bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcome after reconstruction of the anterior cruciate ligament in athletic patients
Authors: Meighan A. A. S. , Keating J. F. , Will E. 
Published: July 2003

We randomised 31 patients with acute tears of the anterior cruciate ligament (ACL) to receive either early (within 2 weeks) or delayed (8 to 12 weeks) reconstruction using a quadruple hamstring graft in order to determine if there was any functional advantage to early reconstruction. Outcome measures included return of knee movement, muscle dynamometry, International Knee Documentation Committee (IKDC) scores and Tegner activity levels. Two cases of symptomatic deep-venous thrombosis occurred in the early group. The mean range of movement was significantly greater at two weeks in the delayed group. Quadriceps muscle power was significantly better in the delayed group at 12 weeks (p < 0.05). These trends were evident at later time points, but were not statistically significant. One patient in each group had clinically significant knee stiffness at 52 weeks. IKDC scores and Tegner activity levels were not significantly different at 52 weeks. We conclude that there is no functional advantage to be gained by early reconstruction of the ACL.
The results of revision knee arthroplasty with and without retention of secure cemented femoral components
Authors: Mackay D. C. , Siddique M. S. 
Published: July 2003

We have compared the survival of 67 revision arthroplasties of the knee undertaken for aseptic loosening with and without the retention of a secure, cemented femoral component. All the patients had undergone a single primary procedure at a mean of nine years previously. In group I (25 knees) the original femoral component was secure and was retained. There were no abrasions or osteolysis. The knees were stable, normally aligned, with minimal bone loss. In group II 42 knees did not fulfil these criteria and underwent revision of both components. The mean follow-up was four years. Re-revision for loosening was required in seven knees (28%) in group I and three (7%) in group II (p < 0.01). The remaining knees function well with Knee Society scores averaging 84/69 and no radiological evidence of osteolysis. When revising cemented implants, retention of a secure femoral component cannot be recommended even when conditions appear to be suitable.
The influence of early ambulation and other factors on headache after lumbar myelography
Authors: Murata Y. , Yamagata M. , Ogata S. , Shimizu K. , Ikeda Y. , Hirayama J. , Yamada H. 
Published: July 2003

In order to determine the influence of early ambulation and other factors on headaches occurring after lumbar myelography we randomised 207 patients (127 men and 80 women) into two groups. Following the investigation, we allowed the 101 patients (65 men and 36 women) in group A to sit or stand freely, while we confined the 106 patients (62 men and 44 women) in group B to bed for 20 hours. The nine patients in group B who could not maintain bed rest were excluded. There was no significant difference between the two groups as regards the prevalence of spinal headache (8.9% in group A v 14.4% in group B). Patients who reported headaches, however, were significantly more likely to be women (18.7%) than men (7.3%), be younger (mean age 45 years v 56 years), have a higher cerebrospinal pressure before removal of fluid (mean values 172 v 137 mm H2O) and a lower systolic (mean values 120 v 134 mmHg) and diastolic blood pressure. We conclude that, although other factors may be associated with headaches, late ambulation is not effective in preventing spinal headaches after lumbar myelography.
Orthotopic and heterotopic lower leg reimplantation
Authors: Daigeler A. , Fansa H. , Schneider W. 
Published: July 2003

Reimplantation is a well-established procedure in reconstructive surgery. This is especially so after amputation of the upper limb since prostheses provide limited function. In unilateral amputation of the lower leg orthotopic reimplantation is the treatment of choice. With bilateral amputation, in which orthotopic reimplantation is not possible because of the complexity of the trauma, heterotopic reimplantation is an option. We report five patients who received orthotopic and two who received heterotopic reimplantations of the lower leg. We assessed the functional outcome with reference to cutaneous sensation, mobility, pain, and the cosmetic result. The functional outcome was good, as was the patients’ satisfaction. Their mobility, stability, and psychological state were satisfactory. Patients with heterotopic reimplantations preferred the reimplanted leg to a prosthesis. Although reimplantation of the lower leg requires prolonged hospitalisation, delayed mobilisation and secondary operations, we conclude that there is an indication for this operation in order to improve the patient’s quality of life.
Open treatment of anterior impingement of the ankle
Authors: Coull R. , Raffiq T. , James L. E. , Stephens M. M. 
Published: July 2003

We assessed the long-term outcome of open debridement for the treatment of anterior impingement of the ankle in 27 patients. By using preoperative radiographs to group patients according to both the McDermott and the van Dijk scoring system, we assessed the accuracy of these classifications in predicting outcome. The Ogilvie-Harris scoring system, a visual analogue scale of patient satisfaction, the time to return to full activities, and the ability to return to sports determined the clinical outcome. Follow-up radiographs were used to assess the recurrence of osteophytes. We also assessed the incidence of talar osteochondral lesions at surgery. At a mean follow-up of 7.3 years, 23 of 25 patients (92%) without joint-space narrowing had a good or excellent result. Improvement in the Ogilvie-Harris score was seen in all patients. In athletes, 19 of 24 (79%) were able to return to sports at the same level. Two patients with preoperative joint-space narrowing had a poor result. Osteophytes usually recurred and most patients did not feel that the range of dorsiflexion returned to normal, but symptomatic relief allowed most to return to high-level sport. Our results for non-arthritic joints suggest that this is a safe and successful procedure.
Operative and functional treatment of rupture of the lateral ligament of the ankle
Authors: Pijnenburg A. C. M. , Bogaard K. , Krips R. , Marti R. K. , Bossuyt P. M. M. , van Dijk C. N. 
Published: July 2003

Consecutive patients with a confirmed rupture of at least one of the lateral ligaments of the ankle were randomly assigned to receive either operative or functional treatment. They were evaluated at a median of 8 years (6 to 11). In total, 370 patients were included. Follow-up was available for 317 (86%). Fewer patients allocated to operative treatment reported residual pain compared with those who had been allocated to functional treatment (16% versus 25%, RR 0.64, CI 041 to 1.0). Fewer surgically-treated patients reported symptoms of giving way (20% versus 32%, RR 0.62, CI 0.42 to 0.92) and recurrent sprains (22% versus 34%, RR 0.66, CI 0.45 to 0.94). The anterior drawer test was less frequently positive in surgically-treated patients (30% versus 54%, RR 0.54, CI 0.41 to 0.72). The median Povacz score was significantly higher in the operative group (26 versus 22, p < 0.001). Compared with functional treatment, operative treatment gives a better long-term outcome in terms of residual pain, recurrent sprains and stability.
Pharmacist Intervention Program for Control of Hypertension
Authors: Chabot Isabelle , Moisan Jocelyne , Grégoire Jean-Pierre , Milot Alain 
Published: July 2003

BACKGROUND: Pharmaceutical care programs have been shown to improve outcomes in hypertension. However, most programs required direct access to patient medical chart and patient consultation sessions by appointment. OBJECTIVE: To follow the current practice of community pharmacy, exploring the effect of an intervention program on blood pressure (BP) and factors affecting BP. METHODS: Treated hypertensive patients were enrolled in a 9-month controlled study involving 9 community pharmacies. The PRECEDE–PROCEED model was used as conceptual framework to identify factors affecting BP, to incorporate those factors in an intervention program, and to evaluate the impact of the program. A computerized decision-aid tool was used by pharmacists from 4 pharmacies to provide pharmaceutical care to subjects (n = 41); pharmacists from the 5 other pharmacies performed usual care (n = 59). As there was a statistically significant interaction due to family income in describing the impact of pharmacists' intervention on BP, population was stratified by family income in the analyses. RESULTS: Compared with the control group, the pharmacy program resulted in significant systolic BP reduction (-7.8 vs. 0.5 mm Hg; p = 0.01) and an increase in the proportion of controlled patients only for those with high incomes. In the high-income group, the program also had a positive impact on physical activity, self-reported adherence, health concerns, and information transmitted. The low-income group did not appear to benefit from the program. CONCLUSIONS: Pharmacist intervention can modify factors affecting adherence, improve adherence, and reduce BP levels in patients treated with antihypertensive agents. Impact of pharmacist intervention on BP differed according to patient income status.
Argatroban for Heparin-Induced Thrombocytopenia in Hepato-Renal Failure and CVVHD
Authors: Dager William E , White Richard H 
Published: July 2003

OBJECTIVE: To report a case of significant hepatic and renal failure with the use of argatroban in a patient with heparin-induced thrombocytopenia (HIT) requiring continuous veno-veno hemodialysis (CVVHD). CASE SUMMARY: A 37-year-old Hispanic man with diabetes mellitus, ethanol abuse, and recent crank use developed a venous thrombosis and possible pulmonary embolism, followed by acute liver and renal failure requiring continuous veno-venous hemofiltration. After several days of heparin therapy, the dialyzer circuit thrombosed and the platelet count decreased to 82 times 103/mm3. Antibodies for HIT by enzyme-linked immunosorbent assay were positive. Heparin was discontinued, and an argatroban infusion was initiated. After 39 hours on argatroban, the infusion was stopped when minor bleeding was observed with a concurrent activated partial thromboplastin time (aPTT) of 100 seconds. The dialyzer circuit did not clot during the argatroban infusion and did not apparently influence dose-related aPTT measurements. Several days were required for the aPTT to decrease after stopping the argatroban infusion. Fresh frozen plasma had no apparent effect on aPTT values. DISCUSSION: Several different agents are currently available to provide effective anticoagulation in patients who have immune-mediated HIT. Argatroban is hepatically cleared and may be the preferred direct thrombin inhibitor in the presence of significant renal impairment, but conversely has prolonged effects in hepatic failure. Limited data are available regarding use of direct thrombin inhibitors in patients who have severe hepatic impairment with concurrent renal failure requiring CVVHD. Scant data are available regarding the effect of hemodialysis on the elimination of argatroban. CONCLUSIONS: The optimal anticoagulant for use in a patient with HIT and concurrent hepatic and renal failure is unclear. No direct thrombin inhibitor has a proven advantage; therefore, selection may depend on clinical factors. Dosing in these patients requires very careful management.
Population‐based patterns of human immunodeficiency virus‐related Hodgkin lymphoma in the Greater San Francisco Bay Area, 1988–1998
Authors: Glaser Sally L. , Clarke Christina A. , Gulley Margaret L. , Craig Fiona E. , DiGiuseppe Joseph A. , Dorfman Ronald F. , Mann Risa B. , Ambinder Richard F. 
Published: July 2003

AbstractBACKGROUNDEpidemiologic characteristics of human immunodeficiency virus (HIV)‐related Hodgkin lymphoma (HL) have not been examined in the Greater San Francisco Bay Area, a center of the HIV/acquired immunodeficiency syndrome (AIDS) epidemic, for a decade, despite changes in AIDS‐associated diseases after the availability of highly active antiretroviral therapies (HAART).METHODSWith population‐based cancer registry data for 1988–1998, the authors examined risk factors, Epstein–Barr virus (EBV) association, incidence rates, and survival probabilities for 1752 patients with HL who were classified as HIV‐positive or HIV‐negative by a cancer registry‐based method.RESULTSOne hundred twenty‐eight patients with HL (7%) were classified with HIV/AIDS; 95% were male. Among males, multivariate analysis (n = 514 patients) found that HIV‐related HL was associated strongly at diagnosis with ages 30–49 years, San Francisco residence, late‐stage disease, lymphocyte depletion and unspecified histologic subtypes, and tumor cell EBV but not with other clinical features or mixed cellularity histology. Survival among patients with HIV‐related HL, although it was poor, did not differ by race/ethnicity but was worse for patients with the nonnodular sclerosis histologic subtypes. Patients who were HIV‐positive with HAART era (1996–1998) diagnoses were slightly older, were less likely to live in San Francisco, and were much more likely to be Hispanic compared with HIV‐positive patients who were diagnosed before the HAART era; they had somewhat less aggressive disease and better survival. Incidence rates were higher for patients with HL overall compared with patients who had HIV‐unrelated HL by 11% for white patients, 22% for black patients, and by 14% for Hispanic patients; excesses were greater in young adults.CONCLUSIONSAmong males in the San Francisco Bay Area, HIV‐related HL had distinctive demographic features, more aggressive clinical characteristics, stronger EBV association, and poorer survival and contributed to elevated regional HL incidence rates, particularly in young adults. Patients with HIV‐related HL who were diagnosed after HAART was introduced appeared to have less aggressive disease and better survival. Cancer 2003;98:300–9. © 2003 American Cancer Society.DOI 10.1002/cncr.11459
Insights into the mechanisms of lymph node metastasis
Authors: Nathanson S. David 
Published: July 2003

AbstractThe mechanisms by which malignant tumors leave the primary tumor site, invade lymphatics, and metastasize to regional lymph nodes (RLNs) are complex and interrelated. Although the phenomenon of lymph node metastasis has been recognized for over 200 years, the exact mechanisms have only recently been the subject of intense interest and sophisticated experimentation. Sentinel lymph node biopsy has rapidly entered the clinical mainstream for melanoma and breast carcinoma, and this technique has provided confirmation of the orderly anatomic progression of tumor cells from primary site to the RLNs through lymphatic capillaries and trunks. Exciting studies involving the pathophysiology of interstitial fluid pressure in tumors and the peritumoral extracellular matrix have focused on lymphatic flow and tumor microenvironment and microcirculation. Molecular techniques have led to the definition of unique markers found on lymphatic endothelial cells. These markers have enabled scientists to identify peritumoral and intratumoral lymphatics and to visualize the ingrowth of tumor cells into the lumena of lymphatic capillaries. Tumor‐secreted cytokines, such as vascular endothelial growth factors (VEGF)‐C and ‐D, bind to VEGF receptors on lymphatic endothelial cells and induce proliferation and growth of new lymphatic capillaries; this process is similar to the well‐known mechanism of angiogenesis, which results from the proliferation of new blood vessel capillaries. Lymphangiogenesis is associated with an increased incidence of RLN metastasis, and it is possible that this step is essential to the metastatic process. Directional movement toward lymphatics and lymph nodes appears to follow a chemokine gradient, and it is likely that some tumor cells that express certain types of chemokine receptors are more likely to metastasize to the RLNs. In contrast, tumor cells that do not express specific receptors that are responsive to lymphatic chemokines may not metastasize. New knowledge regarding the molecules involved in these processes should enable improvements in prognostic and possibly therapeutic approaches to the management of malignant tumors. Cancer 2003;98:413–23. © 2003 American Cancer Society.DOI 10.1002/cncr.11464
Fulvestrant versus anastrozole for the treatment of advanced breast carcinoma in postmenopausal women
Authors: Robertson John F. R. , Osborne C. Kent , Howell Anthony , Jones Stephen E. , Mauriac Louis , Ellis Matthew , Kleeberg Ulrich R. , Come Steven E. , Vergote Ignace , Gertler Stan , Buzdar Aman , Webster Alan , Morris Charles 
Published: July 2003

AbstractBACKGROUNDFulvestrant (ICI 182,780) is a new type of estrogen receptor (ER) antagonist that down‐regulates the ER and has no known agonist effects. The authors report the prospectively planned combined analysis of data from 2 Phase III trials comparing fulvestrant 250 mg monthly (n = 428) and anastrozole 1 mg daily (n = 423) in postmenopausal women with advanced breast carcinoma (ABC) who previously had progressed after receiving endocrine treatment.METHODSThe primary endpoint was time to progression (TTP). Secondary endpoints included objective response (OR), duration of response (DOR), and tolerability. The trials were designed to demonstrate superiority of fulvestrant over anastrozole. Noninferiority of fulvestrant versus anastrozole was determined using a retrospectively applied statistical test.RESULTSAt a median follow‐up of 15.1 months, ≈ 83% of patients in each treatment arm had progressed. The median TTP was 5.5 months in the fulvestrant group and 4.1 months in the anastrozole group, and the OR rates were 19.2% and 16.5% for fulvestrant and anastrozole, respectively (although the difference between treatments was not statistically significant). In patients who responded, further follow‐up (median, 22.1 months) was performed to obtain more complete information on DOR; the median DOR (from randomization to disease progression) in patients who responded to treatment was 16.7 months in the fulvestrant group and 13.7 months in the anastrozole group. In a statistical analysis of DOR (using all randomized patients; from the start of response to disease progression), DOR was significantly longer for patients in the fulvestrant group compared with patients in the anastrozole group. Both drugs were tolerated well; withdrawals due to drug‐related adverse events were 0.9% and 1.2% in the fulvestrant group and the anastrozole group, respectively. The incidence of joint disorders was significantly lower in the fulvestrant group (P = 0.0036).CONCLUSIONSFulvestrant was tolerated well and was at least as effective as anastrozole in the second‐line treatment of patients with ABC. This new hormonaltherapy may provide a valuable treatment option for ABC in postmenopausal women. Cancer 2003;98:229–38. © 2003 American Cancer Society.
Prospective study of the ability of serial measurements of serum chromogranin A and gastrin to detect changes in tumor burden in patients with gastrinomas
Authors: Abou‐Saif Alaa , Gibril Fathia , Ojeaburu Jeremiah V. , Bashir Showkat , Entsuah Laurence K. , Asgharian Behnam , Jensen Robert T. 
Published: July 2003

AbstractBACKGROUNDAssessment of tumor burden changes is essential for the management of patients with neuroendocrine gastrointestinal (GI) tumors. Chromogranin A (CgA) is a tumor marker for such tumors; however, to the authors' knowledge, there is little information on whether serial assessments can assess changes in tumor burden. In this prospective study of patients with gastrinomas, serial changes in serum CgA levels were compared with changes in levels of the specific tumor marker gastrin to determine whether they reflected changes in tumor burden.METHODSIn 72 consecutive patients, the mean CgA and gastrin levels from three determinations were measured on each visit. Changes in markers were correlated with changes in tumor burden determined by imaging. By assessing daily changes, significance changes in CgA and gastrin levels were determined.RESULTSDuring 103 follow‐up visits (mean, 9.6 months), an increased tumor size occurred in 25% of patients, no change occurred in 62% of patients, and a decrease occurred in 13% of patients. In patients who had increasing tumor size, CgA levels increased numerically in 77% of patients, gastrin levels increased in 54% of patients, and the increases were significant in 60–80% of patients. In patients who had tumor stabilization, CgA levels in 63% of patients and gastrin levels in 73% of patients did not show a significant change. Decreased tumor size postresection showed a significant decrease in CgA and gastrin levels in all patients. The sensitivity of CgA and gastrin was as follows: sensitivity for detecting an increase, 62% for CgA and 31% for gastrin; sensitivity for detecting no change, 42% for CgA and 75% for gastrin; and sensitivity for detecting a decrease in tumor size, 85% for CgA and 85% for gastrin. The specificity varied from 53% to 99% for CgA and from 49% to 93% for gastrin.CONCLUSIONSIn patients with gastrinomas, serum CgA and gastrin levels varied considerably from day to day, and this must be taken into consideration. Both markers had low sensitivity and specificity for detecting tumor increases and stabilization. For large tumor decreases postresection, both markers had high sensitivity and specificity. The current results suggest that these markers do not have sufficient sensitivity to replace serial imaging studies for detecting important smaller changes in tumor burden in patients with gastrinomas. Cancer 2003;98:249–61. Published 2003 by the American Cancer Society.DOI 10.1002/cncr.11473
A pilot Phase II trial of concurrent radiotherapy, chemotherapy, and hyperthermia for locally advanced cervical carcinoma
Authors: Jones Ellen L. , Samulski Thaddeus V. , Dewhirst Mark W. , Alvarez‐Secord Angeles , Berchuck Andrew , Clarke‐Pearson Daniel , Havrilesky Laura J. , Soper John , Prosnitz Leonard R. 
Published: July 2003

AbstractBACKGROUNDFive randomized studies have demonstrated a benefit derived from adding cisplatin (CDDP)‐based chemotherapy to radiotherapy (RT) for treatment of cervical carcinoma. The Dutch Phase III pelvic tumor trial demonstrated a survival and local control benefit due to the addition of hyperthermia (HT) to RT. The authors evaluated response and toxicity in patients with locally advanced cervical carcinoma (LACC) who were treated with concurrent weekly CDDP, HT, and RT (whole pelvis [n = 7] and whole pelvis and paraaortic nodes [n = 5]).METHODSFrom August 1998 through December 2000, 12 patients with LACC or locally recurrent cervical carcinoma (LRCC) following hysterectomy were enrolled on a pilot study combining weekly CDDP, HT, and RT.RESULTSTen patients were treated at initial diagnosis. All achieved clinical complete response and durable local control. Two of the 10 experienced recurrence outside the pelvis; 1 of these patients had pulmonary metastasis, and the other had isolated paraaortic nodal involvement. Two patients treated for LRCC experienced local and systemic progression and died of disease within 6 months.CONCLUSIONSIn this small series, trimodality therapy resulted in an excellent clinical response and was well tolerated. The addition of HT to chemoradiotherapy represents a promising new strategy that warrants multiinstitutional collaborative efforts to confirm its efficacy. Cancer 2003;98:277–82. © 2003 American Cancer Society.DOI 10.1002/cncr.11475