bluuebunny/crossref_metadata_2025_split huggingface dataset:
Relation of Cytokines to Vasodilation after Coronary Artery Bypass Grafting
Authors: Wei Minxin , Kuukasjärvi Pekka , Laurikka Jari , Kaukinen Seppo , Honkonen Eva‐Liisa , Metsänoja Riina , Tarkka Matti 
Published: November 2003

AbstractHemodynamic instability is frequent after coronary surgery. The present study tested the hypothesis that inflammation, as determined by circulating cytokine levels, may contribute to the difficulty of controlling arterial blood pressure after coronary artery bypass grafting. A group of 44 male patients undergoing elective coronary artery bypass grafting with cardiopulmonary bypass were studied. Plasma levels of tumor necrosis factor‐α, interleukin‐6 (IL‐6), IL‐8, and IL‐10 were measured before anesthesia induction, 5 minutes and 1 hour after reperfusion to the myocardium, and 2 and 18 hours after arriving in the intensive care unit (ICU). The 29 patients who did not need a vasopressor (norepinephrine) during their ICU stay were designated group I. They were compared to group II, which consisted of 15 patients who required a pressor agent in the ICU. Although no significant differences between groups were found regarding their hemodynamic variables, IL‐6 and IL‐8 levels were higher in the patients who used a pressor agent in the ICU. The norepinephrine dosage used in the ICU correlated with plasma IL‐8 levels 2 hours after arriving in the ICU (r = 0.56, p = 0.031). Circulating IL‐6 levels in group II were significantly higher than those in group I 2 hours after arriving in the ICU (126.5 ± 90.5 vs. 66.5 ± 48.2 pg/ml; p < 0.05). The mean IL‐8 levels were higher in group II at 5 minutes (34.9 ± 25.7 vs. 17.3 ± 11.3 pg/ml) and 1 hour (38.6 ± 30.5 vs. 22.4 ± 16.7 pg/ml) after reperfusion, and 2 hours (33.0 ± 21.6 vs. 22.8 ± 16.7 pg/ml) after arriving in the ICU (p = 0.036). Postoperative vasodilation was associated with increased circulating IL‐8 levels. Strategies that modulate cytokine responses may improve hemodynamic stability after coronary artery bypass grafting.
Prediction of Cardiac Risk prior to Elective Abdominal Aortic Surgery: Role of Multiple Gated Acquisition Scan
Authors: Karkos Christos D. , Thomson George J.L. , Hughes Robert , Joshi Miland , Baguneid Mohamed S. , Hill Jonathan C. , Mukhopadhyay Umasankar S. 
Published: November 2003

AbstractDebate continues regarding the value of cardiac testing before major vascular surgery. Studies looking at whether a low radioisotope left ventricular ejection fraction (LVEF) could reliably predict postoperative cardiac events have produced conflicting results. Technetium‐99m multiple gated acquisition (MUGA) scanning was employed in 122 patients undergoing elective abdominal aortic aneurysm surgery to estimate the resting LVEF and to detect regional or global myocardial wall motion abnormalities (WMAs). Adverse cardiac outcomes were predicted using logistic regression analysis. Among this group of patients, 20 did not proceed to surgery for a variety of reasons, and 102 underwent surgical repair. More than half of the patients (55%) had a history of cardiac disease. The mean ± SD LVEF was 55.5% ± 11.1%. Altogether, 31 patients had WMAs, and 21 had both WMAs and an abnormal LVEF (≤ 50%). Altogether, 20 cardiac complications were encountered in 17 patients (17%). Logistic regression analysis identified four significant predictors of cardiac complications: history of cardiac disease [odds ratio (OR) 10.43; 95% confidence interval (CI) 1.3 and 80.5], the presence of WMAs (OR 10.1, CI 1.4 and 74.6), additional procedures (OR 12.1, CI 1.4 and 103.0), and reoperation during the postoperative period (OR 6.4, CI 1.4 and 30.4). This is the largest reported British series of cardiac testing using MUGA scans prior to abdominal aortic reconstruction. Only the presence of WMAs (not the resting LVEF) was useful for predicting postoperative cardiac events. A history of cardiac disease, additional procedures, and reoperation during the postoperative period also place a patient at high risk for cardiac complications. A normal LVEF is by no means reassuring that a patient is at low risk of suffering an adverse cardiac outcome.
Locally Advanced Breast Cancer inDeveloping Countries: The Place of Surgery
Authors: Apffelstaedt Justus P. 
Published: November 2003

AbstractMost breast cancer patients in developing countries still
present with locally advanced breast cancer (LABC). Because surgery is the most
widely available treatment modality, we examine its place in the management of
LABC. Historically, single local treatment modalities have had disappointing
results, and multimodality therapy has become the norm for combatting LABC.
Combining surgery and radiotherapy will lead to superior local control rates.
Surgery should precede radiotherapy. Preoperative systemic treatment—with
the possible exception of cyclophosphamide, methotrexate, 5‐fluououracil (CMF)
chemotherapy—does not influence surgical complication rates. Hormonal
therapy is understudied and underutilized; its benefits become apparent only in
prolonged follow‐up. Sequencing of local and systemic treatments does not
influence oncologic outcome, but failure to respond to preoperative systemic
therapy may identify patients with a poor prognosis. With multimodality
management including hormonal therapy, chemotherapy, radiotherapy, and surgery,
local control rates of more than 80% and 5‐year survival rates of more than 50%
have become the norm.
Does Fibrin Glue Reduce Lymph Leakage (Pleural Effusion) after Extended Esophagectomy? Prospective Randomized Clinical Trial
Authors: Tachibana Mitsuo , Kinugasa Shoichi , Yoshimura Hiroshi , Dhar Dipok Kumar , Ueda Shuhei , Fujii Toshiyuki , Kohno Hitoshi , Nagasue Naofumi 
Published: November 2003

AbstractFibrin glue has been shown to be effective in improving postoperative chylothorax following various thoracic procedures and in reducing lymphorrhea after axillary dissection. It is unknown, however, whether fibrin glue is effective in reducing lymph leakage (pleural effusion) after esophagectomy. A series of 43 consecutive patients with thoracic esophageal cancer who underwent extended esophagectomy were prospectively randomized to two groups: group A (n = 21), in whom 3 ml of fibrin glue was applied to the dissected mediastinum; and group B (n = 22), in whom fibrin glue was not applied. The time of drain removal and the volume of the thoracic drainage were compared. All data were expressed as the mean ± standard deviation. There were no significant differences in the clinicopathologic characteristics between the two groups. None of the patients developed chylothorax or died during their hospital stay. The daily volume from the thoracic drain (457 ± 273 ml) was significantly (p < 0.05) larger on postoperative day (POD) 1 in group A than in group B (298 ± 158 ml) and tended to be larger (p < 0.10) on PODs 4 and 6 in group A than in group B. The cumulative drainage volume was significantly (p < 0.05) larger on PODs 4 to 6 and POD 9, and it tended to be larger (p < 0.10) on PODs 1, 3, 7, 8, 10, and 11 in group A than in group B, suggesting that the cumulative drainage volume in group A was consistently larger than that in group B. The cumulative numbers of patients with a drain remaining in place were not significantly different for the two groups (p = 0.4683). Three patients in group A, however, had prolonged insertion (> 20 days) of the chest tube. There were no significant differences in the incidence of postoperative chest‐related complications. No patients in group A developed viral infectious disease during the long‐term follow‐up. Application of fibrin glue to the dissected mediastinum seems to induce postoperative lymph leakage and thus be responsible for prolonged chest tube insertion in some patients. Hence the use of fibrin glue cannot be recommended for reducing lymph leakage after esophagectomy.
Expression of Transforming Growth Factor Betas and Their Signaling Receptors in Stone‐containing Intrahepatic Bile Ducts and Cholangiocarcinoma
Authors: Lee King‐Teh , Liu Tsan‐Shium 
Published: November 2003

AbstractTransforming growth factor betas (TGF‐βs) are multifunctional polypeptides that either inhibit or stimulate cell proliferation. They mediate their functions through their signaling receptors. Clinically, hepatolithiasis has been regarded as a risk factor for cholangiocarcinoma. The aim of this study was to examine the expression of TGF‐βs and their receptors in stone‐containing intrahepatic bile ducts (IHD) and cholangiocarcinoma and try to predict whether hepatolithiasis has a predisposition to development of cholangiocarcinoma. Twenty‐eight surgically resected specimens of stone‐containing IHD and 15 specimens of cholangiocarcinoma were subjects for this study. Immunohistochemical analysis was done on three TGF‐βs and their signaling receptors to check their expression in non‐neoplastic and neoplastic bile ducts. No immunoreactivity of TGF‐β1 was found in any specimens. The overexpression of TGF‐β2 and TGF‐β3 was found in both hepatolithiasis (93%–100%) and cholangiocarcinoma (80%) at levels significantly higher than those of normal controls (10%–20%) (p < 0.001). The immunoreactivity of type I receptor (TβRI) and type II receptor (TβRII) also showed increased expression in stone‐containing IHD, whereas TβRII was absent in cholangiocarcinoma. We conclude that the overexpression of TGF‐β2 and TGF‐β3 and the absence of TβRII in cholangiocarcinoma could lead to enhanced tumor cell proliferation. At the same time, the overexpression of TGF‐βs and their receptors in stone‐containing IHD could suggest a close relationship between hepatolithiasis and cholangiocarcinoma.
Obstructive Jaundice Alters Proliferating Cell Nuclear Antigen Expression in Rat Small Intestine
Authors: Sheen‐Chen Shyr‐Ming , Ho Hsin‐Tsung , Chen Wei‐Jen , Eng Hock‐Liew 
Published: November 2003

AbstractTranslocation of bacteria and endotoxin has long been documented in obstructive jaundice, and altered intestinal barrier function is considered to be one of the important mechanisms for this phenomenon. Proliferating cell nuclear antigen (PCNA), also known as cyclin, is an auxiliary protein of DNA polymerase‐δ, and the level of synthesis correlates directly with rates of cellular proliferation and DNA synthesis. This study was designed with the aim of evaluating the effect of obstructive jaundice on PCNA expression in small bowel epithelium. Male Sprague‐Dawley rats were randomized to four groups. Group A (n = 10, control group) underwent a sham operation. Group B (n = 9, obstructive jaundice group for 1 week) underwent common bile duct ligation. Group C (n = 8, obstructive jaundice group for 2 weeks) underwent common bile duct ligation. Group D (n = 8, obstructive jaundice group for 2 weeks) underwent common bile duct ligation with oral glutamine intake. After periods of 7 days and 2 weeks, segments of small bowel were harvested from groups A & B and groups C & D, respectively. Nuclear immunohistochemical expression of PCNA in small bowel was evaluated. The PCNA‐labeling index [(PCNA‐positive cells/500 cells) × 100] was quantified. Comparisons among the four groups were performed. The PCNA‐labeling index in small bowel of group B was significantly higher than that of group A (29.0% vs 21.2%, p = 0.001). After 2 weeks of common bile duct ligation, the PCNA‐labeling index in small bowel of group C was significantly lower than that of group A (19.4% vs 21.2%, p = 0.045). With oral glutamine intake daily, the PCNA‐labeling index in small bowel of Group D was restored and was significantly higher than that of group A (24.5% vs 21.2%, p = 0.002). Obstructive jaundice for 1 week upgraded PCNA expression in rat small intestine. PCNA expression in rat small intestine later became depressed after obstructive jaundice for 2 weeks. Oral glutamine intake daily could effectively restore the PCNA expression in small bowel of rats subjected to obstructive jaundice for 2 weeks.
Experimental Evidence for Mutagenic Potential of Duodenogastric Juice on Barrett’s Esophagus
Authors: Theisen Joerg , Peters Jeffrey H. , Stein Hubert J. 
Published: November 2003

AbstractThe aim of this article is to review the current experimental knowledge of mutagenesis in Barrett’s esophagus (BE) with special emphasis on the effect of bile salts and acid. Human evidence of direct mutagenicity is rare. Only the correlation of increased quantities and a change in the quality of bile salts with the complications of duodenogastric reflux such as BE and esophageal adenocarcinoma as an indirect marker of mutagenicity has been shown in several studies. Further evidence comes fromp53studies demonstrating an increased number of mutatedp53genes in patients with BE, esophageal adenocarcinoma, or both. Most animal and cellular experiments are carried out in a neutral pH environment, not reflecting the true nature of a reflux episode. The few studies using moderate low acid reflux conditions in combination with bile salts demonstrated a combined effect on mutagenicity. Our current knowledge of bile salt mutagenicity is predominantly based on experiments with hepatocytes and colon cancer cell lines. Future studies must be aimed at esophageal cell lines, cultured Barrett’s tissue, and esophageal adenocarcinoma cell lines.
Fluorodeoxyglucose‐Positron Emission Tomography in Adenocarcinomas of the Distal Esophagus and Cardia
Authors: Ott Katja , Weber Wolfgang A. , Fink Ulrich , Helmberger Hermann , Becker Karen , Stein Hubert J. , Müller James , Schwaiger Markus , Siewert Jörg Rüdiger 
Published: November 2003

AbstractAdenocarcinomas of the esophagogastric junction (AEG) are now recognized as a separate tumor entity with increasing incidence. The aim of the present study was to evaluate whether positron emission tomography (PET) using the glucose analog F‐18‐fluorodeoxyglucose (FDG) can be used for metabolic characterization of this tumor type. Fifty‐two patients with histologically proven, locally advanced AEG (distal esophagus, type I: n = 31; cardia, type II: n = 21) were studied by FDG‐PET. None of the tumors had been previously treated. Findings of endoscopy (growth type), endoluminal ultrasound (uT, uN), computed tomography (cN, cranio‐caudal extent, tumor thickness), histological evaluation (Lauren classification, tumor grade), anatomical classification, and survival were correlated with the results of FDG‐PET. There was no correlation between FDG uptake and clinical stage, grade, Lauren classification, or survival. All AEG I tumors were visualized by FDG‐PET with high contrast, whereas FDG uptake by five AEG II tumors (24%) did not differ from background activity. In a quantitative analysis, mean FDG uptake of AEG I tumors was 1.6 times higher than that of AEG II tumors (p = 0.0005). PET can be used to visualize type I adenocarcinomas of the esophagogastric junction (AEG I). In AEG II tumors, however, the use of FDG‐PET appears to be limited. The significantly higher FDG uptake of AEG I tumors compared to AEG II tumors suggests that these two tumor types differ in glucose utilization. This finding strengthens the hypothesis that AEG I and AEG II are two different tumor entities.
Results of Surgical Therapy in Patients with Barrett’s Adenocarcinoma
Authors: Bonavina Luigi , Via Albert , Incarbone Raffaello , Saino Greta , Peracchia Alberto 
Published: November 2003

AbstractThe incidence of adenocarcinoma arising from Barrett’s esophagus is dramatically increasing in Western countries. The purpose of this study was to report our experience in the surgical management of these patients. Between November 1992 and December 2000, 330 consecutive patients with adenocarcinoma of the esophagogastric junction were observed in our institution. Of these, 105 (31.8%) had Barrett’s carcinoma. In 12 individuals (11.4%) adenocarcinoma was discovered during endoscopic surveillance for Barrett’s esophagus. Twelve patients with doubtful cleavage planes at preoperative investigation were treated with neoadjuvant chemotherapy. Overall, 80 patients (76.2%) underwent esophagectomy without operative mortality. The Ivor Lewis approach was used in 70 patients; of these, 31 underwent extended mediastinal lymph node dissection. Seventy‐four patients (92.5%) had R0 resection. The overall 5‐year survival rate was 48%. Survival was significantly associated with stage, lymph node status, and completeness of resection. Early diagnosis remains the prerequisite for curative treatment of esophageal carcinoma. An extended mediastinal lymphadenectomy does not increase morbidity, allows precise tumor staging, and may prove effective in preventing local recurrences. Neoadjuvant therapy requires major improvement before it can be unconditionally recommended outside clinical trials.
Introducing New Technologies: Protecting Subjects of Surgical Innovation and Research
Authors: McKneally Martin F. , Daar Abdallah S. 
Published: November 2003

AbstractThe system for protecting human research subjects is under increasing pressure. Under the currently dominant Regulatory Ethics Paradigm, clinical research protocols must be reviewed and approved by an institutional review board (IRB) or equivalent. Although the IRB was introduced into health care in part to protect patients and investigators from the inherent conflict between the best clinical interest of the individual patient and the interest of science and society in answering a clinical question, its rigorous standards and rigid framework discourage surgeons from seeking potentially valuable early IRB consultation. Most of the important advances in the history of medicine, such as anesthesia, appendectomy, antibiotics, intensive care, and immunization, were introduced through an informal, unregulated innovation process that has been enormously productive but can lead to ratification of ineffective or harmful treatment by credulous physicians and patients. We propose a surgical innovation ethics paradigm that is a more nimble, flexible source of institutional and public oversight and approval of innovations that are in the gray zone prior to their conversion to formal protocols that then require IRB approval. We also discuss the management of personal and institutional conflicts of interest.
Qualitative Research on Trauma Surgery: Getting Beyond the Numbers
Authors: Rich John A. , Grey Courtney M. 
Published: November 2003

AbstractQualitative research methods have a unique role to play in surgical research, revealing important contextual details about the causes and impact of surgical illnesses and treatment. The utility of qualitative methods is illustrated through results of a research study of young, black male victims of interpersonal violence. Narrative analysis of in‐depth interviews with 48 survivors of penetrating violence revealed the impact of these patients’ perceptions of post‐injury care on their pain, the central role of fear of death in their injury experience, and the transforming role providers can play in addressing patient fears of death. The study provides support for the notion that qualitative methods can be a useful approach to understanding marginalized individuals who become our patients after injury. Furthermore, potential applications of multimethod approaches to surgical research (qualitative research methods in combination with quantitative methods) for the study of trainee experiences, patient satisfaction, and racial disparities are recommended.
Priority Setting in Surgery: Improve theProcess and Share the Learning
Authors: Martin Douglas K. , Walton Nancy , Singer Peter A. 
Published: November 2003

AbstractSurgeons and surgical programs encounter priority‐setting
challenges every day, such as in regard to purchasing new technologies or
managing waiting lists for elective surgery. The purpose of this paper was to
explore priority setting in surgery. Traditionally in surgery, priority‐setting
decisions for new technologies have been based on evidence of effectiveness and
cost‐effectiveness; and decisions about managing waiting lists for elective
surgery have been based on urgency rating scores. The fairness of
priority‐setting processes in surgical programs should be enhanced to permit
all relevant information and values to be considered. The quality of these
decisions can be improved by using an approach that captures and shares lessons
from each priority‐setting experience. The approach we propose in this
paper—describe,
evaluate, and improve using a leading conceptual framework for
priority setting, called “accountability for
reasonableness”—can be used by any surgical program to improve its
priority setting, share lessons with others, and develop an evidence base for
how these important health policy decisions should be made.
Salivary Gland Sparing and Improved Target Irradiation by Conformal and Intensity Modulated Irradiation of Head and Neck Cancer
Authors: Eisbruch Avraham , Ship Jonathan A. , Dawson Laura A. , Kim Hyungjin M. , Bradford Carol R. , Terrell Jeffrey E. , Chepeha Douglas B. , Teknos Theodore N. , Hogikyan Norman D. , Anzai Yoshimi , Marsh Lon H. , Ten Haken Randall K. , Wolf Gregory T. 
Published: November 2003

AbstractThe goals of this study were to facilitate sparing of the major salivary glands while adequately treating tumor targets in patients requiring comprehensive bilateral neck irradiation (RT), and to assess the potential for improved xerostomia. Since 1994 techniques of target irradiation and locoregional tumor control with conformal and intensity modulated radiation therapy (IMRT) have been developed. In patients treated with these modalities, the salivary flow rates before and periodically after RT have been measured selectively from each major salivary gland and the residual flows correlated with glands’ dose volume histograms (DVHs). In addition, subjective xerostomia questionnaires have been developed and validated. The pattern of locoregional recurrence has been examined from computed tomography (CT) scans at the time of recurrence, transferring the recurrence volumes to the planning CT scans, and regenerating the dose distributions at the recurrence sites. Treatment plans for target coverage and dose homogeneity using static, multisegmental IMRT were found to be significantly better than standard RT plans. In addition, significant parotid gland sparing was achieved in the conformal plans. The relationships among dose, irradiated volume, and the residual saliva flow rates from the parotid glands were characterized by dose and volume thresholds. A mean radiation dose of 26 Gy was found to be the threshold for preserved stimulated saliva flow. Xerostomia questionnaire scores suggested that xerostomia was significantly reduced in patients irradiated with bilateral neck, parotid‐sparing RT, compared to patients with similar tumors treated with standard RT. Examination of locoregional tumor recurrence patterns revealed that the large majority of recurrences occurred inside targets, in areas that had been judged to be at high risk and that had received RT doses according to the perceived risk. Tangible gains in salivary gland sparing and target coverage are being achieved, and an improvement in some measures of quality of life is suggested by our findings. Additional reduction of xerostomia may be achieved by further sparing of the salivary glands and the non‐involved oral cavity. A mean parotid gland dose of ≤ 26 Gy should be a planning objective if significant parotid function preservation is desired. The pattern of recurrence suggests that careful escalation of the dose to areas judged to be at highest risk may improve tumor control.