bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cancer and Inflammatory Bowel Disease: Bias, Epidemiology, Surveillance, and Treatment
Authors: Solomon Michael J. , Schnitzler Margaret 
Published: August 2002

AbstractIndividuals with chronic ulcerative colitis are at increased risk of developing colorectal carcinoma, particularly if there is long‐standing disease or extensive colitis. It is generally accepted that the risk of colorectal cancer does not begin until 8 to 10 years after the time of diagnosis of ulcerative colitis. Thereafter it increases by approximately 0.5% to 1.0% per year. In patients with Crohn's disease, the risk of malignancy is smaller and less well defined. The most significant predictor of the risk of malignancy in patients with inflammatory bowel disease is the presence of dysplasia in colonic biopsies. There is considerable controversy in the literature regarding the efficacy of colonoscopic surveillance programs and the role of prophylactic surgery to prevent colorectal cancer. Surveillance certainly fails to detect carcinoma in some patients who are having regular colonoscopy. Concerns have also been raised as to the cost‐benefit of colonoscopic surveillance in patients with colitis. Randomized controlled trials of surveillance programs are highly unlikely in view of the low prevalence of IBD in the population, the long period of observation required, and the probability of contamination of surveillance programs by colonoscopy for assessment of disease activity. Despite the lack of clear guidelines, surveillance colonoscopy and biopsy continues to be widely practiced. Research is proceeding to identify genetic and biochemical markers that may prove clinically useful for predicting cancer risk. At present, however, surveillance programs are likely to continue according to institutional practice. It is important for those participating in such programs to be aware of the limitations of colonoscopy and biopsy as a means of reducing the risk of cancer in inflammatory bowel disease.
Strictureplasty for Crohn's Disease: Techniques and Long‐term Results
Authors: Hurst Roger D. , Michelassi Fabrizio 
Published: August 2002

AbstractStrictureplasty for treatment of symptomatic intestinal strictures secondary to Crohn's disease is being performed with increasing frequency. To determine the overall clinical results after strictureplasty for Crohn's disease, all patients undergoing this procedure were prospectively studied. Between 6/1/89 and 2/1/97, 57 Crohn's disease patients underwent 60 operations utilizing strictureplasties. A total of 109 strictureplasties were performed (90 Heineke‐Mikulicz, 6 Finney, and 13 side‐to‐side isoperistaltic). The 30‐day perioperative morbidity was 12%, with complications being less common for patients undergoing elective versus unscheduled operations (p < 0.002). Recurrence of Crohn's disease requiring operation was seen in seven patients after a mean follow‐up of 38 months. The estimated cumulative recurrence rate after 2 years was 15 ± 6% (± standard error) and 22 ± 10% at 5 years. A recurrence developed at the site of the previous strictureplasty in only five cases. Strictureplasty is a safe, effective means of providing long‐term surgical palliation to selected patients with Crohn's disease. Perioperative complication rates are comparable to those seen with standard surgical treatment, and recurrences are not excessive.
Factors Determining Recurrence following Surgery for Crohn's Disease
Authors: Wolff Bruce G. 
Published: August 2002

AbstractMany factors have been examined in an attempt to define groups at higher risk for recurrence or recrudescence of Crohn's disease. Among these factors are age and onset of disease, gender, site of disease, number of resections, symptomatic status at the time of surgery, length of small bowel resection, fistulizing versus obstructive forms of disease, proximal margin length, microscopic margin histology, strictureplasty, and number of sites of disease, as well as the presence of colonic only disease, the presence of granulomas, blood transfusions, family history, and prophylactic treatment. To date, only proctocolectomy with Brooke ileostomy versus other procedures for colonic only disease, and prophylactic treatment have been shown with some degree of confidence to lead to a lower recurrence rate after surgery for Crohn's disease.
Interleukin‐6 Levels in Colorectal Cancer Tissues
Authors: Komoda Hiroshi , Tanaka Yasuhiro , Honda Masaharu , Matsuo Yoshinobu , Hazama Kenji , Takao Tetsuto 
Published: August 2002

AbstractInterleukin‐6 (IL‐6) levels in cancer tissues of 32 patients with colorectal cancer were measured and analyzed in relation to the clinicopathologic findings. The IL‐6 level in cancer tissues was 81.1 ± 118.0 pg/mg protein, which was significantly higher than the 11.2 ± 20.8 pg/mg protein in normal colorectal tissues (p= 0.028). IL‐6 levels in cancer tissues showed no correlation with the incidence of venous invasion, lymphatic invasion, lymph node involvement, or liver metastasis. The IL‐6 level in cancer tissue tended to decrease as the cancer penetration extended. Our results suggest that IL‐6 may play a role in human colorectal cancer growth.
Cost‐benefit Analysis for the Treatment of Severe Obesity
Authors: Martin Louis F. , White Steven , Lindstrom Walter 
Published: August 2002

AbstractCost‐benefit and cost‐effectiveness analyses (CEAs) are only now beginning to be used by business, government, and policymakers to evaluate various medical treatments. The evolution of why CEAs are being demanded is reviewed. To date, a formal CEA of obesity treatments has not been published. This article outlines how a CEA is performed, reviews data relevant to setting up a formal CEA of medical and surgical obesity treatments, and lists published reports that demonstrate the effectiveness of surgical obesity treatments. The general level of discrimination that society allows the obese to suffer also allows medical insurance companies, businesses, and government to not provide many obese Americans with obesity treatments that have established a level of effectiveness far surpassing many other forms of medical therapy. CEAs of obesity treatments, by themselves, cannot be expected to reverse this discrimination. This type of data, however, provides individual obese patients and their physicians with evidence to challenge policymakers’ decisions, especially when cost‐effective obesity treatments are excluded or placed at a lower priority than treatments with less proven effectiveness.
Are the Results of Pancreatectomy for Pancreatic Cancer Improving?
Authors: Tsiotos Gregory G. , Farnell Michael B. , Sarr Michael G. 
Published: August 2002

Abstract.Although pancreatectomy is still performed in a few patients with pancreatic cancer, and nearly all patients who develop pancreatic cancer eventually die of their disease, significant improvements have been made recently. Pancreatectomy is now safer, with major morbidity (hemorrhage, pancreatic anastomotic leak, intraabdominal sepsis) occurring in only about 20% and operative mortality of less than 5%. Two (seemingly subtle) issues cannot be overemphasized when someone carefully studies the literature: (1) There is a crucial difference between actuarial and actual survival, with the former generally being higher whereas the latter is true; and (2) careful re‐review of pathologic specimens (especially in long‐term survivors) initially diagnosed as pancreatic cancer, preferably by an independent pathologist before publishing long‐term results is essential. (Erroneous inclusion of patients with nonductal carcinoma substantially and artificially increases survival.) After curative resection, 5‐year actual survival is realistically about 10% with median survivals of 12 to 18 months. In certain subgroups with favorable pathologic characteristics (neoplasms < 2 cm without nodal or perineural invasion) the prognosis appears to be significantly better, with the 5‐year survival about 20%. The recent improvements in postoperative morbidity and mortality and long‐term outcome (resulting also in decreased cost of care of such patients) have occurred typically in centers with an invested interest in and proven record with pancreatic surgery. Further improvements in survival should be sought at the areas of earlier diagnosis and novel treatments designed to prevent locoregional recurrences; the role of extended resections must be determined by prospective, randomized trials.
Nerve‐sparing Surgery for Advanced Rectal Cancer Patients: Special Reference to Dukes C Patients
Authors: Saito Norio , Koda Keiji , Takiguchi Nobuhiro , Oda Kenji , Soda Hiroaki , Nunomura Masao , Sarashina Hiromi , Nakajima Nobuyuki 
Published: August 2002

Abstract.Several nerve‐sparing operations for advanced rectal cancer that aim to preserve genitourinary function without compromising tumor clearance have been developed in Japan. The aim of this study was to evaluate the survival and local recurrence of these procedures in Dukes B and C patients. A total of 177 patients with advanced rectal cancer underwent curative nerve‐sparing surgery (NSS) over the last 11 years; 52 were Dukes B patients and 54 were Dukes C. Altogether 36 had Dukes C1 and 18 had Dukes C2 tumors, 13 with lateral lymph node metastases, designated lateral LN(+). The 5‐year survival rate was 92% for Dukes B, 67% for Dukes C1, and 39% for Dukes C2 patients: 11% for Dukes C2 patients with lateral LN(+). The local recurrence rate was 6% for Dukes B, 11% for Dukes C1, and 33% for Dukes C2 patients: 20% for the lateral LN(−) group and 39% for the lateral LN(+) group. Almost all of the patients undergoing NSS could micturate spontaneously, but preservation of sexual function was not as successful. Although there is no guarantee of preserving satisfactory sexual function, our NSS is an acceptable procedure for Dukes B, C1, and C2 patients without lateral lymph node metastases.
Extinction of marine renewable resources: a demographic analysis
Authors: Punt A. E. 
Published: August 2002

AbstractA simple (deterministic) population dynamics model is used to examine the level of fishing mortality at which a population is expected to be driven to extinction (Fcrash). Values for Fcrash are determined for six marine fish species (Cape hake, blue grenadier, blue warehou, school shark, gummy shark, and orange roughy) subject to commercial harvest. The sensitivity of the value of Fcrash to changing the selectivity pattern of the fishery and the relationship between the size of the reproductive component of the population and subsequent births to allow for depensatory effects is examined. Fcrash is greatest for highly productive species and when the fishery does not target immature animals. The ratio of Fcrash to the fishing mortality at which maximum sustainable yield is achieved, FMSY, is a decreasing function of the productivity of the population. The possibility of depensation has little impact on FMSY but can substantially reduce the ratio Fcrash/FMSY. A series of stochastic simulations is conducted to assess the probability of detecting that the extent of fishing exceeds Fcrash using the current IUCN A criterion. The results of these simulations are also used to determine the probability that the IUCN A criteria will be triggered when fishing takes place at FMSY. The results indicate that there are substantial probabilities of incorrectly identifying species being harvested at FMSY as being threatened during the ‘fishing down’ phase and also of not identifying species actually at risk of extinction if fishing mortality is not reduced.
Localized outbreak of a willow leaf beetle: plant vigor or natural enemies?
Authors: Björkman C. , Bengtsson B. , Häggström H. 
Published: August 2002

AbstractThe possible roles of plant quality (vigor) and natural enemies in the development of a localized out‐break of the leaf beetle Galerucella lineola (Coleoptera: Chrysomelidae) in a stand of Salix cinerea were investigated. Caged and uncaged larvae on six bushes in the outbreak area were compared with caged and uncaged larvae on six bushes in an adjacent nonoutbreak area in terms of performance. In 1997, when the studies were performed, the natural density of the insect (beetles plus eggs) was six times higher in the outbreak area compared with the nonoutbreak area. Even though the vigor (measured as shoot length) of bushes in the outbreak was 72% higher than that of bushes in the nonoutbreak area, we found no difference between areas in the performance (survival, developmental time, pupal weight) of caged larvae or in the willingness of caged females to lay eggs. Among larvae exposed to natural enemies, the disappearance rate was significantly higher in the nonoutbreak area. The density of generalist predators was significantly higher in the nonoutbreak than in the outbreak area. We conclude that differences in plant quality, despite the observed difference in plant vigor, could not explain the observed difference in beetle density between areas. Lower predation pressure in the outbreak area could, however, not be excluded as a possible reason for the higher density of leaf beetles in this area.
Microscopic Acanthosis Nigricans in Type 2 Diabetes
Authors: McManus R. M. , Gottschalk R. , Alanen K. , Shum D. T. , Grundy P. 
Published: August 2002

Background Acanthosis nigricans (AN) has been associated with insulin resistance. Individuals with type 2 diabetes are insulin-resistant and, therefore, could be expected to manifest AN. However, the prevalence and predictors of AN are unknown in this population. Objective An outpatient population with Type 2 diabetes (DM) was compared with matched controls (C) for microscopic and clinical AN along with measurement of body habitus, insulin, glucose, and androgen levels. >Methods Twenty-four individuals with DM (12M, 12F) from a tertiary care center were compared with 24 C (12M, 12F). Fasting glucose, insulin, sex hormone binding globulin, androstenedione, dihydroepiandrosterone sulfate, and testosterone were measured. Height, weight, waist/hip measures, and a clinical survey for acanthosis were recorded. A 2-mm skin biopsy from midaxilla of the nondominant arm was taken for pathological review. Results C and DM were matched for age and body mass index (BMI). Prevalence of microscopic AN in C was 12% (3/24) and in DM was 21% (5/24; NS). In C, AN was predicted by waist, waist/hip ratio, and fasting insulin measures, while none of the variables examined was predicative of AN in DM. Conclusions Microscopic acanthosis nigricans was found in similar numbers of people with DM when compared with C. Fasting insulin levels most strongly predicted the presence of AN in C, while no significant predictors of AN were found in the population with DM.
Acetabular Component Orientation as an Indicator of Implant Luxation in Cemented Total Hip Arthroplasty
Authors: Cross Alan R. , Newell Susan M. , Chambers Jonathan N. , Shultz Kristin B. , Kubilis Paul S. 
Published: August 2002

Objective—To determine the sensitivity and specificity with which acetabular component angles of inclination and version could be used, alone or in combination, to predict luxation of cemented total hip arthroplasties (THA).Study Design—Comparison of retrospectively selected cases and controlsSample Population—All THA performed at the University of Florida between 1991 and 1998 with the BioMedtrix system and for which at least 2 months of radiographic follow‐up were available. All THA performed at the University of Georgia with the BioMedtrix system which subsequently luxated.Methods—Acetabular component inclination angle (IA) and acetabular version angle (VA) were determined for each THA. Data were grouped according to outcome—luxation or no luxation— with the luxated cases from the 2 institutions pooled. Receiver operator characteristic (ROC) analysis was used to evaluate decision rules for using IA and VA as tests for detecting postoperative luxation. Sensitivity and specificity for luxation and 95% confidence bounds were computed with selected values of IA and VA as cut‐points.Results—The nonluxation group consisted of 68 THA with a median follow‐up time of 5 months (range, 2–60 months). The luxation group consisted of 12 THA with a mean time to luxation of 36 days. The nonluxation group had a mean ± standard deviation (SD) IA and VA of 40.3°± 8.9° and 71.1°± 13.6°, respectively, whereas the luxation group had a mean ± SD IA and VA of 34.7°± 12.6° and 72.9°± 16.6°, respectively. An IA cut‐point of 37.8° achieved 58.3% sensitivity and 57.4% specificity. A VA cut‐point of 73° achieved 75.0% sensitivity and 51.5% specificity. IA and VA considered simultaneously achieved a 50.0% sensitivity and 88.2% specificity.Conclusions and Clinical Relevance—ROC analysis indicated that both IA and VA considered individually or simultaneously were poor indicators of luxation. Although extreme values of IA may predict luxation with high specificity, the potential for luxation cannot be excluded based on apparently appropriate values of IA and VA. The results of this study also indicate that a successful outcome is possible with a wide range of acetabular component positions.
Cecal Amputation Within the Right Ventral Colon for Surgical Treatment of Nonreducible Cecocolic Intussusception in 8 Horses
Authors: Hubert Jeremy D. , Hardy Joanne , Holcombe Susan J. , Moore Rustin M. 
Published: August 2002

Objectives—To report a surgical technique for treatment of nonreducible cecocolic intussusception and outcome in 8 horses.Study Design—Retrospective study.Animals—Eight horses with nonreducible cecocolic intussusception treated by cecal amputation through a right ventral colotomy.Methods—Data were obtained from medical records and telephone conversations by using a standardized questionnaire. The large colon was exteriorized and, if necessary, evacuated of its contents through a pelvic flexure enterotomy. A second colotomy was made on the ventral surface of the right ventral colon (RVC) centered over or immediately distal to the intussusceptum. In most horses, attempts to manually reduce the intussusception by pushing the cecum from within the RVC through the cecocolic orifice were unsuccessful. Invaginated cecum was then pulled into the RVC and amputated; the cecum was either ligated with umbilical tape or sutured proximal to the site of amputation. After amputation, the remainder of the invaginated cecum was reduced. After further resection to healthy tissue, the typhlectomy was closed with a double‐inverting suture pattern.Results—The median horse age was 2 years (range, 1 to 8 years). Duration of colic ranged from 6 hours to 6 months. Median surgical time was 180 minutes (range, 135 to 300 minutes). Median duration of antibiotic therapy was 7 days (range, 5 to 14 days). Median duration of hospitalization was 12 days (range, 6 to 21 days). All horses survived to hospital discharge. One horse died 3 months postoperatively; however, the remainder survived (median survival, 30 months; range, 6 to 96 months) and returned to or exceeded previous function.Clinical Relevance—Despite some contamination during surgery, horses with nonreducible cecocolic intussusception that underwent this method of surgical treatment had a good prognosis.
Evaluation of Samarium‐153 for Synovectomy in an Osteochondral Fragment‐Induced Model of Synovitis in Horses
Authors: Yarbrough T.B. , LEE M.R. , Hornof W.J. , Schumacher H.R. , O'Brien T.R. 
Published: August 2002

Objective—To determine the effects of intraarticular administration of Samarium‐153 (153Sm) bound to hydroxyapatite microspheres (153SmM) on an osteochondral chip–Ninduced synovitis.Study Design—Sixty days after implantation of autogenous osteochondral fragments in the middle carpal and metacarpophalangeal joints,153SmM was administered into 1 joint of each type. The contralateral joints were used as untreated controls.Animals or Sample Population—Fifteen horses without preexisting joint disease were randomly divided into 2 groups (7 in the carpal group, 8 in the metacarpophalangeal group).Methods—Horses had osteochondral fragments that were harvested from the lateral ridge of the trochlea of the talus and implanted bilaterally into a middle carpal joint and a metacarpophalangeal joint; the opposite joint type served as a control. Sixty days later, 10 to 15 mCi of153SmM (20 to 50 μm diam) was injected into the fragment‐implanted joints. Three horses were treated with nonradioactive hydroxyapatite fragments. Horses were examined clinically until they were killed 14 or 30 days later. Control and treated joints were examined grossly and microscopically to determine the effects of153SmM on synovial membrane and cartilage.Results—Intraarticular153SmM caused a transient flare with lameness, effusion, and edema for 48 to 72 hours. Implanted osteochondral chips induced a synovitis characterized by variable degrees of joint damage and synovial infiltrate. Use of153SmM resulted in synovectomy of variable depth and extent.Conclusions—Intraarticular153SmM may be a useful method for synovectomy of inflamed synovial membrane.Clinical Relevance—With further testing, radioactive pharmaceuticals might become useful clinical treatments for persistent synovitis not responsive to conventional techniques.
Intraoperative Hemorrhage During Patent Ductus Arteriosus Ligation in Dogs
Authors: Hunt Geraldine B. , Simpson David J. , Beck Jason A. , Goldsmid Sarah E. , Lawrence Darien , Pearson Martin R.B. , Bellenger Christopher R. 
Published: August 2002

Objective—To determine the prevalence of intraoperative hemorrhage in a consecutive series of dogs undergoing patent ductus arteriosus (PDA) ligation at a veterinary teaching hospital, and to describe strategies to reduce the risk of ductus perforation and deal with hemorrhage when it occurs.Study Design—Retrospective clinical study.Animals—Sixty‐four dogs.Methods—The records of all dogs undergoing PDA ligation at the University Veterinary Center, Sydney between May 1989 and February 1998 were reviewed and the prevalence and nature of complications identified.Results—Serious hemorrhage occurred in 4 of 64 dogs (6.25 %) that underwent PDA ligation. In all cases, hemorrhage resulted from perforation of the craniomedial aspect of the ductus while attempting to expose the tips of the dissecting forceps. Hemorrhage was controlled in 3 dogs by clamping the main pulmonary artery, digital compression of the descending aorta, and completion of ductus ligation during an approximately 5‐minute period of circulatory arrest. The remaining dog exsanguinated during an unsuccessful attempt to locate, clamp, and ligate the bleeding point. The mortality rate for PDA ligation was 1 of 64 dogs (1.6 %).Conclusions—The technique described in this report permits simple ligation of a range of different ductus morphologies in dogs of varying breeds, weights, and ages. In the event of serious hemorrhage, prompt ventricular outflow occlusion and ductus ligation followed by rapid whole blood transfusion is life saving in most cases.