simple, efficacious and effective in securing a patent airway before the fetus is completely delivered, and may prevent lifelong neurodevelopmental complications associated with perinatal asphyxia in such cases. Conclusion: EXIT could be a life‐saving procedure for congenital giant ranula.
An Outbreak of Scabies in a Teaching Hospital Lessons Learned
Authors: Obasanjo Olugbenga O. , Wu Peggy , Conlon Martha , Karanfil Lynne V. , Pryor Patty , Moler Geraldine , Anhalt Grant , Chaisson Richard E. , Perl Trish M. 
Published: February 2006

AbstractObjective:To investigate an outbreak of scabies in an inner-city teaching hospital, identify pathways of transmission, institute effective control measures to end the outbreak, and prevent future occurrences.Design:Outbreak investigation, case-control study, and chart review.Setting:Large tertiary acute-care hospital.Results:A patient with unrecognized Norwegian (crusted) scabies was admitted to the acquired immunodeficiency syndrome (AIDS) service of a 940-bed acute-care hospital. Over 4 months, 773 healthcare workers (HCWs) and 204 patients were exposed to scabies. Of the exposed HCWs, 147 (19%) worked on the AIDS service. Risk factors for being infested with scabies among HCWs included working on the AIDS service (odds ratio [OR], 5.3; 95% confidence interval [CI95], 2.17-13.15) and being a nurse, physical therapist, or HCW with extensive physical contact with infected patients (OR, 4.5; CI95, 1.26-17.45). Aggressive infection control precautions beyond Centers for Disease Control and Prevention barrier and isolation recommendations were instituted, including the following: (1) early identification of infected patients; (2) prophylactic treatment with topical applications for all exposed HCWs; (3) use of two treatments 1 week apart for all cases of Norwegian scabies; (4) maintaining isolation for 8 days and barrier precautions for 24 hours after completing second treatment for a diagnosis of Norwegian scabies; and (5) oral ivermectin for treatment of patients who failed conventional therapy.Conclusions:HCWs with the most patient contact are at highest risk of acquiring scabies. Because HCWs who used traditionally accepted barriers while caring for patients with Norwegian scabies continued to develop scabies, we found additional measures were required in the acute-care hospital. HCWs with skin exposure to patients with scabies should receive prophylactic treatment. We recommend (1) using heightened barrier precautions for care of patients with scabies and (2) extending the isolation period for 8 days or 24 hours after the second treatment with a scabicide for those patients with Norwegian scabies. Oral ivermectin was well tolerated for treating patients and HCWs who failed conventional treatment. Finally, we developed a surveillance system that provides a “barometric measure” of the infection rate in the community. If scabies increases in the community, a tiered triage system is activated to protect against transmission among HCWs or hospital patients.
Increase in Hand-Alcohol Consumption Among Medical Staff in a General Hospital as a Result of Introducing a Training Program and a Visualization Test
Authors: Conrad Christian 
Published: February 2006

AbstractTo assess the impact of training programs, including a visualization test for hand disinfection, we monitored the hand-alcohol consumption of medical staff. The consumption increased steadily from 5.7 L of hand alcohol per capita per year in 1990 to 9.1 L in 1998. There was no significant increase in skin problems.
The Association of Diabetes and Glucose Control With Surgical-Site Infections Among Cardiothoracic Surgery Patients
Authors: Latham Robert , Lancaster Ava D. , Covington Janet F. , Pirolo John S. , Thomas Clarence S. 
Published: February 2006

AbstractObjective:To assess the importance of diabetes, diabetes control, hyperglycemia, and previously undiagnosed diabetes in the development of surgical-site infections (SSIs) among cardiothoracic surgery patients.Setting:A 540-bed tertiary-care university-affiliated hospital.Design:Prospective cohort and case-control studies.Patients:All patients having cardiothoracic surgery between November 1998 and September 1999 were eligible for participation. One thousand patients had preoperative hemoglobin Ale determinations. Seventy-four patients with SSIs were identified.Results:Diabetes (odd ratio [OR], 2.76;P<.001) and postoperative hyperglycemia (OR, 2.02;P=.007) were independently associated with development of SSIs. Among known diabetics, elevated hemoglobin Ale values were not associated with a statistically significantly increased risk of infection; the mean Ale value was 8.44% among those with infections compared with 7.80% for those without (P=.09). Forty-two (6%) of 700 patients without prior diabetes history had evidence of undiagnosed diabetes; their infection rate was comparable to that of known diabetics (3/42 [796] vs 17/300 [6%];P=.72). An additional 30% of nondiabetics had elevated hemoglobin Ale determinations or perioperative hyperglycemia.Conclusions:Postoperative hyperglycemia and previously undiagnosed diabetes are associated with development of SSIs among cardiothoracic surgery patients. Screening for diabetes and hyperglycemia among patients having cardiothoracic surgery may be warranted to prevent postoperative and chronic complications of this metabolic abnormality.
Risk Factors for Surgical-Site Infections Following Cesarean Section
Authors: Killian Carol A. , Graffunder Eileen M. , Vinciguerra Timothy J. , Venezia Richard A. 
Published: February 2006

AbstractObjective:To identify risk factors associated with surgical-site infections (SSIs) following cesarean sections.Design:Prospective cohort study.Setting:High-risk obstetrics and neonatal tertiary-care center in upstate New York.Patients:Population-based sample of 765 patients who underwent cesarean sections at our facility during 6-month periods each year from 1996 through 1998.Methods:Prospective surgical-site surveillance was conducted using methodology of the National Nosocomial Infections Surveillance System. Infections were identified during admission, within 30 days following the cesarean section, by read-mission to the hospital or by a postdischarge survey.Results:Multiple logistic-regression analysis identified four factors independently associated with an increased risk of SSI following cesarean section: absence of antibiotic prophylaxis (odds ratio [OR], 2.63; 95% confidence interval [CI95], 1.50-4.6;P=.008); surgery time (OR, 1.01; CI95, 1.00-1.02;P=.04); <7 prenatal visits (OR, 3.99; CI95, 1.74-9.15;P=.001); and hours of ruptured membranes (OR, 1.02; CI95,1.01-1.03;P=.04).Patients given antibiotic prophylaxis had significantly lower infection rates than patients who did not receive antibiotic prophylaxis (F=02), whether or not active labor or ruptured membranes were present.Conclusion:Among the variables identified as risk factors for SSI, only two have the possibility to be changed through interventions. Antibiotic prophylaxis would benefit all cesarean patients regardless of active labor or ruptured membranes and would decrease morbidity and length of stay. Women's healthcare professionals also must continue to encourage pregnant women to start prenatal visits early in the pregnancy and to maintain scheduled visits throughout the pregnancy to prevent perinatal complications, including postoperative infection.
An Outbreak of Coagulase-Negative Staphylococcal Surgical-Site Infections Following Aortic Valve Replacement
Authors: Lark Rebecca L. , VanderHyde Kristi , Deeb G. Michael , Dietrich Steve , Massey Jeffrey P. , Chenoweth Carol 
Published: February 2006

AbstractObjectives:To determine the cause of a coagulase-negative staphylococcal outbreak and to identify risk factors for surgical-site infections among patients following Medtronic Freestyle bioprosthesis implantation.Design:Retrospective case-control study.Setting:An 800-bed university referral center.Patients:The cohort of 64 patients undergoing Freestyle valve replacement from September 1998 to December 1998.Results:Seven patients developed infection (10.9% vs 1.1% during the preceding 8 months), including two with mediastinals and five with endocarditis. There were no statistically significant differences between cases and controls with respect to age, gender, weight, underlying illness, preoperative hospital stay, duration of surgery, time on bypass, central venous catheter duration, National Nosocomial Infection Surveillance risk index, New York Heart Association class, albumin, or antibiotic prophylaxis. However, only three cases were documented to have received vancomycin prophylaxis. Of all staff evaluated, only surgical resident A was significantly associated with infection (odds ratio, 7.68; 95% confidence interval, 1.3-44.1;P=.02) Pulsed-field gel electrophoresis patterns onStaphylococcus epidermidisisolates from four of the six cases were identical. These cases were performed on different days. Surgical resident A was the only staff member present in the operating room for all cases caused by the epidemic strain. This Sepidermidisstrain, however, was not isolated from operating room staff.Conclusion:A surgical resident was significantly associated with infection. However, the cause of this outbreak was likely multifactorial. Changes occurring during the investigation included institution of vancomycin as routine prophylaxis and modification of surgical technique, which contributed to the resolution of the outbreak.