bluuebunny/crossref_metadata_2025_split huggingface dataset:
Enhanced Expression of Matrix Metalloproteinase‐9 in Abdominal Aortic Aneurysms
Authors: Yamashita Akimasa , Noma Takafumi , Nakazawa Atsushi , Saito Satoshi , Fujioka Kentaro , Zempo Nobuya , Esato Kensuke 
Published: August 2002

Abstract.Abdominal aortic aneurysms (AAAs) are characterized by structural alterations of the aortic wall resulting from degradation of collagen and elastin. Matrix metalloproteinases (MMPs), particularly MMP‐2 and MMP‐9, show strong elastinolytic activity. We examined the levels of mRNA for MMP‐2, MMP‐9, membrane type (MT)‐MMP‐1, tissue inhibitor of metalloproteinase‐1 (TIMP‐1), and TIMP‐2 in AAAs (n= 8), atherosclerotic occlusive diseases (AOD) (n= 8), and normal subjects (n= 8) using the reverse transcription‐polymerase chain reaction (RT‐PCR). We also analyzed the gelatinolytic activity of these metalloproteinases using gelatin zymography. The levels of MMP‐2 and MMP‐9 mRNA were increased in the AAA group compared with those in the AOD group and normal subjects. The levels for TIMP‐1 and TIMP‐2 mRNA in the AAA group were also higher than those in the AOD and normal groups. Only in the case of MT‐MMP‐1 was the difference between AAA and AOD not statistically significant. By gelatin zymography with the same samples used for RT‐PCR, gelatinolytic activity of MMP‐9 was elevated in all AAA tissues. The 62‐kDa form of MMP‐2 was elevated in both the AAA and AOD groups and did not differ significantly between them. Linear regression analysis demonstrated a significant positive correlation between mRNA levels of MMPs and those of TIMPs. These observations suggest that aneurysm formation in patients with atherosclerosis is related to the degree of MMP‐9 expression.
Intraoperative Esophageal Manometry and Fundoplications: Prospective Study
Authors: Slim Karem , Boulant James , Pezet Denis , Lechner Christian , Pelissier Eric , Delasalle Patrick , Bommelaer Gilles , Chipponi Jacques 
Published: August 2002

AbstractThe purpose of this study was to validate the use of intraoperative manometry for assessing fundoplication and to search for predictive manometric criteria. This prospective study concerned 48 patients operated for gastroesophageal reflux. The manometry was carried out pre‐ and intraoperatively for all patients and postoperatively as well for 30 patients. The operative procedures were total fundoplication (n= 25) and posterior (partial) fundoplication (n= 5). The lower esophageal sphincter (LES) pressures and lengths were similar in the preoperative and intraoperative measurements before any esophageal mobilization, whereas the intraoperative LES pressure was significantly higher after fundoplication. The mean postoperative LES pressure decreased by 50 ± 19% compared with the intraoperative pressure after fundoplication. The final intraoperative pressures of two dysphagic patients were not the highest of the study. More importantly, their final intraoperative pressures were 7.5 and 8.2 times the initial pressure, respectively, which was significantly greater than the intraoperative pressure increase of the nondysphagic patients (4.6 ± 2.0 times). The final intraoperative pressure of the only patient with recurrence (18.2 mmHg) was the lowest of the study. In conclusion, intraoperative manometry is an effective method for evaluating the LES, and it could have predictive value for the surgical management of gastroesophageal reflux disease.
Animal Models as the Basis of Pharmacologic Intervention in Trauma and Sepsis Patients
Authors: Redl H. , Schlag G. , Bahrami S. , Yao Y.M. 
Published: August 2002

AbstractWith limited resources and the current concerns about using animals for research purposes, the needs must be clear when setting up trauma and sepsis experiments for pharmacologic interventions. Such interventions are performed typically for four reasons: (1) to study the pathophysiologic role of certain mediators (which can be influenced by pharmacologic agents); (2) to study the therapeutic efficacy of treatment strategies; (3) to study the overall safety of new drugs under trauma/sepsis conditions, which are adjunct studies to standard toxicology; (4) to test new diagnostic procedures in a defined trauma or sepsis setting. Intervention in the inflammatory response may be performed at several levels: (1) at the primary induction site (e.g., by antilipopolysaccharide or by preventing complement activation); (2) at the intermediate mediator level (e.g., by antitumor necrosis factor); (3) at the final mediator level (e.g., by block of polymorphonuclear neutrophil elastase, and (4) at the target (e.g., by membrane stabilization or enhanced antioxidant defense).
Improved Survival of Patients with Papillary Thyroid Cancer after Surgical Microdissection
Authors: Tisell Lars‐Erik , Nilsson Bengt , Mölne Johan , Hansson Göran , Fjälling Martha , Jansson Svante , Wingren Urban 
Published: August 2002

AbstractA total of 195 patients had surgery for papillary thyroid cancer. The mean age at operation was 50 years. A microdissection technique was used for total thyroidectomy and lymph node clearance. Postoperative radioiodine tests showed no uptake or an uptake close to the background activity in 77% of the examined patients. By counting the lymph nodes removed at surgery we were able to check on the quality of the lymph node dissection. Men had a higher incidence (70%) of lymph node metastases than women (45%). Only 4% of the patients had radioiodine ablation of the thyroid remnant. The median follow‐up time was 13 years. None of the patients below 45 years of age at surgery died of thyroid cancer. In the older age group eight patients died of thyroid cancer at a mean age of 75 years. Five of those who died of a thyroid carcinoma had distant metastases at diagnosis. Among patients with resectable disease, three (1.6%) died of thyroid cancer, all of whom had lived for more than 17 years after surgery. Hence longer follow‐up is needed before we know the final mortality in our series. The results suggest that surgical technique and strategy can positively influence the survival of patients with papillary thyroid cancer.
Clinicopathologic Study of Angiogenesis in Japanese Patients with Breast Cancer
Authors: Kato Takao , Kimura Tsunehito , Miyakawa Ryuhei , Tanaka Shinichi , Fujii Akiho , Yamamoto Kazuko , Kameoka Shingo , Hamano Kyoichi , Kawakami Makio , Aiba Motohiko 
Published: August 2002

AbstractTo evaluate the clinicopathologic significance of angiogenesis as a prognostic factor and the objective methods for evaluating angiogenesis, we immunohistochemically stained a representative section of breast tumors with factor VIII‐related antigen staining. There were 109 patients with primary breast cancer from 1971 to 1979. The two methods of identifying angiogenesis were the average microvessel count per square millimeter (AMC) and the highest microvessel count per square millimeter (HMC). There was no relation between microvessel count (AMC or HMC) or age, menopausal status, clinical tumor size (T), histologic classification, nuclear grade, node status, histologic grade (HG), mitosis index, or lymphatic invasion (LI). There was a relation between microvessel count and blood vessel invasion (BVI) (HMC:p= 0.0007) and tumor necrosis (TN) (HMC:p= 0.0050). Univariate analysis showed that AMC or HMC was a statistically significant predictor of overall survival in all patients (p= 0.0086 andp= 0.0307, respectively). Multivariate analysis showed that AMC was an independent predictor of node status when we fitted a model with node status, BVI, and either AMC or HMC; but HMC was not independent. However, when we fitted a model including all 11 of the other indicators and AMC or HMC, the node status, HG, and LI were independent predictors, but AMC and HMC were not. Although AMC was a better method than HMC for evaluating angiogenesis, we cannot confirm angiogenesis as a significant independent prognostic factor associated with long‐term survival in Japanese breast cancer patients.
High Stroke Volume Para‐aortic Counterpulsation Device versus Centrifugal Pump in Cardiogenic Shock: Experimental Study
Authors: Nanas Serafim N. , Nanas John N. , Charitos Christos E. , Gougoulakis Alexandros , Makaritsis Konstantinos , Chatzigeorgiou John , Moussoutzani Kiriaki , Anastasiou‐Nana Maria I. , Moulopoulos Spyridon D. 
Published: August 2002

AbstractDuring the last decades a number of left ventricular assist devices has been used especially for patients resistant to pharmacologic treatment and to intraaortic balloon pump (IABP) support for left ventricular failure. A high stroke volume para‐aortic counterpulsation device (PACD) has been developed utilizing the principle of the diastolic counterpulsation technique. In this study the hemodynamic effects of the valveless PACD were compared to those of the centrifugal blood pump (CBP) in nine dogs in acute experimental cardiogenic shock. Hemodynamic measurements were obtained at baseline with both devices off, PACD on and CBP off, or PACD off and CBP on. There was no difference in mean aortic pressure between PACD on (60.0 ± 11.5 mmHg) and CBP on (69.0 ± 26.8 mmHg). Similarly, there was no difference in left ventricular end‐diastolic pressure with the PACD on (11.9 ± 5.4 mmHg) versus the CBP on (9.9 ± 5.2 mmHg) or the cardiac index with the PACD on (84 ± 36 ml/kg/min) versus the CBP on (77 ± 36 ml/kg/min). However, the left ventricular systolic pressure (55.0 ± 19.0 with PACD versus 73.0 ± 26.0 with CBP,p< 0.001), the tension time index (712 ± 381 versus 1333 ± 694,p< 0.01), and the double product (5629 ± 2574 versus 7440 ± 3294,p< 0.01) were significantly lower during assistance with the PACD than with the CBP. It was concluded that PACD is at least as effective as CBP for restoring hemodynamic status during acute experimental cardiogenic shock. Moreover, the PACD unloads the left ventricle more effectively than CBP, making it suitable for left ventricular mechanical support in cases with reversible myocardial damage.
Comparative Study of the Early Postoperative Course and Complications in Patients Undergoing Billroth I and Billroth II Gastrectomy
Authors: Kyzer S. , Binyamini Y. , Melki Y. , Ohana G. , Koren R. , Chaimoff C. , Wolloch Y. 
Published: August 2002

AbstractDistal gastric resection can be followed by reconstruction according to the Billroth I (BI) or Billroth II (BII)
techniques. The aim of this study was to compare the early postoperative results and complications of patients undergoing BI and those undergoing BII resection. Eighty‐eight patients operated during the years 1991 to 1994 underwent distal gastric resection (41 had BI, and 43 had BII resections). The indications for BI resections were gastric tumors in 39 patients (95%) and duodenal ulcer in 2 (5%). The indications for BII resection were malignancy in 28 patients (65%) and duodenal ulcer disease in 15 (35%). The average duration of the procedure was 147 ± 28 minutes for the BI resection and 175
± 38 minutes for the BII resection (p < 0.05). No patient in the BI group developed anastomic leakage. Two patients who underwent BII resection developed duodenal stump leakage (4.7%). Relaparotomy was indicated in five patients, two from the BI group
(malignant cells in the resection margins) and three from the BII group
(one due to duodenal stump leakage and two for bleeding). There was no postoperative mortality in the BI group. The postoperative mortality in the BII group was 7.1% (p < 0.05). The average proximal gastric resection margins were significantly smaller in the BI group than in the BII group (3.65 ± 2.83 cm and 5.18 ± 2.57 cm, respectively; p < 0.05). The number of lymph nodes found in the resected specimen did not differ significantly between the two groups. Recurrent tumor at the gastric remnant developed in two patients in the BI group but not in the BII group. The results of our study revealed that the BI procedure is accompanied by significantly lower postoperative complication and mortality rates than the BII procedure in cases of gastric malignancy. BI resection performed for malignancy seems to achieve smaller proximal gastric resection margins, which may influence the recurrence rate.
Sentinel Node Biopsy in Melanoma Patients: Dynamic Lymphoscintigraphy Followed by Intraoperative Gamma Probe and Vital Dye Guidance
Authors: Pijpers Rik , Borgstein Paul J. , Meijer Sybren , Hoekstra Otto S. , van Hattum Lex H. , Teule Gerrit J.J. 
Published: August 2002

AbstractBiopsy of the first tumor‐draining lymph node (sentinel node, SN) is bound to become the procedure of choice in regional staging of melanoma patients. A tumor‐negative SN virtually excludes lymphatic metastases and obviates the need for lymph node dissection. The aim of this study was to combine the advantages of three known techniques to improve the yield of successful SN biopsies. A total of 150 drainage areas in 135 patients was evaluated. First, preoperative dynamic and static lymphoscintigraphy was performed after injection of technetium 99m colloidal albumin. In all patients one to three focal accumulations, concordant with SNs, were seen in the lymphatic drainage areas, in 97% within 20 minutes from injection of the tracer. Peroperative identification of the SN, 2 to 24 hours after injection of the tracer, was done with a handheld gamma probe to estimate the optimal site for the small incision and to guide preparation. Vital dye was injected just preoperatively and served to facilitate the final identification and biopsy of the SN. A total of 216 SNs were biopsied. Micrometastases were found in 39 SNs in 30 drainage areas, and in 22 of the 30 the SN was the only node harboring tumor. In 5 of 30 drainage areas, the SN did not contain blue dye and would not have been found without the gamma probe. Up to now (follow‐up 233–691 days) no recurrence has developed in the lymphatic drainage areas where the SN was tumor‐free. It was concluded that by combining these three techniques the SN could be detected and excised in all patients. The procedure combines a steep learning curve with high sensitivity.
Role of Helicobacter pylori in Residual Gastritis after Distal Partial Gastrectomy
Authors: Yamamoto Shigetaka , Yamasaki Yoshio , Kuwata Keiji , Yamasaki Hajime , Nishida Yukihiro , Kobayashi Yasushi 
Published: August 2002

AbstractWe studied the relation between Helicobacter pylori and residual gastritis in 28 patients with gastric cancer on whom distal partial gastrectomy with Billroth I reconstruction was performed over a 13‐month period. They were subjected to serologic testing along with endoscopic and histologic examinations before operation and at 3, 6, and 12 months after operation. Anti‐H. pylori immunoglobulin G (IgG) and serum gastrin levels were measured by serologic tests. The presence or absence of gastritis was determined endoscopically, and gastric mucosal hexosamine levels were determined. Gastritis was measured quantitatively by histologic examination in specimens taken from the gastric mucosa using Rauws’ score. After the initial histologic evaluation we divided the H. pylori‐positive patients into two groups: those with a Rauws’ score of 0 to 3 (“weak” gastritis group), and those with a Rauws’ score of 4 to 10 (“strong” gastritis group), allowing us to compare the results of our three postoperative histologic examinations of the two groups for possible significant differences. Our endoscopic examinations showed gastric mucosal inflammatory changes in both H. pylori‐positive andH. pylori‐negative patients at 3, 6, and 12 months after operation, but there was no significant difference between these two groups at any point. During the histologic examinations, however, anti‐H. pylori IgG assay had become negative in several patients in the “weak” gastritis group at 3 months after operation and was found to have become negative in 78% of all patients in that group 12 months after operation. In contrast, in the “strong” gastritis group H. pylori infection was still evident in the patients 12 months after operation, suggesting that “strong” histologic gastritis may have some connection to H. pyloriinfection, whereas “weak” histologic gastritis has no such connection. The gastric mucosal hexosamine level was higher in the “weak” gastritis group than in the “strong” gastritis group both before operation and at 6 and 12 months, indicating some relation between gastric inflammatory changes and hexosamine levels in gastric mucosa. It further suggested the possibility that H. pyloriplays a role in destroying gastric mucosa by depleting mucin, thus acting as one (though not the only) cause of residual gastritis after distal partial gastrectomy. In conclusion, we found evidence that there is a relation between residual gastritis and H. pyloriinfection, but H. pylori is not the sole cause of residual gastritis after gastric surgery. A causal relation is difficult to detect by simple analysis of histologic findings or by endoscopic observation or clinical symptoms alone.
Role of Nitric Oxide in the Colon of Patients with Ulcerative Colitis
Authors: Tomita Ryouichi , Tanjoh Katsuhisa 
Published: August 2002

AbstractThe cause of impaired motility, such as diarrhea and toxic megacolon, in patients with ulcerative colitis (UC) is unknown. Nitric oxide (NO) has been shown to be a neurotransmitter in the nonadrenergic noncholinergic (NANC) inhibitory nerves in the human gut. To assess the physiologic significance of NO in the colon of patients with UC, we investigated enteric nerve responses on lesional and normal bowel segments derived from patients with ulcerative colitis (n= 6) and patients who underwent colon resection for colonic cancers (n= 10). A mechanographic technique was used to evaluate in vitro muscle responses to electrical field stimulation (EFS) of adrenergic and cholinergic nerves before and after treatment with various autonomic nerve blockers, includingNG‐nitro‐l‐arginine (l‐NNA) and l‐arginine. The results showed that (1) NANC inhibitory nerves were found to act on both normal colon and UC colon; (2) the colon with UC was more strongly innervated by NANC inhibitory nerves than the normal colon; (3) l‐NNA concentration‐dependently inhibited the relaxation in response to EFS in the colon of both normal and UC colon; and (4) this inhibitory effect in the colon of both normal and UC patients was reversed by l‐arginine; (5) NO acts more strongly in the UC colon than the normal colon. These findings suggest that NANC inhibitory nerves play an important role in the impaired motility observed in patients with UC and that NO plays an important role as a neurotransmitter in NANC inhibitory nerves of human colon.
Single‐stage, Bilateral, Video‐assisted Thoracoscopic Lung Volume Reduction Surgery for End‐stage Emphysema
Authors: Vigneswaran Wickii T. , Podbielski Francis J. , Halldorsson Ari , Kong Lawrence , Schwab Toni , Janulaitis Cynthia M. , Khurshid Abid 
Published: August 2002

AbstractThe reintroduction of lung volume reduction surgery has provided functional improvement for selected patients afflicted with end‐stage emphysema. Evolution of the operation from a median sternotomy approach to the two‐stage video‐assisted thoracoscopic surgical technique in our experience has resulted in a faster return to full activity. Nineteen patients underwent video‐assisted thoracoscopic lung volume reduction surgery between July 1995 and August 1997. The 12 men and 7 women in the study had an average age of 63.7 years. All patients were evaluated preoperatively with computed tomography of the chest, radionuclide lung perfusion scan, left ventricular stress test, right heart catheterization, and a monitored rehabilitation program. In 15 patients the operation was performed as a bilateral single‐stage procedure. The operation involved resection of wedges from the upper lobes and in 10 of these patients from the lower lobes as well. In all patients the estimated operative blood loss was less than 150 ml. The mean operative time was 177 minutes (range 115–235 minutes). The mean length of hospital stay was 10.8 days (median 11 days, range 5–24 days). At 2 to 3 months’ follow‐up increases were noted in the FEV1 (51%), PaO2 (27%), and 6‐minute walk distance (18%); and there was a decrease in total lung capacity and respiratory volume. No significant change was observed in carbon monoxide diffusion in the lung. Morbidity included persistent air leaks in three patients and refractory supraventricular tachyarrhythmia in one. There were no perioperative deaths. We therefore recommend this technical modification to reduce operating time and blood loss without compromising surgical exposure or outcome.
Medical Management of Common Bile Duct Stones
Authors: González‐Koch Alvaro , Nervi Flavio 
Published: August 2002

AbstractCommon bile duct stones are a common cause of morbidity and mortality in adults. An increasing number of surgical and medical therapies are available to manage them, with different success rates reported. The various medical treatment strategies were developed during the last decade, but these medical modalities should not be contemplated as a first‐line alternative of treatment. A consensus from experts is that there is no primary indication to use solvents on common bile duct stones because they have a relatively high rate of adverse effects and their success is limited compared with lithotripsy. However, there is a subgroup of patients in whom invasive or surgical treatment is risky or may fail. In these patients stone dissolution by solvent may constitute a plausible therapeutic alternative or may help reduce the size of the stones sufficiently to facilitate subsequent endoscopic extraction. Solvents may also be indicated in settings where endoscopic techniques or lithotripsy are not available and the patient has a T‐tube in the common bile duct. Even in this condition, however, it is probably quicker and more effective to refer the patient to a center with expertise and technologic support to practice stone removal.
Charles B.G. de Nancrede: Academic Surgeon at the Fin de Siècle
Authors: Bloom David A. , Uznis Gretchen , Campbell Darrell A. 
Published: August 2002

AbstractAt the last turn of the century American surgery was in the midst of a number of paradigm shifts, involving transitions in technology, surgical practice, surgical specialization, patient care, surgical training, and medical economics. Charles B. G. de Nancrede was a leader during this formative period. A key figure in the transition from antiseptic to sterile technique in American medicine, he was also a prolific writer, a bold surgeon, and a great surgical educator. De Nancrede created one of the earliest prototypes of the modern multispecialty surgical departments. The coming turn of the century promises new transitions comparable to those of the past.
Genetic and Biochemical Screening for Endocrine Disease: II. Ethical Issues
Authors: Kinder Barbara K. 
Published: August 2002

AbstractThe ability to test for specific genes conferring susceptibility to a variety of diseases has profound ethical implications for the way in which we care for patients. Legislators and health care insurers are scrambling to address the aspects of genetic screening that they believe fall within their purview. Critical to the development of appropriate societal regulations regarding genetic screening is a fundamental understanding of the ethical issues involved. A review of those concerns and the areas in which they interface with legal and insurance issues is the topic of this paper.