bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hypocaloric Support in the Critically Ill
Authors: Patiño José Félix , de Pimiento Sonia Echeverri , Vergara Arturo , Savino Patricia , Rodríguez Mario , Escallón Jaime 
Published: February 2006

Abstract.The critically ill patient exhibits a well defined endocrine and metabolic adaptive response to stressor agents, characterized by incremented resting energy expenditure (hypermetabolism, which is believed to signify increased energy requirements), accelerated whole‐body proteolysis (hypercatabolism), and lipolysis. These phenomena occur in the acute stage, which is also characterized by hyperglycemia, typically accompanied by a hyperdynamic cardiovascular reaction manifested by high cardiac output, increased oxygen consumption, high body temperature, and decrease peripheral vascular resistance. High provisions of glucose‐derived calories tend to accentuate these reactions and increase the degree of hyperglycemia. We have adopted a hypocaloric‐hyperproteic regimen which is provided only during the first days of the flow phase of the adaptive response to injury, sepsis, or critical illness. Our regimen includes a daily supply of 100 to 200 g of glucose and 1.5 to 2.0 g of protein (synthetic amino acids) per kilogram of ideal body weight. We have analyzed the data on 107 critically ill patients, 70 men and 37 women, who were admitted to the surgical intensive care unit and who received nutritional support by the TPN hypocaloric modality for a minimum of 3 days. We found that the high caloric loads contained in TPN regimens results in additional metabolic stress, with consequent hyperdynamic cardiorespiratory repercussion, high CO2 production, and frequently hepatic steatosis. In contrast, our hypocaloric‐hyperproteic approach has resulted in a more physiologic clinical course and considerable reduction in cost. The infusion of high glucose loads, such as those used in hypercaloric TPN, does not seem to suppress the excessive endogenous production of glucose but instead markedly exacerbates the hyperglycemia of the postinjury and acute stress condition. We believe that the hypocaloric‐hyperproteic regimen we utilize during the first few days of the stress situation is more in accordance with the inflammatory and hormonal mediator climate of the initial stages of the flow phase and thus appears to be beneficial vis‐à‐vis the hypercaloric loads that many use as routine metabolic support in critically ill patients.
Catheter‐related Bloodstream Infections
Authors: Sitges‐Serra Antonio , Girvent Meritxell 
Published: February 2006

Abstract.Catheter‐related bloodstream infections (CBIs) rank among the most frequent and potentially lethal nosocomial infections. Intravascular devices become contaminated on the outer surface during nonaseptic insertion or maintenance of the catheter exit site or endoluminally during hub manipulation. CBI is heralded by spiking fever, malaise and rigors and should be promptly diagnosed to prevent endocarditis and septic metastasis. In about two‐thirds of the cases the offending organisms are coagulase‐negative staphylococci; Staphylococcus aureus, gram‐negative bacilli, and Candida sp. are responsible for one‐third of these infections and carry a worse prognosis. Diagnosis of CBI relies on proper bacteriologic techniques, some of which can be performed in situ avoiding withdrawal of the device. Prevention strategies should aim at avoiding extra‐ and endoluminal contamination and should be based on three main pillars: maximal aseptic barriers at insertion, appropriate site maintenance, and junctional (hub) care and protection. Treatment includes catheter withdrawal and appropriate antibiotic coverage. For long‐term cuffed catheters, local treatment with intraluminal administration of antibiotics is effective and can save a significant number of catheters, particularly those colonized by coagulase‐negative staphylococci.
Jejunostomy: Techniques, Indications, and Complications
Authors: Tapia Jesus , Murguia Ricardo , Garcia Gabriel , de los Monteros Pedro Espinoza , Oñate Edgardo 
Published: February 2006

Abstract.Jejunostomy is a surgical procedure by which a tube is situated in the lumen of the proximal jejunum, primarily to administer nutrition. There are many techniques used for jejunostomy: longitudinal Witzel, transverse Witzel, open gastrojejunostomy, needle catheter technique, percutaneous endoscopy, and laparoscopy. The principal indication for a jejunostomy is as an additional procedure during major surgery of the upper digestive tract, where irrespective of the pathology or surgical procedures of the esophagus, stomach, duodenum, pancreas, liver, and biliary tracts, nutrition can be infused at the level of the jejunum. It is also used in laparotomy patients in whom a complicated postoperatory recovery is expected, those with a prolonged fasting period, those in a hypercatabolic state, or those who will subsequently need chemotherapy or radiotherapy. As a sole procedure it is advised for neurologic and congenital illnesses, in geriatric patients who pose difficult care demands, and for patients with tumors of the head and neck. The complications seen with jejunostomy can be mechanical, infectious, gastrointestinal, or metabolic. The rate of technical complications of the Witzel longitudinal technique is 2.1%, for the transverse Witzel up to 6.6%, for the Roux‐en‐Y 21%, for open gastrojejunostomy from 2%, and for the needle catheter technique from 1.5% with 0.14% mortality. The percutaneous endoscopic procedures have as much as a 12% complication rate; no figures exist for laparoscopy. The complications are moderate and severe: tube dislocation, obstruction or migration of the tube, cutaneous or intraabdominal abscesses, enterocutaneous fistulas, pneumatosis, occlusion, and intestinal ischemia. The infectious complications are aspiration pneumonia and contamination of the diet. The gastrointestinal complications are diarrhea 2.3% to 6.8%, abdominal distension, colic, constipation, nausea, and vomiting. The metabolic complications are hyperglycemia 29%, hypokalemia 50%, water and electrolyte imbalance, hypophosphatemia, and hypomagnesemia. These complications are secondary to inadequate selection of nutrition relative to the characteristics of the patient, to inadequate management of the mixture, and to deficient clinical care. The ideal jejunostomy technique depends on the material resources but more importantly on the experience of the surgeon. The benefits of jejunostomy justify the risks.
Tailoring Antireflux Surgery: A Randomized Clinical Trial
Authors: Rydberg Lars , Ruth Magnus , Abrahamsson Hasse , Lundell Lars 
Published: February 2006

Abstract.A hypothesis has been formulated that mandates the adjustment of antireflux surgery to either a total or a partial wrap depending on the motor function of the esophagus to avoid dysphagia and other obstructive complaints. This hypothesis has been tested in a randomized, clinical trial where 106 chronic gastroesophageal reflux patients were allocated to either a total Nissen‐Rossetti (n= 53) or a Toupet partial posterior (n= 53) fundoplication, irrespective of their preoperative esophageal motor function. All patients were followed at least 3 years, during which time none had a relapse of moderate to severe reflux symptoms. Motor dysfunctions defined as peristaltic amplitude ≤ 30 mmHg in the distal third and failed primary peristalsis with or without > 20% simultaneous contractions were noted in 67 patients preoperatively, but these patients did not have a specific symptom profile (e.g., dominated by obstructive symptoms) nor did seven patients with “aperistaltic esophagus.” The incidence of dysphagia decreased from 20% preoperatively to 8% (mild) at 3 years after the operation with no difference between the surgical procedures. We were unable to demonstrate a relation between preoperative manometric findings and postoperative symptoms when assessed in the total group or when subdivided by the type of fundoplication (r < 0.3). Flatulence occurred more frequently among those with a total fundic wrap (p < 0.01). When patients representing motor dysfunction (see above) were specifically analyzed, we again observed no difference in outcome between those having a total or a partial fundic wrap. In conclusion, the concept of tailoring antireflux surgery based on the preoperative motor function of the esophagus in patients with chronic gastroesophageal reflux disease was not supported by the results of this clinical trial.
Surgical Gloves: Current Problems
Authors: Osman Maher O. , Jensen Steen L. 
Published: February 2006

Abstract.One century ago surgical gloves were introduced to practice as part of the new antiseptic technique and originally to protect the hands of the surgeon and his assistants from the harmful dermatologic effects of powerful antiseptics (e.g., carbolic acid) in use at that time. Since then, the wearing of gloves during surgery has been standard practice. Furthermore, the protection value of surgical gloves in preventing cross‐infection has stood the test of time. Nevertheless, materials used in glove manufacturing have caused a succession of iatrogenic problems in surgical patients over the years. More recently, emergence of transmissible viruses, such as hepatitis B and C and human immunodeficiency virus, has led surgeons to consider their own safety with the frequent possibility of perforation of surgical gloves by sharp instruments. In this review we discuss the problems associated with surgical glove practice: glove powder‐induced peritonitis and adhesions, latex rubber‐associated hypersensitivity, and glove perforation.
Primary Retroperitoneal Soft Tissue Sarcomas: Results of Aggressive Surgical Treatment
Authors: Malerba Marina , Doglietto Giovanni Battista , Pacelli Fabio , Carriero Concetta , Caprino Paola , Piccioni Emanuele , Crucitti Pierfilippo , Crucitti Francesco 
Published: February 2006

Abstract.A retrospective study was undertaken to evaluate the results of surgical treatment in a series of patients with primary retroperitoneal sarcomas consecutively treated by the same surgical team. The hospital records of 42 patients with primary retroperitoneal sarcomas who underwent surgical exploration at our unit from 1984 to 1995 were reviewed. A univariate analysis was used to identify the main clinical, pathologic, and treatment‐related factors affecting long‐term survival. Twenty‐five patients (59.6%) underwent radical surgery. The 5‐year survival and 5‐year disease‐free survival after radical resection were 48.1% and 38.8%, respectively. According to the univariate analysis of survival tumor classification (T), stage and gross surgical margins significantly affected prognosis. The study indicates that even though there are predetermined and unmodifiable tumor‐related factors, such as tumor classification (T) and stage, that influence survival in patients with retroperitoneal sarcomas, wide surgical excision offers a concrete chance for long‐term survival.
Thoracoscopic Splanchnicectomy: Pilot Evaluation of a Simple Alternative for Chronic Pancreatic Pain Control
Authors: Moodley Jaynathan , Singh Bhugwan , Shaik Abdool Samad , Haffejee Aref , Rubin Joseph 
Published: February 2006

Abstract.Achieving adequate pain control in patients with chronic pancreatitis remains a surgical challenge. The quest for a procedure that retains all of the residual pancreatic tissue in the absence of ductal dilatation remains elusive. This study sought to evaluate the feasibility and efficacy of thoracoscopic splanchnicectomy and attempted to outline the surgical anatomy appropriate to an adequate denervation. Of 17 patients considered suitable for the procedure, 16 had a sucessful outcome, which was statistically significant (p < 0.001). The longest follow‐up of 30 months suggests that the procedure may be more enduring than percutaneous procedures. However, the surgical anatomy is not predictable owing to the racemose arrangement of the splanchnic fibers, and a long pleurotomy with transection of all medial fibers is necessary to effect denervation. Thoracoscopic splanchnicectomy may effect immediate pain relief with negligible morbidity and absent mortality. Although the follow‐up period is short, the patient with the longest follow‐up remains pain‐free at 30 months. This procedure warrants scrutiny for its role in long‐term pancreatic pain control.
Isolated Vascular Perfusion of Human Colon with Adenocarcinoma
Authors: Pilati Pier Luigi , Rossi Carlo Riccardo , Mocellin Simone , Pozzobon Maurizia , Galeotti Fabrizio , Foletto Mirto , Scalerta Romano , Scagnet Barbara , Alaggio Rita , Lise Mario 
Published: February 2006

2 183 (78–304) mmHg; arterial PCO2 36 (31–46) mmHg. No important signs of tissue damage were found at histology. Autonomous or stimulated peristalsis (or both) was present throughout the experiment. Mean O2 extraction was 7.9 ml/min/100 g (range 3.1–11.0). Mean glucose consumption was 229 mg/100 g (range 174–252). The model worked well and appears promising, particularly for future use in various pharmacokinetic and pharmacodynamic studies of antiblastic agents.
Feasibility of Laparoscopic Cholecystectomy with Miniaturized Instrumentation in 50 Consecutive Cases
Authors: Reardon Patrick R. , Kamelgard Joseph I. , Applebaum Bruce , Rossman Lucho , Brunicardi F. Charles 
Published: February 2006

p = NS), and postoperative LOS for the mini‐LC and conventional LC were 1.5 ± 0.2 and 1.8 ± 0.4 days (mean ± SD), respectively, (p= NS). Of the 50 mini‐LC cases, 5 required conversion to conventional LC. One cystic duct leak was detected and successfully treated conservatively; no common bile duct injuries occurred; and no patients required conversion to open cholecystectomy. This study demonstrates the safety and efficacy of minilaparoscopic instruments for the performance of cholecystectomy. The data reveal that this new technique is comparable to conventional LC.
Type‐oriented Intraoperative and Adjuvant Chemotherapy and Survival after Curative Resection of Advanced Gastric Cancer
Authors: Shimoyama Shouji , Shimizu Nobuyuki , Kaminishi Michio 
Published: February 2006

n = 16); intraoperative chemotherapy and UFT 300 mg/day (P1 group, n= 13); or UFT 600 mg/day (P2 group, n= 17). Patients with an intestinal type of cancer were randomly assigned to one of three treatment groups: H0 (n= 17), H1 (n= 12), and H2 (n= 12); each group was subjected to the same protocols as the P0, P1, and P2 groups, respectively, except for the MMC administration route. MMC (10 mg/patient) was administered intraoperatively into the intraperitoneal cavity (P1 and P2 groups) or the portal vein (H1 and H2 groups). All patients underwent curative resection. Background factors did not differ significantly among the treatment groups. The overall survival rates were progressively worsened in the order of P2, P1, and P0 or H2, H1, and H0, respectively. The survival rate of the P2 group was statistically higher than that of the P0 group (p < 0.05). The intermediate‐term survival rate of the P2 group or H2 group was significantly higher than that of the P0 group (p < 0.05) or H0 group (p < 0.05), respectively. These results suggest the effectiveness of this therapy and the possible eradication of potential micrometastatic foci outside the surgical field by the direct administration of chemotherapeutic agents to the predicted recurrence site.
Methods for estimating understory light conditions using crown projection maps and topographic data
Authors: Takashima Atsushi , Kume Atsushi , Yoshida Shigejiro 
Published: February 2006

AbstractFour types of indices of canopy characteristics were compared to estimate understory light conditions using crown projection maps and topographic data. Crown area (CA) was formulated from the crowns in a focal sub‐block (20 m×20 m). Canopy shade index (CSI) was formulated from the crowns in a focal sub‐block and the surrounding sub‐blocks with topographic effect. Site shade index (SSI) incorporated the shade of the slopes into CSI and represented the total physical closure of the site. Site light index (SLI) incorporated the azimuth of the site into SSI and evaluated the light condition of the understory. We tested the methods using the data on steep old‐growth Cryptomeria japonica forests on Yakushima Island and the three‐dimensional canopy structures of the forests were digitized on a geographic information system. The results were validated by the basic indices obtained by hemispherical photographs: canopy openness (CO) and gap light index (GLI). The three‐dimensional structure of the surrounding canopies and topography had significant effects on the understory light conditions. CA had no significant correlation with CO, whereas CSI and SSI had significant negative correlations with CO. Although SLI had the highest negative correlation with GLI (R2=0.69), CSI had practical utility in the estimation of GLI (R2= 0.65). Our method is applicable to past crown projection maps that have been recorded at many forest research sites, thus making it possible to reconstruct past understory light conditions and to compare them with present conditions.
Immunohistochemical detection of E-cadherin in certain types of salivary gland tumours
Authors: Andreadis D , Epivatianos A , Mireas G , Nomikos A , Poulopoulos A , Yiotakis J , Barbatis C 
Published: February 2006

Objectives: To investigate the topography of E-cadherin and its possible correlation with the histological phenotype of salivary gland tumours.Material and methods: Archival formalin-fixed, paraffin-embedded sections of 54 benign and 56 malignant tumours and 24 samples of normal and inflamed salivary gland tissue were studied immunohistochemically using an Envision/horseraddish peroxidase (HRP) technique.Results: In normal and inflamed salivary gland samples, E-cadherin was expressed at the membrane of acinar, myoepithelial and ductal cells located at cell–cell contact points. Reduction and/or absence of E-cadherin was only observed in pleomorphic adenoma at the peripheral cells of the duct-like or island structures, or in the cells exhibiting plasmacytoid or stromal differentiation. Neoplastic epithelium in Warthin's tumours and in myoepithelial and oncocytic adenomas was strongly positive. Furthermore, a weak to moderate loss of expression which was related to tissue tumour subtype was seen in malignant tumours such as: adenoid cystic carcinomas; polymorphous low-grade adenocarcinomas; acinic cell carcinomas; and mucoepidermoid low-grade, epithelial-myoepithelial, lymphoepithelial and squamous low-grade carcinomas. Moderate to extreme loss or alternative cytoplasmic non-functional expression were observed in cases of salivary ductal carcinoma, carcinosarcoma, myoepithelial carcinoma, oncocytic adenocarcinoma, unspecified adenocarcinoma and squamous high-grade carcinomas.Conclusion: This study suggests a direct association of E-cadherin expression with neoplastic histologic phenotype, which is lost in the more undifferentiated and invasive epithelial salivary gland tumours.
Giant sublingual epidermoid cyst: a report of two cases
Authors: Yılmaz Ismaıl , Yılmazer Cuneyt , Yavuz Haluk , Bal Nebıl , Ozluoglu Levent N 
Published: February 2006

Epidermoid cysts are benign epithelial cysts that occur rarely in the neck. In contrast to dermoid cysts, epidermoid cysts do not include dermal attachments such as hair, hair follicles, sebaceous glands and sweat glands. They may be congenital or acquired. Acquired epidermoid cysts are either post-traumatic or iatrogenic. They rarely enlarge markedly.This study discusses epidermoid cysts in a 34-year-old woman and a 35-year-old man, both of which were giant epidermoid cysts in the sublingual space. Both patients were admitted for difficulty swallowing and cosmetic problems. The cysts of both patients had an aetiology of trauma and were documented by pathology sections and pre-operative magnetic resonance images. Both cysts were excised completely, one intraorally and one externally. Such cysts are benign and ought to be borne in mind in the differential diagnosis of oral cavity and neck cystic masses.
Nosocomial Transmission of Mycobacterium tuberculosis From an Extrapulmonary Site
Authors: D'Agata Erika M.C. , Wise Sharon , Stewart Amelia , Lefkowitz Lewis B. 
Published: February 2006

AbstractObjective:To assess the extent of nosocomial transmission and risk factors associated with tuberculin skin test (TST) conversions among healthcare workers (HCWs) exposed to a patient with genitourinary Mycobacterium tuberculosis.Design:Retrospective cohort study of exposed HCWs.Setting:A 275-bed community hospital in Middle Tennessee.Participants:A total of 128 exposed HCWs and the index patient, who required drainage of a prostatic abscess and bilateral orchiectomy and expired after a 27-day hospitalization. Disseminated tuberculosis was diagnosed at autopsy.Methods:Contact tracing was performed on exposed HCWs. Logistic regression was used to identify independent risk factors associated with TST conversion.Results:A total of 128 HCWs were exposed to the index patient. There was no evidence of active pulmonary tuberculosis throughout the patient's hospitalization; TST conversions occurred only among HCWs who were exposed to the patient during or after his surgical procedures. A total of 12 (13%) of 95 exposed HCWs who were previously nonreactive had newly positive TST: 6 of 28 nurses, 3 of 3 autopsy personnel, 2 of 17 respiratory therapists, and 1 of 12 surgical staff. By logistic regression, irrigation or packing of the surgical site was the only independent risk factor associated with TST conversion among nurses (odds ratio, 9; 95% confidence interval, 1.2-67; P=.03).Conclusion:Manipulation of infected tissues of the genitourinary tract can result in nosocomial transmission of tuberculosis.
An Evaluation of Hospital Special-Ventilation-Room Pressures
Authors: Rice Nancy , Streifel Andrew , Vesley Donald 
Published: February 2006

AbstractObjective:To quantitate the magnitude and consistency of positive (airflow out) and negative (airflow in) hospital special-ventilation-room (SVR) airflow.Design:A room-pressure evaluation was conducted during two seasons on a total of 18 rooms: standard rooms, airborne infection isolation rooms, and protective environment rooms. The pressures were measured using a digital pressure gaugepiezoresistive pressure sensor that measured pressure differentials. With doors closed, the rooms were measured a minimum of 30 times each for a cooling season and a heating season.Results:The standard rooms showed the least amount of variability in pressure differential, with an average of −0.2 Pa (median, −0.2 Pa), and an interquartile range (IQR) of 0.4 Pa. Airborne infection isolation rooms showed more variability in pressure, with an average of −0.3 Pa (median, −0.2 Pa) and an IQR of 0.5 Pa. Protective environment rooms had the greatest fluctuation in pressure, with an average of 8.3 Pa (median, 7.7 Pa) and an IQR of 8.8 Pa. Dramatic pressure changes were observed during this evaluation, which may have been influenced by room architectural differences (sealed vs unsealed); heating, ventilation, and air-conditioning zone interactions; and stack effect.Conclusion:The pressure variations noted in this study, which potentially affect containment or exclusion of contaminants, support the need for standardization of pressure requirements for SVRs. To maintain consistent pressure levels, creating an airtight seal and continuous pressure monitoring may be necessary.