bluuebunny/crossref_metadata_2025_split huggingface dataset:
Liver Trauma: Experience in 348 Cases
Authors: Gao Jing‐mou , Du Ding‐yuan , Zhao Xing‐ji , Liu Guo‐long , Yang Jun , Zhao Shan‐hong , Lin Xi 
Published: January 2004

AbstractLiver trauma, the main cause of death in patients suffering abdominal injury, remains an unresolved problem, especially in its most severe forms. The objective of this study was to probe effective surgical procedures and improve the outcome for patients with severe hepatic injury. A retrospective study of 348 patients with hepatic trauma seen in our institution during the past 12 years was carried out. Of these 348 patients, 259 (74.4%) underwent surgery. To manage severe liver trauma (American Association for the Surgery of Trauma grade III to grade V), procedures such as packing of the laceration with omentum, hepatectomy or direct control of bleeding vessels within the liver substance by means of the Pringle maneuver, selective hepatic artery ligation, retrohepatic caval repair with total hepatic vascular occlusion, and perihepatic packing were selected and combined based on the specific injury. In the 259 patients treated operatively, the survival rate was 86.9% (225/259); and 15 of 40 with retrohepatic venous injury (RHVI) were cured with the maximum blood transfusion of 60 units. In 42 patients treated by perihepatic packing, the bleeding was stopped in 20 of 25 (80%) with RHVI and in 14 of 17 (82%) without such injury (p > 0.75). The percentage of failure of nonoperative management was 17.2% (17/99); and it was 46.7% (14/30) in patients with grade III–V injury. Death occurred in 3 (50%) of 6 failures of grade IV–V injury. The overall mortality rate was 11.8% (41/348), and 51% of the deaths were due to exsanguination. The results suggest that severe hepatic injuries, especially grade IV–V injuries, usually require surgical intervention; reasonable surgical procedures based on classification of liver trauma and combined application of techniques can increase the survival rate; and perihepatic packing is effective in dealing with RHVI.
Acute Compartment Syndrome of the Lower Leg: Retrospective Study on Prevalence, Technique, and Outcome of Fasciotomies
Authors: Heemskerk Jeroen , Kitslaar Peter 
Published: January 2004

AbstractThe acute compartment syndrome is caused by bleeding or edema in a closed muscle compartment surrounded by fascia and bone. It is characterized by increased intracompartmental pressure and decreased tissue perfusion. Well‐known causative incidents are acute trauma and reperfusion after treatment for acute arterial obstruction. Most commonly the lower leg is involved. Inadequate therapy of the syndrome usually leads to muscle ischemia, rhabdomyolysis, and renal insufficiency. Perioperative morbidity and mortality are high. Although compartment syndromes can be caused by various factors, up until now no comparative studies have been published on clinical outcome of compartment syndromes of different origin. In this retrospective study we analyzed 40 successive cases of fasciotomy for acute lower leg compartment syndrome to study whether different causes of the syndrome lead to different clinical outcomes. We also studied other predictive factors for clinical outcome. The causes for the compartment syndromes were trauma, vascular deobstruction, cardiac surgery, and gastrointestinal surgery in lithotomy position. Clinical outcome showed a mortality of 15% and serious overall morbidity. Multivariate analysis showed the only significant predictive determinant of outcome to be the age of the patient. Fasciotomy for acute compartment syndrome is associated with serious morbidity and mortality. No correlation between causative factors and clinical outcome could be found.
Accuracy of Laparoscopy in the Diagnosis and Staging of Lymphoproliferative Diseases
Authors: Silecchia Gianfranco , Raparelli Luigi , Perrotta Nicola , Fantini Aldo , Fabiano Paolo , Monarca Bruno , Basso Nicola 
Published: January 2004

AbstractLaparoscopy seems to be playing an emerging role in the management of lymphoproliferative diseases. The aim of this study was to prospectively analyze personal experience evaluating the role and limits of laparoscopy in the management of lymphomas. From July 1993 to December 2000, 131 consecutive patients were referred to our institution for primary diagnosis (group A, n = 70), suspected relapse (reassessment) (group B, n = 54), or staging/restaging of lymphoproliferative diseases (group C, n = 7). Diagnostic and/or operative laparoscopy was performed in all patients. To assess the accuracy of laparoscopy, the results were analyzed according to the indications for surgery. In all, 128 procedures were completed laparoscopically (95.5%). Conversion was required in 7 cases (5.1%). Causes of the conversions were severe obesity (body mass index 62.5), uncontrolled intraoperative bleeding (HIV+), nondiagnostic tissue sampling (2 cases), perisplenic inflammation and perisplenic abscesses (3 cases). The results of this study highlight the safety of diagnostic and staging laparoscopy and laparoscopic splenectomy in patients with lymphoproliferative diseases (major complications 2.9%, perioperative mortality 0%). In all, 96.4% of patients from group A and 100% of patients from group B were treated on the basis of laparoscopic findings. No false negative diagnosis occurred. Laparoscopy may become the “gold standard” in the management of lymphoproliferative disease in the following settings: for the differential diagnosis of hepatic and/or splenic focal lesions; when percutaneous needle biopsy fails and/or genetic analysis is needed for therapeutic decision; for the primary diagnosis and abdominal staging of patients with diffuse retroperitoneal lymphadenopathy in the absence of peripheral lymphadenopathy; for cases of abdominal restaging after concurrent chemoradiotherapy and in cases of suspected relapse when percutaneous biopsy is not technically possible; and for patients with lymphoproliferative disease when splenectomy is required. Marked splenomegaly with perisplenic inflammatory reaction and lymphadenopathy in HIV+ patients should be considered possible causes of failure of the laparoscopic approach.
Nihilism: A Benign Denial
Authors: Skandalakis John E. , Mirilas Petros 
Published: January 2004

AbstractNihilism is the belief that all possible knowledge on a given topic has been amassed and codified. Ranging from benign denial to deliberate attempts at excommunication, nihilism is often encountered in the history of medicine. Eustachius, Columbus, and Sylvius strongly criticized Vesalius and defended the authority of Galen. Riolan fervently rejected Harvey’s monumental work on the circulation of blood. Gross stated that no honest and sensible surgeon would ever sanction thyroidectomy. Sandstrom’s discovery of the parathyroids was met with silence. Transplantation of parathyroids by Mandl was not appreciated when announced. Aristotle’s dictum that the heart cannot withstand serious injury led to Paget’s statement that cardiac surgery had reached the limits set by nature, which no new techniques could overcome. The first Billroth I operation was welcomed as, “Hopefully, also the last.” Pancreatic surgery was opposed because the organ was of no clinical interest and was impossible for surgeons to reach. Pancreatic transplantation was rejected for many years, despite good results. When Blundell used blood transfusion for postpartum hemorrhage, critics averred that his next exploit would be radical removal of the spleen. Bassini stated that it could be risky to publish more about radical treatment of inguinal hernias. Carcinomas of the lower sigmoid and upper rectum were deemed untreatable because of their inaccessibility. Colostomy during pediatric surgery was rejected many times. Although it is difficult for the human mind to move from a familiar point of view, this propensity should not infect science, thereby impeding advancement.
Pain thresholds during and after treatment of severe depression with electroconvulsive therapy
Authors: Gormsen Lise , Ribe Anette Riisgaard , Raun Peter , Rosenberg Raben , Videbech Poul , Vestergaard Per , Bach Flemming W. , Jensen Troels S. 
Published: January 2004

AbstractPain and depression are often associated suggesting that both conditions share a common neurobiological mechanism, which modulate emotional function and processing of noxious information. Pain thresholds are hypothesized to be altered in depressed patients and normalized with the amelioration of depression. The purpose of this study was therefore to determine pain thresholds in patients during and after treatment with electroconvulsive therapy (ECT) of severe depression and in healthy controls. Seventeen depressed patients (Hamilton depression score > 18) and an age and gender matched control group of same size participated in the study. Pain detection and tolerance thresholds to pressure and pain tolerance thresholds to the Cold Pressor Test by exposure to ice‐water was measured twice in depressed patients during and after ECT and twice in controls with a similar time interval. While ECT significantly improved Hamilton depression score (from mean 23.9 (SD:5) to mean 12.5 (SD:5.7)) there was no significant change in pain thresholds during and after ECT in the patient group. However, depressed patients had significantly lower pain tolerance in the Cold Pressor Test on both examinations and on pressure pain tolerance on the second examination day than their corresponding control subjects. The differential effect of ECT on depression score and pain processing indicate that mood and noxious processing are not medicated directly by the same systems but that a complex relationship between pain and depression exists.
Size at maturity of the smallnose fanskate Sympterygia bonapartii (Müller & Henle, 1841) (Pisces, Elasmobranchii, Rajidae) in the SW Atlantic
Authors: Oddone María Cristina , Velasco Gonzalo 
Published: January 2004

Abstract
The smallnose fanskate Sympterygia bonapartii is found in coastal and shelf waters between southern Brazil and southern Argentina. Since 1994 it has become an alternative and commercially important target of demersal fisheries. In Uruguayan waters, the onset of sexual maturity in the species is at 65.5 cm for females and at 50–57 cm for males.
The origin and significance of an indent on wheat leaves
Authors: LOCK A. A. 
Published: January 2004

The origin and significance of an indent on laminae of wheat is unknown. The constancy, position and emergence of a leaf indent was recorded on a range of winter wheat cultivars sown on two dates in 1998/99 and three dates in 1999/2000. The time when the indent developed was also examined in 1999/2000.The indent appeared to be caused by tissue in the region of the ligule on the previous leaf swelling as the ligule formed. The synchrony between a ligule on one leaf and an indent on the next generally lasted until the ligule appeared from within the previous leaf sheath. The date of plant emergence influenced the pattern of tip to indent length throughout the life of the plant and different varieties also showed different patterns. There was strong correlation between the length of a leaf sheath and the length of the next (younger) lamina from the ligule to the indent.
Psychological consequences of road traffic accidents for children and their mothers
Authors: BRYANT B. , MAYOU R. , WIGGS L. , EHLERS A. , STORES G. 
Published: January 2004

Background. Little is known about the psychological and behavioural consequences of road traffic accidents for children. The study aimed to determine the outcome of road traffic accidents on children and their mothers.Method. A 1-year cohort study of consecutive child attenders aged 5–16 years at an Accident and Emergency Department. Data were extracted from medical notes and from interview and self-report at baseline, 3 months and 6 months.Results. The children had an excellent physical outcome. Fifteen per cent suffered acute stress disorder; 25% suffered post-traumatic stress disorder at 3 months and 18% at 6 months. Travel anxiety was frequent. Post-traumatic consequences for mothers were common.Conclusion. Psychological outcome was poor for a minority of children and associated with disability, especially for travel. There were significant family consequences. There is a need for changes in clinical care to prevent, identify and treat distressing and disabling problems.
Understanding delay in treatment for first-episode psychosis
Authors: NORMAN R. M. G. , MALLA A. K. , VERDI M. B. , HASSALL L. D. , FAZEKAS C. 
Published: January 2004

Background. A lengthy delay often occurs between the onset of symptoms of psychotic disorders and initiation of adequate treatment. In this paper we examine the extent to which this represents a delay in individuals contacting health professionals or a delay in receiving treatment once such contact is made.Method. Pathways to care were examined in 110 patients of the Prevention and Early Intervention Program for Psychosis in London, Canada. Data were collected using structured interviews with patients, family members, consultation with clinicians and review of case records.Results. Family physicians and hospital emergency rooms were prominent components of pathways to care. Both delay to contact with a helping professional and delay from such contact to initiation of adequate treatment appear to be about equally important for the sample as a whole, but some individuals appear to be at risk for particularly lengthy delay in the second component. Individuals with younger age of onset, or who had initial contact with professional helpers before the onset of psychosis and were being seen on an ongoing basis at the time of onset of psychosis, had longer delays from first service contact after onset to initiation of adequate treatment. The greater delay to treatment for those being seen at the onset of psychosis does not appear to reflect differences in age, gender, symptoms, drug use or willingness to take medication.Conclusions. Interventions to reduce treatment delay should increase the public's awareness of the symptoms of psychotic illness and the need to seek treatment, but of equal importance is the education of service providers to recognize such illness and the potential benefits of earlier intervention.
Neurocognitive function in users of MDMA: the importance of clinically significant patterns of use
Authors: HANSON KAREN L. , LUCIANA MONICA 
Published: January 2004

Background. Use of MDMA (ecstasy), a serotonin neurotoxin, has been associated with memory impairment and psychological dysfunction. This study examined cognitive functioning in abstinent MDMA users and MDMA-naïve controls.Method. Participants completed measures of intelligence, motor function, attention, memory span, verbal fluency, immediate and delayed verbal memory, and working memory. They were also assessed for the presence of psychopathology. In addition to comparing cognitive function in MDMA users relative to controls, the possibility that clinically dysfunctional MDMA use increases the risk of cognitive impairment was examined.Results. MDMA users exhibited relative deficits in mnemonic and executive functions. Additionally, users that met DSM-IV substance use disorder criteria for lifetime MDMA abuse or dependence exhibited a number of additional deficits relative to those who did not meet these criteria.Conclusion. These findings suggest that clinically dysfunctional, rather than purely recreational, MDMA use is associated with cognitive impairment. Future research studies of diverse samples of users may shed light on the mechanisms that underlie these differences.
Pathways to care of first-admitted subjects with psychosis in South-Western France
Authors: COUGNARD A. , KALMI E. , DESAGE A. , MISDRAHI D. , ABALAN F. , BRUN-ROUSSEAU H. , SALMI L. R. , VERDOUX H. 
Published: January 2004

Background. A limited number of studies have assessed the pathways to care of patients with first-episode psychosis. The aim of the study was to describe the pathways to care of subjects with psychosis between onset of psychosis and first admission, and to examine the demographic and clinical factors influencing access to care.Method. Number and type of helping contacts since onset of first psychotic symptoms were assessed using multiple sources of information in 86 subjects with psychosis first-admitted in two hospitals of South-Western France. Characteristics independently associated with long delays between onset of symptoms and first helping contact, first treatment and first admission were explored using logistic regressions.Results. Twelve per cent of subjects were first admitted without any previous helping contact. The patients were seen by a median of two helpers (maximum 7). For most patients (70%), the first helping contact was a health care professional, and the same proportion of patients had a first contact with a GP or a psychiatrist. The type of first contact was not predicted by demographic or clinical characteristics. Subjects with poor pre-morbid functioning or at-risk behaviour were more likely to have a delayed access to care.Conclusions. The delay in access to care may not be totally attributed to inadequate management by health professionals, but may be a characteristic of the disease itself, at least in part independent of the organization of the health system.
Parental separation at birth and depression in adulthood: a long-term follow-up of the Finnish Christmas Seal Home Children
Authors: VEIJOLA J. , MÄKI P. , JOUKAMAA M. , LÄÄRÄ E. , HAKKO H. , ISOHANNI M. 
Published: January 2004

Background. Early separation of a child from the mother has been considered a risk factor for later depression. We investigated the association between very early separation and depression in adulthood in a unique dataset.Method. The index cohort consisted of 3020 subjects born in 1945–1965 in Finland, isolated from their family due to tuberculosis in the family and placed in special nurseries, immediately after birth, for an average time of 7 months. Those subjects alive at 1 January, 1971 were identified. For every index subject two reference subjects were chosen, the matching criteria being sex, year of birth and place of birth. Data on depression were obtained from the Finnish Hospital Discharge Register by the end of year 1998.Results. In males, 4·2% of the index subjects and 2·6% (Adjusted Rate Ratio RR 1·7, 95% CI 1·3–2·3) of the reference subjects had been treated in hospital due to a depressive episode. In females the respective figures were 3·9% for index subjects and 3·6% (RR 1·1, 95% CI 0·8–1·5) for reference subjects.Conclusions. The index subjects had an elevated risk for hospital treated depression in adulthood. One explanation may be that the very early temporal separation from the mother at birth may have unfavourable effects on later psychological development. On the other hand, separation from the parents at birth was not found to be strongly associated with severe adulthood depression.
Post-traumatic stress disorder among patients with chronic pain and chronic fatigue
Authors: ROY-BYRNE P. , SMITH W. R. , GOLDBERG J. , AFARI N. , BUCHWALD D. 
Published: January 2004

Background. Fibromyalgia (FM), a chronic pain condition of unknown aetiology often develops following a traumatic event. FM has been associated with post-traumatic stress disorder (PTSD) and major depression disorder (MDD).Method. Patients seen in a referral clinic (N=571) were evaluated for FM and chronic fatigue syndrome (CFS) criteria. Patients completed questionnaires, and underwent a physical examination and a structured psychiatric evaluation. Critical components of the diagnostic criteria of FM (tender points and diffuse pain) and CFS (persistent debilitating fatigue and four of eight associated symptoms) were examined for their relationship with PTSD.Results. The prevalence of lifetime PTSD was 20% and lifetime MDD was 42%. Patients who had both tender points and diffuse pain had a higher prevalence of PTSD (OR=3·4, 95% CI 2·0–5·8) compared with those who had neither of these FM criteria. Stratification by MDD and adjustment for sociodemographic factors and chronic fatigue revealed that the association of PTSD with FM criteria was confined to those with MDD. Patients with MDD who met both components of the FM criteria had a three-fold increase in the prevalence of PTSD (95% CI 1·5–7·1); conversely, FM patients without MDD showed no increase in PTSD (OR=1·3, 95% CI 0·5–3·2). The components of the CFS criteria were not significantly associated with PTSD.Conclusion. Optimal clinical care for patients with FM should include an assessment of trauma in general, and PTSD in particular. This study highlights the importance of considering co-morbid MDD as an effect modifier in analyses that explore PTSD in patients with FM.
Analysing the contributions of genes and parent–child interaction to childhood behavioural and emotional problems: a model for the children of twins
Authors: SILBERG J. L. , EAVES L. J. 
Published: January 2004

Background. Despite the demonstrable influence of both genes and the family environment on children's behavioural and emotional development, the mechanisms by which these factors are transmitted from parents to their children are not known. Numerous aspects of the family have long been associated with behavioural and emotional problems in children; it is not clear, however, whether these family variables represent genuine environmental risks or secondary consequences of the underlying genetic liability shared between parents and their children.Method. In this study we present a model for analysing the non-genetic contributions of family background to risk for childhood and adolescent depression and conduct disturbance using simulated data on adult MZ and DZ twins, their spouses and children.Results. The twin offspring design provides substantial power to detect remarkably small non-genetic effects on parent–offspring resemblance against the background of genetic transmission. As presented, the model is able to resolve the direction of transmission from both parent to child (passive genotype–environment correlation) and child to parent (evocative genotype–environment correlation).Conclusions. Unlike many other genetic studies, a study of twins and their children can sort out which putative family environmental risk factors do actually have a significant environmental impact on the child and which ones only appear to do so because they are associated with genetic mediation.