bluuebunny/crossref_metadata_2025_split huggingface dataset:
Damage control laparotomy for generalized necrotizing enterocolitis
Authors: Banieghbal Behrouz , Davies Michael R. 
Published: March 2004

AbstractMacroscopic generalized necrotizing enterocolitis (G‐NEC) is associated with a very high mortality in neonates. In some instances, however, multiple bowel segments are necrotic, with most of the remaining small bowel damaged but viable. In these selected patients morbidity can be reduced and survival increased with an aggressive and early surgical approach. We have termed this approach damage control laparotomy (DCL). Over a 5 1/2‐year period, all neonates with G‐NEC with adequate length of viable small bowel were subjected to DCL. The procedure is characterized by a resuscitative period of a few hours followed by laparotomy and resection of dead/perforated bowel. The bowel ends are either anastomosed or tied, and the bowel is returned to the abdomen to allow full tissue demarcation. Re‐look laparotomy is performed 3–4 days later, at which time any new necrotic bowel is excised and re‐joined, to achieve small bowel continuity. In this prospective study, 104 neonates with G‐NEC underwent operation; 27 neonates (26%) were considered to have an adequate potential length of viable bowel and were selected for DCL. Nineteen neonates survived in the follow‐up period. Early mortality was due to sepsis syndrome in 6 patients, and late mortality in 2 neonates was secondary to the short bowel syndrome. The DCL procedure is another step toward improving survival in surgical G‐NEC; this technique avoids proximal stomas and their complications, and at the same time it preserves the best possible bowel length.
Bloodless liver resection using the Monopolar Floating Ball plus Ligasure diathermy: Preliminary results of 16 liver resections
Authors: Sakamoto Yoshihiro , Yamamoto Junji , Kokudo Norihiro , Seki Makoto , Kosuge Tomoo , Yamaguchi Toshiharu , Muto Tetsuichiro , Makuuchi Masatoshi 
Published: March 2004

AbstractBlood loss during liver transection and ischemia‐reperfusion injury associated with hepatic inflow occlusion are significant drawbacks during liver surgery. Sixteen patients underwent liver resection using the Monopolar Floating Ball (FB) plus LigaSure (LS) diathermy without occlusion of the hepatoduodenal ligament (group FB‐LS). The liver parenchyma was precoagulated using the FB, and the uncovered tiny vessels were sealed using LS. Surgical outcomes were retrospectively compared with 16 well matched patients who underwent liver resection using the conventional clamp crushing method with Pringle’s maneuver (group CC). The amount of blood loss during liver transection was significantly less in group FB‐LS than in group CC [200 ml (0–990 ml) vs. 480 ml (120–1800 ml);p = 0.006]. The median time it took to complete the liver transection was significantly longer in group FB‐LS than in group CC [144 minutes (43–335 minutes) vs. 58 minutes (18–94 minutes); p < 0.0001]. Hepatic inflow occlusion was temporally used in five patients in group FB‐LS to achieve hemostasis in hepatic venous tributaries for 6,10, 19, 26, and 61 minutes, respectively. Using these two electronic devices allows liver resection to be safely performed, with the advantage of minimal blood loss and a reduced inflow occlusion period compared to the conventional method. The major disadvantage may be a slower transection speed. A prospective randomized trial is needed to clarify the clinical benefits of liver resections performed using this novel technique.
Impact of intraoperative parathyroid hormone monitoring on the prediction of multiglandular parathyroid disease
Authors: Clerici Thomas , Brandie Michael , Lange Jochen , Doherty Gerard M. , Gauger Paul G. 
Published: March 2004

AbstractOptimal interpretation of the results of intraoperative parathyroid hormone (IOPTH) monitoring during neck exploration for primary hyperparathyroidism (pHPT) is still controversial. The reliability of the “50% rule” in multiglandular disease (MGD) is often disputed, mostly because of competing pathophysiologic paradigms. The aim of this study was to ascertain and corroborate the ability of IOPTH monitoring to detect MGD in a practice, combining conventional and alternative parathyroid‐ectomy techniques. This is a retrospective single institution analysis of 69 consecutive patients undergoing cervical exploration for pHPT by various approaches. The IOPTH measurements were performed after induction of anesthesia but prior to skin incision and 10 minutes after excision of the first visualized enlarged parathyroid gland. In this series, 55 patients (80%) had single adenomas, and 14 patients (20%) had MGD. In 8 of the 14 patients with MGD, IOPTH levels were obtained sequentially after removal of every enlarged gland. Of these 8 patients, 6 (75%) had a false‐positive decrease (decrease below 50% of baseline value in presence of another enlarged gland) failing to predict the presence of a second enlarged gland. In 2 cases IOPTH monitoring provided a true‐negative result, correctly predicting MGD. If MGD is defined by gross morphologic criteria, IOPTH monitoring fails to predict the presence of MGD reliably. However, if MGD is defined by functional criteria, the course of these patients does not seem significantly affected. The importance of these findings must be further investigated, especially with regard to the outcome of minimally invasive parathyroid procedures.
Clinical and molecular biologic characteristics of early‐onset versus late‐onset colorectal carcinoma in Filipinos
Authors: Uy Gemma B. , Kaw Leoncio L. , Punzalan Corazon K. , Querol R Ireneo Luis C. , Koustova Elena V. , Bowyer Mark W. , Hobbs Christine M. , Sobin Leslie H. , Wherry David C. 
Published: March 2004

AbstractA case‐control study of Filipino patients who underwent surgical resection for colorectal cancer (CRC) during a 1‐year period was undertaken. Thirty‐five patients under age 40 years were identified. Paraffin blocks of these and 35 randomly selected patients over age 40 underwent histologic and immunohistochemical evaluation. Markers chosen for evaluation included the apoptosis‐associated gene products (p53 and bcl‐2), a tumor proliferation activity‐related factor (Ki‐67), and the markers (MLH1 and MSH2) of DNA microsatellite instability (MSI). Results were correlated with age and the stage and location of the tumor. The average age of the early‐onset group was 30.7 years compared to the late‐onset group at 67.0 years; and the male/female ratio was equivalent. The younger patients had a significantly higher Dukes’ stage, the tumors were more poorly differentiated, and they were more frequently of the mucinous and signet ring cell histopathologic type. Expression of p53 was higher in the younger patients (p < 0.001) and was independent of the degree of differentiation or the stage of the tumor. No differences of expression were noted for the other markers measured. The increased frequency of CRC in Filipino patients less than 40 years of age offers a unique opportunity to gain a better understanding of carcinogenesis, which might be exploited during diagnosis and management. The differences noted between the early‐ and late‐onset CRC are provocative and provide an impetus for increased screening in Filipinos.
Total mesorectal excision for rectal cancer: The truth lies underneath
Authors: Fernández‐Represa Jesús A. , Mayol Julio M. , Garcia‐Aguilar Julio 
Published: March 2004

AbstractThe surgical technique itself has emerged as a crucial factor for local recurrence since the popularization of total mesorectal excision for the treatment of rectal cancer. This procedure is associated with lower local recurrence rates after “curative” surgery compared to traditional dissection of the rectum. The aim is to remove an intact mesorectal envelope from the promontorium down to the pelvic floor by sharp dissection with tumorfree margins and without causing injury to the pelvic nerves. However, the description of total mesorectal excision has been confusing. Moreover, the implication that total excision of all the perirectal fat contained within the perirectal fascia en bloc in all patients with rectal cancer can minimize local recurrence remains contentious. Therefore a critical appraisal of the procedure is required. Nonrandomized clinical studies have shown that total mesorectal excision reduces the local recurrence rate and increases disease‐free survival in patients with adenocarcinoma of the middle and distal third of the rectum. Circumferential resection margins of 2 mm or more are associated with a lower local recurrence rate. Additional benefits in local control can be obtained with neoadjuvant treatment. Thus the modern treatment of rectal cancer combining total mesorectal excision with neoadjuvant chemoradiation results in excellent local tumor control. However, it is achieved at the cost of significant functional sequelae and impaired quality of life. The development of therapeutic alternatives that can achieve similar rates of local and distant tumor control without the mortality, morbidity, and functional consequences of radical surgery is a major challenge for colorectal surgeons.
Adverse effects of direct current cardioversion on cardiac pacemakers and electrodes
Authors: Waller Christiane , Callies Frank , Langenfeld Heiner 
Published: March 2004

Abstract
Use of pacing in sick sinus syndrome and recent developments in pacemaker therapy for intermittent atrial fibrillation raise the question of whether external electrical cardioversion should be used for termination of atrial fibrillation. This paper analyzes three cases of pacemaker and/or electrode dysfunction appearing after direct current (DC) cardioversion for termination of atrial fibrillation. Despite similar conditions during cardioversion in all cases, different dysfunctions reflecting damage to the pulse generator and/or a rise of the stimulation threshold in both, atrial and ventricular leads, have been observed. The possible mechanisms for these effects are discussed and recommendations for the management of cardioversion in patients with permanent pacemaker systems are given.
Radiofrequency catheter ablation of an accessory pathway through an anomalous inferior vena cava with azygos continuation
Authors: Guerra Ramos Jose Maria , Font Enrique Rodriguez , Moya i Mitjans Angel 
Published: March 2004

Abstract
A 59-year-old man with Wolff–Parkinson–White syndrome and an infrahepatic interruption of his inferior vena cava with an azygos continuation underwent a successful ablation of a right anteroseptal accessory pathway with a femoral approach through the azygos vein and superior vena cava.
Ice mapping during cryothermal ablation of accessory pathways in WPW: the role of the temperature time constant
Authors: Theuns Dominic A.M.J. , Kimman Geert P. , Szili-Torok Tamas , Res Jan C.J. , Jordaens Luc J. 
Published: March 2004

Aim
Cryothermal energy has the ability reversibly to demonstrate loss of function with cooling, ice mapping, at less deep temperatures. The purpose of this study was to investigate the time course of the temperature during ice mapping of accessory pathways.

Methods and results
Thirteen patients with the Wolff–Parkinson–White (WPW) syndrome underwent cryoablation. After identification of a prospective ablation site, ice mapping was performed by cooling the tip to a minimum of −30 °C. Successful ice mapping was defined by loss of accessory pathway (AP) conduction. A total of 104 ice maps were analyzed. Successful ice mapping was demonstrated in 17 attempts. There was no significant difference in mapping temperature between successful and unsuccessful ice mapping (−29.4±3.2 °C vs −30.4±1.7 °C). The temperature time constant τ during successful ice mapping was significantly shorter compared with unsuccessful ice mapping (7.0±1.1 s vs 10.1±1.3 s; P&lt;0.0001). The response time (RT) to mapping temperature of −30 °C was significantly prolonged in unsuccessful ice mapping attempts (35.8±4.5 s vs 53.5±11.0 s; P&lt;0.0001). Significant correlations were found between successful ice mapping and the temperature time constant, and between RT and the temperature time constant (P&lt;0.001).

Conclusion
The ability to identify prospective ablation sites by ice mapping was demonstrated. Successful ice mapping attempts were characterized by a short temperature time constant and a short response time to mapping temperature with a sudden disappearance of pathway conduction.
Clinical value of routine predischarge testing after ICD-implantation
Authors: Buob Axel , Siaplaouras Stephanos , Tscholl Dietmar , Schäfers Hans-Joachim , Böhm Michael , Jung Jens 
Published: March 2004

Abstract

Aims
After implantation of a cardioverter/defibrillator (ICD) predischarge testing is often performed to ensure appropriate therapy function. Nevertheless there is no proven evidence for the necessity of this examination. In this retrospective single-centre analysis we investigated the clinical value of routine predischarge testing.

Methods and results
Predischarge testing was performed in 161 patients 6±2 days after primary implantation of an ICD. There were no complications related to ICD-testing. In 17 of 161 patients (11%) there was at least one pathological finding. In 4 of 17 patients we observed a defibrillation energy requirement (DER) with a safety margin of less than 10 J. In two of these patients an early lead repositioning was undertaken and in two patients reversal of the shock polarity was used to achieve an adequate DER. In 13 of 17 patients we detected a distinct deviation of pacing thresholds or R-wave sensing amplitudes. In two of these patients an early electrode repositioning was performed because of lead displacement. In the remaining 11 patients we found an adequate DER at first, whereas in two patients a further lead repositioning was still necessary during follow-up. In 144 of 161 patients (89%) predischarge testing was without pathological findings. None of these patients needed revision of the ICD-lead during a mean follow-up of 24±13 months.

Conclusions
Abnormal measurements during predischarge testing are not rare findings in ICD-recipients. Noninvasive methods cannot rule out inadequate defibrillation function. A normal predischarge test seems to be a reliable predictor for a stable electrode function during the first years of follow-up.
Mortality of patients with implanted cardioverter/defibrillators in relation to episodes of atrial fibrillation
Authors: Deneke Thomas , Lawo Thomas , Gerritse Bart , Lemke Bernd ,   for the European GEM DR™ Investigators
Published: March 2004

Abstract

Aims
This study was undertaken to evaluate if a history of episodes of atrial fibrillation (AF) has an effect on survival in patients (pts) with implanted cardioverter defibrillators (ICD).

Methods and results
Retrospective analysis of baseline characteristics, medication and endpoints in pts receiving a dual-chamber ICD comparing pts without (group 1: n=291) and with a history of AF (group 2: n=68).
Pts in groups 1 and 2 did not differ with regard to baseline characteristics. Forty-one pts (8.7%) experienced a detected episode of AF.
During the study period (mean follow-up 9.5 months) 25 pts died (5.8% of group 1 vs 11.8% of group 2). Patient survival was found to be 97.9% vs 91.2% (n=279 vs 63) at 3 months after implantation, 97.5% vs 89.7% (n=244 vs 54) at 6 months, and 93.7% vs 86.5% (n=96 vs 28) at 12 months in group 1 vs group 2 (p=0.005).
The risk of death increased after a first episode of AF was experienced during follow-up (RR=5.0, p=0.0007). Independent predictors of mortality are NYHA class (p=0.002), history of AF (p=0.009 for predicting early mortality), and detected episodes of AF during follow-up (p=0.001).

Conclusion
ICD-patients with a history of AF had a higher than average risk of death early after implantation and after device-detected episodes of AF.
Electrical storm in Brugada syndrome successfully treated using isoprenaline
Authors: Maury P. , Couderc P. , Delay M. , Boveda S. , Brugada J. 
Published: March 2004

Abstract
A case of an electrical storm occurring in a patient implanted with a cardioverter-defibrillator for Brugada syndrome is reported. Recurrent ventricular fibrillation was initiated by short-coupled isolated monomorphic ventricular premature beats probably originating from the right ventricular outflow tract, associated with a manifest electrocardiographic pattern of Brugada syndrome. Infusion of atropine accelerated the heart rate but did not prevent ventricular fibrillation, however, low doses of isoprenaline quickly obviated any recurrence of ventricular fibrillation. This was associated with the disappearance of the short-coupled premature beats together with a normalization of the electrocardiographic pattern. Possible mechanisms are discussed according to the accepted pathophysiological hypothesis.
Prognostic significance of right ventricular extrasystoles
Authors: Zweytick B. , Pignoni-Mory P. , Zweytick G. , Steinbach K. 
Published: March 2004

Abstract
Extrasystoles (RVES) from the right ventricular outflow tract (RVOT) are a common arrhythmia in routine ECGs.

Methods
In this prospective study 56 consecutive patients with RVES (22 males, 34 females) were examined for morphological and/or functional right ventricular (RV) abnormalities by 12-lead, Holter, exercise ECGs, transthoracic echocardiography and signal averaging. The follow-up time was 3.1–15.8 years (arithmetic mean±SD=7.2±1.6 years; median, 6.9 years). Patients with hyperthyroidism, structural cardiovascular and/or lung diseases were excluded.

Results
A total of 57.1% of the patients with RVES presented with echomorphologic abnormalities of the right ventricle (RV). In 26.8% the echomorphologic right ventricular abnormalities progressed in 33.3% of patients with normal RVs at baseline (group I) and in 21.9% of those with abnormal RVs at baseline (group II).
No significant differences were found between the 2 patient groups in terms of age at onset, family history, ECG changes, late potentials and malignant right ventricular outflow tract arrhythmias on 24-h and exercise ECGs. While females predominated in group I, males were numerous in group II (p=0.006). Sustained ventricular tachycardia, syncope or sudden death were absent throughout the follow-up.

Conclusion
Patients with RVES carry a good prognosis in terms of morbidity and mortality no matter whether echomorphologic abnormalities are present or not.
The DATAS rationale and design: a controlled, randomized trial to assess the clinical benefit of dual chamber (DDED) defibrillator
Authors: Quesada Aurelio , Almendral Jesús , Arribas Fernando , Ricci Renato , Wolpert Christian , Adragao Pedro , Cobo Eric , Navarro Xavier 
Published: March 2004

Abstract
Single chamber (SC) implantable cardioverter defibrillators (ICDs) have several limitations that might be relevant during follow-up, like atrial pacing requirements, inadequate therapies, sustained atrial tachyarrhythmias and difficulties to achieve an accurate diagnosis of the arrhythmia. Dual chamber (DC) ICDs offer an attractive and rational solution, although controversy remains if the costs and complexity of these devices offer a real clinical advantage. The Dual Chamber & Atrial Tachyarrhythmias Adverse Events Study (DATAS) was designed to analyze the ability of DC ICD, DDED, to reduce clinically significant adverse events compared with SC ICD in a non-selected population with conventional indications for ICD implantation. This is a prospective, multicentre, randomized, open labelled study, with three arms: two of them (simulated SC ICD and true DC ICD) cross-over, and the third (true SC ICD) parallels the other two. The composite primary end point comprises four Clinically Significant Adverse Events (CSAE): (1) all-cause mortality, (2) invasive intervention, hospitalization or prolongation of hospitalization due to cardiovascular cause, (3) inappropriate shocks, and (4) sustained symptomatic atrial tachyarrhythmias that (a) require urgent termination or (b) last more than 48 h leading to therapeutic intervention. Secondary end points constitute each of the individual components of CSAE, cardiovascular status, quality of life and a detailed analysis of atrial and ventricular arrhythmias. To date (June 2003) there have been 343 patients enroled from 947 screened patients. The projected enrolment includes 360 patients and the conclusion of the study is expected at the beginning of 2005.
ECG signs mimicking acute inferior wall myocardial infarction are associated with elevated myocardial enzymes during isolation of pulmonary vein for focal atrial fibrillation
Authors: Schwab Joerg Otto , Burkhardt Dietmar , Yang Alexander , Schrickel Jan , Lüderitz Berndt , Lewalter Thorsten 
Published: March 2004

Abstract
In this study, we report an intraprocedural incident in patients undergoing ablation for atrial fibrillation. During left atrial manipulation our patients suffered from acute chest pain, showed ECG signs of an acute inferior wall myocardial infarction, and increased levels of cardiac Troponin I (cTnI). We strongly recommend being aware of unexpected reactions during isolating pulmonary veins for focal atrial fibrillation, especially when passing the dorsal part of the left atrium. If pericardial effusion is ruled out and ECG signs as well as symptoms disappear, the ablation procedure should proceed. We think patients undergoing pulmonary vein ablation for atrial fibrillation should be informed of this threatening complication.
High viral loads despite absence of clinical and pathological findings in cats experimentally infected with feline coronavirus (FCoV) type I and in naturally FCoV-infected cats
Authors: Meli M , Kipar A , Müller C , Jenal K , Gönczi E , Borel N , Gunn-Moore D , Chalmers S , Lin F , Reinacher M , Lutz H 
Published: February 2004

Specified pathogen-free cats were naturally infected with FCoV or experimentally infected with FCoV type I. Seroconversion was determined and the course of infection was monitored by measuring the FCoV loads in faeces, whole blood, plasma and/or monocytes. Tissue samples collected at necropsy were examined for viral load and histopathological changes. Experimentally infected animals started shedding virus as soon as 2 days after infection. They generally displayed the highest viral loads in colon, ileum and mesenteric lymph nodes. Seroconversion occurred 3–4 weeks post infection. Naturally infected cats were positive for FCoV antibodies and monocyte-associated FCoV viraemia prior to death. At necropsy, most animals tested positive for viral shedding and FCoV RNA was found in spleen, mesenteric lymph nodes and bone marrow. Both experimentally and naturally infected cats remained clinically healthy. Pathological findings were restricted to generalized lymphatic hyperplasia. These findings demonstrate the presence of systemic FCoV infection with high viral loads in the absence of clinical and pathological signs.