bluuebunny/crossref_metadata_2025_split huggingface dataset:
Recurrent Laryngeal Nerve Identification and Assessment during Thyroid Surgery: Laryngeal Palpation
Authors: Randolph Gregory W. , Kobler James B. , Wilkins Jamie 
Published: August 2004

AbstractElectrical identification and monitoring of the recurrent laryngeal nerve (RLN) has been proposed as an adjunct to standard visual identification of the nerve during thyroid and parathyroid surgery. This study was undertaken to assess laryngeal palpation as an intraoperative technique for identifying and assessing the RLN during surgery and to investigate the relation between laryngeal palpation and associated laryngeal electromyographic (EMG) activity. The postcricoid region of the larynx during surgery was palpated through the posterior hypopharyngeal wall to sense posterior cricoarytenoid muscle contraction in response to ipsilateral RLN stimulation (i.e., the “laryngeal twitch response.”) Laryngeal palpation was performed in a series of 449 consecutive thyroid and parathyroid surgeries with 586 RLNs at risk. All patients underwent preoperative and postoperative laryngoscopy to assess vocal cord mobility. In a subset of patients, laryngeal palpation and simultaneous laryngeal EMG recordings were compared during intraoperative RLN stimulation. In this series, there was no permanent RLN paralysis. There was one case of temporary RLN paralysis secondary to neural stretch that resolved 6 weeks postoperatively (temporary paralysis rate: 0.2% of patients, 0.2% of nerves at risk). Intraoperative laryngeal palpation of the laryngeal twitch response reliably correlated with normal postoperative vocal cord function. Loss of the laryngeal twitch response occurred in the single case of temporary paralysis in the setting of an anatomically intact nerve. Laryngeal palpation correlated well with simultaneous laryngeal EMG activity. There were no palpation‐induced laryngeal injuries or laryngeal edema. There were also no RLN injuries due to repetitive neural stimulation. Intraoperative laryngeal palpation during RLN stimulation is a safe, reliable method for neural monitoring that can assist in RLN identification and assessment during thyroid and parathyroid surgery. Most importantly, it provides important prognostic information regarding ipsilateral vocal cord function at the completion of the initial side of the thyroid or parathyroid surgery. Intraoperative laryngeal palpation allows the surgeon to stage contralateral surgery if RLN damage is diagnosed, thereby avoiding the potential for bilateral vocal cord paralysis. We believe that laryngeal palpation is useful as an adjunct to formal EMG monitoring during thyroid and parathyroid surgery.
Local Anesthesia Use for Laparoscopic Cholecystectomy
Authors: Inan Aydin , Sen Meral , Dener Cenap 
Published: August 2004

AbstractThis study aimed to investigate the effects and timing of local anesthesia during laparoscopic surgery in terms of postoperative pain, nausea, and the need for opioids and antiemetics. This prospective study was carried out on 142 patients who underwent laparoscopic cholecystectomy. Peroperative local anesthesia was not administered to 53 patients (group A). The skin, subcutis, fascia, and parietal peritoneum were infiltrated with 0.5% bupivacaine HCl at trocar sites before trocar insertion in 46 patients (group B). Local anesthesia was given to 43 patients in equal doses at the same sites and the same manner at the end of surgery (group C). The higher requirement for analgesics in group A patients was statistically significant when compared with that in group B and C patients. The mean doses of analgesics postoperatively were significantly higher in group B than in group C. The time delay to the first antiemetics was significantly shorter in group A than in group C. Applying local anesthesia to the skin, subcutis, fascia, and parietal peritoneum through trocar sites reduces the postoperative analgesic requirement and pain intensity. This approach is more effective when applied at the end of an operation than at the start.
Laparoscopic Cholecystectomy as a Day Surgery Procedure: Implementation and Audit of 136 Consecutive Cases in a University Hospital
Authors: Vuilleumier Henri , Halkic Nermin 
Published: August 2004

AbstractLaparoscopic cholecystectomy (LC) has been routinely performed since 1989 at our institution, and patients were traditionally admitted for 2 days. In 1996 we implemented a protocol for LC as a day surgery procedure at our center. Although initially reported by others, it has not yet been introduced as routine in Switzerland. The objective of this prospective study was to determine acceptability and safety of LC as an outpatient procedure in a university hospital. Data were collected prospectively for 136 LCs between January 1996 and December 2001. Patients were selected for the study if they wanted to go home within less than 24 hours, had no previous jaundice, and had no anesthetic contraindication. Systematic preoperative liver function tests and hepatic ultrasonography were performed. All patients were admitted on the day of operation. LC was performed using a three‐trocar technique. Systematic cholangiography was performed, and all the procedures were completed laparoscopically. There were no common bile duct explorations. Postoperative complications were the following: nausea in seven patients, a minor umbilical hematoma in two. According to patient preference, 101 (74%) were discharged after an overnight stay (less than 24 hours) and 32 (24%) on the same day. The unplanned admission rate was 2%, and none of the patients was subsequently readmitted. The reasons for unplanned admissions were two patients with persistent nausea and one patient for whom an overnight stay was scheduled who presented with a ruptured subcapsular hematoma of the liver. Altogether, 97% of the patients were satisfied with the care they received. Operative costs were not significantly different when comparing inpatient and outpatient LC. The main postoperative savings were in the postoperative costs. Our results confirm that LC as a day surgery procedure is safe, effective, and acceptable to patients and their relatives. These results were achieved by using selection criteria that considered not only the surgical pathology but also the individual and by using appropriate techniques and planned postoperative analgesia.
Outcome of Laparoscopic Cholecystectomy in Patients 80 Years and Older
Authors: Tambyraja Andrew L. , Kumar Sudhir , Nixon Stephen J. 
Published: August 2004

AbstractAdvanced age is associated with an increase in postoperative complications. This study assesses the indications and outcome for laparoscopic cholecystectomy (LC) in patients aged 80 years or older. Consecutive, unselected patients aged 80 years or over undergoing LC between 1991 and 2000 were included. A retrospective case review enabled analysis of clinical and operative factors together with in‐hospital morbidity, 30‐day mortality, and duration of hospital stay. A series of 117 patients, 79 women and 38 men with a median age of 83 years (range 80–93 years), underwent LC. Indications for LC were chronic cholecystitis in 62 (53%) patients, acute cholecystitis in 28 (24%), gallstone pancreatitis in 12 (10%), and other conditions in 15 (13%). Six (5%) patients required conversion to an open procedure. Overall, 26 (22%) patients developed a postoperative complication. There were no bile leaks or bile duct injuries. One patient, with gangrenous cholecystitis, died after LC. The median postoperative hospital stay was 3 days (range 1–31 days). LC can be performed safely with low morbidity in patients over age 80 years.
Effectiveness of Endoscopic Nasobiliary Drainage for Postoperative Bile Leakage after Hepatic Resection
Authors: Terajima Hiroaki , Ikai Iwao , Hatano Etsuro , Uesugi Takehiko , Yamamoto Yuzo , Shimahara Yasuyuki , Yamaoka Yoshio 
Published: August 2004

AbstractThe effectiveness of endoscopic nasobiliary drainage (ENBD) for postoperative bile leakage after hepatic resection was investigated retrospectively. Between 1997 and 2002 a series of 486 hepatectomies without biliary reconstruction were performed. Bile leakage was divided into two categories. Type A was defined as bile leakage communicating with the main bile tree fistulographically or endoscopic cholangiographically, and type B was bile leakage without such a patency of bile flow. Bile leakage developed in 31 patients (6.4%) (types A/B = 16/15). Type A frequently occurred at the major Glisson’s sheath. In contrast, most type B cases occurred at the peripheral bile duct at the cut surface of the liver. Among the type A patients, 10 of 11 were effectively treated with ENBD. For the type B patients, 12 of 15 patients were successfully treated with intraabdominal drainage via surgical drains inserted during the operation or percutaneous tubes newly inserted for biliary fluid collection. ENBD was effective in two of three type B patients. The duration of bile leakage significantly shortened after initiation of ENBD in type A patients (15.3 ± 6.9 vs. 25.8 ± 13.2 days, p < 0.05). The classification based on communication with the main bile tree is useful for determining therapeutic strategy. Type A leakage has a good indication for ENBD, whereas type B can be treated with intraabdominal drainage in most cases, although ENBD may be effective in some intractable type B cases. It is preferable to initiate ENBD as early as possible to shorten the duration of bile leakage and the subsequent hospital stay.
True versus Mild Hyperthermia during Isolated Hepatic Perfusion: Effects on Melphalan Pharmacokinetics and Liver Function
Authors: Pilati Pierluigi , Mocellin Simone , Rossi Carlo R. , Ori Carlo , Innocente Federico , Scalerta Romano , Ceccherini Mauro , Da Pian Pier Paolo , Nitti Donato , Lise Mario 
Published: August 2004

AbstractHyperthermic antiblastic isolated hepatic perfusion (IHP) with melphalan has been recently proposed as an alternative therapeutic option for patients with unresectable liver tumors. Although melphalan–heat antiblastic synergism is at a maximum at temperatures higher than 41 °C, IHP has so far been performed in humans at lower temperatures. In this experimental work, we compared IHP under mild versus true hyperthermic conditions in terms of drug pharmacokinetics and liver function. Ten pigs were submitted to IHP with melphalan 1.5 mg/kg at a mean temperature of 40 °C (group A, n = 5) or 42 °C (group B, n = 5). After a 60‐minute perfusion, a 15‐minute washout was performed. Perfusate‐to‐plasma leakage was monitored using scintigraphy. Throughout perfusion, samples from the systemic blood, perfusate, and liver parenchyma were obtained to measure melphalan concentrations. Liver function was assessed using standard blood tests and the indocyanine green‐based test. No deaths related to the IHP procedure were recorded. All animals had transient liver function impairment, with all liver function test results returning to normal within the observation period. At histologic examination, liver damage was similar under both hyperthermic conditions. Melphalan levels in the perfusate were not significantly different in the two study groups (the mean perfusate/plasma area under the curve from 0 to 60 minutes ratios were 463 and 501, respectively). These results correlated well with those obtained using the scintigraphic method. Liver drug concentrations remained unchanged after true hyperthermia IHP. Under true hyperthermic conditions, neither an increase in liver parenchyma toxicity nor changes in melphalan pharmacokinetics were observed. These findings support the use of true hyperthermia in the clinical setting to exploit fully the antitumor synergism between melphalan and heat.
Surgical and Endovascular Procedures for Treating Isolated Iliac Artery Aneurysms: Ten‐year Experience
Authors: Matsumoto Kenji , Matsubara Kentaro , Watada Susumu , Akiyoshi Takurin , Inoue Fumihiko , Kaneda Munehisa , Shintani Tsunehiro , Kitajima Masaki 
Published: August 2004

AbstractCharacteristics of atherosclerotic isolated iliac artery aneurysms (IAAs) and various strategies for their treatment were assessed retrospectively. The computerized medical records of 18 patients who underwent surgical or endovascular treatment of an IAA during the 10 years from April 1993 to March 2003 at our university hospital were reviewed to obtain information on patient demographics, risk factors, type of IAA treatment, and outcome. Additional data were obtained by mail and telephone. Patients with an IAA were compared with 168 patients treated for an abdominal aortic aneurysm (AAA) also at our institution. Early in the series of isolated IAA repairs, patients underwent prosthetic graft interposition (n = 7) or thromboexclusion (n = 4). Subsequently, patients had either endovascular thromboembolization (n = 4) or endovascular thromboembolization with femorofemoral crossover bypass (n = 3). No perioperative deaths occurred in the series. Deep venous thrombosis developed postoperatively in one patient; there were no other serious complications. The cumulative patency rate for the implanted interposition grafts during the mean observation time of 5.5 years was 100%. No endoleakage was observed after the endovascular procedures. In the long‐term, five patients died of causes unrelated to the IAA treatment. A statistical analysis revealed no significant differences between the IAA group and the AAA group with respect to atherosclerotic risk factors. In conclusion, open surgical procedures to repair isolated IAAs generally have a good outcome, although the risk of injury to adjacent iliac veins remains. Endovascular treatments appear to have some advantages, but studies including long‐term follow‐up are needed to assess the efficacy and durability of prosthetic grafts used for these procedures.
Treatment of Hydatid Cyst of the Liver: Where Is the Evidence?
Authors: Dziri Chadli , Haouet Karim , Fingerhut Abe 
Published: August 2004

AbstractTreatment of hydatid cyst of the liver ranges from surgical intervention (conventional or laparoscopic approach) to percutaneous drainage and to medical therapy. The aim of this systematic review was to provide “evidence‐based” answers to the following questions: Should chemotherapy be used alone or in association with surgery? What is the best surgical technique? When is the percutaneous aspiration injection and reaspiration technique (PAIR) indicated? An extensive electronic search of the relevant literature without limiting it to the English language was carried out using MEDLINE and the Cochrane Library. Key words used for the final search were “hydatid cyst,” “liver,” “treatment,” “meta analysis,” “randomized controlled trial,” “prospective study,” “retrospective study.” All relevant studies reporting the assessment of one modality of treatment or a comparison of two or several therapeutic methods to treat hydatid cyst of the liver and published in a peer‐reviewed journal were considered for analysis. This systematic review allowed us to conclude that chemotherapy is not the ideal treatment for uncomplicated hydatid cysts of the liver when used alone (level II evidence, grade B recommendation). The level of evidence was too low to help decide between radical or conservative treatment (level IV evidence, grade C recommendation). Omentoplasty associated with radical or conservative treatment is efficient in preventing deep abscesses (level II evidence, grade A recommendation). The laparoscopic approach is safe (level IV evidence, grade C recommendation). Drug treatment associated with surgery (level II evidence, grade C recommendation) requires further studies. Percutaneous drainage associated with albendazole therapy is safe and efficient in selected patients (level II evidence, grade B recommendation). The level of evidence is low concerning treatment of complicated cysts.
Elevated circulating levels of thioredoxin and stress in chronic heart failure
Authors: Jekell Andreas , Hossain Akter , Alehagen Urban , Dahlström Ulf , Rosén Anders 
Published: August 2004

AbstractBackground:Chronic heart failure (CHF) is a complex syndrome, in which reactive oxygen species and inflammatory cytokines are important stressors that contribute to the pathogenesis.Aim:We have studied physiological stress response parameters in CHF, in particular the redox‐active regulator thioredoxin.Subject:A case–control study was conducted including a consecutive sample of CHF patients (n=27) of NYHA class II and III; comparison control subjects (n=29) were recruited from an association for retired people.Method:Baseline levels of Trx, lipid peroxides (oxidative stress), TNF and IL‐6 cytokines, platelet‐activation marker P‐selectin, cortisol (as peripheral effector of HPA axis), and the potent antioxidant selenoprotein Trx‐reductase were assessed.Results:Mean (±S.E.M.) plasma levels of Trx were significantly higher in patients with CHF (32±3 ng/ml), than in the healthy subjects (12±3 ng/ml, P<0.0001). Trx levels increased in proportion to severity of disease (NYHA class III>NYHA class II) and degree of stress. Trx elevation correlated well with increased oxidative stress (lipid peroxides, P<0.0001), circulatory P‐selectin (P<0.0001), morning level of free salivary cortisol (P=0.0002), and serum creatinine (P=0.0417), but not with pro‐inflammatory cytokines TNF and IL‐6.Conclusion:Trx was strikingly elevated in heart failure cases compared with controls, signifying an adaptive stress response that is higher the more severe the disease.
Visual-spatial processing and dimensions of schizophrenia: a preliminary study on 62 schizophrenic subjects
Authors: Loas Gwenolé 
Published: August 2004

AbstractThe aim of the study was to explore the relationships between the performance in figure-ground segregation and the clinical dimensions in schizophrenia. Sixty-two schizophrenic subjects filled out the embedded figures test (EFT) and the schizophrenic symptomatology was rated using the brief psychiatric rating scale (BPRS). The BPRS items were grouped into four categories: positive, negative, general and disorganization. The results showed in male schizophrenics negative and significant correlations between EFT scores and negative or disorganization subscales. Taken into account that in schizotypic subjects EFT scores was negatively correlated with negative dimension of schizotypy we suggested that those relationship could constitute a trait of the disease.
Do Pacific cod (Gadus macrocephalus) and walleye pollock (Theregra chalcogramma) lack a herding response to the doors, bridles, and mudclouds of survey trawls?
Authors: Somerton David A. 
Published: August 2004

Abstract
Pacific cod and walleye pollock were subjected to herding experiments in which trawl hauls are conducted repeatedly in an area with the bridles varied among three distinct lengths. For the flatfishes in these studies, catch per unit of area swept (cpue) by the trawls increased greatly with increasing bridle length, indicating that flatfish are stimulated to herd into the path of the net by the action of the bridles. In contrast, the cpue of Pacific cod and walleye pollock did not increase significantly with increasing bridle length. This lack of significance indicates that these two species respond only weakly to any herding stimuli produced by the 83–112 Eastern and Poly Nor'eastern trawls used to conduct groundfish trawl surveys in the North Pacific Ocean.
Spatial and seasonal variation in reproductive characteristics and spawning of southern calamary (Sepioteuthis australis): spreading the mortality risk
Authors: Moltschaniwskyj Natalie A. , Steer Michael A. 
Published: August 2004

AbstractSouthern calamary (Sepioteuthis australis) in Tasmania form spawning aggregations in Great Oyster Bay on the central east coast of Tasmania during spring/summer; these are targeted by commercial fishers. However, it is not known if there are similar aggregations farther south in Tasmania or at other times of the year, mainly because the species lives for less than a year. Therefore, this study describes and identifies differences in reproductive ecology of southern calamary on the east and southeast coasts of Tasmania, by sampling adults and surveying egg masses at inshore sites in both regions. Inshore populations on both coasts showed a similar seasonal trend of large gonosomatic index, reproductive output, and body size, and of greatest abundance during spring, and lowest in autumn. The number of egg masses was higher on the east coast, where mature calamary formed large spawning aggregations during spring and summer. However, there were no such aggregations during winter or autumn. Along the southeast coast, spawning activity was sporadic, resulting in isolated, low density, egg patches deposited over broader areas during spring, summer, and winter. There was no evidence of areas of seagrass or macroalgae associated with large depositions of egg masses at any time on the southeast coast. It appears that, by adopting different spawning behaviour in different locations and seasons, southern calamary may spread the risk of mortality in both space and time. The biological significance of this is unclear, particularly with respect to understanding the mechanisms that drive the development of spawning aggregations. Both spatial and seasonal spawning patterns appear to result from specific use of inshore sites at certain times of the year.
Misoprostol vs. oxytocin for induction of labor at term
Authors: Nigam A. , Singh V.K. , Dubay P. , Pandey K. , Bhagoliwal A. , Prakash A. 
Published: August 2004

AbstractEfficacy of misoprostol was studied for induction of labor at term. Seventy patients were randomized to Group A (n=36, oral misoprostol 50 μg four hourly to maximum of 5 doses) and B (n=34, continuous oxytocin infusion). Induction‐delivery interval was shorter with misoprostol (7.7±2.8 h against 14.3±4.8 h with oxytocin) but the rates of vaginal delivery, cesarean, neonatal outcome variables were similar. Hence, misoprostol is an effective agent for induction of labor at term.
Effect of pamidronate on bone turnover and implant migration after total hip arthroplasty: A randomized trial
Authors: Wilkinson J. Mark , Eagleton Alison C. , Stockley Ian , Peel Nicola F. A. , Hamer Andrew J. , Eastell Richard 
Published: August 2004

AbstractIn this trial we studied the effect of pamidronate on periprosthetic bone turnover and pelvic implant migration over 2 years after hybrid total hip arthroplasty (THA). Twenty‐two patients received 90 mg of pamidronate and 22 received placebo at randomization 5 days after surgery. Rapid periprosthetic bone loss occurred in the placebo group over the first 6 months and was accompanied by transient increases in biochemical markers of bone turnover. Partial recovery in bone mass occurred in most region after this period. No recovery of bone mass occurred at the femoral calcar or the medical wall of the acetabulum. Femoral calcar bone loss at 2 years was strongly predicted by acute biomarker changes at week 6. Pamidronate therapy reduced femoral bone loss in the region of the femoral calcar (P=0.01), but did not affect pelvic bone loss. Pamidronate therapy also inhibited the transient rise in biochemical markers of bone turnover during this period. Pamidronate therapy did not affect acetabular cup migration. Cup migration was inversely related to subject age, but unrelated to initial post‐operative bone mineral density, or subsequent bone loss.In summary, early periprosthetic bone loss is associated with a transient expansion of the bone remodeling space. Bisphosphonate therapy reduces femoral calcar bone loss and bone turnover after THA, but did not influence cup migration in this study. Acute changes in biochemical markers predict femoral periprosthetic bone loss. © 2004 Orthopaedic Research Society. Published by Elsevier Ltd. All rights reserved.