bluuebunny/crossref_metadata_2025_split huggingface dataset:
Staging of squamous esophageal cancer: Accuracy and value
Authors: Hölscher Arnulf H. , Dittler Hans Joachim , Siewert J. Rüdiger 
Published: October 2004

AbstractEndoscopic ultrasonography (EUS) and computed tomography (CT) should be used as complementary methods for TNM staging of esophageal cancer. EUS is the most accurate modality for staging primary tumor and mediastinal lymph node metastases. CT should be used to detect infiltration of other mediastinal organs and distant metastases. For esophageal cancer staging magnetic resonance imaging (MRI) is not superior to CT. For detection of cervical lymph node metastases percutaneous ultrasonography is appropriate. In patients with advanced distal carcinoma of the esophagus, hepatic and peritoneal metastases and intraabdominal lymph node infiltration should be ruled out by laparos‐copy prior to surgery. The results of preoperative staging are relevant if the management of esophageal cancer comprises not only surgery but also endoscopic mucosectomy, primary palliative procedures, and especially neoadjuvant radiochemotherapy. Within therapeutic trials the precise staging prior to treatment is essential for analysis of the results. The value of routine postoperative staging during a follow‐up program is yet unproved for esophageal cancer.
Esophageal cancer, early disease: Diagnosis and current treatment
Authors: Becker Horst Dieter 
Published: October 2004

AbstractMost esophageal cancers are at a fairly advanced stage at the time of diagnosis, and curative therapy is not possible. For those that are detected early, cure may be possible, particularly if there is no lymphatic spread. Radical therapeutic approaches result in increased treatmentrelated mortality, high treatment‐induced morbidity, and reduced quality of life. Therefore it is one of the major targets in the treatment of esophageal cancers to classify the tumor and to perform adequate stage‐related therapy. The modern diagnositic procedures, such as endoscopy, endoluminal sonography, computed tomography (CT) scanning, and endoscopic biopsy, have led to major advances in preoperative staging. Endoluminal sonography is able to predict the depth of tumor infiltration in the esophageal wall and the existence of local lymph node metastasis, whereas CT scanning demonstrates distant metastasis. Histologic classification of the tumor together with genetic and cell biologic characteristics can predict the prognosis. Currently, the best prospect for cure of early esophageal cancer is surgical resection through the abdominothoracic approach, although less radical surgical procedures such as transhiatal resection without extensive lymph node dissection seem to achieve the same results. Even less traumatic is the use of minimal invasive techniques, which certainly will be used more often in the future. For early esophageal cancers limited to the epithelium and the lamina propria, local destruction of the tumor leads to long‐term survival and cure. Techniques such as endoscopic resection, laser coagulation, photodynamic laser activation and argon beam exposure have been described and seem to achieve similar results. Another conservative method for treating early esophageal tumors is radiotherapy, although it has been shown in several studies that radiochemotherapy is superior to radiotherapy alone, at least in more advanced cases. In future, treating local early esophageal tumors will consist in exact preoperative staging followed by a surgical therapy that includes local excision of tumors limited to epithelium or a more aggressive approach if advanced infiltration of the esophageal wall has been proved. In these cases combined radiochemotherapy plus surgery is promising. In cases with increased operative risk the combination of local tumor destruction plus radiocheotherapy may improve the results.
Operable squamous esophageal cancer: Current results from the East
Authors: Zhang Da Wei , Cheng Gui Yu , Huang Guo Jun , Zhang Ru Gang , Liu Xiang Yang , Mao Yu Sun , Wang Yong Gang , Chen Sin Jie , Zhang Liang Ze , Wang Liang Jun , De Zhang Cao , Yang Lin , Meng Pin Jun , Sun Ke Lin 
Published: October 2004

AbstractFrom 1958 through 1992 a total of 3603 patients underwent surgery for esophageal squamous cell carcinoma in our department. Among these patients 3099 resections were performed, for an overall resectability of 86.0%. Of the resections, 2341 (75.5%) were classified as curative and 758 (24.5%) palliative. The overall morbidity and 30‐day mortality rates were 23.4% and 3.8%, respectively. For resected cases the mortality was 4.0%. The more than 5‐year follow‐up rate of patients with resection was 97%. The actual 5‐, 10‐, and 15‐year survival rates were 30.4%, 23.6%, and 17.9%, respectively. Recurrence or metastasis remained the cause of death in 60.9% and 25.5% of patients who lived longer than 5 years and 15 years, respectively, after operation. The TNM staging, lymph node metastasis, extraesophageal invasion, tumor differentiation, tumor length, and category of operation were major determinants influencing long‐term prognosis. The left thoracotomy approach was used exclusively in 2613 cases (84.3% of all resected cases) in which intrathoracic resections and anastomoses were performed. The stomach was used as a substitute for the esophagus in 98.8% of the resected cases compared with 1.2% colon transplants. The former procedure was far safer than the latter. Above‐average results presented in this paper support the surgical policy we have pursued thus far: to resect the primary tumor by partial or subtotal esophagectomy and to remove all lymph nodes wherever they were found in all patients with disease earlier than stage III. Early detection and early treatment no doubt are the only ways to materially improve the long‐term surgical results.
Operable esophageal cancer: Current results from the West
Authors: Watson Anthony 
Published: October 2004

AbstractResults are presented from a consecutive series of 396 patients referred to hospital in one of the areas of highest incidence in the United Kingdom in a unit that saw all referred cases for assessment and subsequent decision on the most appropriate therapeutic modality. Standard criteria were applied when selecting those patients in whom an attempt at curative resection was justified. Of the 396 patients, only 164 (41%) were considered fit enough to undergo thoracoabdominal resection and to have a tumor that had not invaded contiguous structures or metastasized. The remainder were treated by palliative intubation and more recently by laser photocoagulation. Of the patients who underwent resection, most had an Ivor Lewis esophagogastrectomy and lymphadenectomy, those with proximal lesions undergoing three‐stage total esophagectomy. The overall 30‐day mortality was 8.3%, falling to 6.7% during the period 1985–1990 when thoracic epidural analgesia was used routinely and fatal respiratory complications were avoided. Overall 5‐year survival rate was 23%. However, stratification for tumor staging showed that the 5‐year survival for node‐negative patients was 47% and for tumors confined within the adventitia 71%. Results of surgical treatment of squamous esophageal carcinoma in the West are considerably more depressing than those in many Eastern series. This difference is largely related to the late presentation in the West, as the relatively low incidence does not justify screening programs. However, results equivalent to those in Eastern series are obtained for the small subset of patients who do present with early disease. More than 90% of patients were able to eat satisfactorily and to gain weight after resection, although return to previous best weight occurred infrequently and was usually confined to patients surviving beyond 5 years. Although adjuvant therapy was used little in this series, it is believed that current prospective studies involving amultimodal adjuvant regimens offer the best hope of improving survival.
Lymph node dissection
Authors: Hennessy Thomas P. J. 
Published: October 2004

AbstractCervical lymph nodes are involved in 43% of patients with an upper esophageal lesion, 33% of patients with a middle third tumor, and 29% with a tumor of the lower third. Conventional two‐field lymph node dissection removing the abdominal and lower mediastinal lymph node groups leads to inaccurate staging and is inadequate for preventing local recurrence. Three‐field lymphadenectomy involves bilateral removal of the lower cervical groups of nodes, the superior, middle, and inferior mediastinal lymph nodes and the abdominal groups. The advantages of this extended dissection are improved survival, diminished incidence of local recurrence, and more accurate staging. The benefits in terms of improved survival may accrue to patients both with and without cervical lymph node involvement. Three‐field node dissection improves 5‐year survival to around 35% without an increase in the mortality rate. The incidence of recurrent laryngeal nerve paralysis is increased with the operation and could be as high as 14% or more.
Advanced esophageal carcinoma
Authors: Lerut Toni E. , de Leyn Paul , Coosemans Willy , Van Raemdonck Dirk , Cuypers Philippe , Van Cleynenbreughel Ben 
Published: October 2004

AbstractFrom 1976 until 1990 a total of 212 patients with squamous cell carcinoma of the thoracic esophagus were referred for surgical treatment. Resectability was 84.1% (161 of 191). Actuarial 5‐year survival in patients with negative lymph nodes was 51.2% versus 12.4% in lymph nodepositive patients. Therefore advanced carcinoma was defined to compromise all patients with involved regional (N1) or distal lymph nodes (M+Ly) as well as patients with T4 tumors or solid organ metastasis (M+org) irrespective of their lymph node status. Comparing complete (R0) versus incomplete (R1–R2) resections for stage III and IV carcinoma revealed 20% and 0% five‐year survivals, respectively. There was no 5‐year survival in the stage IV group. When excluding solid organ metastasis, the median survival shifted from 8.5 months after incomplete (R1–R2) to 20 months after complete (R0) resection. In 1991 three‐field lymphadenectomy was initiated that included bilateral cervical lymphadenectomy. Thirty‐seven patients have been treated so far (23 squamous cell carcinoma, 14 adenocarcinomas). Cervical lymph nodes were positive in 24.3% with an incidence up to 28.5% for distal‐third carcinoma. Subsequently, 6 patients (16%) moved from M0 to M+Ly status. Our results confirm the key role of surgery not only in improving survival and locoregional tumor control but in refining the accuracy of staging advanced carcinomas provided complete resection is possible. Nowadays other options in the treatment of advanced carcinoma are mainly based on neoadjuvant chemoradiotherapy with response rates ranging from 40% to 60% but until now without evidence of improved 5‐year survival rates and with local or distant failure rates of approximately 30% and 45%, respectively. For clinically nonresectable (T4) or presumed nonresectable tumors, neoadjuvant therapy seems to have an important role, as it may convert these tumors into resectable and therefore potentially curable cancers. Toxicity remains a drawback, as it is probably responsible for preoperative dropouts and slight but definitive higher postoperative mortality and morbidity. When the disease clearly is incurable, the best options today are laser therapy and an endoprosthesis, which result in good relief of dysphagia in approximately 80% to 85% of patients and a procedure‐related mortality below 5%.
Quality of life with carcinoma of the esophagus
Authors: Gelfand Gary A. J. , Finley Richard J. 
Published: October 2004

AbstractManagement of squamous carcinoma of the esophagus remains a dilemma for the clinician. Current treatments produce significant morbidity and mortality, yet most patients still die of their disease. Given the limitations, survival alone is insufficient to assess the various options; quality of life (QOL) must also be addressed. This paper reviews the topic of QOL, the various instruments available to measure it, and methods to evaluate such instruments. A 16‐year review of the literature was performed to assess the extent to which QOL has been addressed in patients with esophageal carcinoma. Only 51 of 7569 references on esophageal neoplasms considered QOL. Only 3 used documented QOL instruments with appropriate statistical testing. Currently there is no well validated instrument for measurement of QOL in patients with esophageal carcinoma.
Human parathyroid blood supply determined by laser‐Doppler flowmetry
Authors: Johansson Kenth , Ander Stefan , Lennquist Sten , Smeds Staffan 
Published: October 2004

AbstractThe blood supply of 53 normal human parathyroid glands was studied with laser Doppler flowmetry in 45 patients undergoing operations on the thyroid and parathyroid glands. The inferior and superior thyroid arteries and other vessels that might supply the parathyroid glands were occluded so their contribution to parathyroid perfusion could be studied. Occlusion of the main trunk of the inferior thyroid artery resulted in a reduction of blood flow by one‐third, and a similar reduction was obtained after occlusion of the superior thyroid artery. The results demonstrate that the blood supply to the parathyroid glands is not as dependent on the inferior thyroid artery as has previously been suggested but that other routes of blood supply may be equally or, in some cases, even more important.
Minimizing the risk of bile duct injury at laparoscopic cholecystectomy
Authors: Cox Michael R. , Wilson Thomas G. , Jeans Philip L. , Padbury Robert T. A. , Toouli James 
Published: October 2004

AbstractThe introduction of laparoscopic cholecystectomy (LC) has been associated with an increase in the incidence of operative bile duct injuries. An operative technique that involves commencing the laparoscopic dissection on the body of the gallbladder and dissecting toward the cystic duct has been developed that minimizes the risk of major duct injury. The aim of this study was to assess prospectivel the safety of this dissection technique. A group of 410 patients underwent LC for symptomatic cholelithiasis from January 1991 to December 1992. There was a single common hepatic duct injury: a small (1 mm) side hole in a patient with acute cholecystitis and choledocholithiasis. It was managed at open operation with exploration of the common bile duct and insertion of a T‐tube. There were no partial or complete common bile duct transections in this series. We concluded that the technique of commencing the dissection on the gallbladder is safe and minimizes the risk of serious common bile duct injury at LC.
Clinicopathologic features of gastric cancer infiltrating the lower esophagus
Authors: Takeshita Kimiya , Ashikawa Toshihisa , Tani Masao , Saito Naoya , Maruyama Michio , Sunagawa Masakatsu , Habu Hiroshi , Endo Mitsuo 
Published: October 2004

AbstractA total of 211 patients with gastric cancer in the upper third of the stomach were clinicopathologically evaluated. Of the 211 patients, 82 had esophageal infiltration and 129 did not. These two groups were compared. The study on patients who had undergone resection and radioisotope (99mTc‐phytate) uptake testing revealed that it was important to dissect the lymph nodes (predominantly nodes 7,9,11, and 16) during surgery in the patients with gastric cancer plus esophageal infiltration. When cancer infiltration of the esophagus exceeds 1 cm, the preferred surgical procedure is lower esophagectomy and total gastrectomy with abdominal and intrathoracic lymphadenectomy via the left thoracoabdominal approach. When residual cancer is suggested in the more proximal esophageal stump due to intramural metastasis from vascular invasion, rapid pathologic diagnosis should be made by frozen sections during surgery and then subtotal esophagectomy by blunt removal of the esophagus proximally from the aortic arch using a left thoracotomy considered.
Hardy–Sobolev critical elliptic equations with boundary singularities
Authors: Ghoussoub N. , Kang X.S. 
Published: October 2004

Unlike the non-singular case

s=0

, or the case when 0 belongs to the interior of a domain

Ω

in

ℝ^n

(

n⩾3

), we show that the value and the attainability of the best Hardy–Sobolev constant on a smooth domain

Ω

,

\mu _{s}(\Omega ): = \inf \left\{\int \limits_{\Omega }\left|\nabla u\right|^{2}dx;u∊H_{0}^{1}(\Omega )\text{ and }\int \limits_{\Omega }\frac{\left|u\right|^{2*(s)}}{\left|x\right|^{s}} = 1\right\}

when

0<s<2

,

2^∗(s)=\frac{2(n - s)}{n - 2}

, and when 0 is on the boundary

∂Ω

are closely related to the properties of the curvature of

∂Ω

at 0. These conditions on the curvature are also relevant to the study of elliptic partial differential equations with singular potentials of the form:

- \Delta u = \frac{u^{p - 1}}{\left|x\right|^{s}} + f(x,u)\text{ in }\Omega \subset ℝ^{n},

where

f

is a lower order perturbative term at infinity and

f(x,0)=0

. We show that the positivity of the sectional curvature at 0 is relevant when dealing with Dirichlet boundary conditions, while the Neumann problems seem to require the positivity of the mean curvature at 0.

Résumé

Contrairement au cas non-singulier

s=0

, ou au cas d’une singularité à l’intérieur d’ un domaine

Ω

de

ℝ^n

(

n⩾3

), on montre que la valeur de la meilleure constante dans l’inégalité de Hardy–Sobolev sur un domaine régulier,

\mu _{s}(\Omega ): = \inf \left\{\int \limits_{\Omega }\left|\nabla u\right|^{2}dx;u∊H_{0}^{1}(\Omega )\text{ et }\int \limits_{\Omega }\frac{\left|u\right|^{2*(s)}}{\left|x\right|^{s}} = 1\right\}

quand

0<s<2

,

2^∗(s)=\frac{2(n - s)}{n - 2}

, et quand 0 appartient à la frontière, est étroitement liée aux propriétés de la courbure de

∂Ω

en 0. Ces mêmes conditions sur la courbure sont aussi pertinentes pour l’existence de solutions d’équations à potentiel singulier de la forme :

- \Delta u = \frac{u^{p - 1}}{\left|x\right|^{s}} + f(x,u)\text{ in }\Omega \subset ℝ^{n},

où

f

est une perturbation d’ordre inférieur à l’infini et

f(x,0)=0

. On montre que la positivité de la courbure sectionelle est suffisante pour l’existence de solutions des problèmes avec conditions de Dirichlet au bord, tandis que pour les problèmes de Neumann, c’est la positivité de la coubure moyenne qui compte.
Behavioral and cellular consequences of increasing serotonergic activity during brain development: a role in autism?
Authors: Whitaker‐Azmitia Patricia M. 
Published: October 2004

AbstractThe hypothesis explored in this review is that the high levels of serotonin in the blood seen in some autistic children (the so‐called hyperserotonemia of autism) may lead to some of the behavioral and cellular changes also observed in the disorder. At early stages of development, when the blood–brain Barrier is not yet fully formed, the high levels of serotonin in the blood can enter the brain of a developing fetus and cause loss of serotonin terminals through a known negative feedback function of serotonin during development. The loss of serotonin innervation persists throughout subsequent development and the symptoms of autism appear. A review of the basic scientific literature on prenatal treatments affecting serotonin is given, in support of this hypothesis, with an emphasis on studies using the serotonin agonist, 5‐methoxytryptamine (5‐MT).In work using 5‐MT to mimic hyperserotonemia, Sprague‐Dawley rats are treated from gestational day 12 until postnatal 20. In published reports, these animals have been found to have a significant loss of serotonin terminals, decreased metabolic activity in cortex, changes in columnar development in cortex, changes in serotonin receptors, and “autistic‐like” behaviors. In preliminary cellular findings given in this review, the animals have also been found to have cellular changes in two relevant brain regions: 1. Central nucleus of the amygdala, a brain region involved in fear‐responding, where an increase in calcitonin gene related peptide (CGRP) was found 2. Paraventricular nucleus of the hypothalamus, a brain region involved in social memory and bonding, where a decrease in oxytocin was found. Both of these cellular changes could result from loss of serotonin innervation, possibly due to loss of terminal outgrowth from the same cells of the raphe nuclei. Thus, increased serotonergic activity during development could damage neurocircuitry involved in emotional responding to social stressors and may have relevance to the symptoms of autism.
Strategies to prevent eclampsia in a developing country: I. Reorganization of maternity services
Authors: McCaw‐Binns A.M. , Ashley D.E. , Knight L.P. , MacGillivray I. , Golding J. 
Published: October 2004

AbstractObjective: To determine whether changes in primary and secondary care service delivery could prevent antenatal eclampsia. Method: One intervention (St. Catherine) and two control (St Ann, Manchester) parishes were chosen. The health system in St. Catherine was restructured. Primary antenatal clinics had clear instructions for referring patients to a high‐risk antenatal clinic or to hospital. Guidelines were provided to high‐risk clinics and the antenatal ward for appropriate treatment of hypertension and preeclampsia when induction of labor should occur. Antenatal eclampsia incidence was monitored before and during the intervention and compared with control parishes (no intervention). Each eclampsia case was investigated to identify inadequacies in the system. Results: The process resulted in better identification of women at risk. Antenatal eclampsia incidence dropped dramatically as care improved. Compared with control areas, by completion of the study, the rate was significantly lower than at the start: OR 0.19 (95% CI: 0.13–0. 27; p<0.001 trend). Antenatal admissions for hypertensive disorders declined significantly, and the number of bed days halved. Conclusion: Reorganization of maternal care can have major public health benefits and cost savings; however, women need to be alerted to recognise and act upon signs of impending eclampsia.
Risk factors and obstetric complications associated with macrosomia
Authors: Stotland N.E. , Caughey A.B. , Breed E.M. , Escobar G.J. 
Published: October 2004

AbstractObjectiveMacrosomia is associated with adverse maternal outcomes. The objective of this study was to characterize the epidemiology of macrosomia and related maternal complications.MethodLive births (146,526) were identified between 1995 and 1999 in the Kaiser Permanente Medical Care Program's Northern California Region (KPMCP NCR) database. Bivariate and multivariate analyses were performed for risk factors and complications associated with macrosomia (birth weight >4500 g).ResultMale infant sex, multiparity, maternal age 30–40, white race, diabetes, and gestational age >41 weeks were associated with macrosomia (p<0.001). In bivariate and multivariate analyses, macrosomia was associated with higher rates of cesarean birth, chorioamnionitis, shoulder dystocia, fourth‐degree perineal lacerations, postpartum hemorrhage, and prolonged hospital stay (p<0.01).ConclusionMacrosomia was associated with adverse maternal outcomes in this cohort. More research is needed to determine how to prevent complications related to excessive birth weight.