bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nonprotruding Colorectal Neoplasms: Epidemiologic Viewpoint
Authors: Rubio Carlos A. 
Published: August 2002

AbstractHistologic sections from 781 nonprotruding colorectal neoplasias (adenomas and early carcinomas) recorded in Sweden and in Japan were reviewed by the same observer, using strict histologic criteria. Low grade dysplasia (LGD) was present in 82.8% (299/361) of the nonprotruding neoplasms recorded in Sweden but in only 42.6% (179/420) of those recorded in Japan. On the other hand, high grade dysplasia (HGD) was found in 42.4% (178/420) of the nonprotruding colorectal neoplasias in Japanese patients but in only 14.1% (51/361) of those in Swedish patients. Whereas 15.0% (63/420) of the nonprotruding neoplasms in Japan were intramucosal carcinomas (IMCs) or submucosal carcinomas (SMCs), only 3.0% (11/361) of those reviewed in Sweden were IMCs or SMCs. Thus in Japan the lesions were histologically more "advanced" (significantly more lesions had HGD) and more "aggressive" (significantly more lesions were IMC or SMC)
than in Sweden. The cause(s) of that phenomenon remains elusive. The term nonpolypoid adenoma connotes a group of dysplastic lesions with different histologic phenotypes. Interestingly, similar phenotypes were recently found in overt colorectal carcinomas in both Sweden and Japan. Experimental and clinical findings indicate that nonprotruding colorectal adenomas are closely associated with colonic lymphoid nodules, suggesting that the lymphoid‐associated colorectal mucosa might be the birthplace of many nonprotruding adenomas (and consequently of nonprotruding early colorectal carcinomas).
Histopathology of Early Colorectal Cancer
Authors: Jass Jeremy R. 
Published: August 2002

AbstractThe histopathologic spectrum of early colorectal cancer (ECC) is compared from the Western and Japanese perspective. In the West, most ECC presents as a malignant adenoma, whereas superficial ECC with no adenomatous component is well described in the Japanese literature. Furthermore, superficial ECC is thought to progress rapidly and disseminate early. The discrepant viewpoints are considered in the light of different approaches to histopathologic interpretation. Lesions reported by Japanese pathologists as superficial carcinomas limited to the mucosa are diagnosed as flat adenomas in the West. In one Japanese series only 4 of 218 (1.8%) flat or small sessile neoplasms removed by endoscopic mucosal resection were associated with submucosal invasion by carcinoma. Therefore superficial ECC with submucosal spread is uncommon. Most ECC in hereditary nonpolyposis colorectal cancer evolves through the adenoma—carcinoma pathway (including flat adenoma). However, adenoma removal in the context of population‐based screening programs has not lowered the incidence of colorectal cancer; flat colorectal neoplasia may be important in clinical practice.
Radiographic Diagnosis of Early Colorectal Cancer, with Special Reference to the Superficial Type of Invasive Carcinoma
Authors: Maruyama Masakazu , Koizumi Koichi , Kai Shunkichi , Kazami Akira , Handa Takayoshi 
Published: August 2002

AbstractThe possibility of radiographically diagnosing carcinoma with submucosal involvement (invasive carcinoma) is discussed based on 119 invasive carcinomas of the large bowel that had been treated surgically and colonoscopically over a period of 9 years (1989—1997) at the Cancer Institute Hospital in Tokyo. Of these lesions, 38 were superficial‐type invasive carcinoma, accounting for 31.9% (38/119) of all invasive colorectal carcinomas, including 36 lesions (94.7%, 36/38) of types IIa and IIa+IIc and 2 lesions (5.3%, 2/38) of type IIc+IIa. No pure type IIc was seen. The radiographic images obtained were correlated with macroscopic findings and analyzed in terms of visualization of the lesion's contour, central depression, converging folds, and basal indentation. A definitive diagnosis of superficial invasive carcinoma can be made radiographically if a lesion measures 10 mm and reveals moderate to severe basal indentation in a complete or nearly complete profile radiographic image. Attention should be paid to the presence of superficial‐type advanced carcinomas measuring 10 mm or less, which is not infrequently experienced in Japan. Polypoid invasive carcinoma can be definitively diagnosed in the same way with much more certainty than can the superficial type because few polypoid advanced carcinomas are less than 20 mm. The size and the radiographic sign of the basal indentation are the most important indicators for the diagnosis of invasive carcinoma.
Value of Contralateral Surveillance Mammography for Primary Breast Cancer Follow‐up
Authors: Kollias James , Evans Andrew J. , Wilson A. Robin M. , Ellis Ian O. , Elston Christopher W. , Blamey Roger W. 
Published: August 2002

AbstractMammographic screening of the contralateral breast is often advocated during follow‐up of women previously treated for primary operable breast cancer. The purpose of this study was to determine the value of this investigation. Between 1987 and 1995 a total of 5102 contralateral screening mammograms were performed biennially on 2511 women aged ≤ 70 years following treatment for primary operable breast cancer. Sixty‐five metachronous contralateral breast cancers were identified: 21 (32%) at routine clinical examination, 24 (37%) at mammography, and 20 (31%) by patients between routine follow‐up appointments. The prognostic features of metachronous cancers were better or similar to those of the first cancer in 59 of 65 (91%) cases. Because of the favorable prognostic characteristics of the contralateral cancer, mammographic screening may have contributed to the long‐term survival of 16 of 26 women in whom the histologic characteristics of the first cancer predicted a good prognosis. The cancer detection rate with mammography for these women was 6.5 per 1000 contralateral mammogram investigations at a cost of £3852 per cancer detected. The results of this study suggest that surveillance mammography of the contralateral breast is of value in women whose first cancer predicted a favorable prognosis.
Débridement of Gunshot Wounds: Semantics and Surgery
Authors: Saadia Roger , Schein Moshe 
Published: August 2002

AbstractDébridement is a well established modality for management of gunshot wounds. The word “débridement” is originally French. It was used for the first time during the eighteenth century in the surgical context and meant “wound incision.” For French surgeons, it has retained to this day its original meaning. In medical English, though, the use of the term has been marred by persisting confusion about its definition. Two quite different surgical procedures still compete for the definition of débridement: wound incision and wound excision. These procedures are also at the center of a modern controversy about the management of gunshot wounds. The orthodox doctrine, inherited from military surgeons, consists of aggressive tissue excision around the bullet track. This radical policy is being challenged by advocates of a more conservative approach. Minimal tissue excision is sufficient and safe in many cases provided careful monitoring of the wound is instituted. Wound incision alone to relieve tension and allow drainage is possible in certain cases. The tug‐of‐war between excision and incision is outlined herein with reference to the semantic tribulations of the word “débridement” and the implications for patient care.
Is the New Classification of Neuroendocrine Pancreatic Tumors of Clinical Help?
Authors: Schindl Martin , Kaczirek Klaus , Kaserer Klaus , Niederle Bruno 
Published: August 2002

AbstractA new concept of classifying neuroendocrine pancreatic tumors based on clinicopathologic patterns was summarized recently. To evaluate the clinical reliability and prognostic specificity of this classification system, 100 neuroendocrine pancreatic tumors were retrospectively categorized as “benign,”“uncertain,” and “malignant” based on tumor risk factors (size, local invasion and angioinvasion, cell atypia, metastases) and were followed for disease recurrence and progression. Altogether, 71 functioning tumors (insulinoma, gastrinoma, glucagonoma, enterochromaffin‐like (ECL)oma, somatostatinoma) and 29 nonfunctioning neuroendocrine pancreatic tumors (NETs) were studied. NETs had an increased risk of malignancy (p < 0.05). Tumor size, gross invasion, and metastases correlated significantly with tumor behavior and allowed us to distinguish between “benign” and “malignant” tumors. About 89% of the tumors ≤ 20 mm were “benign,” whereas 71% > 20 mm were “malignant” (p < 0.05). In patients with “benign” and “uncertain” neuroendocrine pancreatic tumors, neither recurrence nor progression of disease was seen. About 41% of the patients with “malignant” tumors died of the disease. The 5‐year estimated cumulative survival of those with “benign” and “uncertain” tumors was 100% and 52 ± 10% for those with “malignant” tumors (p < 0.05). Histomorphologic details classifying the behavior of an “uncertain” tumor are known only after initial treatment and definitive histopathologic investigation. Thus this information is of limited clinical help for treatment strategies.
Postoperative Elevated Serum Levels of Intact Parathyroid Hormone after Surgery for Parathyroid Adenoma: Sign of Bone Remineralization and Decreased Calcium Absorption
Authors: Westerdahl Johan , Valdemarsson Stig , Lindblom Pia , Bergenfelz Anders 
Published: August 2002

AbstractIncreased levels of intact parathyroid hormone (PTH) have been documented after surgery for primary hyperparathyroidism (pHPT) despite normocalcemia. The pathogenesis remains to be elucidated. Seventeen consecutive patients operated on for solitary parathyroid adenoma were investigated before and at 8 weeks and 1 year after surgery with serum levels of intact PTH, biochemical variables known to reflect PTH activity, and bone mineral content (BMC). In addition, an oral calcium loading test was performed 8 weeks after the operation. All patients had low or normal serum calcium levels during follow‐up. Eight weeks after operation six patients (35%) had an increased serum PTH level. These patients (group I) preoperatively had higher serum levels of PTH and alkaline phosphatase than patients with normal PTH levels (group II). They also had lower BMC and larger parathyroid adenomas. They did not differ in renal function. At 8 weeks after operation group I showed higher mean serum levels of osteocalcin and propeptide of type I procollagen but lower urinary calcium excretion. In contrast to patients in group II, they also showed a lower calciuric response and a trend to a lower calcemic response during the oral calcium load. The two groups showed similar parathyroid sensitivity for calcium. Patients in group I demonstrated a significant increase in BMC the first year after the operation. Increased serum PTH 8 weeks after surgery for sporadic parathyroid adenoma was not due to persistent pHPT or impaired renal function. Instead, the results imply there is diminished calcium absorption and increased bone turnover with cortical bone remineralization.
Lung Volume Reduction Surgery for Chronic Obstructive Pulmonary Disease: Where Do We Stand?
Authors: McKenna Robert J. , Gelb Arthur , Brenner Matt 
Published: August 2002

AbstractLung volume reduction surgery (LVRS) is a promising new treatment for selected patients with moderate to severe symptoms of emphysema. Medical management, including pulmonary rehabilitation, has been shown to reduce oxygen requirements during exercise and probably to reduce hospitalization for patients with severe emphysema, but it does not improve pulmonary function. By improving the elastic recoil of the lung, LVRS is the first treatment to demonstrate substantial improvement in pulmonary function and quality of life for selected patients with emphysema. The most important selection factor for LVRS is the presence of a heterogeneous pattern of emphysema. Because it is found in only 20% of patients with emphysema, only a small number of patients are candidates for the procedure. Published reports indicate that the optimal operative technique appears to be a bilateral staple operation during a single anesthetic. This procedure offers a 68% chance of oxygen independence, 85% chance of prednisone independence, and 60% to 70% improvement in pulmonary function for patients with an upper lobe distribution of emphysema. The long‐term benefits of the procedure are currently unknown, so several randomized, prospective studies are now comparing LVRS with maximal medical management.
Value of Bronchoscopic Pneumonia Diagnosis: Prospective Study
Authors: Prokop A. , Gawenda M. , Krüger I. , Pichlmaier H. 
Published: August 2002

AbstractIn a prospective clinical study we examined whether bronchoscopically controlled suctioning is preferable to the blind suctioning of mucus aspirates for bacterial identification of intensive care unit patients with pneumonia. Forty patients with clinical and radiologic signs of pneumonia underwent both bronchoscopically controlled and blind endotracheal lavage. Bronchoscopically controlled suctioning did not demonstrate greater sensitivity for identifying organisms than the results obtained from blind suctioning (58 organism were bronchoscopically identified, compared to 57 organisms identified by blind suctioning; p= 0.32, NS). Arterial and mixed venous partial oxygen pressure and shunt also showed no significant differences 15 minutes before and after examination, nor did the blood pressure or pulse. The use of four of the bronchoscopes resulted in preinterventional contamination withPseudomonas. Bronchoscopically controlled lavage shows no advantages over blind endotracheal lavage for diagnosing pneumonia. Blind suctioning with single‐use sterile catheters can be done more quickly and inexpensively with fewer personnel and a lower complication rate.
Clinical Significance of DNA Ploidy Pattern in Stage III Gastric Cancer
Authors: Sakusabe Masaru , Kodama Masashi , Sato Yasuhiko , Kikuchi Toshiki , Koyama Kenji 
Published: August 2002

AbstractNuclear DNA contents from stage III gastric cancers of 216 patients undergoing curative resection from 1972 to 1987 were measured by flow cytometry using paraffin‐embedded materials. To determine the clinical significance of the DNA ploidy pattern, the correlation between it and conventional clinicopathologic findings was studied and a prognostic factor for gastric cancer was investigated by both univariate and multivariate analysis. Survivals were compared for diploidy and aneuploidy patterns in subclasses of stage III gastric cancer as well. The grade of each clinicopathologic factor showed no differences between diploidy and aneuploidy patients. The multivariate analysis revealed that the pvalue and Hazard ratio of the DNA ploidy patterns were 0.001 and 2.099, respectively. Consequently, it was a valuable independent prognostic factor that could be used in addition to lymph node metastasis and depth of invasion. For the most advanced subclass of stage III gastric cancer the 5‐year survival rate of patients with a diploid tumor was significantly higher than that for those with aneuploid tumor. No difference was observed for the other subclasses. These results indicate that the DNA ploidy pattern is a valuable independent prognostic factor for gastric cancer, and that it is more useful for evaluating the prognosis of patients with more advanced lesions undergoing “curative resection.”
Inhibition of Unstimulated Exocrine Pancreatic Secretion by Peptide YY in the Rat
Authors: Robinson Diane C. , Rudnicki Marek , Tito Joseph M. , Gold Michael S. 
Published: August 2002

AbstractPeptide YY is an ileocolonic peptide known to inhibit postprandial and cholecystokinin‐induced pancreatic exocrine secretion. It has also been shown to increase intestinal water and electrolyte absorption. These findings implicate PYY as being potentially useful for controlling watery diarrhea. Although its inhibitory effect on stimulated pancreatic secretion has been well established, PYY effects on interdigestive, unstimulated pancreatic secretion is not known. This study was designed to evaluate the effect of PYY on basal pancreatic exocrine secretion in a conscious rat. Male Sprague‐Dawley rats were prepared with catheters for internal biliary bypass, pancreatic juice collection, and intraduodenal reinfusion of pancreatic juice. Jugular and carotid catheters were inserted for drug infusions and blood sampling. After overnight recovery, fasting rats were infused over 6 hours with saline or PYY (400 or 800 pmol/kg/hr). Pancreatic juice was measured and sampled at 60‐minute intervals for volume and its protein and bicarbonate content. The remainder was reinfused into the duodenum. Before and after the experiment, pancreatic juice was automatically reinfused by a photocell‐controlled peristaltic pump system. Intraductal pancreatic secretion was not affected by PYY at a dose of 400 pmol/kg/hr. PYY at a dose of 800 pmol/kg/hr significantly reduced the volume of pancreatic secretion and its protein and bicarbonate content. Pancreatic secretory response normalized within 24 hours. In conclusion, unstimulated pancreatic exocrine secretion can be inhibited by exogenous PYY in the rat.
Sepsis, SIRS, and MODS: What’s in a Name?
Authors: Nathens Avery B. , Marshall John C. 
Published: August 2002

AbstractProgress in the care of the critically ill patient with life‐threatening infection has been hampered by inconsistent, often confusing terminology. The clinical syndrome of sepsis—familiar to all yet definable by none—describes a highly heterogeneous group of disorders with different causes and differing prognoses. The imminent availability of mediator‐directed therapy has created a sense of urgency to develop better methods for delineating discrete clinical syndromes and to modulate the host response, which may bring both benefit and harm, depending on the clinical circumstances. The term systemic inflammatory response syndrome (SIRS) was introduced several years ago to describe the familiar clinical syndrome of sepsis, independent of its cause. SIRS can result from trauma, pancreatitis, drug reactions, autoimmune disease, and a host of other disorders; when it arises in response to infection, sepsis is said to be present. SIRS describes a dynamic process that has adaptive survival value for the host. The maladaptive consequence of this process in the critically ill patient is the development of progressive but potentially reversible remote organ dysfunction—the multiple organ dysfunction syndrome. The development of cogent conceptual frameworks for classification of the septic response in critically ill patients is more than a question of linguistic pedantry. Optimal therapy presupposes identification of an homogeneous patient population with a characteristic disease process and a predictable response to an intervention. Although progress has been made in identifying such groups of critically ill patients, the disappointing results of clinical trials of agents that so clearly demonstrate efficacy in animal models indicates that considerable work remains.
Peritoneal Carcinomatosis from Adenocarcinoma of the Colon
Authors: Sugarbaker Paul H. , Schellinx Monique E. T. , Chang David , Koslowe Patricia , von Meyerfeldt Maarten 
Published: August 2002

AbstractPeritoneal carcinomatosis is a major cause of surgical treatment failure in patients with colorectal cancer. In the past patients with this condition have had a lethal outcome. In this study, 64 consecutive patients were treated by the cytoreductive approach, which involved surgery to maximally resect all cancer in the abdomen and pelvis, early postoperative intraperitoneal chemotherapy with 5‐fluorouracil (5‐FU) and mitomycin C, and three cycles of adjuvant intraperitoneal 5‐FU with systemic mitomycin C. The clinical features that may affect prognosis were assessed and critically analyzed statistically. Peritoneal implant size of < 5 cm present in the abdomen and pelvis at the time of exploration correlated with a good prognosis (p < 0.0001), as did complete cytoreduction with tumor removed to nodules < 2.5 mm (p < 0.0001). Involvement of only one or two of the five abdominopelvic regions, compared to three or more regions, was a significant determinant of prognosis (p < 0.0001). Finally, a mucinous histologic type correlated adversely with prognosis when compared to intestinal‐type adenocarcinomas (p < 0.001). These data suggest that patients with small‐volume peritoneal seeding from colon cancer should be treated with cytoreductive surgery and aggressive regional and systemic chemotherapy in an attempt to achieve long‐term disease‐free survival.
Tropical Pyomyositis
Authors: Ansaloni Luca 
Published: August 2002

AbstractTropical pyomyositis (TP), a suppurative disease caused predominantly by Staphylococcus aureus, is responsible for 3% to 4% of surgical admissions in some hospitals in certain tropical countries. This study describes the clinical features of 35 patients with TP (20 males, 15 females; mean ± SD age 28.3 ± 14.1 years) admitted to our hospital during a 1‐year period and analyzes the causal association between ancylostomiasis, human immunodeficiency virus (HIV) infection, and TP. Concerning the supposed etiologic association between Ancylostoma duodenale infection and TP, among the 35 patients with TP the stool examination of 22 (62.8%) revealed the presence of eggs of A. duodenale. In a control group of 100 asymptomatic subjects the prevalence of ancylostomiasis was 55%. The Odds ratio between the two groups is 1.38 (exact 95% confidence limits = 0.59 < OR < 3.34). Furthermore, the pus from all TP abscesses (41 in 35 patients) was carefully collected and examined microscopically, but nematode larvae were not detected in any of the specimens. Hence these results do not support an association between ancylostomiasis and TP. With the aim of correlating TP with HIV infection, I carried out a case‐control comparison of HIV seroprevalence among the patients affected by TP and an age‐ and sex‐matched control group of healthy subjects. Eleven patients with TP were HIV antibody‐positive (seroprevalence 31.42%), as were two controls (seroprevalence 5.71%). The matched analysis produced a Mantel‐Haenszel matched Odds ratio of 5.50 and a maximum likelihood estimate of OR (MLE) of 5.50 (exact 95% confidence limits for MLE: 1.20 < OR < 51.07). Among the 11 patients HIV‐seropositive, 9 (81.8%) fulfilled the World Health Organization clinical case definition (CCD) for AIDS, compared with 1 of 24 (4.1%) HIV‐negative subjects. The chi‐square test for difference in fulfilling the CCD for AIDS between patients with TP seropositive and seronegative result was statistically significant (p < 0.0001). It is concluded that TP is a bacterial infection highly significantly associated with HIV infection and thus must be considered a strong sign of stage III–IV of HIV disease.