bluuebunny/crossref_metadata_2025_split huggingface dataset:
Glutamine
Authors: Labow Brian I. , Souba Wiley W. 
Published: August 2002

AbstractRelatively little was known about glutamine metabolism until the 1930s, when Sir Hans Krebs first demonstrated glutamine hydrolysis and biosynthesis in the kidney. Subsequent studies by Rose in 1938 demonstrated that glutamine is a nonessential (dispensable) amino acid, as it can be readily synthesized de novo in virtually all tissues in the body. Because the body has the capacity to synthesize considerable quantities of glutamine, it has been assumed that glutamine is not required in the diet. However, this amino acid becomes quite depleted during the course of a catabolic insult such as injury or infection, indicating that the ability of glutamine production to meet demands during a variety of surgical illnesses is impaired. In states of health, the assumption that glutamine is not required in the diet is probably valid, although it is difficult to test the hypothesis, as glutamine is present in virtually all dietary proteins. Most naturally occurring food proteins contain 4% to 8% of their amino acid residues as glutamine; therefore less than 10 g of dietary glutamine is likely to be consumed daily by the average person. In contrast to this usual dietary availability, studies in stressed patients indicate that considerably larger amounts of glutamine (20—40 g/day) may be necessary to maintain glutamine homeostasis. Thus from a nutritional standpoint, glutamine may be thought of as a drug as well as a nutrient. This paper reviews the physiology and biochemistry of glutamine with an emphasis on its metabolism in surgical illnesses and its role as a conditionally essential amino acid.
Stress Caused by Minimally Invasive Cardiac Surgery versus Conventional Cardiac Surgery: Incidence of Systemic Inflammatory Response Syndrome
Authors: Hamano Kimikazu , Kawamura Tsutomu , Gohra Hidenori , Katoh Tomoe , Fujimura Yoshihiko , Zempo Nobuya , Miyamoto Masaki , Tsuboi Hidetoshi , Tanimoto Yoshinori , Esato Kensuke 
Published: August 2002

Abstract.The present study was conducted to evaluate the degree of stress in patients induced by minimally invasive cardiac surgery (MICS) in comparison with that caused by conventional cardiac surgery. We did this by assessing the incidence of systemic inflammatory response syndrome (SIRS). A total of 48 adult patients who underwent surgery for single valve disease were included in this study, 27 of whom underwent conventional surgery and 21 MICS. We evaluated the stress inflicted on the patients in these two groups by analyzing the duration and degree of SIRS and the level of C‐reactive protein (CRP). SIRS was assessed by measuring body temperature, heart rate, respiratory rate, and white blood cell counts. There were no significant differences in the operating times, perfusion times, or aorta clamp times between the two groups; and the mean volume of blood transfusion did not differ significantly either. There was no significant difference in the incidence of SIRS or the mean duration of SIRS between the two groups. The CRP levels did not differ significantly between the two groups. Thus although MICS is superior to conventional cardiac surgery in that only a small skin incision is required, the stress experienced by the patient may be the same as that experienced by the patient undergoing conventional cardiac surgery.
Clinical Trials of New and Novel Therapeutic Agents
Authors: Baue Arthur E. , Durham Rodney M. , Mazuski John E. 
Published: August 2002

AbstractThroughout this issue ofWorld Journal of Surgeryare recommendations and descriptions of therapy to prevent the development of multiple organ failure (MOF). The subjects include advances in monitoring; circulatory, pulmonary, and gut support; blood treatment; immune modulation; and control of the inflammatory process. Additional methods of organ support include recommendations for resuscitation and initial care and for early definitive operations. New therapeutic agents such as growth factors, glucan, ketaconazole, and antithrombin III are described. Finally, methods to support organ function before it fails (circulation, lungs, and kidneys) are described.
Clonal Analysis of Nodular Parathyroid Hyperplasia in Renal Hyperparathyroidism
Authors: Tominaga Yoshihiro , Kohara Setsuko , Namii Yasushi , Nagasaka Takaharu , Haba Toshihito , Uchida Kazuharu , Numano Masahiro , Tanaka Yuji , Takagi Hiroshi 
Published: August 2002

AbstractAlthough it is well known that chronic renal failure induces parathyroid hyperplasia, the pathogenesis and development of this parathyroid lesion in this disease are poorly understood. Histopathologically, there is progression from diffuse to nodular hyperplasia, and each nodule consists of a single cell type with aggressive proliferative potential. Pathophysiologic and clinical investigations have suggested that neoplastic tumors may emerge from nodular hyperplasia. In this study the clonality of parathyroid tissue in nodular and diffuse hyperplasia in renal hyperparathyroidism was analyzed by a method based on restriction fragment length polymorphism of the X chromosome‐linked phosphoglycerokinase gene and on random inactivation of the gene by methylation. DNA of peripheral lymphocytes was screened in 43 women undergoing parathyroidectomy for advanced renal hyperparathyroidism, and 10 of these patients appeared to be heterozygous. Fourteen specimens from these patients were available for clonal analysis. The analysis showed that all four specimens of diffuse hyperplasia were polyclonal, whereas all seven specimens from nodules in nodular hyperplasia and all three samples representing parathyroid tissue removed from forearm because of graft‐dependent recurrence were revealed to be monoclonal. It is likely that the clonal origin of each nodule is independent. These results suggest that in renal hyperparathyroidism parathyroid glands initially grow diffusely and polyclonally, and then the cells in the nodules are later transformed monoclonally and proliferate aggressively. From the present study it can be concluded that nodular hyperplasia represents monoclonal parathyroid neoplasia, which might explain why patients with nodular hyperplasia in renal hyperparathyroidism are refractory to medical treatment, requiring parathyroidectomy. To prevent recurrences, nodular hyperplastic tissue should not be left at surgery.
Ingested Foreign Bodies of the Gastrointestinal Tract: Retrospective Analysis of 542 Cases
Authors: Velitchkov Nadko G. , Grigorov Georgi I. , Losanoff Julian E. , Kjossev Kirien T. 
Published: August 2002

AbstractIngested foreign bodies (FBs) present a common clinical problem. As the incidence of FBs requiring operative removal varies from 1% to 14%, it was decided to perform this study and compare the data with those from the world literature, as well as to outline an algorithm for management, including indications for surgery. We reviewed all patients with FB ingestion from 1973 to 1993. There were 542 patients with 1203 ingestions, aged 15 to 82 years. Among them, 69.9% (n= 379) were jail inmates at the time of ingestion, 22.9% (n= 124) had a history of psychosis, and 7.2% (n= 39) were alcoholics or denture‐wearing elderly subjects. Most foreign bodies passed spontaneously (75.6%;n= 410). Endoscopic removal was possible in 19.5% (n= 106) and was not associated with any morbidity. Only 4.8% (n= 26) required surgery. Of the latter, 30.8% (n= 8) had long gastric FBs with no tendency for distal passage and were removed via gastrotomy; 15.4% (n= 4) had thin, sharp FBs, causing perforation; and 53.8% (n= 14) had FBs impacted in the ileocecal region, which were removed via appendicostomy. Conservative approach to FB ingestion is justified, although early endoscopic removal from the stomach is recommended. In cases of failure, surgical removal for gastric FBs longer than 7.0 cm is wise. Thin, sharp FBs require a high index of suspicion because they carry a higher risk for perforation. The ileocecal region is the most common site of impaction. Removal of the FB via appendicostomy is the safest option and should not be delayed more than 48 hours.
Diagnostic standards for acute pancreatitis
Authors: Ranson John H. C. , Shamamian Peter 
Published: August 2002

AbstractAn accurate history and thorough physical examination will often raise clinical suspicion of acute pancreatitis in the differential diagnosis of a patient presenting with acute abdominal pain. An accurate diagnosis is needed to eliminate etiologies of acute abdominal pain and to appropriately direct therapy. Confirmation of the diagnosis is most often made by evaluation of serum amylase and lipase levels. Although hyperamylasemia is found in the majority of patients with acute pancreatitis, other nonpancreatic acute abdominal conditions may be present with hyperamylasemia. CT scanning provides an accurate confirmation of clinical and laboratory findings and offers excellent anatomic and morphologic representation of the pancreas and peripancreatic tissue. The following article, written by the late John H.C. Ranson, presents a discussion of the modalities available for diagnosing acute pancreatitis.
Superconducting quantum interference device magnetometer for diagnosis of ischemia caused by mesenteric venous thrombosis
Authors: Allos Suhail H. , Staton Daniel J. , Bradshaw L. Alan , Halter Susan , Wikswo John P. , Richards William O. 
Published: August 2002

AbstractAlthough mesenteric venous thrombosis carries a better prognosis than arterial thrombosis, mortality and morbidity are still high. Previous studies have shown that the basic electrical rhythm (BER) of the bowel decreases early after induction of arterial ischemia. Furthermore, our studies have shown that these changes occur prior to pathologic changes and that they can be recorded noninvasively using a superconducting quantum interference device (SQUID). SQUIDs measure magnetic fields that are created by the electrical activity of the gastrointestinal smooth muscle and have been used to measure the BER of the small intestine in human volunteers. This study was conducted to determine if a SQUID could be used for early noninvasive detection of mesenteric venous ischemia in an animal model. Simultaneous recordings from serosai electrodes and a SQUID outside the abdomen were taken from anesthetized New Zealand rabbits. Recordings were made for 15 minutes before and 90 minutes after injection of thrombin into the superior mesenteric vein. The basic electrical rhythm of the small bowel dropped from 16.42 ± 0.69 to 8.80 ± 0.74 cycles per minute at 30 minutes and to 6.82 ± 0.722 after 90 minutes (p < 0.0001, paired t‐test). The correlation coefficient between the SQUID and electrical recordings was 0.954 (p < 0.0001). These data suggest that the ischemia caused by mesenteric venous thrombosis results in changes in the bioelectrical activity, which can be noninvasively detected using a SQUID.
Future Role of the Pathologist in Reporting Colorectal Cancer
Authors: Jass Jeremy R. 
Published: August 2002

AbstractA pathology report on a surgical specimen of colorectal cancer has prognostic implications and is assuming increasing importance in relation to decisions regarding postoperative adjuvant therapy. The classic pathologic report is a static description of the extent of spread within the surgical specimen. The clinician, on the other hand, needs to know how far the tumor has spread in the patient. For the radiotherapist the report on rectal cancer must include a detailed account of anatomic location and spread, including relations to peritoneum and extent of mesorectal involvement. The oncologist aims to improve survival of patients undergoing “curative” surgery. Untreated, a subset of such patients die of metastatic disease, occult hepatic metastases being present at the time of surgery. An estimate of the risk of micrometastatic disease requires a prognostic classification utilizing independent pathobiologic variables. Reporting of colorectal cancer needs to become more closely tailored to clinical endpoints relevant to therapeutic decision‐making. This paper looks critically at current practice and future directions.
Patterns of Injury in Victims of Urban Free‐Falls
Authors: Velmahos George C. , Demetriades Demetrios , Theodorou Demetrios , Cornwell Edward E. , Belzberg Howard , Asensio Juan , Murray James , Berne Thomas V. 
Published: August 2002

AbstractThe objective of this study was to identify the patterns of injury in urban free‐fall victims so as to establish guidelines of management. This prospective study at an academic level I trauma center included 187 consecutive patients who presented to our trauma center during a 9‐month period (September 1994 to June 1995) after a fall from a height of 5 to 70 feet. Only three falls were from heights of more than 40 feet. Of these patients, 116 (65.1%) suffered significant trauma. Fractures were the most common injuries, accounting for 76.2% of all injuries. Spinal fractures were detected in 37 patients and were associated with neurologic deficits in 7. Intraabdominal injuries occurred in 11 patients, requiring operative intervention in 9 of them. Solid organ lacerations prevailed, but small bowel perforation and bladder rupture were present in one case each. A significant retroperitoneal hematoma was detected in only one case and a thoracic aortic rupture in one more. The height of the fall correlated highly with the incidence of intoxication and severity of injury, the need for operation, the length of hospitalization, and mortality. Most urban free‐falls occur from moderate heights. The spinal column is frequently injured and therefore should be thoroughly assessed clinically and radiographically in all fall victims. Intraabdominal organ injuries are much more common than retroperitoneal ones. Thus the abdominal cavity should be the primary target of aggressive workup in hemodynamically unstable patients. The height of the fall is a good predictor of injury severity and outcome prognosis.
Ethics of Xenotransplantation: Animal Issues, Consent, and Likely Transformation of Transplant Ethics
Authors: Daar A.S. 
Published: August 2002

AbstractThe shortage of organs, breakthroughs in research, involvement of biotechnology companies, absence of ethically more acceptable alternatives, and a vaguely perceived “time to put man on the moon” feeling have contributed to the current reawakening of interest in xenotransplantation. The focus of ethical attention has changed from the moral correctness of using animals for research/therapy to an increasingly appreciated danger of the establishment and spread of xenozoonoses in recipients, their contacts, and the general public. The United Kingdom has established an embargo on clinical trials and has set up a national regulatory authority to oversee and coordinate the development of research, establish guidelines, and decide on when trials can proceed. In the United States, on the other hand, the overall attitude is to “proceed with caution,” and the Food and Drug Administration has approved a number of xenotransplant studies. The Public Health Service guidelines on reducing infection risk are still evolving and are likely to end up being more cautious than they are currently. There are a number of reasons for not using subhuman primates for xenotransplantation, including their closeness to humans, the likelihood of passing on infections, their depletability (gorillas, chimpanzees), their slow breeding, and the expense of breeding them under specified‐pathogen free conditions. The pig, although domesticated and familiar, is too distant to evoke the same feelings we have for primates, has the correct‐size organs, is probably less likely to pass on infections, breeds rapidly, and is not endangered; moreover, millions of them are eaten every year. Although drawing ethical conclusions is difficult, at this stage of knowledge and debate it seems acceptable to manipulate pigs genetically and to proceed to using their organs for xenotransplantation trials when infection control measures and the scientific base justify it. The question of informed consent is likely to be a vexing one. It might end up more of a binding legal contract than consent as we understand it now. Xenotransplantation is also unlikely to cost less than, or significantly alleviate the shortage of, cadaveric organs in the short term. The international dimension of the risk of infection is becoming obvious, but there has so far been no effort to convene an international forum to agree on universally acceptable guidelines.
Genetics of Inflammatory Bowel Disease: Implications for the Future
Authors: Peña A. Salvador , Crusius J. Bart A. 
Published: August 2002

AbstractThere is overwhelming evidence that genetic factors play a role in the predisposition to suffer the development of the chronic inflammatory bowel diseases. The genetic analysis of complex diseases, such as ulcerative colitis and Crohn's disease, is difficult. The presence of disease heterogeneity, the relative low frequency in the population, the degree to which first‐degree relatives are affected (approximately 10%), the presence of genes with minor genetic effects, and ethnic differences are some of the difficulties encountered when identifying disease susceptibility loci. Two major approaches to identifying these genes are being followed at present. The first, family‐based, consists of studying linkage analysis in sibling pairs and parental transmission in genome‐wide screening using microsatellite markers. These studies are appropriate and helpful for finding genes of major or moderate effects but may provide difficulty when identifying genes with minor effects. Risch and Merikangas have pointed to the power of association studies utilizing candidate genes in families. These studies should be considered in the future in genome‐wide screens when technologic advances permit. The second approach is based on classic epidemiologic designs, population‐based studies, using candidate genes in the framework of a biologic hypothesis. Recent data using both approaches in both Crohn's disease and ulcerative colitis are reviewed. The results of genome‐wide linkage studies have not reached consensus but suggest that these diseases are different and polygenic in nature. We have started our studies with the hypothesis that an abnormal immune dysbalance contributes to the biologic basis of disease. We therefore study polymorphisms in genes encoding proinflammatory and regulatory cytokines. Preliminary data of these association studies suggest the importance of several genes with small effects in determining the severity and prognosis of these diseases.
Late Outcome of 304 Consecutive Patients with Multiple Gland Enlargement in Primary Hyperparathyroidism Treated by Conservative Surgery
Authors: Proye Charles , Carnaille Bruno , Quievreux Jean‐Louis , Combemale Frederic , Oudar Christophe , Lecomte‐Houcke Martine 
Published: August 2002

AbstractThe aim of this study was to assess the late outcome of patients with primary hyperparathyroidism and multiple gland enlargement (MGE) treated by conservative surgery. MGE in primary hyperparathyroidism is the presence of two or more enlarged glands weighing more than 50 mg. Conservative surgery consists in resecting the grossly enlarged glands without biopsying the normal glands. Some authors have suggested that this approach overlooks minute hyperplasia, leading to late recurrences of hyperparathyroidism; conversely, it may result in the unnecessary resection of grossly enlarged, but not hyperfunctioning, glands. Altogether 1231 patients were operated on for primary hyperparathyroidism between 1966 and 1995. Of these patients, 304 (24.9%) had MGE, including 42 cases of multiple endocrine neoplasia (MEN), 12 familial cases, and 250 seemingly sporadic cases. Two, three, or four glands (or more) were involved in 61.8%, 21.4%, and 16.4% of cases, respectively. During the early postoperative period one patient died and ten were reoperated for persistent hypercalcemia. The pathologic diagnoses were double adenomas (13.5%), hyperplasia (35.8%), association of the two (39.8%), and a normal second gland (10.8%) on light microscopy findings. None of the 30 deaths that occurred during follow‐up was related to hyperparathyroidism. Altogether 190 patients (79%) were available for follow‐up (average 89.3 months): 90% were normocalcemic, 4.7% hypocalcemic, and 5.2% hypercalcemic. A late iPTH assay was done in 147. PTH was appropriate to the serum calcium level in 84.3% and appropriate to normal calcemia in 91.6% of 132 cases. Conservative surgery is thus an acceptable treatment for MGE in patients with hyperparathyroidism. Few late recurrences occur, for which there are no individual predictive criteria.
Significant Changes in Blood Pressure, Glucose, and Lipids with Gastric Bypass Surgery
Authors: Cowan George S.M. , Buffington Cynthia K. 
Published: August 2002

AbstractThe morbidly obese have a disproportionately greater risk of hypertension, diabetes, and coronary artery disease than their lean or less seriously obese counterparts. Roux‐en‐Y gastric bypass surgery has been found to be highly effective in inducing, and sustaining, weight loss in individuals with morbid obesity. The purpose of the present study was to examine the effects of weight loss with Roux‐en‐Y gastric bypass surgery (GBP) on blood pressure, fasting blood glucose, and the lipid/lipoprotein status of 61 morbidly obese women and 21 men. Anthropometric and blood pressure assessments and blood samples for glucose and lipid/lipoprotein analyses were obtained before surgery and at 6 to 12 months postoperatively. By this time, morbidly obese (MO) males and females had lost 33% and 30% of their initial body weight, respectively, along with significant reductions in fasting blood glucose (p < 0.01) and systemic blood pressure (p < 0.05). Weight loss with GBP was also associated with significant reductions in the apoprotein B‐containing lipoproteins and the triglyceride and cholesterol composition of these particles. There was a trend (p < 0.10) toward increased serum levels of high density lipoprotein (HDL)‐cholesterol following GBP, and significant (p < 0.05) improvement in HDL subfraction distribution and composition. These findings demonstrate the effectiveness of GBP in inducing metabolic changes in the MO population, which may reduce the risk of coronary artery disease, diabetes, and hypertension.