bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rare variants of malignant melanoma
Authors: Milton G. W. , Shaw H. M. 
Published: August 2005

AbstractThe personal experience with 5 rare types of malignant melanoma is reviewed to point out some of the practical problems in the diagnosis and management of these tumors. The rare forms discussed are conjunctival, nasal, oral, vulvar, and penile melanomas. All pigmented lesions in the oral cavity, but not the penis or vulva, should be prophylactically excised as lesions in the mouth have a higher malignant potential. Local excision of all 5 forms of primary melanomas, no matter how locally advanced they may be, is the sole treatment. Nevertheless, anatomic constraints often preclude surgery with generous margins and consequently local recurrence, particularly for conjunctival, nasal, and oral primary lesions, is usually the major first failure in treatment. Lymph node dissection is only performed if the regional nodes are palpable at the time of first presentation. Elective lymph node dissections are not performed since the patients are often elderly, the lymphatic drainage is usually ambiguous or multiple, and the disease tends to spread hematogenously rather than lymphatically. Surgery still remains the cornerstone of treatment for these rare forms of melanoma but prognosis is very poor since surgery is often a palliative rather than a curative measure. Improved survival may depend on identifying more effective chemotherapeutic and immunologic agents.
Malignant melanoma in childhood: A clinicopathologic study of 13 cases and comparison with spitz nevi
Authors: Crotty Kerry A. , McCarthy Stanley W. , Palmer Alexander A. , Ng Alan B. P. , Thompson John F. , Gianoutsos Mark P. , Shaw Helen M. 
Published: August 2005

AbstractThe clinical and histological features of 13 malignant melanomas in children <13 years of age in New South Wales, Australia, were compared with those in a control group of children with 15 Spitz nevi, 4 of which were considered atypical, and 2 unusual compound nevocellular nevi. Six of the controls had been previously diagnosed histologically as malignant melanoma. The objective observations made by one or more histopathologists experienced in reporting melanocytic lesions, and the clinical details, mainly from the Sydney Melanoma Unit files, were entered on a detailed protocol. Evaluation was assisted by the use of SPSS‐X software on a mainframe VAX computer. Six of the 13 children with malignant melanoma died with their disease. The most frequent clinical features found in the malignant melanomas were bleeding, ulceration, itching, and black or variegated color. Recent enlargement and darkening were noted in the majority of both the malignant melanomas and the Spitz nevi. Histological features favoring malignancy in this series were mitoses within 0.25 mm of the dermal margin of the melanoma, a dermal mitotic rate exceeding 2/mm2, ulceration, surface exudate, large pigment granules, and clear‐cell differentiation. The median thickness of the malignant melanomas was 1.3 mm but in the 4 children who died with melanoma the median thickness was 2.9 mm. Absence of mitoses, predominance of spindle cells, and diffuse maturation favored Spitz nevus. The median thickness of the Spitz nevi was 0.7 mm.
Palliative care and melanoma: The care of the patient with progressive disease
Authors: Lickiss J. N. 
Published: August 2005

AbstractThe World Health Organization has taken the lead in recent years in encouraging an appropriate focus on palliative care which includes but goes beyond terminal care. Comprehensive care of patients with advanced progressive disease requires increased emphasis, with adequate resources. Management of major symptoms is a crucial component of such a care program and requires the application of recent advances in palliative therapeutics (notably but not only good quality pain management), whether or not direct antitumor strategies are being continued. The choice of treatment approaches must be related to the patient's personal priorities.
Who benefits from antireflux surgery?
Authors: Stein Hubert J. , DeMeester Tom R. 
Published: August 2005

AbstractPrior to any rational therapy of gastro‐esophageal reflux disease, an objective diagnosis of the presence and the cause of the disease are necessary. Gastro‐esophageal reflux disease, i.e., increased esophageal exposure to gastric juice, can be due to a mechanically defective lower esophageal sphincter, inefficient esophageal clearance of refluxed gastric contents, and abnormalities of the gastric reservoir that augment physiologic reflux. Antireflux surgery is designed to correct a mechanically defective sphincter, i.e., a sphincter with a mean pressure below 6 mm Hg, a mean length exposed to the positive pressure environment of the abdomen of less than 1 cm, or a mean overall length of less than 2 cm. In our experience, this is found in approximately 50% to 60% of patients with gastro‐esophageal reflux disease. Antireflux surgery is not indicated in patients with increased esophageal exposure to gastric juice secondary to ineffective clearance or gastric abnormalities. Consequently, the indications to proceed with an antireflux procedure are persistent or recurrent symptoms and/or complications of gastro‐esophageal reflux disease after 8 to 12 weeks of intensive acid suppression therapy, the objective documentation of increased esophageal exposure to gastric juice with 24 hour esophageal pH monitoring, and the presence of a mechanically defective lower esophageal sphincter on manometry. In patients selected according to these criteria, Nissen fundoplication provides effective relief of reflux symptoms in 91% of patients with more than 10 year follow‐up.
Mechanisms of action of antireflux surgery: Theory and fact
Authors: Little Alex G. 
Published: August 2005

AbstractDespite the absence of definitive explanations regarding either the physiologic or surgical factors which curtail gastro‐esophageal reflux, effective antireflux operations exist. This article explores the theoretical factors relevant to the surgical control of reflux. These theoretical features include: (1) the pressure, length, and location of the manometrically defined lower esophageal sphincter (LES); (2) the gastro‐esophageal valve as defined by the angle of His and a mucosal flap valve; and (3) the mechanical effects of a fundoplication which serve to increase the opening pressure of the cardia and optimize the physical relationships described by the law of La Place. Finally, the relation of these theoretical factors to actual operations is discussed.
Minimizing the side effects of antireflux surgery
Authors: DeMeester Tom R. , Stein Hubert J. 
Published: August 2005

AbstractTo address the durability and long‐term side effects of the Nissen fundoplication as surgical therapy for gastroesophageal reflux disease, we evaluated 100 patients postoperatively. With careful attention to technical detail as described, the incidence of temporary postoperative dysphagia was 39% and permanent dysphagia was 3%. Effective relief of reflux symptoms over more than 10 years was achieved in 91% of the patients with minimal side effects.
Minimally invasive antireflux procedures
Authors: Stein H. J. , Feussner H. , Siewert J. R. 
Published: August 2005

AbstractThe advance of endoscopic and laparoscopic techniques in recent years has prompted several groups throughout the world to investigate the possibilities for a minimally invasive approach to reconstruct a defective antireflux mechanism in patients with intractable gastro‐esophgeal reflux disease. Prospective trials are needed to evaluate the long‐term durability and efficiency of these procedures.
Single-Pot Solution Phase Synthesis Optimization Using Fully Automated Systems for Combinatorial Screening
Authors: Wendler Christian , Krüger-Sundhaus Thomas , Beller Matthias , Gördes Dirk , Thurow Kerstin 
Published: August 2005

The optimization of synthesis conditions plays an important role in chemistry and life sciences. A wide variety of reaction parameters should be explored to minimize the use of educts and maximize the yields of desired products in high purity. A fully automated system for combinatorial synthesis has been developed and used for the optimization of synthesis conditions of a multicomponent single-pot reaction. In order to explore optimal reaction conditions for the synthesis of pure endo isomer of 3-(2-bromo-benzoylamino)-cyclohex-4-ene1,2-dicarboxylic acid diethyl ester, an intermediate in the synthesis route of lycorizidine analogues, several hundred experiments were carried out with varying reaction temperature, times, concentrations, and ratios of educts. In this case study, financial aspects also were considered in order to minimize synthesis costs. The system was integrated using a Zymate XP robot as a system integrator. In addition to a GC/MS and an HPLC system, a multicomponent solid dispenser workbench and a liquid handling system are located within this fully automated system.
Do Xylem Fibers Affect Vessel Cavitation Resistance?
Authors: Jacobsen Anna L. , Ewers Frank W. , Pratt R. Brandon , Paddock William A. , Davis Stephen D. 
Published: August 2005

Abstract
Possible mechanical and hydraulic costs to increased cavitation resistance were examined among six co-occurring species of chaparral shrubs in southern California. We measured cavitation resistance (xylem pressure at 50% loss of hydraulic conductivity), seasonal low pressure potential (P min), xylem conductive efficiency (specific conductivity), mechanical strength of stems (modulus of elasticity and modulus of rupture), and xylem density. At the cellular level, we measured vessel and fiber wall thickness and lumen diameter, transverse fiber wall and total lumen area, and estimated vessel implosion resistance using (t/b)h 2, where t is the thickness of adjoining vessel walls and b is the vessel lumen diameter. Increased cavitation resistance was correlated with increased mechanical strength (r 2 = 0.74 and 0.76 for modulus of elasticity and modulus of rupture, respectively), xylem density (r 2 = 0.88), and P min (r 2 = 0.96). In contrast, cavitation resistance and P min were not correlated with decreased specific conductivity, suggesting no tradeoff between these traits. At the cellular level, increased cavitation resistance was correlated with increased (t/b)h 2 (r 2 = 0.95), increased transverse fiber wall area (r 2 = 0.89), and decreased fiber lumen area (r 2 = 0.76). To our knowledge, the correlation between cavitation resistance and fiber wall area has not been shown previously and suggests a mechanical role for fibers in cavitation resistance. Fiber efficacy in prevention of vessel implosion, defined as inward bending or collapse of vessels, is discussed.
Distinctive Cortical Articulatory Representation in Cleft Lip and Palate: A Preliminary Functional Magnetic Resonance Imaging Study
Authors: Shinagawa Hideo , Ono Takashi , Honda Ei-ichi , Kurabayashi Tohru , Iriki Atsushi , Ohyama Kimie 
Published: August 2005

Objective: To investigate cortical representation of articulation of the bilabial plosive in patients with cleft lip and palate. Design: We examined cortical representation for /pa/-articulation in cleft lip and palate patients using blood oxygenation level–dependent functional magnetic resonance imaging. Subjects: Data from four postsurgical adult cleft lip and palate patients were compared with those from six healthy volunteers. Results: Activation foci were found in the bilateral primary sensorimotor cortex in all cleft lip and palate patients, as in the controls. The sensorimotor cortex ipsilateral to the side of cleft lip and palate showed greater activation in unilateral cleft lip and palate patients, whereas the sensorimotor cortex contralateral to the side on which cheiloplasty had been performed earlier showed greater activation in a bilateral cleft lip and palate patient. Conclusions: The results suggest that there may be an ipsilateral dominance in cortical representation during bilabial articulation to the side of the cleft in the upper lip.
Endoscopic management of nonvariceal gastrointestinal bleeding
Authors: Steffes Christopher P. , Sugawa Choichi 
Published: August 2005

AbstractEndoscopic management of upper gastrointestinal bleeding has been expanded from a purely diagnostic role to a therapeutic role in many patients. In addition to controlling active bleeding, it is an option in a patient who is clinically at a high risk of rebleeding, or in patients who have peptic ulcers with visible vessels or stigmata indicating high risk. Several methods have been studied, and currently the most useful include thermal cautery with the heater probe or bipolar electrocoagulation, and injection using epinephrine and/or sclerosants. Endoscopic hemostasis can effect permanent control of bleeding in many patients, but should be considered complementary to conventional surgical control in other patients, where temporary control to stabilize the patient is a desired end.
Approaches to the endoscopic treatment of esophageal varices
Authors: Van Stiegmann Greg , Yamamoto Manabu 
Published: August 2005

AbstractEndoscopic therapy is commonly employed for both initial and subsequent definitive treatment of variceal bleeding. Sclerotherapy performed with a flexible endoscope is currently the most widespread technique. Available data suggests that such treatment does not improve outcome in the acute treatment of variceal bleeding (first 30 days) but appears superior to conventional medical management in the long term. Sclerotherapy does not appear better or worse than pharmacological therapy or surgical therapy when these treatments are compared in the elective setting. Although effective, endoscopic sclerotherapy is recognized to be associated with many major and minor treatment‐related complications and a significant incidence of recurrent hemorrhage. In response to these shortcomings newer forms of endoscopic therapy such as polymer injection and endoscopic ligation have been developed. Polymer injection appears well suited for patients with active bleeding and for those with gastric varices but does not have advantages for chronic treatment aimed at variceal eradication. Endoscopic ligation appears at least as effective as conventional sclerotherapy for control of acute bleeding and prevention of rebleeding and is associated with few treatment induced complications. While endoscopic therapy will likely continue as the most commonly employed treatment for patients with hemorrhage from esophageal varices, newer methods with wider margins of safety and efficacy seem destined to supplement or replace conventional endoscopic sclerotherapy.
Laser therapy of gastrointestinal tumors
Authors: Eckhauser Marc L. 
Published: August 2005

AbstractSurgical resection remains the therapy of choice for the treatment of potentially curable gastrointestinal tract (GI) malignancies. Many of these tumors are incurable at the time of diagnosis and therapy should be directed towards palliation with the intent of minimizing pain, bleeding, obstruction, and potential morbidity. Endoscopic laser therapy is uniquely applicable for the palliation of GI tumors and in selective instances may be appropriate for the treatment of early lesions. Eighty‐six patients with GI malignancy have been treated at our institution since 1985. Thirty‐one patients had advanced upper GI lesions (esophagus: 26, gastric: 3, duodenal: 1, and pancreatic: 1) and 55 patients had lower GI tumors (colon: 37 and rectal: 18). Pre‐resectional recanalization for obstructing colorectal carcinomas obviating initial operative diversion was performed in 31 (56%) of 55 patients. Twenty‐four patients had palliative laser therapy (obstruction: 17 and hemorrhage: 7) with resolution of their symptoms. There was 1 laser related perforation in the pre‐resectional group and the overall complication rate was 1.2%. Endoscopic Nd:YAG and currently photodynamic laser therapy for GI tumors has proven to be an effective mode of therapy for advanced GI neoplasms with minimal morbidity. The utility of photodynamic therapy for the treatment of early stage esophageal and gastric cancers remains controversial.
Laparoscopy in the emergency setting
Authors: Sackier Jonathan M. 
Published: August 2005

AbstractLaparoscopy has been available for 90 years and was actively undertaken by the gynecologists. Today the vast majority of gynecological procedures are performed by this route. Despite the efforts of a few enthusiastic surgeons, the general surgical community did not incorporate laparoscopy into their armamentarium until the advent of laparoscopic cholecystectomy. However, this endoscopic technique has much to contribute, especially in the setting of emergency care. It is of value in formulating a treatment algorithm and in avoiding unnecessary laparotomy in both blunt and penetrating trauma. Laparoscopy helps to define the nature of obscure abdominal diagnoses, avoids unnecessary appendectomy, and provides the window of opportunity for surgery in mesenteric ischemia due to either arterial or venous thrombosis or embolus. It is also of value in patients with pain or fever of unknown origin, displaced gastrostomy or dialysis tubes, and in the rare patient with gastrointestinal bleeding where other diagnostic modalities have been unable to yield the diagnosis.In this article the instrumentation and techniques will be outlined and the role of laparoscopy in each of the above situations will be detailed. As with all surgical procedures, it is vital that the surgeon be well‐trained and knowledgeable about the correct use of the technique, its possible pitfalls and how to avoid them, as well as knowing the contraindications.
The spectrum of laparoscopic surgery
Authors: Cuschieri A. 
Published: August 2005

AbstractLaparoscopic procedures have begun to replace many conventional operations because of the avoidance of major surgery and the rapid recovery of the patient. The majority of these traditional operations will be performed laparoscopically in the future. For example, patients who suffer from achalasia will be able to undergo laparoscopic cardiomyotomy and patients with non‐cardiac chest pain of esophageal origin will be able to undergo thoracoscopic myotomy. Likewise, a viable alternative to long‐term medication with H2blockers or omeprozole will be laparoscopic posterior vagotomy and anterior lesser curve seromyotomy. As methods are developed to deal with the extraction of large specimens, many ablative procedures will be undertaken by the laparoscopic route. Extraction techniques must not compromise the need for histopathalogical examination of the resected specimen in cancer resections. The ultimate spectrum of laparoscopic surgery will be determined by the progress in remote handling technology, overcoming the manipulative restrictions inherent in the current instrumentation. Research evaluating the efficacy of new methods will be essential.
Endosonography in patient selection for surgical treatment of esophageal carcinoma
Authors: Fok Manson , Cheng Stephen W. K. , Wong John 
Published: August 2005

AbstractA prospective study was carried out to examine the usefulness of endosonography (ES) in the pre‐operative staging of patients with carcinoma of the esophagus, and its relevance in predicting resectability and the type of resection. The results of ES were compared with staging by conventional pre‐operative methods and with operative staging according to the new American Joint Commission of Cancer staging classification. Of the 89 patients studied, 62 had a resection, 22 a bypass operation, and 5 had no operation. ES examination was unsuccessful in 19 patients because of complete or near complete tumor obliteration of the esophageal lumen and was incomplete in 13 patients because of distal tumor obstruction. These 32 patients accounted for 36% of all ES examinations, 27% of resection group, 55% of bypass group, and 60% of no operation group. The 45 patients who had a satisfactory ES examination and who had underwent a transthoracic resection were analyzed. The sensitivity and specificity of ES in detecting the depth of esophageal involvement were 89% and 96%, respectively, and for lymph node metastasis were 85% and 86%, respectively. However, ES was neither sensitive in detecting extra‐esophageal infiltration to mediastinal organs nor was it able to determine the extent of intra‐abdominal spread. The accuracy of pre‐operative staging was 82% by ES compared with 51% by conventional staging (p<0.001). ES correctly identified more advanced stage of disease in 14 (31%) patients as compared with conventional staging. On the evaluation of resectability, which was based on conventional investigations without ES, the result was unaffected even if the additional findings of ES were available. Furthermore, the prediction of whether the resection was curative or palliative was similar by conventional assessment (71%) and by ES (80%).ES can provide more precise pre‐operative staging, but when surgery is the preferred treatment for palliation even for advanced stages of disease, the added information of ES has not helped in guiding the decision to operate nor the pre‐operative assessment of the type of resection, both of which can be determined by simple conventional pre‐operative investigations.
Pre‐operative radiotherapy prolongs survival in operable esophageal carcinoma: A randomized, multicenter study of pre‐operative radiotherapy and chemotherapy. The second scandinavian trial in esophageal cancer
Authors: Nygaard Knut , Hagen Steinar , Hansen Hanne Sand , Hatlevoll Reidulv , Hultborn Ragnar , Jakobsen Anders , Mäntyla Matti , Modig Hans , Munck‐Wikland Eva , Rosengren Bengt , Tausjø Johan , Elgen Kjell 
Published: August 2005

AbstractIn a prospective multicenter study, 186 patients with squamous cell esophageal carcinoma, who after evaluation were considered suitable for surgery, were randomized to 4 treatment groups: Group 1, surgery alone; Group 2, pre‐operative chemotherapy (cisplatin and bleomycin) and surgery; Group 3, pre‐operative irradiation (35 Gy) and surgery; Group 4, pre‐operative chemotherapy, radiotherapy, and surgery. Three‐year survival was significantly higher in the pooled groups receiving radiotherapy as compared with the pooled groups not receiving radiotherapy. Comparison of the groups having pre‐operative chemotherapy with those not having chemotherapy showed no significant difference in survival. Female patients had a significantly better survival than males. The results indicate that pre‐operative irradiation had a beneficial effect on intermediate term survival, whereas the chemotherapy regime used did not influence survival.