bluuebunny/crossref_metadata_2025_split huggingface dataset:
Revising Z: Part I – logic and semantics
Authors: Henson Martin C. , Reeves Steve 
Published: August 2002

Abstract.

This is the first of two related papers. We introduce a simple specification logic Z

C

comprising a logic and a semantics (in ZF set theory) within which the logic is sound. We then provide an interpretation for (a rational reconstruction of) the specification language Z within Z

C

. As a result we obtain a sound logic for Z, including a basic schema calculus.
Immunohistochemical Expression of P53and Oncogenes in Ulcerative Colitis‐associated ColorectalCarcinoma
Authors: Brüwer Matthias , Schmid Kurt W. , Senninger Norbert , Schürmann Guido 
Published: August 2002

The role of the tumor suppressor gene p53and proto‐oncogenes mdm‐2, waf‐1,and bcl‐2 in sporadic colorectal carcinoma (CRC) hasbeen well investigated. However, little is known about the role ofthese genes in the development of ulcerative colitis‐associatedcolorectal carcinoma (CAC). Colectomy specimens from patients with CAC,patients with ulcerative colitis (UC) and dysplasia, patients withlong‐standing UC without carcinoma or dysplasia, and patients with CRC were investigated in comparison to normal colon (NC) specimens frompatients with diverticulosis without histologic signs of inflammation.Immunohistochemistry was performed with antibodies against p53, mdm‐2,waf‐1, and bcl‐2; and staining was evaluated semiquantitatively with anexpression of more than 20% of tumor cell nuclei or epithelial cellnuclei in nontumor specimens considered "positive." Statisticalanalysis was performed using Fisher’s exact test. In carcinomas, p53 was positive in 50% of CRC tissues and 60% of CACtissues without statistical difference. Positive expression of p53 was found in most high‐grade dysplasia but not inlow‐grade dysplasia (p < 0.01). Whereas mdm‐2 and bcl‐2 were only sporadicallyexpressed, waf‐1 was observed in most specimens, with ahigh prevalence in UC without carcinoma or dysplasia (11/15). NCspecimens were always negative for all antibodies. Immunohistochemicalexpression of p53, mdm‐2, waf‐1, and bcl‐2 issimilar for CAC and CRC. The malignant potential of dysplasia in UC ispartially confirmed by a high prevalence of p53 and waf‐1 expression, suggesting that CAC may develop alongpathways that are different from CRC. High expression ofwaf‐1 in nonmalignant long‐standing UC has to be provedover a long‐term course in its role as an independent cancer riskfactor in UC patients.
Surgical Indications and Strategies for Necrotizing Enterocolitis in Low Income Countries
Authors: Banieghbal Behrouz , Schoeman Leonie , Kalk Fredrick , da Fonseca John M. , Davies Michael R.Q. 
Published: August 2002

In high income countries, mortality of neonates due to necrotizing enterocolitis (NEC) is decreasing due to advances in early detection and sepsis management. Surgical strategies,
by and large, are becoming less relevant as the sophistication of intensive care facilities increases in those countries. Management of septic neonates with NEC in low income countries, however, due to inherent resource constraints cannot achieve the same standards as those reported from high income countries. Surgeons therefore play an important role because they can offer different surgical strategies in line with the deficiency of their environment. Over a 4‐year period,
172 neonates who had surgery for NEC in a single institution were prospectively followed up. Standard surgical practices of the high income countries were compared to those adopted by the authors. The end point was early mortality, taking into account the anatomical zones of the involved intestine. Survival was increased from 21% to 84% by early surgery and by extending the length of colon resected in cases of ileocolic NEC. In this approach, a short resuscitative period is followed by intestinal resection including most of the diseased colon as well as the perforated/dead bowel. A more modest improvement in survival was noted with a planned re‐look laparotomy in neonates with generalized NEC.
Treatment of Erectile Dysfunction: What Should We Do Next?
Authors: Tsukamoto Taiji , Sato Yoshikazu , Horita Hiroki , Itoh Naoki 
Published: August 2002

AbstractBecause sildenafil (Viagra) is scheduled to be clinically available in the near future, urologists in Japan must prepare for changes in the treatment of erectile dysfunction. The drug will surely influence our current clinical style of diagnosis and treatment of the dysfunction. We herein discuss this issue, referring to favorable and unfavorable effects that will be brought about by the drug. We also propose several future studies that we should do, including those on testosterone replacement therapy. We present results of our experiment using testosterone replacement therapy in aged rats and speculate about the mechanism by which the hormone replacement works in the sex center of the brain.
Growth Factors in Clinical Practice
Authors: Jiang Zhu‐Ming , Wilmore Douglas W. , Liu Wei , Liu Yue‐Wu 
Published: August 2002

AbstractGrowth factors enhance protein synthesis and thus reduce the catabolic response to injury. As a result of bioengineering and new manufacturing techniques several anabolic agents have become available for clinical use and have been evaluated in surgical patients with catabolic illness. Data support the anabolic effects of growth home in such patients, but its expense and possible deleterious effects during the acute phase of illness limit its use to selected patient groups. Insulin‐like growth factor‐1 has also been studied, but specific indications for its use have not been identified in catabolic patients. Testosterone and derivatives of this hormone exert anabolic effects, but few randomized trials include catabolic surgical patients, and higher doses of some derivative compounds are associated with hepatic dysfunction. Nonetheless, as we move into the future, studies will determine the specific doses for administration of these and other anabolic factors in specific patient groups. Anabolic therapy will shorten the length of therapy and improve the outcome in the future.
Relation between Effective Utilization of Exogenous Fat Emulsion as Energy Substrate and Oxygen Metabolism after Surgery
Authors: Sane Souji , Baba Masamichi , Kusano Chikara , Shirao Kazusada , Yamada Haruhiko , Aikou Takashi 
Published: August 2002

AbstractIt is known that fat oxidation is increased in patients who have sustained surgical stress, but it is not clear whether fat emulsion should be administered during the early postoperative period. The aim of this study was to evaluate the utilization of exogenous fat emulsion after major surgery. Total parenteral nutrition composed of glucose/amino acids or glucose/amino acids/fat was administered for 6 days to 18 patients who had undergone esophagectomy. The caloric intake was significantly less than the resting energy expenditure (REE), and there was no difference in substrate utilization in either group up to postoperative day (POD) 2. After POD 4, fat utilization was significantly increased in the fat group. The total ketone body concentration was higher in the fat group than in the glucose group on POD 1 and 2. The arterial ketone body ratio (AKBR), which reflects the rate of turnover of the Krebs cycle, was positively correlated with the caloric intake/REE ratio. It was negatively correlated with the oxygen delivery index, oxygen consumption, and lactate concentration between POD 0 and POD 2. The lactate concentration was decreased and the AKBR was increased by POD 4. Fat emulsion was effectively utilized as energy substrate after POD 4, after the relative tissue hypoxia had improved and the AKBR had increased. The utilization of exogenous fat emulsion was closely related to deficient caloric intake and oxygen metabolism.
Risk Factors for Recurrence after Resection of Hepatitis C Virus‐related Hepatocellular Carcinoma
Authors: Kubo Shoji , Hirohashi Kazuhiro , Tanaka Hiromu , Tsukamoto Tadashi , Shuto Taichi , Ikebe Takashi , Yamamoto Takatsugu , Wakasa Kenichi , Nishiguchi Shuhei , Kuroki Tetsuo , Kinoshita Hiroaki 
Published: August 2002

AbstractAlthough there have been many studies of the risk factors for recurrence after resection of hepatocellular carcinoma (HCC), the subjects were patients with various viral status in the previous studies, and hepatitis C viremia has not been evaluated. We investigated risk factors, including hepatic C viremia and histologic findings of noncancerous hepatic tissue, for recurrence after resection of hepatitis C virus (HCV)‐related HCC. A total of 223 patients who underwent liver resection for HCV‐related HCC were studied. HCV viremia, laboratory data, degree of HCC malignancy, histologic findings in noncancerous hepatic tissue, preoperative interferon therapy, and operative methods were evaluated for recurrence risk by univariate and multivariate analyses. Serum levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and total bilirubin, and the proportion of patients with a high histologic activity score (mild to severe active hepatitis) were significantly higher in patients with HCV viremia than in those without viremia. Serum albumin was significantly lower in patients with HCV viremia. By univariate analysis, older age (> 65 years old), HCV viremia, elevated AST (> 40 IU/L) and ALT (> 45 IU/L), large tumors (> 40 mm), multiple HCCs, moderately or poorly differentiated HCC, portal invasion, mild to severe active hepatitis, and lack of preoperative interferon therapy were risk factors for recurrence. Multivariate analysis showed that older age, HCV viremia, high AST, multiple HCCs, and portal invasion were independent risk factors. For HCV‐related HCCs, not only the degree of maliganacy of the HCC but also HCV viremia and active hepatitis are risk factors for recurrence.
Assessment of Proliferative Activity of Glandular Cells in Hyperfunctioning Parathyroid Gland Using Flow Cytometric and Immunohistochemical Methods
Authors: Xiao‐Lin Pan , Koide Naohiko , Kobayashi Shinya , Kobayashi Masaru , Sugenoya Akira , Iida Futoshi , Katsuyama Tsutomu , Usuda Nobuteru , Nagata Tetsuji 
Published: August 2002

AbstractThe proliferative activity of epithelial cells in hyperfunctioning parathyroid glands was estimated by flow cytometric and immunohistochemical procedures. A total of 30 parathyroid glands, 29 hyperfunctioning glands, and 1 normal gland were studied. The pathology of the 29 glands was determined to be hyperplasia in 19 and adenoma in 10. The S‐phase cell population was expressed in terms of the S‐phase fraction (%SPF) calculated from the histogram by DNA flow cytometry and in terms of the BrdU immunostaining labeling index (BrdU LI). Cells in all stages of the cell cycle were studied by Ki‐67 immunostaining and expressed in terms of the labeling index (Ki‐67 LI). Both BrdU LI and Ki‐67 LI values were low, ranging from 0% to 0.58% and from 0.21% to 2.62%, respectively. The BrdU LIs were lower than the Ki‐67 LIs, ranging from one‐sixth to one‐twelfth of the values depending on the disease. There were significant correlations between the two indices (p< 0.001). The %SPF determined by flow cytometry was consistently higher than both the BrdU LI and the Ki‐67 LI. This discrepancy cannot be explained precisely, and further improvements are required for the flow cytometric analysis of %SPF. The cell cycle study by BrdU and Ki‐67 immunohistochemistry suggested that the glandular cells of the hyperfunctioning parathyroid were characterized by low proliferative activity. No evidence of rapid cell turnover rate assumed from the flow cytometric study could be observed in the hyperfunctioning parathyroid gland.
Adrenal Surgery in the Elderly: Too Risky?
Authors: Lo Chung Yau , van Heerden Jon A. , Grant Clive S. , Söreide Jon Arne , Warner Mark A. , Ilstrup Duane M. 
Published: August 2002

AbstractSurgical treatment for adrenal disease may be withheld from elderly patients because of concern about prohibitive operative morbidity and mortality. To obtain objective data in our practice, we analyzed the results of adrenalectomy for patients aged 65 years and older. From 1984 to 1993 there were 85 patients (41 men, 44 women) with ages ranging from 65 to 84 years (median 69 years) who underwent adrenalectomy for Cushing syndrome (n= 19), pheochromocytoma (n= 16), adrenocortical carcinoma (n= 7), benign adenoma (n= 26), or primary hyperaldosteronism (n= 17) at our institution. Median follow‐up was 26 months (range 1 month to 9.1 years). A retrospective review with respect to preoperative risks and postoperative morbidity and mortality was performed utilizing the American Society of Anesthesiologists (ASA) physical status classification and the modified Goldman multifactorial cardiac risk scheme. Survival was estimated by the Kaplan‐Meier methods. Operative mortality was 7% (six patients). No patients with pheochromocytoma or primary hyperaldosteronism died during the postoperative period. Patients undergoing adrenalectomy for adrenocortical carcinoma had a significantly higher operative mortality (43%) (p= 0.006). Postoperative complications developed in 19 patients (22%), and there was a reoperation rate of 6% (5 patients). Nineteen percent of patients required postoperative intensive care admission and had a median stay of 2 days (range, 1–38 days). Median hospital stay was 7 days (range 3–47 days). Seventy‐three patients (86%) remained alive at study completion. Two‐ and five‐year survivals were 86% and 84%, respectively. Goldman class II or greater was an excellent predictor of increased morbidity (p= 0.032) and mortality (p= 0.036). With the exception of adrenocortical carcinoma, adrenal surgery for elderly patients can be performed with acceptable morbidity and mortality. The Goldman multifactorial cardiac risk scheme reliably predicts postoperative outcome in this elderly group of patients.
Preoperative Change of Thyroid Stimulating Hormone Receptor Antibody Level: Possible Marker for Predicting Recurrent Hyperthyroidism in Patients with Graves’ Disease after Subtotal Thyroidectomy
Authors: Sugino Kiminori , Mimura Takashi , Ozaki Osamu , Iwasaki Hiroyuki , Wada Nobuyuki , Matsumoto Akihiko , Ito Kunihiko 
Published: August 2002

AbstractTo make the surgical treatment for Graves’ disease more ideal, it is important to elucidate factors related to postoperative thyroid dysfunction in addition to thyroid remnant. Because TSH receptor antibody (TRAb) is thought to be one of the essential causes of Graves’ disease, we investigated whether preoperative changes in serum TRAb levels are related to postoperative recurrent hyperthyroidism. Between 1987 and 1992 a total of 1520 patients with Graves’ disease were treated by subtotal thyroidectomy. Of these patients 335 visited Ito Hospital with no history of drug treatment of their disease and were treated surgically after several courses of antithyroid drug (ATD) therapy. There were 68 males and 267 females with a mean age of 25.8 years. The mean follow‐up period was 48 months (range 12–84 months). Factors analyzed by univariate and multivariate analysis were as follows: age, sex, duration of ATD treatment, weight of resected thyroid, weight of thyroid remnant, preoperative titer of MCHA, TRAb at the time of initial examination (TRAb1), TRAb at the time of surgery (TRAb2), and ΔTRAb, the difference between TRAb1 and TRAb2 (ΔTRAb = TRAb1 − TRAb2). The chi‐square test was used for univariate analysis and a logistic model for multivariate analysis. Of this group, 119 patients were euthyroid (35.5%), 50 were hyperthyroid (14.9%), and 166 were hypothyroid (49.3%). Significant factors related to recurrent hyperthyroidism were weight of thyroid remnant and ΔTRAb in both univariate and multivariate analyses. ΔTRAb is a possible new marker for predicting postoperative recurrent hyperthyroidism. If the preoperative TRAb level is not improved by ATDs in patients with Graves’ disease, the thyroid remnant should be made smaller.
Duodenal but not gastric transection disturbs motility of the sphincter of Oddi in the dog
Authors: Shibata Chikashi , Sasaki Iwao , Naito Hiroo , Ohtani Noriya , Sato Shoichi , Ise Hideo , Matsuno Seiki 
Published: August 2002

AbstractThe aim of the present study was to elucidate the effect of gastric and duodenal transection on biliary manometry in anesthetized dogs. The basal biliary pressure and increase in pressure during saline perfusion at rates of 1.0 and 1.5 ml/min were studied in intact controls, during infusion of cholecystokinin (CCK) alone, and after gastric and duodenal transection. CCK dose‐dependently lowered the basal pressure and the increase in pressure during perfusion. Gastric transection 1.5 cm proximal to the pylorus did not affect these parameters. In contrast, duodenal transection 1.0 cm distal to the pylorus significantly increased these parameters compared to all other groups. These observations suggest that the proximal duodenal transection, as performed during conventional distal gastrectomy, may contribute to the pathogenesis of postgastrectomy gallstone formation by altering motor function of the sphincter of Oddi.
Surgical Perspective on Invasive Candida Infections
Authors: Dean David A. , Burchard Kenneth W. 
Published: August 2002

AbstractInvasive and disseminated Candida infections have become a major source of morbidity and mortality in the modern surgical intensive care unit. The most common risks for invasion and dissemination are the use of antibiotics, central venous lines, total parenteral nutrition, burns, immunosuppression, and other markers for severity of illness (APACHE > 10, ventilatory use for > 48 hours). Data suggest that colonization can be a late predictor of invasive disease in today's critically ill surgical patient and that prophylaxis or early treatment in high risk patients is warranted, particularly before invasive/disseminated disease becomes life‐threatening. When advanced disease is present, the diagnosis of invasive or disseminatedCandida infection is often prompted by clinical suspicion and supported by consistent clinical data; laboratory tests alone lack sufficient sensitivity and specificity to direct therapeutic decision‐making. Once the diagnosis of invasive or disseminatedCandida infection is ascertained, early systemic treatment, along with treatment of localized infection, is as fundamental as with any other serious infectious disease. Reported toxicity and efficacy supports the use of fluconazole for most patients with invasive/disseminated Candida infections. For the most critically ill surgical patient amphotericin B remains the treatment of choice. Prophylaxis and early treatment strategies with minimally toxic agents may diminish the need to use more toxic therapy in the most severely ill patients.
Role of Fine‐needle Aspiration Biopsy and Frozen Section Examination in Determining the Extent of Thyroidectomy
Authors: Hamming Jaap F. , Vriens Menno R. , Goslings Bernard M. , Songun Ilfet , Fleuren Gert J. , van de Velde Cornelius J.H. 
Published: August 2002

AbstractTraditionally the extent of thyroidectomy in patients with nodular thyroid disease has been based on peroperative frozen section examination (FS). Fine‐needle aspiration biopsy (FNAB) and FS were evaluated with regard to the reliability to determine whether an operation for cancer is necessary. Both methods were performed in 240 patients operated for nodular thyroid disease and compared with the final histology on paraffin sections. Altogether 72 (30%) patients were found to have a malignant lesion on final histology. Only a malignant FNAB diagnosis and a malignant FS diagnosis were considered positive results for determining the extent of thyroidectomy. The test characteristics were equal: the sensitivity of FNAB and FS was 67%, the specificity 99%, and the accuracy 89%. The positive predictive value was 96% for FNAB and 98% for FS; the negative predictive values were 88% and 87%, respectively. Further analysis of the results indicates that FS is not necessary for patients with a malignant FNAB result. These patients should undergo a therapeutic operation for malignancy. When the FNAB result is uncertain, patients should undergo diagnostic surgery, and definitive surgery should be based on the final histology. Routine use of FS can be omitted.
Amitogenic Alginates: Key to First Clinical Application of Microencapsulation Technology
Authors: Hasse Christian , Zielke Andreas , Klöck Gerd , Schlosser Anja , Barth Peter , Zimmermann Ulrich , Sitter Helmut , Lorenz Wilfried , Rothmund Matthias 
Published: August 2002

AbstractMicroencapsulation refers to a technique of immunoisolation by coating single cells or tissue with a semipermeable membrane. By combining microencapsulation with a specific tissue culturing method, iso‐, allo‐, and xenotransplantation of parathyroid tissue has been achieved without immunosuppression in a long‐term animal model. Prior to its clinical use, continued analyses of the alginate, used as a coating substance, determined its mitogenic properties. Purification of the commercially available alginate was achieved using patented electrophoretic procedures, resulting in an amitogenic alginate suitable for use in humans. However, this alginate exhibited entirely different physical properties. We have recently shown that isotransplanted parathyroid tissue remains vital and functioning in vivo over long periods of time using the novel amitogenic alginate. It is essential to document, whether the alginate is able to maintain immunoisolation. We have therefore assessed its in vivo function compared to the mitogenic alginate in a transgenic animal model. Altogether 600 parathyroid glands from 300 Lewis rats (donor animals) were excised and subjected to tissue culture. Thereafter they were allotransplanted to 30 parathyroidectomized Dark‐Auita rats, microencapsulated with the amitogenic or the mitogenic alginate or naked, with 10 recipient animals in each group. Total serum calcium and parathyroid hormone levels were monitored continuously at weekly intervals for 30 weeks. After 26 weeks the transplant beds were excised and subjected to histologic examination. More than 6 months after allotransplantation 9 of 10 animals that had received amitogenic transplants, compared to 7 of 10 animals in the group with mitogenic microcapsules were normocalcemic. Animals that had received naked parathyroid tissue were hypocalcemic as soon as 2 weeks after allotransplantation. Correspondingly, normocalcemic animals showed vital parathyroid tissue inside the microcapsules, which were surrounded by a significantly smaller rim of fibroblasts when amitogenic alginate had been used. In addition to confirming physiologic long‐term function, we were able to document for the first time that immunoisolation can also be achieved with the novel amitogenic alginate, which is suitable for clinical use.