bluuebunny/crossref_metadata_2025_split huggingface dataset:
Leukocyte activation by isolated hyperthermic liver and limb perfusion due to malignancy
Authors: Arnestad Jan Petter , Bengtsson Anders , Bengtson Jan‐Peter , Hafstrom Larsolof , Redl Heinz , Schlag Günther 
Published: December 2004

AbstractFourteen patients with liver tumor malignancy and sixteen patients with malignant melanoma localized to one limb were studied regarding leukocyte activation with the release of polymorphonuclear neutrophilic (PMN) elastase and of neopterin and formation of cytokines (TNF‐α and Il‐6) during the surgical treatment. Patients undergoing liver resection (n=10), abdominal hysterectomy (n=10), or hip replacement surgery (n=10) served as control groups. Isolated hyperthermic liver perfusion was performed with cytostatic‐containing perfusate (melphalan and cisplatinum). Patients with recurrent malignant melanoma confined to one limb underwent isolated hyperthermic limb perfusion with cytostatic‐containing perfusate (melphalan). Blood samples for determination of PMN elastase, neopterin, TNF‐α, and IL‐6 were drawn from the patients preoperatively, 1 minute before the start of the perfusion, 60 and 120 minutes after the start of the perfusion, and 24 hours postoperatively. Samples from the perfusate were drawn 60 minutes after the start of the perfusion. High concentrations of plasma PMN clastase were found both in patients undergoing liver and limb perfusion and in patients undergoing liver resection surgery. Elevated concentrations of Il‐6 were found in the patients undergoing liver perfusion and in patients undergoing liver resection. In none of the patients were there increased concentrations of neopterin or TNF‐α. The perfusate contained high concentrations of PMN elastase, neopterin, and IL‐6. This study also demonstrated that major surgery leads to elevated concentrations of PMN elastase and IL‐6. An increase of PMN elastase and IL‐6 was seen in response to perfusion and to surgical trauma.
Benign hepatic tumors: Focal nodular hyperplasia and hepatocellular adenoma
Authors: Nagorney David M. 
Published: December 2004

AbstractFocal nodular hyperplasia (FNH) and hepatocellular adenoma (HA) are uncommon benign hepatic tumors that continue to pose diagnostic and therapeutic challenges. An update of a recent Mayo Clinic experience is presented to highlight the management of patients harboring these neoplasms. A marked female predominance was seen. Incidental diagnosis was more prevalent with FNH, whereas symptomatic presentation was typical of HA. The frequency of oral contraceptive steroid use was similar regardless of tumor histology. Preoperative diagnosis remains difficult. Scintigraphy proved most specific, and ultrasonography and computed tomography were equally sensitive. Resection was employed in most patients. There was no mortality and minimal morbidity. Selective observation of FNH was uneventful, but resolution of HA after abstinence of oral contraceptive steroids was uncommon. These findings and data from the literature support selective management of benign liver tumors.
Results of hepatic resection for hepatocellular carcinoma
Authors: Kawasaki Seiji , Makuuchi Masatoshi , Miyagawa Shinichi , Kakazu Tohru , Hayashi Ken , Kasai Hide , Miwa Shiro , Hui Al‐Min , Nishimaki Keiji 
Published: December 2004

AbstractThe results of 122 hepatic resections in 112 patients with hepatocellular carcinoma are described. The type of liver resection performed was selected according to the patient's liver function. Forty‐nine patients underwent anatomic resections, including 1 trisegmentectomy, 5 lobectomies, 11 segmentectomies, and 32 subsegmentectomies; the remaining 63 patients had nonanatomic resections. The 1‐, 2‐, and 3‐year survivals after liver resection for all patients, taking into account one operative and one hospital death (0.9% each), were 92.4%, 85.0%, and 78.9%, and disease‐free survivals at 1, 2, and 3 years were 68.6%, 46.2%, and 32.6%, respectively. Twenty‐one repeat hepatic resections (17.2% of the total of 122 resections) were performed with no hospital mortality. Cumulative survival from the time of repeat hepatectomy in these 21 patients was 84.2% and 56.3% at 1 and 2 years, respectively. Among the factors that may affect survival or disease‐free survival, the absence of vascular invasion (p<0.05) and intrahepatic metastases (p<0.01) were significantly related to the disease‐free survival time. A good outcome was obtained after liver resection in 112 patients with hepatocellular carcinoma through appropriate choice of the type of resection, careful follow‐up, and a vigorous surgical approach for recurrence.
Hepatic resection for noncolorectal nonneuroendocrine metastases
Authors: Schwartz Seymour I. 
Published: December 2004

AbstractThe experience with hepatic resection for metastatic lesions, exclusive of colorectal and neuroendocrine tumors, is anecdotal. The reduction in operative mortality leads to a reconsideration of the subject. A review of the literature suggests a selective approach. These is little improvement to be anticipated for resection of metastases from tumors of the esophagus, stomach, small intestine, or pancreas. Resection of metastases from primary renal cell carcinoma, Wilms' tumor, and adrenocortical carcinoma is indicated. There is little to recommend resection of metastases from gynecologic or breast primary carcinomas. Resection as palliation is to be considered for all lesions, particularly bulky metastases from ocular melanomas.
Impact of therapeutic endoscopy on the treatment of bleeding duodenal ulcers: 1980–1990
Authors: Miller Alexander R. , Farnell Michael B. , Kelly Keith A. , Gostout Christopher J. , Benson Joanne T. 
Published: December 2004

AbstractTherapeutic endoscopy (TE) has provided a new means for treating peptic ulcer disease, prompting a reevaluation of surgery's role. The aim of this study was to determine if surgical therapy of bleeding duodenal ulcers has changed since the advent of TE. This retrospective review involved consecutive time periods during which TE was (1985–1990) and was not (1980–1984) widely available. Exclusion criteria were prior gastric surgery, nonpeptic conditions, and untreated ulcers. Inclusion standards were met by 252 patients (180 men, 72 women) whose mean age was 67 years. Patients were grouped by the initial therapeutic intervention. Groups were similar in age, medical condition (mean APACHE II score 16), and morbidity. Seventy‐five patients had surgery alone during 1980–1984 and 38 during 1985–1990. TE was initially performed on 134 patients during 1985–1990. Bleeding (n=30) and perforation (n=1) prompted emergent operation in 23% of cases following TE. Thus 69 (38+31) patients underwent surgery between 1985 and 1990. Preprocedure transfusions averaged 4.1 units in the endoscopic group and 8.2 units in the operative groups (p<0.0001). Disagreement existed between the endoscopic and surgical descriptions of ulcer location in 53% of cases. Emergent surgery was required in 45% of hemodynamically unstable patients versus 14% of stable patients who initially underwent TE (p<0.0001). Sixty‐one percent of incompletely visualized TE‐treated lesions required operation, and 18% of well visualized ulcers underwent operation (p<0.0001). Hospital mortality was similar (8% versus 16%) in the endoscopic and operated groups (p=0.7). Mean follow‐up was 540 days. The number of operations performed for bleeding duodenal ulcer did not change significantly during the TE era, and a significant subset (23%) of endoscopically treated patients required surgical therapy. TE failure was portended by hemodynamic instability or incomplete endoscopic visualization.
Carcinoma of the ampulla of vater: Histopathologic analysis of tumor spread in Whipple pancreatoduodenectomy specimens
Authors: Shirai Yoshio , Tsukada Kazuhiro , Ohtani Tetsuya , Koyama Syuntaro , Muto Terukazu , Watanabe Hidenobu , Hatakeyama Katsuyoshi 
Published: December 2004

AbstractControversies exist regarding the application of the pylorus‐preserving pancreatoduodenectomy (PPPD) to malignancies. This study was intended to disclose the pattern of spread of ampullary cancer and to substantiate that tumor spread at resectable stages does not involve the tissues preserved by PPPD. We examined 40 consecutive Whipple pancreatoduodenectomy specimens: mucosal cancer, 4 cases; cancer invading (but not penetrating) the sphincter of Oddi, 1; cancer invading the submucosa of the duodenum, 12; cancer invading the proper muscle of the duodenum, 5; cancer invading the subserosal layer of the duodenum, 7; and cancer invading pancreatic parenchyma, 11. Five cases of mucosal cancer or cancer invading (but not penetrating) the sphincter spread locally without nodal involvement and showed a 5‐year survival of 80% without recurrence, being better (p<0.05) than the 40% survival for patients with more advanced cancers. Sixty‐three percent of the remaining 35 cases had metastasis to regional lymph nodes. The 5‐year survival of 28% among those with cancer penetrating the proper muscle was worse (p<0.05) than the 59% survival for those with less advanced cancers. No cases had involved the anatomic structures that would have been preserved by a PPPD. In three cases (7.5%), gastric cancer coexisted. In conclusion, ampullary cancer not penetrating the sphincter spreads locally. Once penetrating the sphincter, it often spreads regionally and causes recurrence. Cancer penetrating the proper muscle of the duodenum bears a worse prognosis. PPPD is an attractive alternative to the Whipple operation for ampullary cancer because no involvement was found in the tissue preserved by the PPPD. However, surgeons should be aware of a concomitant gastric cancer when doing a PPPD.
Traumatic rupture of the aortic isthmus: An emergency?
Authors: Pate James W. , Fabian Timothy C. , Walker William 
Published: December 2004

AbstractThe objectives of this study were to explore the hypotheses that: (1) patients with traumatic rupture of the aortic isthmus (TRA) who have not exsanguinated into the pleural cavity upon hospital presentation are unilikely to develop rupture of the hematoma during the time necessary to investigate all injuries and attend to those of more immediate danger; and (2) appropriate medical therapy can prevent free rupture of the hematoma. The medical records of 112 patients who were proved to have TRA at the isthmus resulting from injury within the preceding 7 days were reviewed. Fifty of these patients received medical treatment aimed at decreasing aortic wall stress; 46 were managed under a formal protocol. The available English language and European literature for the past 15 years was surveyed for evidence of the effects of delay between injury and aortic repair. Eight patients died before aortic repair, six of aortic exsanguination (all within 4 hours of injury). Of 77 patients for whom the time of injury was recorded and the aorta was repaired, 36 were repaired within 12 hours of injury and 41 between 12 hours and 24 weeks; none developed aortic hemorrhage. No patient receiving adequate medical therapy died of rupture of the hematoma. Other major surgery preceded aortic repair in 33 patients. We conclude that the concept that traumatic rupture of the aorta should always take priority over other injuries is incorrect. Pharmacologic reduction of wall stress appears to decrease the probability of rupture of the periaortic hematoma.
Carcinoembryonic antigen levels in the peritoneal cavity: Useful guide to peritoneal recurrence and prognosis for gastric cancer
Authors: Nishiyama Masahiko , Takashima Ikuhiro , Tanaka Takashi , Yoshida Kazuhiro , Toge Tetsuya , Nagata Nobuo , Iwamori Shigeru , Tamura Yoichi 
Published: December 2004

AbstractAt the time of laparotomy, peritoneal washings were collected from 155 gastric cancer patients and the levels in carcinoembryonic antigen (CEA) determined. The CEA levels in peritoneal washings were statistically independent of those in sera and could more reliably predict the presence of peritoneal metastasis than a cytologic study. Peritoneal recurrence was seen in 14 of 118 patients after curative operation. Of the 14 patients, 10 (71%) had elevated levels of CEA (100 ng/g protein) at surgery. Of these 10 cases, 2 of the tumors were classified as stage IB and 4 had no serosal invasion. Only one patient with peritoneal metastasis and a low CEA level was free from relapse more than 1 year after operation. Kaplan‐Meier's analysis showed that a high CEA level in peritoneal washings was a predictor of poor prognosis in patients who underwent either curative or noncurative resection. A proportional hazards regression analysis showed that a high CEA level in peritoneal washings was statistically significant in terms of predicting a shorter interval until peritoneal recurrence (p=0.0002) and for survival (p=0.0001). The CEA level in peritoneal washings is therefore of value as an indicator of peritoneal recurrence and prognosis.
Fiber: Effect on bacterial translocation and intestinal mucin content
Authors: Frankel Wendy , Zhang Wei , Singh Anu , Bain Allison , Satchithanandam Subramaniam , Klurfeld Dave , Rombeau John 
Published: December 2004

AbstractTotal parenteral nutrition (TPN) and elemental diet (ED) produce intestinal atrophy and increase bacterial translocation (BT) to mesenteric lymph nodes. The increased rate of BT may be due to alterations in mucosal structure, enzyme activity, or mucin content. Fiber improves intestinal structure and function in rats and may reduce the rate of BT. This study determined whether the addition of fiber to TPN or ED would maintain intestinal integrity and decrease BT to the mesenteric lymph nodes. Fifty‐six adult male Sprague‐Dawley rats underwent placement of jugular catheters and were assigned to one of five dietary groups: TPN, TPN+oral oat fiber (TPNF) 2 g/day, ED, ED+oral oat fiber (EDF) 2 g/day, or AIN‐76 (control); they were pair‐fed for 7 days. On day 8 the mesenteric lymph nodes were removed for bacterial cultures; and jejunal mucosal weight, DNA, protein, alkaline phosphatase, maltase, and jejunal mucin content were measured. Enteral nutrition significantly decreased BT when compared to parenteral feeding, and fiber significantly decreased BT when administered to rats receiving TPN or ED. Improvements in intestinal mucosal structure were not consistently associated with decreased rates of BT. Additionally, BT occurred independently of jejunal mucin concentration. Mechanisms other than maintenance of mucosal structure or mucin content are important in the mediation of fiber‐induced decreased BT in rats receiving TPN or ED.
Hereditary breast cancer and family cancer syndromes
Authors: Lynch Henry T. , Lynch Jane , Conway Theresa , Watson Patrice , Feunteum Jean , Lenoir Gilbert , Narod Steven , Fitzgibbons Robert 
Published: December 2004

AbstractHereditary breast cancer (HBC) shows extant clinical and genetic heterogeneity. Clinically one finds the onset of breast cancer at an early age, an excess of bilaterality, and patterns of multiple primary cancer such as combinations of breast and ovarian carcinoma in the hereditary breast‐ovarian cancer (HBOC) syndrome. In addition to HBOC, one sees a variety of putative breast cancer‐prone genotypes inclusive of hereditary site‐specific breast cancer, and the Li‐Frameni (SBLA) syndrome that is characterized by cancers involving all three germinal layers including sarcomas, brain tumors, leukemia, lymphoma, and adrenal cortical carcinoma in addition to often markedly early‐onset breast cancer. Breast cancer is also associated with autosomal dominantly inherited Cowden's disease and autosomal recessively inherited ataxia‐telangiectasia. Examples of pedigrees depicting clincal examples of these several HBC syndromes are presented in order to describe HBC's heterogeneity. The recent identification of the BRCA1 gene in early‐onset hereditary sitespecific breast cancer and the HBOC syndrome has led to new challenges for the genetic counselor. We review genetic counseling, which embraces surveillance and management recommendations that are responsive to the natural history of HBC and address the concept for future development of centers of expertise for HBC in the interest of improving cancer control.
Management of metastatic breast cancer
Authors: Wong Karmen , Henderson I. Craig 
Published: December 2004

AbstractSystemic treatment almost certainly prolongs the median survival of women with metastatic breast cancer, and it may prolong the survival of a small number of patients substantially. Even with conventional therapy, 10% or more patients may live into the second decade after recurrence. However, the disease cannot be eradicated, and the primary goal of treatment remains palliation and improvement of the quality of life. Because of the great variability in the pattern and course of the disease from one patient to another, therapy should be selected judiciously to maximize response and minimize toxicity. In some clinical situations, such as pathologic fractures and brain metastases, local therapies alone, such as surgery or irradiation, are the treatments of choice. Patients who will respond to endocrine therapy are well defined, and all patients with the characteristics of an endocrine responder deserve a chance at palliation with this modality alone because of its limited toxicity. A number of new forms of endocrine therapy with more specific targets at estrogen and progesterone receptor sites are now in clinical trials. When used appropriately, chemotherapy significantly improves patient quality of life despite its toxicity. No drug combinations, schedules, or doses have been shown to prolong survival or provide better net palliation than classic CMF (oral cyclophosphamide with intravenous methotrexate and 5‐fluorouracil) or CAF (intravenous cyclophosphamide, doxorubicin, and 5‐fluorouracil). Treatment with these combinations in excess of 6 to 9 months provides only marginal additional benefits and no survival advantage. The role of high dose chemotherapy with autologous bone marrow transplantation remains a promising area of investigation, but the available survival data are entirely compatible with the possibility that this modality will eventually prove inferior to conventional therapy. Many new cytotoxic agents with unique mechanisms of action are currently under investigation, including taxol, taxotere, Topotecan, and amonafide. Taxol may be the most promising therapy now available for patients whose disease has become refractory to doxorubicin. Biologic therapies using monoclonal antibodies against a specific oncogene or its product have entered clinical trials, and novel drug delivery systems using liposomes are under evaluation.
Adjuvant therapy of breast cancer
Authors: Davidson Nancy E. , Abeloff Martin D. 
Published: December 2004

AbstractAbout 180,000 American women will be diagnosed with early stage breast cancer during 1993. In many of these patients breast cancer is a systemic disease at diagnosis and thus not curable by local treatment alone. The development of optimal forms of systemic adjuvant therapy has been a major area of research for more than 30 years. The two most widely employed types of adjuvant therapy, cytotoxic chemotherapy and tamoxifen, have been shown to improve relapse‐free and overall survival in certain patient subsets. This review highlights recent advances in adjuvant therapy of early stage breast cancer and discusses current treatment guidelines.
Surface Electromyographic Studies of Swallowing in Normal Subjects: A Review of 440 Adults. Report 3. Qualitative Data
Authors: Vaiman Michael , Eviatar Ephraim , Segal Samuel 
Published: December 2004

OBJECTIVESurface electromyographic studies were performed on 440 normal adults to describe and evaluate different types of normal swallows clinically useful for ENT department.STUDY DESIGNProspective observational study of healthy volunteers.METHODSEMG recordings were made using stick‐on surface electrodes. Rectified and filtered EMG signals were evaluated. Parameters evaluated include the graphic configuration of activity of the orbicularis oris, masseter, submental group, and infrahyoid muscles, the last 2 covered by platysma, during single swallowing and continuous drinking. Four tests were examined: voluntary saliva swallows, voluntary separate swallows as normal, voluntary separate swallows of excessive amount of water (20 mL), drinking of 100 mL of water. Graphic recording of activity of the above‐mentioned muscles during swallowing and drinking were evaluated for groups of adults of different ages.RESULTSThere are several types of normal swallows as seen at the surface EMG records. There was no difference between EMG recordings of male and female swallows. Only group of elderly patients (age 70+) shows age‐induced differences in recorded swallows. There are two main types of normal swallow: single‐share and double‐share swallows. The oral phase of swallowing, being under conscious control, is very variable and should not be taken into consideration during evaluation of records. Final oral, pharyngeal, and initial esophageal stages of swallowing can be defined and evaluated at the rectified and filtered surface EMG record.CONCLUSIONThe normal muscle activity during swallows and drinking has several graphic patterns which can be identified and described similar to EKG records when surface EMG is rectified and filtered. The method of EMG recording is quick and simple, and can be used for screening and evaluation purposes in outpatient and inpatient ENT departments. These parameters represent activities required for normal deglutition, and can be used to identify abnormalities in ENT patients, and provide a basis for comparison of swallowing performance both within and between patients. These normal data form a valuable basis for future comparison with patients in pre‐ and postoperative stages and in EMG monitoring during ENT treatment.
A Diagnostic Paradigm for Childhood Idiopathic Sensorineural Hearing Loss
Authors: Preciado Diego A. , Lim Lynne H.Y. , Cohen Aliza P. , Madden Colm , Myer David , Ngo Chris , Bradshaw John K. , Lawson Louise , Choo Daniel I. , Greinwald John H. 
Published: December 2004

OBJECTIVEOur objective was to determine the diagnostic yield of laboratory testing, radiological imaging, and GJB2 mutation screening in a large cohort of patients with differing severities of idiopathic sensorineural hearing loss (SNHL).DESIGN AND SETTINGWe undertook a retrospective study of patients presenting with SNHL at our institution from 1993 to 2002.RESULTSLaboratory testing had an extremely low yield. Patients with unilateral SNHL had a significantly higher imaging yield than those with bilateral. The diagnostic yield of GJB2 screening was significantly higher in patients with severe to profound SNHL than in those with less severe SNHL. However, a relatively large number of patients with mild to moderate SNHL had positive GJB2 screens.CONCLUSIONSBased on diagnostic yields, we propose a cost‐effective stepwise diagnostic paradigm to replace the more commonly used and costly simultaneous testing approach. EBM rating: C. (Otolaryngol Head Neck Surg 2004;131: 804–9.)