bluuebunny/crossref_metadata_2025_split huggingface dataset:
Blunt Liver Injuries in Polytrauma: Results from a Cohort Study with the Regular Use of Whole‐body Helical Computed Tomography
Authors: Matthes Gerrit , Stengel Dirk , Seifert Julia , Rademacher Grit , Mutze Sven , Ekkernkamp Axel 
Published: November 2003

AbstractThe estimated prevalence of liver injury in patients with blunt multiple trauma ranges from 1% to 8%. The objective of this study was to investigate the profile of accompanying liver injury in a cohort of polytraumatized patients who had regularly undergone contrast‐enhanced, whole‐body helical computed tomography (CT). We enrolled consecutive patients admitted between September 1997 and January 2001 to a level I trauma center. Clinical baseline data were compiled as part of a nationwide trauma registry. Morphologic features were evaluated descriptively, whereas prognostic variables were assessed by logistic regression analysis. We identified 218 patients [149 men, mean age 35 ± 18 years, mean injury severity score (ISS) 35 ± 10], 55 of whom had sustained blunt liver trauma [25.2%, 95% confidence interval (CI) 19.6–31.5%]. The prevalence of Moore III to V lesions was 10.1%. There were 99 parenchymal contusions, 15 capsular tears, and 2 liver fractures. Surgery was required in 15 patients and was best predicted by the classification of the American Association for the Surgery of Trauma [odds ratio (OR) 3.91, 95% CI 1.59–9.61]. The mortality rate was 0.0035/person/day. Patients requiring surgical repair had fourfold increased relative odds of case fatality (OR 4.50, 95% CI 1.01–19.96). Sevenfold increased relative odds were observed if liver laceration was considered the leading injury (OR 7.17, 95% CI 1.17–43.97). The prevalence of liver lacerations among multiple‐trauma patients is likely to be underestimated and must be determined by the independent application of reference standards, such as helical CT. High‐grade hepatic injuries and the need for surgical repair are associated with poorer survival prognosis.
Intraperitoneal Administration of the Angiogenesis Inhibitor Thalidomide Does Not Impair Anastomotic Healing following Large Bowel Resection in a Rabbit Model
Authors: Mall Julian W. , Schwenk Wolfgang , Philipp Andreas W. , Büttemeyer Rolf , Pollmann Christian 
Published: November 2003

AbstractThe effects of thalidomide after intraperitoneal instillation on the healing of colonic anastomoses are not known. A series of 40 New Zealand White rabbits underwent an end‐to‐end colonic anastomosis. The animals were randomized into four groups. Groups 1 (n = 10) and 2 (n = 10) were treated with dissolved thalidomide 200 mg/kg intraperitoneally, whereas groups 3 (n = 10) and 4 (n = 10) were treated only with the dissolver. Animals were sacrificed at day 3 (groups 1, 3) and day 7 (groups 2, 4). Anastomotic healing was tested by measuring the bursting pressure in vitro. Immunohistochemical staining of the anastomotic site was performed with polyclonal antibodies against CD31 and Mib‐1, to determine a possible antiangiogenic or antiproliferative effect. Statistical analysis was performed using Spearman’s log rank correlation and paired t‐test. On postoperative day 3 (p > 0.19) and postoperative day 7 (p > 0.73), there was no difference in bursting pressure in the treatment and the control groups. Angiogenesis scores were reduced at day 3 in the thalidomide group (p < 0.05), but did not differ between the groups at day 7. White blood cell counts were decreased in the treatment groups at day 3 (p < 0.01) and day 7, compared to control groups (p < 0.01). There was no difference in the expression of Mib‐1 in either group at day 3 or day 7. The intraperitoneal administration of thalidomide does not interfere with the healing of colonic anastomosis. Although the angiogenesis score is diminished at day 3, this did not lead to a reduced bursting pressure at day 3 or day 7.
Ideal Reconstruction after Total Gastrectomy by the Interposition of a Jejunal Pouch Considered by Emptying Time
Authors: Tono Chiriro , Terashima Masanori , Takagane Akinori , Abe Karoru 
Published: November 2003

AbstractTo establish the ideal form of the pouch for jejunal pouch interposition reconstruction (JPI) after total gastrectomy, the postoperative gastrointestinal function and symptoms were investigated in comparison with jejunal interposition reconstruction (JI). A total of 20 patients who underwent curative surgery for gastric cancer were enrolled in this study. In the JI group (n = 9), an isoperistaltic jejunum about 40 cm in length was interposed between the esophagus and the duodenum. In the JPI group (n = 11), a proximal pouch about 15 cm in length with a 10‐cm conduit was also interposed between the esophagus and the duodenum. At follow‐up 6 months postoperatively, food transit was evaluated using a radiolabeled semisolid test meal. The half‐emptying time was 6.9 minutes in the JI group and 46 minutes in the JPI group. The reservoir function influenced the recovery of the patients’ body weight and development of the serum total protein in the early postoperative period. An early half‐emptying time caused dumping symptoms in JI group. In the JPI group, there were no dumping symptoms; however, extended food clearance of pouch causes postprandial symptoms such as reflux (1 patient), vomiting (2 patients), and discomfort (2 patients). In those patients with symptoms, half‐emptying times were longer than 60 minutes. There was a statistically significant correlation between the pouch length and the half‐emptying time of the gastric substitute in JPI group (p = 0.0039, r = 0.789). If we estimate that the appropriate half‐emptying time is 20 to 60 minutes, correlation of the pouch length and the half‐emptying time shows that the ideal pouch length is about 12–15 cm in JPI. In jejunal pouch interposition reconstruction after total gastrectomy, an adequate procedure leads to nutritional advantage and prevents postoperative symptoms.
Pathological Basis of Gastroesophageal Reflux Disease
Authors: Chandrasoma Parakrama 
Published: November 2003

AbstractMany of the present definitions of Barrett’s esophagus are based on the dogma that 2 to 3 cm of cardiac mucosa normally line the distal esophagus and proximal stomach. Recent autopsy data refute this dogma. Cardiac mucosa has been shown to be frequently absent from the squamocolumnar junctional zone. When present, its extent is less than 0.5 cm in almost all children and most adults. Cardiac mucosal length increases with age. Patients who have cardiac mucosa are significantly more likely to have abnormal acid exposure in the esophagus as measured by 24‐hour pH studies. The length of the cardiac mucosa correlates significantly with the amount of reflux: the greater the length of the cardiac mucosa, the more reflux there is. These new data provide insights into the pathology of gastroesophageal reflux. Normalcy is defined as an esophagus lined by squamous epithelium and a stomach lined by gastric mucosa. Reflux disease is defined by the presence of cardiac mucosa in a junctional biopsy. The severity of reflux disease is quantifiable by the length of cardiac mucosa present. Mutational reflux disease (Barrett’s esophagus) is defined by the occurrence of intestinal metaplasia in cardiac mucosa and is quantitated by the amount of intestinal metaplasia present. Neoplastic reflux disease is defined as the occurrence of low grade dysplasia, high grade dysplasia, and adenocarcinoma in Barrett’s esophagus. An attempt is made here to develop a rational grading system for reflux based on these highly objective histologic criteria.
Barrett’s Esophagus: Model of Neoplastic Progression
Authors: Ramel Stig 
Published: November 2003

AbstractHuman cancer progression is characterized by clonal expansion of cells with accumulated genetic errors. Invasive carcinomas contain all the genetic errors that were acquired during neoplastic progression and then continue to accumulate further abnormalities, leading to tumor heterogeneity. Many investigations of human cancer have given valuable insights in genetic abnormalities important for tumor biology. Early events responsible for neoplastic progression, however, are often impossible to investigate in invasive cancers because the premalignant tissue in which the tumors develop are often overgrown and the premalignant conditions cannot be studied in vivo because they are either not detected owing to lack of symptoms or are removed before cancer develops. Unlike many other premalignant conditions Barrett’s esophagus is often associated with symptoms leading to diagnosis at an early stage before cancer develops, and the premalignant epithelium is seldom removed at an early stage of cancer progression. Furthermore, in patients who present with invasive carcinoma the tumor is often surrounded by premalignant epithelium, which is available for further investigations. Therefore Barrett’s esophagus is an excellent model in which to study the early events of neoplastic progression. It may not only contribute to a better understanding of the neoplastic process but also provide a base for safer assessment of cancer risk during surveillance for early detection of esophageal adenocarcinoma.
Prevention of Adenocarcinoma by Reversing Barrett’s Esophagus with Mucosal Ablation
Authors: Sampliner Richard E. 
Published: November 2003

AbstractThe ultimate goal of therapy in patients with Barrett’s esophagus (BE) is to reduce the risk of developing adenocarcinoma of the esophagus. Neither pharmacologic nor surgical therapy has been documented to reduce this risk. There is preliminary evidence that many forms of mucosal ablation combined with acid reduction therapy result in restitution of normal squamous epithelium in patients with BE. Acid reduction can be accomplished with high‐dose proton pump inhibitor therapy or antireflux surgery. Endoscopic ablation can be accomplished with photodynamic therapy, laser, multipolar electrocoagulation, a heater probe, and argon plasma coagulation. These techniques require further study so the complication rates can be compared. The success of reversing BE must be evaluated in a standard way utilizing large‐capacity biopsy forceps through a therapeutic endoscope. Ideally, patients at high risk of developing adenocarcinoma of the esophagus can be treated with ablation therapy and followed to document a reduction in the development of adenocarcinoma of the esophagus. A validated biomarker would help select high risk patients appropriate for reversal therapy. Currently, patients who are at prohibitive risk for surgery or who refuse surgery are candidates for combination therapy including mucosal ablation to reverse their BE. This therapy offers the promise of less morbidity and greater quality of life than resection.
Surgical Competence
Authors: Patil Nivritti G. , Cheng Stephen W.K. , Wong John 
Published: November 2003

AbstractRecent high‐profile cases have heightened the need for a formal structure to monitor achievement and maintenance of surgical competence. Logbooks, morbidity and mortality meetings, videos and direct observation of operations using a checklist, motion analysis devices, and virtual reality simulators are effective tools for teaching and evaluating surgical skills. As the operating theater is also a place for training, there must be protocols and guidelines, including mandatory standards for supervision, to ensure that patient care is not compromised. Patients appreciate frank communication and honesty from surgeons regarding their expertise and level of competence. To ensure that surgical competence is maintained and keeps pace with technologic advances, professional registration bodies have been promoting programs for recertification. They evaluate performance in practice, professional standing, and commitment to ongoing education.
The Surgeon and Human Immunodeficiency Virus
Authors: Mielke Jens , Kalangu Kazadi K.N. 
Published: November 2003

AbstractThe moral dilemmas faced by surgeons worldwide who treat patients infected with the human immunodeficiency virus (HIV) can be viewed against the background of experience in sub‐Saharan countries, where the community prevalence is in excess of 25% (90% of hospital inpatients). When seeking consent for an HIV test before surgery, frank communication regarding the surgeons’ perspective of risks to themselves and the patient is helpful. When consent for a test must be obtained from a substitute decision‐maker, the surgeon should consider if the patient would want the decision‐maker to know the result. Understanding the natural history of HIV in the surgical setting can help deal with the uncertainties encountered and should be a research priority for developing countries. International professional organizations are useful platforms for the exchange of ideas when surgeons encounter uncertainty by increasing access to journals and creating opportunities for discussion. Although supervisory bodies in some parts of the world prevent HIV‐infected surgeons from putting patients at risk by offering surgery, the withdrawal of their services in developing countries can cause more harm than good. Surgeons in that position may be entitled to offer surgery but only with full disclosure of the risk of HIV infection to the patient. The decision‐making process known as ”accountability for reasonableness” allows surgeons to determine fairness, legitimacy, and acceptability when making resource allocation decisions involving patients with HIV.
Cardiac Surgery in Eastern Europe: Continuing Challenge
Authors: Borst Hans G. 
Published: November 2003

AbstractThe post‐Soviet calamities of East European cardiac surgery highlight the spectrum of marked differences in overall operative capacities among individual post‐Communist countries. A comparison with the level of cardiac surgery in Western Europe reveals the importance of continuing relief, comprising both educational and material help. The East European Program of the European Association for Cardio‐thoracic Surgery exemplifies current efforts to address these needs.
Preservation of Form and Function during Management of Cancer of the Larynx and Hypopharynx
Authors: Lefebvre Jean Louis , Lartigau Eric 
Published: November 2003

AbstractThe treatment of laryngeal and hypopharyngeal cancer has seen notable changes during the twentieth century. Intensive surgical research has allowed laryngologists to deal with almost any local extension and to propose an appropriate surgical procedure for each case. This surgery is able to control the disease in most patients locally but is limited in its indications (resectable diseases and operable patients). On the other hand, radiotherapy has been impressively improved (dosimetry, definition of target volume) and has become an indisputable alternative to surgery. The two approaches are comparable in terms of local control and functional results when dealing with early disease. For advanced disease, however, the debate is open between surgery, which is more efficient but mutilating, and radiotherapy, which can preserve the larynx in many instances even though it requires sometimes mutilating surgery for salvage. The appearance of platinum‐based chemotherapy has updated this discussion. To date, most of the randomized comparisons of mutilating/nonmutilating approaches have been with induction chemotherapy followed by irradiation if there has been a good clinical response to the chemotherapy. There are other options as well that deserve evaluation (e.g., radiotherapy with altered fractionation or with concurrent chemotherapy), although surgery still seems to be indicated in certain cases. Finally, efforts should be made to select patients properly (based on tumor characteristics, clinical aspects, imaging, and biology) for the various strategies with the primary goal of curing the patient and secondarily to preserve laryngeal form and function when possible.
Preoperative Radiotherapy for Adult Head and Neck Soft Tissue Sarcoma: Assessment of Wound Complication Rates and Cancer Outcome in a Prospective Series
Authors: O’Sullivan Brian , Gullane Patrick , Irish Jonathan , Neligan Peter , Gentili Fred , Mahoney James , Sellmann Susanna , Catton Charles , Waldron John , Brown Dale , Witterick Ian , Freeman Jeremy , Bell Robert 
Published: November 2003

AbstractCombination surgery and radiotherapy (RT) is frequently used in soft tissue sarcoma (STS). Because lower doses and smaller irradiation volumes are possible in preoperative RT (pre‐op RT), this approach can be especially valuable in anatomic settings where critical organs are in close proximity to the RT target area. A recent multicenter phase III trial (SR.2 trial of the National Cancer Institute of Canada Clinical Trials Group) comparing pre‐op RT against post‐op RT for extremity STS has shown significantly higher major wound complication rates (35%) with pre‐op RT. We postulated that wound complication rates may be less frequent in the head and neck with better vascularity and wider use of secondary wound reconstruction. Using a prospective database, we identified 40 consecutive patients with head and neck STS treated with pre‐op RT (50 Gy) and subsequent (4 to 6 weeks later) resection between 1/89 and 8/99 in a single institution setting. Major wound complications (MWC) were classified by the identical criteria used in the SR.2 trial. Intracranial extension was evident in 5 patients, whereas 50% of the patients had large tumors (> 5 cm). Deep tumor was present in 34 (85%), and 6 (15%) were superficial to fascia. In this series, 31 patients (77.5%) had secondary reconstruction of the acquired soft tissue deficit. The actuarial 2‐year local relapse‐free rate was 80%, and the metastatic relapse‐free rate was 85%. Major wound complications occurred in 8 of 40 patients (20%) within 120 days of surgery according to the SR.2 criteria: secondary wound surgery (3), readmission or prolonged hospital admission for wound care (2), deep packing (0), prolonged dressing changes (2), and invasive procedure for wound care (1). The latter was a minor wound management problem (a single outpatient drainage of a seroma) for the combined rate of 8/20 or 20%. Our findings show that (1) pre‐op RT in head and neck STS is associated with lower rates of major wound complications compared to extremity cases; (2) pre‐op RT provides high rates of local control in an adverse group of cases of adult head and neck STS; (3) the choice of scheduling of RT should be based on anatomic issues with emphasis on the trade‐offs between RT doses and volumes versus wound morbidity for individual patients. This is especially important when tumor may be adjacent to critical head and neck structures which may be protected from the high‐dose RT area.
Quality‐of‐life Outcomes in Head and Neck Cancer Patients
Authors: Morton Randall P. , Izzard Mark E. 
Published: November 2003

AbstractQuality‐of‐life (QL) is a relatively new concept in head and neck oncology outcomes research. It is important to have a clear definition and to use reliable and valid measures in its assessment. QL studies should use patient self‐reported data and should account for treatment or disease‐related symptoms and the domains of physical and psychosocial functioning, together with a patient‐rated global QL score. Within head and neck cancer there are very distinct differences between sites. Oral cancer and laryngeal cancer lead to very different QL outcomes. Care must be used when comparing treatments; organ‐preservation techniques do not necessarily lead to better QL outcomes, especially in laryngeal cancer. An assessment of life‐utility (QALY) may be helpful in determining how meaningful survival is after treatment, and can be used to provide information to purchasers of health care services in support of better resource allocation for head and neck cancer patients.
Surgery for Inguinal Hernia in Byzantine Times (A.D. 324–1453): First Scientific Descriptions
Authors: Lascaratos John G. , Tsiamis Constantine , Kostakis Alkiviadis 
Published: November 2003

AbstractThe aim of this article is to present the techniques applied by Byzantine physicians for inguinal hernia repair and to note their influence on the development of surgery after that time. A study and analysis of the original texts of the Byzantine medical writers, written in Greek, and containing the now mostly lost knowledge of the ancient Hellenistic and Roman periods, was undertaken. Two Byzantine physicians, Aetius of Amida (6th century A.D.) and Paul of Aegina (7th century A.D.), described two techniques for confrontation of inguinal hernia, namely the surgical removal of the prolapsed peritoneum and the cauterization of the groin. These methods were probably derived from the texts of earlier Greek surgeons to which they added their own keen observations. The study of Byzantine medical and literary texts proves that the surgical techniques for inguinal hernia were practiced in Byzantine times and influenced later Arabian and European surgery, thus constituting significant roots of surgery.
Radical Surgery for Mesothelioma: How CanWe Obtain Evidence?
Authors: Treasure Tom , Swift Simon , Tan Carol 
Published: November 2003

AbstractAsbestos exposure in industry and construction sites in the
1960s and 1970s has left a legacy of mesothelioma, a diffuse pleural cancer,
with a lag time of 40 to 50 years and due to peak around 2015 to 2020. Some
surgeons believe that by radical surgery they can prolong life and relieve
symptoms, but the evidence comes from very carefully selected series. How do
surgeons respond to demand for evidence of benefit? In this article we explore
how evidence for major surgical operations has been gained and how mesothelioma
fits into this history.
Role of Surveillance in Intestinal Metaplasia of the Esophagus and Gastroesophageal Junction
Authors: Tytgat Guido N.J. , van Sandick Johanna W. , Lanschot J. Jan B. van , Obertop Huug 
Published: November 2003

AbstractThis article reviews current concepts of cancer surveillance in esophageal columnar metaplasia (Barrett’s esophagus) and intestinal metaplasia at the gastroesophageal junction. An overview is given of the available data on the prevalence of intestinal metaplasia in biopsies from the distal esophagus and from the gastroesophageal junction. Furthermore, special attention is given to the endoscopic detection of dysplasia and early malignancy. Finally, the costs of endoscopic surveillance and its effect on mortality rates from esophageal adenocarcinoma are discussed.
Do patients drop out prematurely from exposure therapy for PTSD?
Authors: Hembree Elizabeth A. , Foa Edna B. , Dorfan Nicole M. , Street Gordon P. , Kowalski Jeanne , Tu Xin 
Published: November 2003

AbstractMany studies have demonstrated the efficacy of exposure therapy in the treatment of chronic posttraumatic stress disorder (PTSD). Despite the convincing outcome literature, a concern that this treatment may exacerbate symptoms and lead to premature dropout has been voiced on the basis of a few reports. In this paper, we examined the hypothesis that treatments that include exposure will be associated with a higher dropout rate than treatments that do not include exposure. A literature search identified 25 controlled studies of cognitive–behavioral treatment for PTSD that included data on dropout. The results indicated no difference in dropout rates among exposure therapy, cognitive therapy, stress inoculation training, and EMDR. These findings are consistent with previous research about the tolerability of exposure therapy.