bluuebunny/crossref_metadata_2025_split huggingface dataset:
Factors Affecting Recurrence following Incisional Herniorrhaphy
Authors: Anthony Thomas , Bergen Patricia C. , Kim Lawrence T. , Henderson Mark , Fahey Thomas , Rege Robert V. , Turnage Richard H. 
Published: August 2002

AbstractThe purpose of this study was to determine the influence of chronic illness, obesity, and type of repair on the likelihood of recurrence following incisional herniorrhaphy. The medical records of 77 patients who underwent elective repair of a midline incisional hernia at the Dallas Veterans Affairs Medical Center between 1991 and 1995 were reviewed. Demographic data, presence of chronic illnesses, type of repair, and presence of recurrence were noted. Ninety‐six percent of the patients were men, with an average age of 59 years. More than 50% of the patients had chronic lung or cardiac diseases and more than 40% weighed ≥120% of their ideal body weight and had a body mass index (BMI) ≥30. Sixty‐two percent of the patients underwent primary reapproximation of the fascia (tissue repair), whereas 38% underwent repair with prosthetic material (prosthetic repair). The overall recurrence rate was 45%, with a median follow‐up of 45 months (range 6–73). Seventy‐four percent of the recurrences presented within 3 years of repair. The recurrence rate for those patients undergoing a tissue repair was 54%, whereas the recurrence rate following prosthetic repair was 29%. The incidence of recurrence for patients with pulmonary or cardiac disease or diabetes mellitus was similar to that of patients without these illnesses. The percent ideal body weight and BMI of patients who developed a recurrent hernia, particularly following a prosthetic repair, were significantly greater than those of patients whose repairs remained intact. These data strongly support the use of prosthetic repairs for incisional hernias, particularly in patients who are overweight.
Trends in Perforated Peptic Ulcer: Incidence, Etiology, Treatment, and Prognosis
Authors: Svanes Cecilie 
Published: August 2002

AbstractAfter increasing steeply at the beginning of the twentieth century, ulcer perforation incidence during the last decades has declined in the young and in men, and it has risen among the elderly and in women. These changes can be attributed to a cohort phenomenon: Ulcer perforation risk is particularly common in the cohorts born after the turn of the twentieth century and is less common in previous and succeeding birth cohorts. A decline in total incidence is expected with the death of the high risk cohorts. Most ulcer perforations among subjects < 75 years of age can be attributed to smoking. Subjects with a history of ulcer perforation therefore have poorer long‐term survival than the general population, most pronounced for younger generations. About one of four ulcer perforations can be attributed to the use of nonsteroidal antiinflammatory drugs, a risk factor of particular importance in the elderly. Ulcer perforation was frequently treated by gastric resection in former days, whereas suture, being the first method introduced in 1887, is the method of choice today. The introduction of antibiotics improved the prognosis of ulcer perforation surgery greatly. Postoperative lethality decreased until 1950 but has remained stable since then. Lethality is higher in the elderly and is higher after gastric than after duodenal perforation. The delay before surgical treatment is a strong determinant for lethality, complication rates, and hospital costs. Treatment delay seems to have increased during the last few decades and is higher among women and the elderly. The prognosis of ulcer perforation is poorer in women owing to longer treatment delay.
Long‐term Prognosis after Partial Gastrectomy for Gastroduodenal Ulcer
Authors: von Holstein Christer Staël 
Published: August 2002

AbstractThe decline in duodenal ulcer disease and the established relation of peptic ulcer to Helicobacter pylori have virtually abolished the need for elective ulcer surgery. However, a substantial proportion of the population around retirement age has previously been subjected to partial gastric resection due to peptic ulcer, and the long‐term outcome of these patients is of continuing relevance. Patients subjected to elective surgery could represent a selected group of healthy subjects with a lower overall morbidity, but reports indicate that patients operated on for peptic ulcer have more advanced disease associated with excess smoking and a different pattern of social behavior. The surgical procedure induces enterogastric reflux, leading to profound changes in the remnant mucosa and the formation of carcinogens in the gastric juice. In addition, metabolic abnormalities are common, especially fat malabsorption. Evaluation of the impact of these factors on morbidity and mortality is difficult. Increased mortality in gastrointestinal tumors (especially gastric stump carcinoma), respiratory diseases and other smoking‐related malignancies, and suicide are found in the long‐term follow‐up after partial gastric resection due to peptic ulcer. However, these hazards to life are offset by a decreased mortality in cardiovascular disease. Preventive measures against suicide and especially tobacco smoking are recommended to improve the outcome for this cohort.
Effects of Medical Treatment on Gastric Mucosal Abnormalities in Gastroduodenal Ulcer Disease
Authors: Aoki Teruaki , Takayama Sumio , Nimura Hiroshi , Tsutsumi Jun 
Published: August 2002

AbstractThe development of carcinoma in cases of gastric ulcer disease during long‐term H2‐blocker treatment is slowly increasing, and ulcers that require such treatment exhibit the characteristics of intractable conditions, including linear ulcers, simultaneous gastric and duodenal ulcers, immature intestinal metaplasia of the gastric epithelium, and atrophic gastritis accompanied with multiple ulcer cicatrices. The incomplete form of intestinal metaplasia resembling Filipe's type III lesions and showing structural atypia developed in the background gastric mucosa in such cases, and the characteristics of this metaplasia included structural atypia, a residuum of gastric‐type mucous cells, rapid proliferative activity, and in some areas abnormal expression of P53 protein. In addition, in rat studies it was demonstrated that prolonged administration of H2‐blockers while gastric ulcers were present accelerated cell proliferation in the background gastric mucosa in the long term. Accordingly, it was considered possible that the development of the incomplete form of intestinal metaplasia, which was strongly suggested to have some relation to the sites where intestinal‐type gastric carcinoma appeared, was accelerated by mucosal injury due to chronic ulcers and by persistent elevation in intragastric pH. The results of the present study of gastric carcinoma as a complication of peptic ulcer disease indicated the possibility that Helicobacter pylori was a major contributory factor to the development of the incomplete form of intestinal metaplasia from damage to the background mucosa, but it was unclear whether H. pylori made any direct contribution to carcinogenesis.
Influence of Two‐dimensional and Three‐dimensional Imaging on Endoscopic Bowel Suturing
Authors: Hanna George B. , Cuschieri Alfred 
Published: August 2002

Abstract.Several three‐dimensional (3‐D) video‐endoscopic systems have been introduced in surgical practice to enhance depth perception during minimal access surgery (MAS), but the facilitation of endoscopic manipulations by the current 3‐D systems remains unproved. The aim of the study was to investigate the influence of 2‐D and 3‐D imaging modalities on intracorporeal suturing. The standard task consisted of suture closure of 60 mm enterotomies made in porcine small bowel with continuous seromuscular 3/0 Polysorb. Ten experienced surgeons participated in the study. The imaging systems were Storz (2‐D), Welch Allyn (3‐D), and Zeiss (as both 2‐D and 3‐D). Each surgeon performed two tasks with each modality in a random sequence. The outcome measures were execution time, suture line leakage pressure, and suture placement score. In addition, the participating surgeons assigned subjective scores on the image quality and the adverse effects of the imaging systems. There was no significant difference in the execution time, leakage pressure, and suture placement score among the various imaging modalities. Depth perception was rated as similar with 2‐D and 3‐D imaging. Surgeons experienced visual strain with the three systems, but it was rated higher with 3‐D imaging. With the current technology, we have not documented any significant difference in task efficiency and quality of endoscopic bowel suturing by trained surgeons between 2‐D and 3‐D imaging systems.
Standard and Nonstandard Applications of Sentinel Node‐guided Melanoma Surgery
Authors: Schachter Jacob , Laish Avishag , Mekhmandarov Sergey , Feinmesser Meora , Fenig Eyal , Tamir Gabriel , Gutman Haim 
Published: August 2002

Abstract.Identification and histologic study of the sentinel node (SN) is an acceptable, yet not firmly established, guide for treating intermediate‐thickness melanoma. This study widens the range of applications of this technique. We included 97 patients with intermediate‐thickness melanoma lesions or lesions for which there is no standard treatment. Fifty‐six underwent preoperative lymphoscintigraphy, and all underwent intraoperative lymphatic mapping (IOLM) using blue dye, followed by frozen section study and total node processing by serial sections. Elective lymph node dissection was performed in cases of metastasis to the sentinel node or technical failures with high risk. Four categories were defined: (A) intermediate‐thickness lesions (mean 2.27 mm) (n= 45); (B) thin lesions (mean 1.14 mm) with risk factors of regional failure (n= 27); (C) lesion thickness close to but more than 4 mm (n= 10); and (D) lesions of undetermined thickness (n= 15). Median follow‐up was 30 months (range 13–51 months). Intraoperative lymphatic mapping successfully identified the sentinel node (SN) in 93% of basins explored. Metastases were detected in 11 SNs. There were three lymph basin recurrences in patients with previously negative SNs, all salvaged by therapeutic lymph basin dissection and are NED (no evidence of disease). Two SN+ patients had systemic recurrences; one died of his disease, and the other is alive with disease. One SN− patient died NED owing to other cause. This technique spared 83% of category A patients from lymph node dissection. It allowed better staging and better decision making for treatment in categories B and D; and it prevented early regional recurrences in category C patients. Intraoperative lymphatic mapping with SN guidance is a novel, low‐morbidity approach applicable and advantageous for a wide range and subgroups of melanoma patients.
Estimate of population extinction risk and its application to ecological risk management
Authors: Iwasa Y. , Hakoyama H. , Nakamaru M. , Nakanishi J. 
Published: August 2002

AbstractEnvironmental threats, such as habitat size reduction or environmental pollution, may not cause immediate extinction of a population but may shorten the expected time to extinction. We developed a method to estimate the mean time to extinction for a density‐dependent population with environmental fluctuation and to compare the impacts of different risk factors. We first derived a formula of the mean extinction time for a population with logistic growth and environmental and demographic stochasticities expressed as a stochastic differential equation model (canonical model). The relative importance of different risk factors is evaluated by the decrease in the mean extinction time. We studied an approximated formula for the reduction in habitat size that enhances extinction risk by the same magnitude as a given decrease in survivorship caused by toxic chemical exposure. In a large population (large K) or in a slowly growing population (small r), a small decrease in survivorship can cause the extinction risk to increase, corresponding to a significant reduction in the habitat size. Finally, we studied an approximate maximum likelihood estimate of three parameters (intrinsic growth rate r, carrying capacity K, and environmental stochasticity σ2e) from time series data. By Monte Carlo sampling, we can remove the bias very effectively and determine the confidence interval. We discuss here how the reliability of the estimate changes with the length of time series. If we know the intrinsic rate of population growth r, the mean extinction time is estimated quite accurately even when only a short time series is available for parameter estimation.
Radical Lateral Body‐Wall Resection for Fibrosarcoma With Reconstruction Using Polypropylene Mesh and a Caudal Superficial Epigastric Axial Pattern Flap: A Prospective Clinical Study of the Technique and Results in 6 Cats
Authors: Lidbetter David A. , Williams Fred A. , Krahwinkel D. J. , Adams William H. 
Published: August 2002

Objective—To describe and evaluate a technique for radical resection of the lateral body wall for treatment of fibrosarcoma with reconstruction using polypropylene mesh and a caudal superficial epigastric axial pattern flap in cats.Study Design—Prospective, clinical study.Animals or Sample Population—Six client‐owned cats with fibrosarcoma.Methods—Six cats with histologically confirmed fibrosarcoma of the lateral body wall were staged using radiography and/or computer tomography scanning. Preoperative radiotherapy was used in 3 cats. All cats had the lateral abdominal wall resected and reconstructed with polypropylene mesh. A caudal superficial epigastric flap was mobilized and rotated to close the skin deficit. The animals were evaluated after surgery for wound complications, tumor recurrence, and metastasis. Outcome was assessed by patient examination and client consultation.Results—Minor dehiscence of the skin flaps occurred in 2 cats, and 1 other cat was successfully resuscitated from respiratory and cardiac arrest after surgery. All tissue specimens were tumor‐free at the surgical margins. Follow‐up times ranged from 12 to 21 months, with a mean time of 17.2 months. None of the cats had evidence of local tumor recurrence or metastasis; outcome was judged good to excellent in all cats.Conclusions and Clinical Relevance—Radical lateral body‐wall resection and reconstruction is an effective technique for achieving local tumor control with acceptable patient morbidity. Further studies are needed to assess whether the technique will result in improved tumor‐free intervals and survival times.
Microvascular Free Tissue Transfer of the Rectus Abdominis Muscle in Dogs
Authors: Calfee Earl F. , Lanz Otto I. , Degner Daniel A. , Peterson Steven L. , Duncan Robert B. , Broadstone Richard V. , Martin Robert A. , Austin Brenda 
Published: August 2002

Objective—To assess donor‐site morbidity and survival of the rectus abdominis muscle with an overlying skin graft after free tissue transfer to a medial femorotibial defect in dogs.Study Design—Experimental study.Sample Population—Phase 1:6 canine cadavers; phase 2:7 adult mixed‐breed dogs.Methods—Phase 1: The rectus abdominis muscle was removed from canine cadavers, muscular and vascular dimensions were recorded, and angiography was performed. Phase 2: Muscular transfer was performed through anastomosis of the caudal epigastric artery and vein to the saphenous artery and medial saphenous vein. Transferred tissues were evaluated on postoperative days 3, 6, 10, and 13. Animals were examined daily until euthanasia between postoperative days 31 and 42. Postmortem angiograms were performed and tissues collected for histopathologic evaluation.Results—Phase 1: Appropriate vascular dimensions for microvascular anastomosis were confirmed and surgical technique perfected. Phase 2: Muscular excision produced minimal donor‐site morbidity. All muscles survived after microvascular transfer and angiography confirmed vascular patency. All of the skin grafts survived, with one graft undergoing partial necrosis.Conclusions—The rectus abdominis muscle can be successfully transferred to a medial femorotibial defect and can serve as a bed for acute skin grafting. No significant donor‐site morbidity is associated with its removal.Clinical Relevance—Microvascular free tissue transfer of the canine rectus abdominis muscle has not been previously described. This technique provides a new alternative for repair of appropriate wounds. Additional studies are needed to define its utility in clinical patients.
Limb Sparing Using a Double Bone‐Transport Technique for Treatment of a Distal Tibial Osteosarcoma in a Dog
Authors: Rovesti Gian Luca , Bascucci Marco , Schmidt Karin , Marcellin‐Little Denis J. 
Published: August 2002

Objective—To evaluate the treatment of a spontaneously occurring osteosarcoma in a dog by means of tumor resection and bone regeneration of a 12‐cm defect using double bone transport.Study Design—Case report.Animals or Sample Population—An 11 year‐old client‐owned German shepherd.Methods—After tumor resection, a preassambled Ilizarov frame was secured to the proximal tibia and to the tarso‐metatarsal region. Two osteotomies were performed in the proximal metaphysis. The two bone segments were transfixed with 1.5‐mm‐diameter wires, each secured to a ring, and bone transport was performed until the distal segment reached the talar surface. Cisplatin was administered 14, 35, and 59 days after surgery.Results—Bone regenerate was first visible radiographically 4 weeks after surgery. The frame was removed 162 days after surgery. The hock was protected with a plaster cast because the tarsal arthrodesis was not complete. The dog underwent tibiotarsal arthrodesis 201 days after osteosarcoma resection. The dog died of metastatic disease 239 days after the initial surgery.Conclusions—Even though this dog died of systemic metastases, local recurrence did not develop. Cisplatin chemotherapy did not appear to negatively affect bone regeneration.Clinical Relevance—To our knowledge, the double transport technique has not been previously described in the veterinary literature. In this dog, this technique decreased the duration of treatment compared with a conventional single‐segment transport technique.
The Effects of Acetabular Cup Temperature and Duration of Cement Pressurization on Cement Porosity in a Canine Total Hip Replacement Model
Authors: Shields S. L. , Schulz K. S. , Hagan C. E. , Kass P. 
Published: August 2002

Objective—To determine the effect of acetabular cup temperature and duration of cement pressurization on porosity of the acetabular cement mantel.Study design—In vitro study.Methods—Twenty‐four polyurethane foam blocks prepared for acetabular prosthetic implantation were implanted with polyethylene acetabular cups using four combinations and variations of temperature and pressure: (1) high temperature/short‐term pressurization; (2) high temperature/long‐term pressurization; (3) low temperature/long‐term pressurization; and (4) low temperature short‐term pressurization. Five 1‐mm‐thick slices were taken from the center of each block using a tissue processing system. The slices were scanned into a personal computer using a photo slide scanner. Imaging software was used to determine cement surface area and size, number, and distribution of pores. The quality of the cement‐implant interface was subjectively evaluated. Statistical analysis of relative cement porosity was performed by a Kruskal‐Wallis analysis of variance comparing the four groups individually and combining the short‐term pressurization groups versus the long‐term pressurization groups.Results—There were no significant differences in cement porosity between the four test groups (P= .11). There were no significant differences in porosity between the combined groups (P= .48).Conclusions—There is no benefit in prewarming acetabular cups before implantation. There are no deleterious effects of short‐term pressurization of the cement during implantation.
Postoperative Rupture of an Aortic Aneurysmal Dilation Associated with a Patent Ductus Arteriosus in a Dog
Authors: Olsen Dennis , Harkin Kenneth R. , Banwell Max N. , Andrews Gordon A. 
Published: August 2002

Objective—To describe an unusual case of fatal aortic aneurysm rupture after standard ligation of a left‐to‐right shunting patent ductus arteriosus (PDA) and review the literature concerning the causes of aneurysm and applicable medical physics of blood flow that may contribute to mural failure.Study design—Clinical case report.Sample population—An 11‐month‐old female Brittany spaniel.Results—A PDA was diagnosed in the dog after referral for a grade IV/IV cardiac murmur. Diagnostic tests performed included a minimum database, thoracic radiography, and echocardiography. Conventional surgical ligation of the PDA was performed. The postoperative recovery from anesthesia was uneventful. Approximately 5 hours after surgery, the dog vocalized once and collapsed. All resuscitative efforts failed. Necropsy showed a large, spiral rupture of the cranial and dorsal wall of the aorta that extended from the left subclavian artery to 2 cm distal to the PDA‐aorta junction. No evidence of intramural, perianeurysmal hemorrhage or inflammation was noted. Histopathologic examination of the ruptured aneurysm showed that the wall lacked a defined tunica intima and endothelial cell layer. A distinct separation of the thinned tunica media parallel to the elastic fibers was noted.Conclusions and clinical relevance—Dilatation of the aorta near the area of a PDA is one of the recognized abnormalities associated with the condition. Aneurysmal dilatation results from and contributes to abnormal blood flow dynamics and increased aortic wall tension, which promotes expansion. Although an unusual and previously unreported sequela, rupture of the aneurysm should be considered a possible complication when ligation of a PDA with a conspicuous aortic aneurysmal dilation is performed.
VDAC Channels
Authors: Blachly‐Dyson Elizabeth , Forte Michael 
Published: August 2002

AbstractTrafficking of metabolites across the outer mitochondrial membrane is believed to be mediated primarily by the pore‐forming voltage‐dependent anion channel, VDAC (also known as mitochondrial porin). An expanding body of in vitro studies have strongly suggest that the pore formed by VDAC can be regulated in a number of ways that implicate it as a site for the regulation of mitochondrial function, yet technical limitations have prevented the extension these studies to a relevant cellular context. The goal of this brief review is to summarize recent data that examine the role of VDAC and its regulation in the context not of the isolated protein or organelles but in cells, focusing on the application of genetic strategies in a number of experimental systems.
BCL‐2 Proteins: Regulators of the Mitochondrial Apoptotic Program
Authors: Gross Atan 
Published: August 2002

AbstractBCL‐2 family members are pivotal regulators of the apoptotic process. Mitochondria seem to be a major site‐of‐action for these proteins. Several prominent alterations occur to mitochondria during apoptosis that include the release of intermembrane space molecules, changes in the membrane potential, ionic changes, and more. All these changes seem to be part of the mitochondrial apoptotic process. The BCL‐2 family members are believed to be the major regulators of this program; however, their exact mechanism of action still remains a mystery. In addition, the exact contribution of mitochondria to the apoptotic process is still unclear. This review summarizes and examines the current knowledge regarding these two issues.