bluuebunny/crossref_metadata_2025_split huggingface dataset:
Case Study: Formal Verification of a Computerized Railway Interlocking
Authors: Borälv Arne 
Published: August 2002

Abstract.
We describe a case study in system-level verification of a computerized railway interlocking developed by ADtranz Spain, installed and put into test use at a subway station in Madrid. The formal modelling and analysis was carried out by personell at ADtranz Sweden using a tool for automatic formal modelling of the interlocking system and the commerical verification software NP-Tools, which is based on Stålmarck's patented proof procedure.
The case study took about one man week in total, of which most of the time was spent modelling safety requirements. The analysis discovered an error that had passed the traditional verification phase.
The actual analysis time, disproving the safety requirements by supplying a countermodel, was done in a matter of seconds. The corrected software could be proved to fulfil the safety requirements in the same amount of time.
This case study is one of many carried out by ADtranz during 1995-98 in the process in which they have replaced the traditional techniques used for system level verification of safety with formal techniques. We give an overview of the formal methods and tools used which today are integrated in the development environment at ADtranz.
Gastrointestinal Anastomosis with the Nickel‐Titanium Double Ring
Authors: Nudelman Israel L. , Fuko Vladimir V. , Morgenstern Sara , Giler Shamai , Lelcuk Shlomo 
Published: August 2002

Abstract.We used a dog model to test the safety and effectiveness of sutureless gastrointestinal anastomoses (n= 23) (end‐to‐end, end‐to‐side, or side‐to‐side) with the nickel‐titanium double ring with temperature‐dependent shape memory. Results were compared to conventional hand‐sutured anastomoses (n= 5). Examination performed after 2 weeks' follow‐up showed no leaks and no difference in return of bowel function between the experimental groups and the control group. Microscopic studies showed a complete epithelial lining and perfectly functioning anastomoses. We conclude that the nickel‐titanium double‐ring device may have an important place in the armamentarium of the gastrointestinal surgeon.
Familial Papillary Thyroid Carcinoma: Genetics, Criteria for Diagnosis, Clinical Features, and Surgical Treatment
Authors: Musholt Thomas J. , Musholt Petra B. , Petrich Thorsten , Oetting Gundula , Knapp Wolfram H. , Klempnauer Juergen 
Published: August 2002

AbstractHereditable predisposition to papillary thyroid carcinoma (PTC) and multinodular goiter (MNG) without evidence of an association with other malignancies as a distinct entity was recognized only recently. A meta‐review of the literature on familial PTC (FPTC) was undertaken, and characteristics of families with frequent occurrence of PTC or MNG (or both) were summarized. A database on thyroid cancer patients maintained in our institution was searched for potential FPTC families. Clinical examinations were performed in 6 of 12 Hannover kindreds identified, and blood samples of all family members were collected for genetic analyses. Clinical presentations and histopathologic features of the FPTC cases were compiled. Based on the FPTC meta‐review and own experience, predictive criteria to identify families at risk were developed: Exclusion criteria were previous radiation exposure and coincidence with neoplasia syndromes. Primary criteria for susceptibility to FPTC are (1) PTC in two or more first‐degree relatives and (2) MNG in at least three first‐ or second‐degree relatives of a PTC patient. Secondary criteria are diagnosis in a patient younger than 33 years, multifocal or bilateral PTC, organ‐exceeding tumor growth (T4), metastasis (N1, M1), and familial accumulation of adolescent‐onset thyroid disease. A hereditary predisposition to PTC is considered if both primary criteria or one primary criterion plus three secondary criteria are present. Family history‐taking is recommended for all PTC patients to identify FPTC kindreds at risk. Blood relatives of FPTC index patients who harbor MNG should undergo thorough and regular clinical screening. Suspicious lesions should prompt early surgical intervention.
Determining Which Patients Require Evaluation for Blunt Cardiac Injury following Blunt Chest Trauma
Authors: Nagy Kimberly K. , Krosner Seth M. , Roberts Roxanne R. , Joseph Kimberly T. , Smith Robert F. , Barrett John 
Published: August 2002

Abstract.The objective of this study was to determine prospectively which risk factors require cardiac monitoring for blunt cardiac injury (BCI) following blunt chest trauma. All patients who sustained blunt chest trauma had an electrocardiogram (ECG) on admission to our urban level I trauma center. Those with ST segment changes, dysrhythmias, hemodynamic instability, history of cardiac disease, age >55 years, or a need for general anesthesia within 24 hours (group 1) were admitted to the intensive care unit (ICU) for 24 hours where they were subjected to serial ECGs, creatinine phosphokinase (CPK) assays, and echocardiography (ECHO). Those with only mechanism for BCI, i.e., none of the above risk factors (group 2), were admitted to a nonmonitored bed and had a follow‐up ECG 24 hours later. A series of 315 patients were admitted with blunt chest trauma during a 17‐month period; 144 patients were in group 1 and 171 in group 2. Overall, 22 patients were diagnosed as BCI (+BCI), defined as evolving ST segment changes, dysrhythmias, a CPK‐MB index of >2.5, or hemodynamic instability. Of the 18 +BCI patients in group 1, all were symptomatic (i.e., none was included solely for a cardiac history, age, or need for general anesthesia). Six of these patients required treatment for dysrhythmias, hypotension, or pulmonary edema; one of whom died. Four patients with +BCI were in group 2 and had ECG changes at 24 hours; none of these four had any sequelae from their +BCI. None of the ECHOs demonstrated abnormal wall motion. Patients who sustain blunt chest trauma with a normal ECG, normal blood pressure, and no dysrhythmias on admission require no further intervention for BCI. Patients with ST segment changes, dysrhythmias, or hypotension following blunt chest trauma should be monitored for 24 hours, as this subgroup occasionally requires further treatment for complications of BCI. ECHO adds nothing as a screening test.
Congenital Short Colon
Authors: Wakhlu Avtar Kishan , Wakhlu Ashish , Pandey Ashutosh , Agarwal Rajiv , Tandon R.K. , Kureel S. N. 
Published: August 2002

AbstractCongenital short colon (CSC) is a condition in which the colon is replaced, wholly or partially, by a dilated pouch together with anorectal malformation and a colourinary fistula. Most of the reported series have been from northern India where this malformation is frequent. This paper details the management of 108 patients with CSC over a period of 23 years. The patients were classified into two types: (1) Partial short colon, where a segment of normal colon is present between the ileum and the sac. These patients could be treated by excision of the pouch and pull‐through of the segment of normal colon during either single‐ or two‐stage surgery. (2) Complete short colon, where the ileum opened directly into the sac, and formation of a tube from this sac (coloplasty) was required in one or more stages to provide a length of normally functioning colon. Review of the results showed staged management to be superior. The follow‐up has ranged between 3 and 7 years, with satisfactory long‐term results in both groups of patients. We have evolved a protocol for the management of CSC that has improved the prognosis and quality of life of these patients.
Medical Treatment of Metastasizing Carcinoid Tumors
Authors: Arnold R. 
Published: August 2002

AbstractLong‐acting somatostatin analogs, such as octreotide, comprise the therapeutic modality of choice for the symptomatic relief of flush and diarrhea in patients with carcinoid syndrome. The sequelae of gastric acid hypersecretion in patients with gastrin‐producing duodenal carcinoids (gastrinoma) are perfectly controlled by proton pump inhibitors. Antiproliferative medical strategies to control the growth of metastatic carcinoid tumors include long‐acting somatostatin analogs, interferon alpha, and the combination of the two. However, the success rate is less than 50%, and it is questionable whether true tumor regression can be expected. Controlled prospective studies are mandatory to address the question whether interferon or somatostatin analogs or the combination of the two should be used as first‐line medical strategies and if hepatic artery embolization in patients with liver metastases should be performed before beginning medical therapy. Chemotherapy, including etoposide and cisplatin, has been shown to be effective only for purely differentiated neuroendocrine carcinomas and not for slowly growing carcinoids.
Two‐Dimensional Proton Magnetic Resonance Spectroscopy for Tissue Characterization of Thyroid Neoplasms
Authors: Mackinnon Wanda B. , Delbridge Leigh , Russell Peter , Lean Cynthia L. , May George L. , Doran Sinead , Dowd Susan , Mountford Carolyn E. 
Published: August 2002

AbstractWe have previously demonstrated that one dimensional (1D) proton (1H) magnetic resonance spectroscopy (MRS) can distinguish normal thyroid tissue from thyroid carcinoma using a spectral ratio of peak intensity at 1.7 ppm/0.9 ppm. Two dimensional (2D) 1H‐MRS allows identification of specific molecules that have overlapping peaks in the 1D‐MR spectrum. Specimens from 93 consecutive thyroid nodules were examined using 2D 1H‐MRS on a Bruker AM‐360 wide‐bore spectrometer. There was a progressive increase in lipid cross peaks assigned to di‐/triglycerides when comparing colloid/hyperplastic nodules to follicular adenoma, and adenoma to carcinoma. A specific cross peak attributable to cholesterol/cholesteryl esters was commonly seen in carcinomas. In contrast, two unassigned cross peaks unique to the thyroid were more prevalent in benign lesions. There was an overall increase in cross peaks attributable to cell surface fucosylation in carcinoma when compared to benign lesions, although the fucose spectral pattern was not specific for cancer. On this basis, a spectral ratio of peak intensity at 2.05 ppm/0.9 ppm more clearly distinguished benign follicular adenoma from carcinoma. 2D 1H‐MRS thus identifies chemical changes that allow more specific tissue characterization of thyroid neoplasms.
Intraabdominal Pressure and Gastric Intramucosal pH: Is There an Association?
Authors: Sugrue M. , Jones F. , Lee Anna , Buist M.D. , Deane S. , Bauman A. , Hillman K. 
Published: August 2002

AbstractThis study evaluated the potential association between increased intraabdominal pressure (IAP) and abnormally low gastric intramucosal pH (pHi) (≤ 7.32) in postoperative patients and assessed its effect on patient outcome. Altogether 73 patients undergoing major abdominal surgery over a 9‐month period were studied prospectively. All underwent gastric tonometry and intravesical IAP measurements three time daily. An IAP of ≥ 20 mmHg and a pHi of ≤ 7.32 were considered abnormal. The development of the following complications were also documented: hypotension [mean aortic pressure (MAP) < 80 mmHg], abdominal sepsis, renal impairment, and death. The median APACHE II score was 16 (range 5–34). Twenty‐two patients had upper gastrointestinal (GI) surgery, 27 lower GI surgery, and 24 aortic surgery; 44 of these patients underwent emergency surgery. Abnormal pHi (≤ 7.32) occurred in 36 patients while on the intensive care unit. Compared to patients with normal pHi, abnormal pHi patients were 11.3 times (3.2–43.5) [odds ratio ± 95% CI] more likely to have an increased IAP. Abnormal pHi was significantly associated with hypotension (χ2 = 6.8;p= 0.009), sepsis (χ2= 3.7;p= 0.06), renal impairment (χ2= 28.3;p= 0.0000001), relaparotomy (χ2= 4.1;p= 0.04), and death (χ2= 9.7;p= 0.002). This study demonstrated a significant clinical association between increased IAP and abnormal pHi. An abnormally low pHi was associated with poor outcome.
Five Years as a Flying Surgeon in Zimbabwe
Authors: Cotton Michael H. 
Published: August 2002

AbstractSurgical services in the developing world are often based on a Western model where the patient has to seek out the surgeon. A reverse policy was instituted to overcome severe logistical problems. Funding was obtained for air flights to 10 distant rural hospitals and a program of visits advertised in advance. Patients were selected by the resident doctor and seen either as in‐ or outpatients. A list was drawn up and patients were operated on that day and if necessary the following day when earlier postoperative cases were reviewed. More than 500 operations were performed of varying complexity, and complications were reported in fewer than 10. A scheme where the surgeon visits the rural patient in his or her home area is cost‐effective, popular, and beneficial to the hospital staff. It obviates the need for distant referral where there may be language difficulties and where visits from relatives are precluded. It also reduces the workload of overstretched referral centers. It provides the means to teach the local resident doctor rudiments of surgical practice, and it provides regular contact between the outstation and the referral center.
Hemodilution in Clinical Surgery: State of the Art 1996
Authors: Kreimeier U. , Messmer K. 
Published: August 2002

AbstractAcute normovolemic hemodilution entails removal of blood from a patient either immediately before or shortly after induction of anesthesia and simultaneous replacement with cell‐free fluid. Nowadays, because of their predictable volume effects, the synthetic colloids (6% dextran 60/70, 6% hydroxyethyl starch 200,000) are preferred as volume substitutes; albumin should be avoided because of its high cost. Hemodilution has experienced a renaissance in recent years, mainly due to the evolving discussion of legal aspects, immunologic changes, viral infections, and a potentially higher cancer recurrence rate associated with the transfusion of homologous blood. Hemodilution should be considered for elective surgical patients free of contraindications and presenting with an initial hemoglobin concentration ≥ 12 g/dl and an anticipated blood loss of ≥ 1500 ml. The efficacy of this method (judged by the need to give homologous blood transfusion) depends on the preoperative (initial) hematocrit, the target hematocrit (to which hemodilution is performed), and the preset intra‐ and postoperative transfusion trigger. In the past, data from clinical trials showed that in healthy subjects a target hematocrit of 20% to 25% (hemoglobin 7.0–8.0 g/dl) is feasible and safe for the patient. The lower the target hematocrit accepted, the more extensive is the monitoring required: Intraoperative target hemoglobin concentrations of 5.0 g/dl and less have been tolerated by surgical patients without adverse effects. The safety and efficacy of acute normovolemic hemodilution in terms of reducing homologous blood transfusion requirements has been demonstrated in various clinical studies. Hemodilution therefore is regarded an integral part of programs aimed at reducing the need for homologous blood and can thus be successfully combined with preoperative autologous blood deposition, intraoperative blood salvage, and carefully adjusted surgical techniques. Hemodilution is feasible and relatively cost‐effective, and it minimizes adverse effects associated with transfusion of homologous blood, particularly transmission of viral diseases, immunosuppression, and infectious complications.
Use of Pentastarch Solution in the Treatment of Patients with Hemorrhagic Hypovolemia: Randomized Phase II Study in the Emergency Room
Authors: Younes Riad N. , Yin Ko C. , Amino Claudio J. , Itinoshe Mario , Rocha e Silva Mauricio , Birolini Dario 
Published: August 2002

AbstractThis study evaluates the hemodynamic effects of the administration of 10% pentastarch solution (PS) during the initial treatment of hypovolemia in trauma patients. This prospective randomized phase II study included trauma patients admitted to the emergency room with hemorrhagic hypovolemia: systolic blood pressure (SBP) < 90 mmHg. Upon admission, the patients were randomized to receive 10% PS (n= 12) or isotonic 0.9% NaCl solution (IS) (n= 11), infused intravenously in 250‐ml boluses, repeated until SBP > 100 mmHg. Blood pressure, infused volumes necessary to maintain SBP, and overall survival rates were determined and compared between groups. SBP increased significantly following either IS (from 64.4 ± 9.2 mmHg to 111.1 ± 6.3 mmHg), or PS (from 63.7 ± 10.6 mmHg to 108.1 ± 9.8 mmHg) when compared to admission values (p < 0.05). Endovenous volumes infused were greater (p= 0.001) in IS patients (1420 ± 298 ml) than in PS patients (356 ± 64 ml). No blood was transfused into PS patients, compared to 370 ± 140 ml of red blood cells transfused into IS patients (p= 0.015). Mortality rates were similar in the two groups (p= 0.725). We concluded that PS is a safe, efficient method for inducing hemodynamic recovery of hypovolemic trauma patients, with a clear reduction in the intravenous volumes required for acute resuscitation.
Antibiotic‐Resistant Gram‐Positive Cocci: Implications for Surgical Practice
Authors: Barie Philip S. 
Published: August 2002

AbstractGram‐positive infections are causing more serious infections than ever before in surgical patients, who are increasingly aged, ill, and debilitated. Invasive procedures disrupt natural barriers to bacterial invasion, and indwelling catheters may act as conduits for infection. The use of broad‐spectrum antibiotics selects for the emergence of resistant pathogens. Potential sites of nosocomial gram‐positive infections include the urinary tract, surgical site (including prosthetic devices), intravascular loci, lung and pleural space, facial sinuses, and peritoneal cavity. Responsible organisms include species from the genera Enterococcus andStaphylococcus. Methicillin‐resistant strains ofStaphylococcus aureus (MRSA) and Staphylococcus epidermidis (MRSE) emerged during the 1970s, leading to a marked increase in the use of vancomycin as the treatment of choice. Vancomycin use, in turn, has been implicated (along with widespread cephalosporin use) in the emergence of vancomycin‐resistant enterococci (VRE) during the 1990s. Of great concern is the likely emergence of vancomycin‐resistant staphylococci, which would constitute a public health emergency. Vancomycin remains the treatment of choice for infections caused by MRSA/MRSE, but rampant inappropriate use (e.g., prophylaxis in non‐penicillin‐allergic patients, treatment of methicillin‐sensitive strains) must be curtailed. Chloramphenicol is increasingly the treatment of choice for serious VRE infections. Infection control policy must also minimize the possibility of transmission. All infected or colonized patients should be isolated and all environmental surfaces considered contaminated. Disposable gloves are mandatory for all patient contact, even incidental contact, and must be disposed of after each patient encounter. Hand‐washing (the single most effective infection control measure) is mandatory after glove disposal. Gowns should be worn for direct contact with infected patients and masks used when aerosolization or splashing of secretions is likely.
Outcome after Elective Infrarenal Aortic Aneurysm Surgery
Authors: Cohen Jonathan D. , Singer Pierre , Grunberg Gloria , Grozovski Elad , Sulkes Jaqueline , Zelikovski Avigdor 
Published: August 2002

AbstractWe conducted a prospective case series study to investigate the causes of and factors influencing morbidity and mortality in 102 consecutive patients after elective infrarenal abdominal aneurysm (AAA) surgery between 1992 and 1995. Preoperative factors (demographics, risk factor indexes, electrocardiographic findings, ejection fraction, and stress imaging scans were indicated) and intraoperative factors (duration of surgery, size of aneurysm, complications, units of blood transfused, and additional procedures performed) were recorded. Patients were admitted to the intensive care unit (ICU) for at least 24 hours and followed for 30 days postoperatively. The mortality rate was 4.9%, due in all cases to multiorgan dysfunction syndrome (MODS). Death was preceded by colon ischemia (two patients), intraabdominal bleeding (two patients), or sepsis (one patient). Only the preoperative blood urea nitrogen correlated with mortality (p= 0.042). Complications occurred in 59% of patients in the ICU and involved the cardiovascular system in 83% of them (heart rate > 90 bpm in 49%). On multivariate analysis, only duration of surgery was associated with ICU complications (p= 0.018). No complication resulted in mortality. Ward complications occurred in 13%, and 5% of these patients required readmission to the ICU. Although cardiac complications are considered the major cause of mortality after infrarenal AAA surgery, all five deaths in the present series were due to MODS. Preoperative screening should be more selective, and intraoperative and postoperative care should be stressed.
Pouchitis: Risk Factors, Etiology, and Treatment
Authors: Nicholls R. John , Banerjee Anjan K. 
Published: August 2002

AbstractA Medline literature review of pouchitis has been conducted, and relevant information from this search and the authors’ own experience has been used to produce an overview on pouchitis at the current time. Particular attention is given to etiology, pathophysiology, and clinical management.
Evaluation of Surgical Treatment of Renal Hyperparathyroidism by Measuring Intact Parathormone Blood Levels on First Postoperative Day
Authors: Kinnaert Paul , Tielemans Christian , Dhaene Michel , Decoster‐Gervy Christine 
Published: August 2002

AbstractIntact parathormone (inPTH) has a short half‐life. Its blood level on the first day after total parathyroidectomy and subcutaneous parathyroid implantation (PTX + G) should therefore allow an early diagnosis of missed residual parathyroid tissue. We tested this hypothesis in 72 uremic patients who were followed for 6 to 110 months after operation. Nine were reoperated for recurrence of the disease. Graft removal was successful in four patients who had post‐PTX inPTH levels of 16 pg/ml or lower. In five patients, an overlooked parathyroid gland had to be resected. All of them had elevated post‐PTX inPTH blood levels ranging from 72 to 791 pg/ml (upper normal limit 55 pg/ml). Three of these patients had presented with hypocalcemia after PTX. We conclude that the inPTH blood concentration on the first day after PTX allows more precise evaluation of the efficacy of the surgical procedure than the postoperative evolution of blood calcium levels. It is also useful for localizing the source of excessive PTH secretion (graft or overlooked gland) when the disease recurs.
Starvation Injury after Gastric Reduction for Obesity
Authors: Mason Edward E. 
Published: August 2002

AbstractGastric reduction operations are designed to control body weight by establishing a small, meal‐size juxtaesophageal, gastric pouch that empties into the jejunum (gastric bypass) or the larger portion of the stomach (gastroplasty). If the outlet of the pouch is too small, a patient may be limited to ingesting clear liquids. Vomiting then occurs if heavier liquids or normal foods are taken. An occasional patient has difficulty eating properly and vomits even though the pouch volume and outlet are of optimum size. For a patient who reports vomiting, a distinction must be made between episodic improper eating and uncontrolled starvation. Three types of starvation injury are described: (1) sudden death from protein malnutrition; (2) refeeding syndrome; and (3) Wernicke‐Korsakoff syndrome. The mechanisms of the development, manifestations, prevention, and treatment of these complications are explained. Surgeons who treat severe obesity should be aware of these complications and be prepared to manage patients who have uncontrolled vomiting so that such complications either do not develop or are recognized and treated as early as possible before serious and irreversible injury occurs.