bluuebunny/crossref_metadata_2025_split huggingface dataset:
Vagus nerve stimulation in chronic treatment-resistant
depression
Authors: Corcoran Ciaran D. , Thomas Philip , Phillips Jack , O'Keane Veronica 
Published: August 2006

SummaryWe evaluated the efficacy and safety of vagus nerve stimulation therapy in
the treatment of 11 patients with chronic treatment-resistant depression.
Mood was evaluated at frequent intervals over the year following
implantation. All measures of depression, including the Hamilton Rating
Scale for Depression reduced significantly. The response and remission rates
were 55% and 27% respectively at 1 year. Side-effects were common, and some
were severe.
Attitudes of mental health practitioners to the Hippocratic Oath: tradition and modernity in psychiatry
Authors: Marzanski Marek , Coupe Tim , Musunuri Padmapriya 
Published: August 2006

Aims and MethodTo establish whether psychiatrists believe that medicine should be practised according to the principles of the Hippocratic Oath, an anonymised postal questionnaire survey was conducted of all medical staff at the Caludon Centre, an 80-bed in-patient mental health unit in Coventry.ResultsThirty-three respondents (82.5%) believed that medicine should be practised according to the Oath. Support for the 15 separate statements derived from the Oath varied considerably.Clinical ImplicationsThe principles of the Oath remain an important guide to the ethical basis of medical practice for most medical staff surveyed.
Psychiatric admission booking: audit of the impact of a standardised admission form
Authors: Dinniss Stephen , Dawe Jocelyn , Cooper Michael 
Published: August 2006

Aims and MethodWe used a complete audit cycle to assess the quality and completeness of current admission bookings by junior doctors and whether the introduction of a standardised admission form led to improvements.ResultsFollowing the introduction of the standardised form significant improvements were found in almost all areas, including the recording of basic data, history, mental state, physical examination, risk assessments and diagnosis.Clinical ImplicationsThe introduction of a standardised admission form improved the completeness of information obtained. The form may also be used as an educational tool and to assist trainees preparing for examinations.
Satisfaction with a research mentoring scheme for specialist registrars
Authors: Winter Nicole , Rathod Shanaya , Gregoire Alain 
Published: August 2006

Aims and MethodFollowing the introduction of a new research mentoring process, a survey was conducted of Wessex specialist registrars' views on research training.ResultsOf 34 respondents, 26 (76.5%) had agreed a plan with a research mentor and 31 (91.2%) were making good use of their research day for specified purposes. Of 24 trainees undertaking research, 21 (87.5%) felt adequately supported, 20 (83.3%) were interested in their research, 16 (66.7%) enjoyed it and 21 (87.5%) gained research knowledge/skills.Clinical ImplicationsAgreeing a research training plan with a mentor, coupled with regularly reviewed support and supervision through a newly developed mentoring process, was associated with high levels of trainee satisfaction. Compared with a previous survey, these results indicate considerable improvement in research training.
Rewarming Rates in Urban Patients with Hypothermia: Prediction of Underlying Infection
Authors: Delaney Kathleen A. , Vassallo Susi U. , Larkin Gregory L. , Goldfrank Lewis R. 
Published: August 2006

Abstract
Background:
In the urban setting, hypothermia is commonly associated with illness or intoxication, with death often secondary to infection.
Objectives:
To evaluate factors that affect the rewarming rate (RWR) and the ability of the RWR and other clinical markers to predict the presence or absence of underlying infection in an adult urban population.
Methods:
This was a prospective observational study of hypothermic patient visits to a large emergency department. Serial temperatures were obtained during rewarming to construct rewarming curves. Rewarming modalities selected by emergency physicians were correlated with admission temperatures. Univariate associates of RWR and infection were assessed.
Results:
The authors identified 96 patient visits. The median temperature was 89.5°F (31.9°C; range, 73.0°F to 95.0°F [22.8°C to 35.0°C]). Thirteen patients had temperatures of < 80.0°F (26.0°C). Seven died within 14 hours of presentation; six, of infection. No patient experienced ventricular fibrillation. Potential candidate predictors of infection from a multivariate analysis were a RWR of < 1.80°F (1.0°C) per hour and a serum albumin of < 2.7 g/dL. Rapid rewarming was associated with the absence of infection and a temperature below 86.0°F (30.0°C). In patients without significant underlying illness, rewarming rates appeared to be independent of the modality of rewarming.
Conclusions:
Rewarming rates reflect intrinsic capacity for thermogenesis. Increased RWRs were associated with the absence of infection. The achievement of normothermia did not prevent death in infected patients. Initiation of invasive rewarming in urban patients with hypothermia who have not had hypothermic cardiac arrest may be unwarranted. Management of this population should emphasize support, detection, and treatment of underlying illness.
Lymph Node Status and TS Gene Expression Are Prognostic Markers in Stage II/III Rectal Cancer After Neoadjuvant Fluorouracil-Based Chemoradiotherapy
Authors: Liersch Torsten , Langer Claus , Ghadimi B. Michael , Kulle Bettina , Aust Daniela E. , Baretton Gustavo B. , Schwabe Wolfgang , Häusler Peter , Becker Heinz , Jakob Christiane 
Published: August 2006

Purpose According to the CAO/ARO/AIO-94 trial of the German Rectal Cancer Study Group, preoperative combined fluorouracil (FU) -based long-term chemoradiotherapy (CT/RT) is recommended for patients with International Union Against Cancer (UICC) stage II/III rectal cancer. However, despite the local benefit of neoadjuvant treatment, the overall prognostic value remains uncertain in comparison with adjuvant CT/RT. Furthermore, the prognostic value of molecular biomarkers, such as thymidylate synthase (TS), thymidine phosphorylase (TP), and dihydropyrimidine dehydrogenase (DPD), all of which are involved in the FU metabolism, is unknown in neoadjuvant settings. We assessed the impact of standardized preoperative CT/RT and intratumoral TS, TP, and DPD levels on patient outcome. Patients and Methods Forty patients with rectal cancer pretherapeutic UICC stage II/III, receiving preoperative FU-based CT/RT (CAO/ARO/AIO-94 trial) followed by standardized surgery, including total mesorectal excision, were investigated. Downsizing, downstaging, tumor regression, as well as TS, TP, and DPD gene expression of post-treatment surgical specimens were correlated with disease-free survival (DFS) and overall survival (OS). Results Significant downsizing (P < .001) and downstaging (P = .001) were achieved with preoperative CT/RT. During a median follow-up of 49 months (95% CI, 43 to 58 months), the cancer recurrence rate was 28.2%. DFS and OS were significantly increased in patients with downstaging (P < .001 and P = .003, respectively), compared with patients without downstaging. All patients who developed cancer recurrence had a persistent positive lymph node status after preoperative CT/RT (P < .001) and a significantly higher TS gene expression (P = .035) compared with those patients without recurrence. Conclusion Persistent positive lymph node status and high intratumoral TS expression after preoperative CT/RT are predictive of an unfavorable prognosis in rectal cancer UICC stage II/III.
Risk of Cardiovascular Mortality in Prostate Cancer Patients in the Rotterdam Randomized Screening Trial
Authors: Otto Suzie J. , Schröder Fritz H. , de Koning Harry J. 
Published: August 2006

Purpose To estimate the risk of cardiovascular disease (CVD) mortality in prostate cancer patients in the Rotterdam section of European Randomized Study of Screening for Prostate Cancer, in both arms, and to compare this with the risk in the general population. Methods Standardized mortality ratios (SMRs) of cardiovascular mortality for 2,211 prostate cancer patients were calculated including analyses for treatment subgroups (surgery, radiotherapy, watchful waiting, and hormone therapy). Cardiovascular mortality was defined as death as a result of all CVD and as a result of coronary heart disease, acute myocardial infarction, other diseases of the heart, and cerebrovascular accidents. The prevalence of self-reported comorbidities at entry of the trial was evaluated as well. Results After a mean follow-up of 5.5 years, 258 prostate cancer patients (12%) had died. The SMR of all-cause mortality was 0.90 (95% CI, 0.79 to 1.01). The risk for cardiovascular mortality was low compared with that in the general population; the SMRs varied between 0.37 and 0.49. Low cardiovascular mortality risks were also seen within each treatment subgroup. CVD was the most frequently self-reported comorbidity at entry and prostate cancer patients undergoing radical prostatectomy reported the lowest rates (24%) compared with those receiving other therapies (40% to 42%). Conclusion Although some self-selection has occurred, prostate cancer treatment did not increase the risk of dying as a result of cardiovascular causes in our cohort. The risk was significantly lower for all primary treatment modalities, suggesting that less emphasis should be put on CVD as a contraindication for aggressive (surgical) treatment for prostate cancer patients.
Randomized Multicenter Trial of Hyperthermic Isolated Limb Perfusion With Melphalan Alone Compared With Melphalan Plus Tumor Necrosis Factor: American College of Surgeons Oncology Group Trial Z0020
Authors: Cornett Wendy R. , McCall Linda M. , Petersen Rebecca P. , Ross Merrick I. , Briele Henry A. , Noyes R. Dirk , Sussman Jeffrey J. , Kraybill William G. , Kane John M. , Alexander H. Richard , Lee Jeffrey E. , Mansfield Paul F. , Pingpank James F. , Winchester David J. , White Richard L. , Chadaram Vijaya , Herndon James E. , Fraker Douglas L. , Tyler Douglas S. 
Published: August 2006

Purpose To determine in a randomized prospective multi-institutional trial whether the addition of tumor necrosis factor alpha (TNF-α) to a melphalan-based hyperthermic isolated limb perfusion (HILP) treatment would improve the complete response rate for locally advanced extremity melanoma. Patients and Methods Patients with locally advanced extremity melanoma were randomly assigned to receive melphalan or melphalan plus TNF-α during standard HILP. Patient randomization was stratified according to disease/treatment status and regional nodal disease status. Results The intervention was completed in 124 patients of the 133 enrolled. Grade 4 adverse events were observed in 14 (12%) of 129 patients, with three (4%) of 64 in the melphalan-alone arm and 11 (16%) of 65 in the melphalan-plus-TNF-α arm (P = .0436). There were two toxicity-related lower extremity amputations in the melphalan-plus-TNF-α arm, and one disease progression–related upper extremity amputation in the melphalan-alone arm. There was no treatment-related mortality in either arm of the study. One hundred sixteen patients were assessable at 3 months postoperatively. Sixty-four percent of patients (36 of 58) in the melphalan-alone arm and 69% of patients (40 of 58) in the melphalan-plus-TNF-α arm showed a response to treatment at 3 months, with a complete response rate of 25% (14 of 58 patients) in the melphalan-alone arm and 26% (15 of 58 patients) in the melphalan-plus-TNF-α arm (P = .435 and P = .890, respectively). Conclusion In locally advanced extremity melanoma treated with HILP, the addition of TNF-α to melphalan did not demonstrate a significant enhancement of short-term response rates over melphalan alone by the 3-month follow-up, and TNF-α plus melphalan was associated with a higher complication rate.
Disadvantage of Men Living Alone Participating in Radiation Therapy Oncology Group Head and Neck Trials
Authors: Konski Andre A. , Pajak Thomas F. , Movsas Benjamin , Coyne James , Harris Jonathan , Gwede Clement , Garden Adam , Spencer Sharon , Jones Christopher , Watkins-Bruner Deborah 
Published: August 2006

Purpose This study evaluated whether males without partners were disadvantaged for survival in Radiation Therapy Oncology Group (RTOG) head and neck cancer clinical trials. Methods Patients treated on three RTOG trials were studied. The Cox proportional hazards model was used to determine if sex and the interaction between sex and marital/partner status were independent prognostic variables for overall survival controlling for Karnofsky performance status, tumor stage, nodal stage, primary site, and protocol treatment. Results A total of 1,901 patients (1,509 men) were entered onto the three RTOG trials, with 1,822 (1,438 men) analyzable patients. Prognostic variables independent of disease-related variables for survival in multivariate analyses restricted to men were age, marital/partner status, and income. Conclusion The apparent disadvantage of unpartnered men is striking, even after controlling for disease and other demographic variables. Possible explanations could easily be tested in observational studies, leading to evaluation of simple interventions to improve their outcome.
Predictors of Recurrence in Patients With T2 and Early T3, N0 Adenocarcinoma of the Rectum Treated by Surgery Alone
Authors: Nissan Aviram , Stojadinovic Alexander , Shia Jinru , Hoos Axel , Guillem Jose G. , Klimstra David , Cohen Alfred M. , Minsky Bruce D. , Paty Philip B. , Wong W. Douglas 
Published: August 2006

Purpose Treatment of rectal cancer with neoadjuvant radiotherapy has been shown to reduce local recurrence and improve overall survival. The role of chemoradiotherapy in patients with T2, N0 and early T3, N0 rectal cancer, treated by radical surgery with total mesorectal excision, remains controversial. The aim of this study was to identify predictors of recurrence in this group of patients to enhance treatment selection. Patients and Methods One hundred patients with primary T2-3, N0 adenocarcinoma of the rectum, uniformly treated by surgery alone, were studied. The pathology slides available for 97 patients were rereviewed. Three patients with incomplete data sets were excluded. Clinical and survival data were obtained from a prospective computerized database and updated from hospital and office charts. The study end points were disease-free survival, disease-specific survival (DSS), time to pelvic recurrence (PR), and distant recurrence. Results Complete follow-up was available for all study patients. Median follow-up was 79.5 months (range, 57.7 to 105.9 months). During this time period 30 patients (31.9%) died as a result of disease and 64 patients (68.1%) remained alive and disease free. Five-year DSS was 73%. The cumulative risk for PR was 8% at 5 years and 10% at 8 years. Lymphovascular invasion, preoperative serum carcinoembryonic antigen (CEA > 5 ng/mL) level, and age older than 70 years were all associated with adverse outcome. Conclusion Patients with T2-3, N0 rectal cancers and either lymphovascular invasion or elevated CEA levels have reduced survival and a higher incidence of PR, and should be considered for future randomized trials.
Pooled Analysis of Safety and Efficacy of Oxaliplatin Plus Fluorouracil/Leucovorin Administered Bimonthly in Elderly Patients With Colorectal Cancer
Authors: Goldberg Richard M. , Tabah-Fisch Isabelle , Bleiberg Harry , de Gramont Aimery , Tournigand Christophe , Andre Thierry , Rothenberg Mace L. , Green Erin , Sargent Daniel J. 
Published: August 2006

Purpose Oxaliplatin, fluorouracil, and leucovorin are commonly used to treat advanced and resected colorectal cancer. This analysis compares the safety and efficacy of oxaliplatin plus fluorouracil/leucovorin administered bimonthly (FOLFOX4) in patients age younger than and at least 70 years. Patients and Methods This retrospective analysis included 3,742 colorectal cancer patients (614 age ≥ 70) from four clinical trials testing FOLFOX4 in the adjuvant, first-, and second-line settings. End points included grade ≥ 3 adverse events, response rate (in advanced disease), progression or relapse-free survival, dose-intensity, and overall survival in the studies with mature survival data. Results Grade ≥ 3 hematologic toxicity (neutropenia [43% v 49%; P = .04] and thrombocytopenia [2% v 5%; P = .04]) were significantly higher in older patients. Older age was not associated with increased rates of severe neurologic adverse events, diarrhea, nausea/vomiting, infection, overall incidence of grade ≥ 3 toxicity (63% v 67%; P = .15), or 60-day mortality (1.1% v 2.3%; P = .20). The relative benefit of FOLFOX4 versus control did not differ by age for response rate, progression or recurrence free-survival (hazard ratio, 0.70 for FOLFOX4 v control for age < 70, 0.65 for age ≥ 70; P = .42), or overall survival (hazard ratio, 0.77 age < 70, 0.82 age ≥ 70; P = .79). Dose-intensity did not differ by age at cycles 1, 3, 6, or 12. Conclusion FOLFOX4 maintains its efficacy and safety ratio in selected elderly patients with colorectal cancer. Its judicious use should be considered without regard to patient age, although scant data are available among patients older than 80 years.
Tympanoplasty: Should grafts be placed medial or lateral to the tympanic membrane?
Authors: Doyle Patrick J. , Schleuning Alexander J. , Echevarria John 
Published: August 2006

AbstractSince the introduction of tympanoplasty, there have been enthusiastic reports describing the use of skin, vein, fascia and perichondrium in repairing the tympanic membrane. Both endaural and postauricular techniques have been used. In the last few years most surgeons have concluded that fascia or perichondrium are the most suitable materials available for grafting. These materials have been placed either medial or lateral to the tympanic membrane.
A new technique for the correction of orbital hypertelorism
Authors: Converse John Marquis , Wood‐Smith Donald 
Published: August 2006

AbstractOrbital hypertelorism is one of the most severe congenital deformities, frequently achieving monstrous proportions because of the wide divergence between the ocular globes. It is complicated by ocular anomalies; prominent among which are strabismus and amblyopia. The etiology is for the most part congenital although traumatic hypertelorism is seen and careful differentiation must be made between the true and false varieties of the deformity. The basis of intercanthal distance is a poor criterion of hypertelorism and we prefer the use of the distance between the anterior lacrimal crests as a more reliable means of measurement and have checked all our cases by the use of anterior‐posterior skull laminagrams.The surgical technique used is based on that developed by Tessier and his associates in 1967; the original two‐stage procedure has been replaced by a one‐stage modification of this operation introduced by us (Converse, et al., 1970) with preservation of olfaction. The operation consists of raising a large scalp flap through a coronal incision with removal of a major portion of the frontal bone which is subsequently replaced. The frontal lobes are raised from the anterior cranial fossa exposing the roof of each orbit and the subperiosteal elevation is extended over the lower portion of the frontal bone and contiguous orbital rims. Combined with an incision through the lower eyelid, exposure of the entire orbit on its inner aspect just anterior to the optic foramen is obtained and lines of osteotomy are made through the orbital walls and combined with resection of an appropriate central portion of bone to enable medial motion of the orbits. The bony defects are grafted with autogenous bone grafts and the soft tissues are replaced in position.Twenty‐five cases of orbital hypertelorism involving bilateral and unilateral hypertelorism are presented without unusual complications being observer. The orbits have been mobilized medially for a distance up to 40 millimeters without complications, and the operative procedures are all performed in collaboration with the neurosurgeon.Most patients have required subsequent extraocular muscle balancing surgery and correction of medial canthal deformities.
Osteoplastic obliteration of the frontal sinuses. A review of 100 patients
Authors: Bosley William R. 
Published: August 2006

AbstractOne hundred consecutive osteoplastic frontal sinus operations were reviewed. The obliteration of the frontal sinus was achieved by natural bony obliteration instead of by operative fat obliteration. The operation was performed for 6 cases of trauma, 13 cases for an osteoma, 56 cases for frontal sinusitis without previous frontal sinus surgery and 25 cases for frontal sinusitis with previous frontal sinus surgery. Headaches were the presenting chief complaint of all cases, and 93 of them had some degree of frontal sinusitis. Localized osteomyelitis of the frontal sinus was present in 42 cases. Although 85 patients were completely satisfied with the results of the operation, 15 continued to have frontal headaches. Complete bony obliteration of the frontal sinus occurred in 93 cases. The seven patients who had incomplete bony obliteration of the frontal sinus are being followed closely for signs and symptoms of recurrent frontal sinus disease.
The histopathological changes in the temporal bone resulting from acute smallpox and chickenpox infection
Authors: Bordley John E. , Kapur Y. P. 
Published: August 2006

AbstractTwenty‐two pairs of temporal bones collected through a collaborative program arranged between the Christian Medical College, Vellore, South India, and The Johns Hopkins University, were processed in the Temporal Bone Laboratory at the Johns Hopkins University. They have been reviewed and are reported here. Otological examinations were obtained on all cases, and simple hearing tests were carried out in the majority of them. Eighteen of the patients died of smallpox and four of chickenpox. The principal lesions have been found in the middle ears of both groups. In many ears the changes resemble acute necrotizing otitis media. There is much round cell infiltration, and, in a number of sections, inclusion bodies have been found, including one Guarnieri body. Such changes relate closely to lesions found elsewhere in the body in the presence of a virus invasion. There are no previous histopathological studies of changes in the ear in acute smallpox or chickenpox infection, that can be found in the literature.
Acute periorbital swelling
Authors: Healy Gerald B. , Stuart Strong M. 
Published: August 2006

AbstractThe origin of acute periorbital swelling is not always evident. Careful attention to the history, physical findings in the nose and adjacent areas and X‐ray appearances should lead to a correct diagnosis in each case.Infections of the frontal, ethmoid and maxillary sinuses, the tear sac and nasal vestibule as well as fractures of the nasal and zygomatic bones account for most of the cases.
VIIIth nerve round window action potentials masked by high frequency noise in rats and guinea pigs: A comparative study
Authors: Bone Robert C. , Crowley David , Rauchbach Erol 
Published: August 2006

AbstractTheoretical and experimental evidence supports the hypothesis that the VIIIth nerve action potential is a precise summation of individual neuron responses. Based on this concept, the action potential, as measured at the round window was altered in a predictably reproducible manner, by the addition of narrow frequency bands of masking noise. Rat and guinea pig cochleas were studied by means of an analytic method described by Teas, Eldredge and Davis. The latency and amplitude of the VIIIth nerve action potential were compared by analysis of variants for variable stimulus intensity and noise band frequency; in addition, interspecies variability was characterized. Results are discussed in light of known anatomic and behavioral data. Applications to human electrocochleography are discussed.