bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluating and minimising social stress in the care of captive bottlenose dolphins (Tursiops aduncus)
Authors: Waples Kelly A. , Gales Nicholas J. 
Published: August 2002

AbstractStress can increase an organism’s susceptibility to disease. Thus, managing stress and its causes are important elements of captive care. Social factors such as changes in group dynamics, competition over resources, and unstable dominance hierarchies are potential stressors for highly social animals such as bottlenose dolphins (Tursiops sp). We present three case studies of mortality and illness in captive bottlenose dolphins and suggest that stress, resulting from social instability and ensuing aggressive interactions, is likely to have played a role in these health consequences. Stress is implicated by blood profiles, loss of appetite, and gastric ulcers, and social problems and instability are evident in the quantitative analysis of individual activity levels and association patterns. This is a unique study on marine mammals in that it demonstrates a correlation between quantitative behavioral indices and physiological measures of stress and health. Recommendations are made for the management of captive dolphins including regular quantitative assessment of behavior and associations and maintenance of appropriate groupings of age and sex classes. Behavioral records can be an important early indicator of health problems and may also serve as a useful tool for recognizing potentially stressful social changes and circumstances. Zoo Biol 21:5–26, 2002. © 2002 Wiley‐Liss, Inc.
Anterior labroligamentous periosteal sleeve avulsion lesion at the superior glenoid labrum
Authors: Atay Ahmet Ö. , Aydıngöz Üstün , Doral Nedim M. , Leblebicioğlu Gürsel 
Published: August 2002

AbstractAn unusual type of anterior labroligamentous periosteal sleeve avulsion (ALPSA) lesion in the superior, instead of the usual inferior, part of the anterior glenoid labrum is presented in a 33‐year‐old man who sustained a traumatic dislocation of his left shoulder. Magnetic resonance imaging raised the possibility of an ALPSA lesion and later arthroscopy confirmed the diagnosis. Arthroscopic repair of the lesion was performed after the labral avulsion was lateralized.
Colorectal Carcinogenesis Based on Molecular Biology of Early Colorectal Cancer, with Special Reference to Nonpolypoid (Superficial) Lesions
Authors: Watanabe Toshiaki , Muto Tetsuichiro 
Published: August 2002

AbstractThe multistep genetic model of colorectal carcinogenesis is based on the concept of the adenoma—carcinoma sequence. The adenoma—carcinoma sequence theory has been generally accepted for polypoid early colorectal cancers (ECCs). On the other hand, an increasing number of nonpolypoid (superficial) ECC have been reported. Nonpolypoid (superficial) ECCs show distinct characteristics histologically and genetically, and some claim these lesions may develop by de novo type carcinogenesis. In fact, clinicopathologic studies have shown that most nonpolypoid (superficial) cancers have no adenomatous lesions in the surrounding area. Genetic analyses have also revealed that nonpolypoid (superficial) ECCs show a pattern of genetic alterations different from that of polypoid ECCs. The K‐ras mutation rate is lower in nonpolypoid (superficial) ECCs than in polypoid ECCs, but there is no significant difference in the p53 mutation rate between two types of tumor. During the development of ECCs, the K‐ras gene seems to determine the macroscopic configuration: whether polypoid or nonpolypoid (superficial). These results suggest that nonpolypoid (superficial) ECCs originate from a pathway different from the conventional genetic pathway that follows the adenoma—carcinoma sequence. However, this does not mean that this new pathway is following de novo type carcinogenesis, because there is a possibility that nonpolypoid (superficial) adenomas, or so‐called flat adenomas, develop into nonpolypoid (superficial) ECCs following the adenoma—carcinoma sequence. At the present time, there is still not enough evidence to conclude whether nonpolypoid (superficial) ECC is derived from de novo carcinogenesis or the conventional adenoma—carcinoma sequence. Further analysis, especially concerning APC gene mutation in ECCs, is essential to elucidate the carcinogenesis of nonpolypoid (superficial) ECCs.
New Ultradeformable Drug Carriers for Potential Transdermal Application of Interleukin‐2 and Interferon‐a Theoretic and Practical Aspects
Authors: Hofer Christian , Hartung Rudolf , Göbel Roland , Deering Petra , Lehmer Antonie , Breul Jürgen 
Published: August 2002

AbstractTransfersomes (TFs) are highly deformable hydrophilic lipid vesicles that are able to penetrate the skin barrier spontaneously because of their characteristics. Transfersomes are able to transport noninvasively low‐ and high‐molecular‐weight molecules into the body. We describe the formulation and several biologic characteristics of interleukin‐2 (IL‐2)‐ and interferon‐α (IFNα)‐containing TFs. TFs contain natural phosphatidylcholine and sodium cholate. Recombinant human IL‐2 and human hybrid IFNα were added to TFs and incubated for 24 hours at 4°C. Immunotransfersomes were isolated from free IL‐2 and IFNα by filtration (Centrisart, Sartorius). The biologic activity of immunotransfersomes was measured by a cytotoxic lymphoid line assay for IL‐2 and by an A549‐encephalomyocarditis virus assay for IFN; concentrations of proteins were determined by the enzyme‐linked immunosorbent assay (ELISA). It was possible to incorporate a large amount of IL‐2 and IFN in TFs (75‐80%), and the incorporated IL‐2, and IFN were biologically active. The increased lipid/protein ratio (90.9/1.0) led to a growing probability of association. We were thus able to show that IL‐2 and IFN are trapped by transfersomes in a biologically active form and in sufficient concentrations for immunotherapy. In upcoming experiments these IL‐2‐ and IFN‐containing TFs will be used for a transdermal approach in the murine RENCA cell line model.
Gunshot Injuries of the Head of the Pancreas: Conservative Approach
Authors: Degiannis E. , Levy R.D. , Velmahos G.C. , Potokar T. , Florizoone M.G.C. , Saadia R. 
Published: August 2002

AbstractThis study is comprised of 48 patients with gunshot injuries of the head of the pancreas, many of which were high velocity injuries. The purpose of this study was to evaluate our management policy for these injuries based on our recent wide experience. Patients with grade II and III injuries underwent conservative surgery, with 0% and 21% postoperative mortality, respectively, directly related to the pancreatic injury. For patients in whom the duodenum was involved, pyloric exclusion was applied depending on the grade of the duodenal injury. We concluded that moderate gunshot injuries of the head of the pancreas (grade II) can be safely treated by débridement and suture repair, with or without drainage. Severe (grade IV) injuries warrant a pancreaticoduodenectomy. Most grade III injuries can be treated by débridement and drainage unless an associated severe duodenal injury is present, in which case resection may be indicated.
Somatostatin Receptor Scintigraphy in Patients with Carcinoid Tumors
Authors: Kwekkeboom Dik J. , Krenning Eric P. 
Published: August 2002

AbstractIn 80% to 90% of patients with carcinoids, tumor sites can be detected with [111In‐DTPA‐d‐Phe1]‐octreotide scintigraphy. Unexpected, additional localizations are reported in one‐third to two‐thirds of patients. In a group of 52 patients, we analyzed the results of various combinations of octreotide scintigraphy and conventional imaging. Octreotide scintigraphy, alone or in combination with other imaging modalities, led to the detection of more tumor sites than any combination of conventional imaging techniques. The combination of octreotide scintigraphy, chest radiography, and ultrasonography of the upper abdomen led to the detection of lesions in all patients in whom they could be demonstrated by any imaging means, with a sensitivity of 87% in terms of the number of detected lesions. The calculated cost for this imaging regimen was higher than for the combination of conventional imaging as applied in our group. However, the benefit was the detection of at least one lesion in 11% of patients in whom with conventional imaging no abnormalities were found. Moreover, if the results from our patient group were extrapolated to a group of 100 patients, the advantage in terms of the number of extra lesions detected would be 65 extra lesions per 100 patients. The detection of more tumor sites in patients who are known to have one tumor localization with conventional imaging may be essential when deciding whether to perform surgery. Octreotide scintigraphy can be used to localize tumors, direct the choice of medical therapy, and (expected in the near future) select patients for radiotherapy. The impact on patient management is fourfold: Octreotide scintigraphy may detect resectable tumors that would be unrecognized with conventional imaging techniques; it may prevent surgery in patients whose tumors have metastasized to a greater extent than can be detected with conventional imaging; it may direct the choice of therapy in patients with inoperable tumors; and in the future it may be used to select patients for radionuclide therapy.
Surgery for Asymptomatic Pancreatic Lesion in Multiple Endocrine Neoplasia Type I
Authors: Skogseid B. , Öberg K. , Eriksson B. , Juhlin C. , Granberg D. , Åkerström G. , Rastad J. 
Published: August 2002

AbstractPatients with multiple endocrine neoplasia (MEN) type I underwent pancreatic surgery at presymptomatic (n= 8, mean age 33 years) or symptomatic (n= 12, mean age 51 years) stages of pancreatic endocrine involvement with the principal aim to evaluate postoperative morbidity, survival, and malignant potential of the pancreatic lesion. Radiologic signs of malignancy were not identified in any patient prior to exploration. All patients displayed multiple tumors with generally complex immunoreactivity. Normal postoperative pancreatic tumor markers were recorded in five of the asymptomatic patients, which became abnormal in three of them at a mean of 3 years after surgery. All patients remained without symptoms for a mean of 6 years after operation. In four symptomatic individuals (33%) metastases were identified at exploration, and two died with tumor; 83% of symptomatic patients displayed persistent or recurrent endocrine morbidity from the pancreatic lesion. Recognizing lead time bias, this limited and uncontrolled patient comparison suggests that exploration at the symptomatic stage of pancreatic involvement in MEN‐I patients is unsatisfactory. Rather than to obtain biochemical cure, surgery in asymptomatic patients might be regarded as a means of cancer prevention. The malignancy of the pancreatic lesion may be preceded by several decades of biochemical abnormality. Extensive screening for this lesion allows diagnosis during adolescence and the timely application of primary exploration. Active management of individuals with repeated biochemical analyses followed by selective reintervention could enable satisfactorily maintained pancreatic functions and substantial duration of cancer prevention.
Reducing the Occupational Risk of Infections for the Surgeon: Multicentric National Survey on More Than 15,000 Surgical Procedures
Authors: Pietrabissa Andrea , Merigliano Stefano , Montorsi Marco , Poggioli Gilberto , Stella Marco , Borzomati Domenico , Ciferri Enrico , Rossi Giuseppe , Doglietto Gianbattista 
Published: August 2002

AbstractThe objective of this study was to find the incidence of accidental exposures to blood and body fluids among surgeons during operations and to describe their dynamics. A probabilistic model was also used to predict the cumulative 30‐year risk to the surgeon of contracting hepatitis B and C viruses (HBV, HCV) or human immunodeficiency virus (HIV) infection and estimate the effect of preventive strategies in reducing this risk. A multicentric prospective survey, based on self‐administered questionnaires, was conducted during a period of 6 months in 39 Italian hospitals. An accidental exposure to blood or body fluids occurred in 9.2% of 15,375 operations. In about 2% of procedures a parenteral‐type injury, such as actual skin puncture or eye contamination, was suffered by the operating surgeon. A needle‐stick injury was the commonest accident, and its occurrence was found to vary with the phase of the procedure and its length. The current lifetime risk of acquiring HBV, HCV, and HIV infection in our regions was estimated to be as high as 42.7%,
34.8%, and 0.54%, respectively. The adoption of preventive strategies is expected to reduce this risk to 21% for HBV, 16.6% for HCV, and
0.23% for HIV infection. Active immunization of surgeons against HBV is strongly recommended. The case is also made for the use of a face‐shield combined with a permanent change in our surgical practice capable of reducing the current high rate of parenteral injuries.
Cytokines in Inflammatory Bowel Disease
Authors: Rogler Gerhard , Andus Tilo 
Published: August 2002

AbstractCytokines play a central role in the modulation of the intestinal immune system. They are produced by lymphocytes (especially T cells of the Th1 and Th2 phenotypes), monocytes, intestinal macrophages, granulocytes, epithelial cells, endothelial cells, and fibroblasts. They have proinflammatory functions [interleukin‐1 (IL‐1), tumor necrosis factor (TNF), IL‐6, IL‐8, IL‐12] or antiinflammatory functions [interleukin‐1 receptor antagonist (IL‐1ra), IL‐4, IL‐10, IL‐11, transforming growth factor β (TGFβ)]. Mucosal and systemic concentrations of many pro‐ and antiinflammatory cytokines are elevated in inflammatory bowel disease (IBD). An imbalance between proinflammatory and antiinflammatory cytokines was found for the IL‐1/IL‐1ra ratio in the inflamed mucosa of patients with Crohn's disease, ulcerative colitis, diverticulitis, and infectious colitis. Furthermore, the inhibition of proinflammatory cytokines and the supplementations with antiinflammatory cytokines reduced inflammation in animal models, such as the dextran sulfate colitis (DSS) model, the trinitrobenzene sulfonic acid (TNBS) model, or the genetically engineered model of IL‐10 knockout mice. Based on these findings a rationale for cytokine treatment was defined. The first clinical trials using neutralizing monoclonal antibodies against TNFα (cA2) or the antiinflammatory cytokine IL‐10 have shown promising results. However, many questions must be answered before cytokines can be considered standard therapy for IBD.
Can Adrenal Incidentalomas Be Safely Observed?
Authors: Barry M. Kevin , van Heerden Jon A. , Farley David R. , Grant Clive S. , Thompson Geoffrey B. , Ilstrup Duane M. 
Published: August 2002

AbstractWe currently recommend excision of adrenal incidentalomas ≥ 4 cm in size and all hormonally active tumors. The optimal management and follow‐up of smaller nonfunctioning tumors are controversial. The aim of this study was to determine the clinical outcome of a well defined population of patients with incidentalomas followed without operative intervention. The study group comprised 231 patients, identified from the records of abdominal or thoracic computed tomographic (CT) scans performed between 1985 and 1989. The primary outcome variable analyzed was survival. Follow‐up was obtained by office records, telephone contact, or letter. There were 101 male and 130 female patients with a mean age at diagnosis of 64 years (range 5–86 years). Most adrenal tumors were unilateral (right 113; left 98); 20 were bilateral. Mean tumor size was 2 cm (range 1–6 cm). In nine (4%) patients the tumor was ≥ 4 cm. Follow‐up [mean 7 years; range 1 month (patient died) to 11.7 years] was complete in 224 (97%) patients. Ninety‐one (39%) patients had one or more additional CT scans performed during the follow‐up period, with only four patients demonstrating a > 1 cm increase in the size of the adrenal mass. Surgical excision of these four lesions identified benign pathology. Eighty‐one (35%) patients died of conditions unrelated to adrenal pathology. No patient developed subsequent adrenal hyperfunction or adrenal malignancy. Within the context of our guidelines, conservative management of adrenal incidentalomas considered benign or nonfunctioning at diagnosis is appropriate. Additional information provided by repeat CT scanning appears to confer limited benefit. This study does not support laparoscopic removal of small, nonfunctional adrenal tumors, as has been suggested.
Subtotal Adrenalectomy by the Posterior Retroperitoneoscopic Approach
Authors: Walz Martin K. , Peitgen Klaus , Saller Bernhard , Giebler Reiner M. , Lederbogen Sebastian , Nimtz Konstanze , Mann Klaus , Eigler Friedrich W. 
Published: August 2002

AbstractThe retroperitoneoscopic approach offers an established operative procedure for primary adrenal gland tumors. It allows a detailed view of the adrenal gland and its surrounding region. Therefore clear differentiation between normal and neoplastic adrenal tissue is sometimes possible, permitting a planned, unilateral, subtotal resection of the gland. Between July 1994 and August 1997 primary benign adrenal gland tumors (11 Conn adenomas, 4 pheochromocytomas, 4 Cushing adenomas, 3 hormonally inactive tumors; 2.4 ± 1.2 cm in size; 8 on the right, 14 on the left) were removed from 22 patients by the posterior retroperitoneoscopic approach maintaining tumor‐free portions of the ipsilateral adrenal gland. Two patients suffered from bilateral pheochromocytomas associated with multiple endocrine neoplasia (MEN‐IIa) syndrome and had previously undergone complete adrenalectomy of the contralateral gland. Following subtotal resection the operating time and blood loss did not differ significantly (p > 0.05) from that seen with complete extirpation (46 patients operated during the same period). All patients with Conn adenomas and pheochromocytomas were biochemically and clinically cured (follow‐up 11 months; range 1–31 months). The four patients with Cushing adenoma currently require decreasing cortisol substitution. In the two MEN‐II patients adrenal gland cortical function could be maintained; one patient is on low‐dose steroid supplementation and the other on none. No local recurrence of tumors has been observed. In selected cases the retroperitoneoscopically performed subtotal adrenal gland resection is a safe procedure that can potentially maintain the function of the adrenal gland cortex.
Pheochromocytoma, a Rare Cause of Hypertension: Long‐term Follow‐up of 55 Surgically Treated Patients
Authors: Favia Gennaro , Lumachi Franco , Polistina Franceso , D’Amico Davide F. 
Published: August 2002

AbstractPheochromocytoma is a rare tumor that is found in only 0.1% of patients with diastolic hypertension. We analyze the results of our experience in management of pheochromocytomas and long‐term results of its surgical treatment. From 1977 to 1996 we operated on 55 patients with a pheochromocytoma: 29 males and 27 females with an average age of 41 years (range 10–63 years). In 44 (80.0%) patients episodic hypertension or paroxysms were observed; 7 (12.7%) patients had permanent hypertension, and 4 (7.3%) had a normal arterial blood pressure (ABP). 131/123I‐MIBG scintigraphy (33 patients) and magnetic resonance imaging (12 patients) showed 100% sensitivity and computed tomography (47 patients) 97.9% sensitivity. At operation five (9.1%) tumors were bilateral, five extraadrenal, and five multiple. In four (7.3%) patients an association with familial syndromes (three MEN‐IIb, one von Recklinghausen disease) was observed. Five (9.1%) malignant tumors were discovered, and two patients are still alive 30 and 104 months after surgery, one of them with relapse. In 43 (78.2%) patients we preferred a flank incision, and no intraoperative deaths occurred. Mean follow‐up was 88 months (6–232 months) with recurrence in only 1 (2.0%) of 50 patients without malignancy. In patients with benign pheochromocytomas the recurrence rate did not seem to be elevated in our series. Nevertheless, because the lifelong follow‐up requires only annual 24‐hour urinary catecholamine measurement (less than $40 per patient per year) and periodic ABP measurements, it is suggested for all patients who undergo surgery for pheochromocytoma.
Origin of Laparoscopy: Coincidence or Surgical Interdisciplinary Thought?
Authors: Litynski G.S. , Paolucci V. 
Published: August 2002

AbstractThe history of laparoscopy illustrates the interaction between the many areas of medicine and technology; in fact, the development of that technique is a cummulative effort of internists, gynecologists, and surgeons. At the beginning of our century, however, neither group was particularly open to the idea of scholarly exchange. In this respect, an early pioneer of laparoscopy, Georg Kelling (1866–1945) of Dresden and the story surrounding the invention of the laparoscopy are interesting exceptions. Although Kelling regarded himself a surgeon, he devoted a great deal of energy to the development of “nonsurgical” methods of treatment. He spent a great part of his life determining stomach capacity, constructing a semiflexible tube endoscope (straightened after the insertion), and attempting to alleviate gastrointestinal bleeding by means of high‐pressure pneumoperitoneum (lufttamponade). To observe the effects of insufflation on abdominal organs, Kelling introduced a cystoscope into the abdominal cavity. In fact, the invention of “celioscopy” or laparoscopy (1901) can be called a synthesis of Kelling's work with insufflation and his fascination with endoscopy.
Gallbladder Perforation during Laparoscopic Cholecystectomy
Authors: Sarli Leopoldo , Pietra Nicola , Costi Renato , Grattarola Mario 
Published: August 2002

Abstract.A matched‐cohort analytic study was performed to assess the influence on postoperative morbidity and on long‐term outcome of gallbladder perforation (GP) during laparoscopic cholecystectomy (LC) and to determine the existence of risk factors of GP. A total of 1127 consecutive patients who underwent successful LC were included. All patients received a preoperative dose of intravenous antibiotic. If GP occurred, free bile was aspirated, the abdominal cavity was irrigated, spilled stones were retrieved whenever possible, and antibiotic treatment was prolonged. Intraoperative GP occurred in 131 cases (11.6%). The Cox multivariate proportional hazards model showed that the surgeon's experience was the only factor associated with a higher risk of GP (p < 0.0001). Patients who had GP were retrospectively matched with 131 patients who did not have perforation. Statistical differences between the two matched groups were found for the median length of surgery: 74 minutes in the GP group versus 61 minutes, p < 0.01). No differences were found for (1) postoperative complications and reoperations (3.8% in GP group vs. 6.1%, and 0% in GP group vs. 0.8%, respectively); or (2) mean postoperative hospital stay (2.9 ± 2.3 days in GP group vs. 2.6 ± 1.6 days). No late consequences occurred that could be attributed to intraoperative GP. The results suggest that the frequency of GP during LC tends to diminish as the surgeon gains experience with this type of surgery. This event does not cause complications if adequate prophylactic antibiotic therapy is administered; spilled stones are retrieved whenever possible, and the abdominal cavity is abundantly irrigated.