Prospective comparison of helium versus carbon dioxide pneumoperitoneum.

Background: During prolonged laparoscopic operations with carbon dioxide (CO2) pneumoperitoneum (PP), hypercapnia with significant acidosis has been reported to occur in some patients with pulmonary dysfunction. An alternate inert insufflation gas like helium (He) could avoid this problem.

Methods: This prospective, IRB-approved study compared the cardiopulmonary response in 20 patients with both CO2 and He PP.

Structure of disordered eating in a twin community sample.

Objective: To describe the types of eating problems experienced by women in an Australian twin population.

Method: Questions assessing preoccupation with weight or shape, use of various methods of weight control, difficulties with weight control, disordered eating, or binging, were administered to a group of 3,869 female twins. Exploratory and confirmatory factor analyses were used to summarize and describe problematic eating behaviors.

NIST SRM 1945, whale blubber, NIST SRM 1974a, organics in mussel tissue, and NIST SRM 1941a, organics in marine sediment as certified reference materials for polychlorinated dioxins and furans in marine ecosystems.

Few natural matrix Standard Reference Materials are available for the validation of analytical methods measuring polychlorinated dioxins and furans (PCDDs and PCDFs) in marine ecosystems. The concentrations of PCDDs and PCDFs in NIST SRM 1945, SRM 1974a, and SRM 1941a are of interest because the analysis of marine mammal, mussel tissues and sediments have become important tools in the determination of organochlorine contamination of the environment. Because these SRMs have been demonstrated to be homogenous for other organic contaminants, they would be expected to be reliable standards for validation of polychlorinated dioxins and furans in marine mammals, mussels and sediments as well.

Geographic variation in patient surveillance after colon cancer surgery.

Purpose: Considerable variation among surgeons exists in the current practice of patient surveillance after colon cancer treatment. We evaluated whether geographic factors are responsible for this observed variation.

Methods: Profiles of hypothetical patients and a detailed questionnaire based on the profiles were mailed to 2,733 members of two national surgical societies.

Laparoscopic cholecystectomy can disseminate in situ carcinoma of the gallbladder.

Background: Early case reports suggest more frequent and rapid recurrences of carcinoma of the gallbladder after laparoscopic cholecystectomy (LC) than after open cholecystectomy. This cancer has a poor prognosis and occurs in 1 percent of patients who undergo cholecystectomies.

Study Design: A recent community hospital series of gallbladder carcinoma (GBC) was reviewed and the total reported experience of GBC after LC was compiled.

Surveillance after curative colon cancer resection: practice patterns of surgical subspecialists.

Background: In the literature, suggested strategies for the follow-up of colon cancer patients after potentially curative resections vary widely. The optimal regimen to monitor for recurrences and new primary tumors remains unknown. The nationwide cost impact of wide practice variation is also unknown.

Distal pancreatectomy for cancer: results in U.S. Department of Veterans Affairs hospitals, 1987-1991.

Although cancers of the pancreatic body and tail are often advanced at the time of diagnosis, resection of localized tumors can result in long-term survival. A search of the computerized records of the U.S.

Sonographic diagnosis of unsuspected gallbladder cancer: imaging findings in comparison with benign gallbladder conditions.

Objective: Several sonographic findings were analyzed to determine their significance in distinguishing gallbladder cancer from benign conditions of the gallbladder. The analyzed findings were gallstone number and size; floating stones; displaced stones; wall thickening, irregularity, and echogenicity; mucosal plaque; intraluminal mass; gallbladder-replacing mass; invasive gallbladder mass; gallbladder mucosal discontinuity; hyperechoic gallbladder mucosa; and submucosal or transmural echolucency.

Materials And Methods: Sonograms of 20 patients with unsuspected, pathologically proven gallbaldder cancer and 65 patients with benign gallbladder conditions (predominantly acute or chronic cholecystitis) were retrospectively assessed by two observers who were unaware of experimental conditions.

How tumor stage affects surgeons' surveillance strategies after colon cancer surgery.

Background: The factors that influence decision making among surgeons are not well understood. This study sought to evaluate how the tumor stage of patients subjected to potentially curative surgery for colon cancer affects the follow-up strategies used by practicing surgeons.

Methods: Hypothetical patient profiles and a detailed questionnaire based on these profiles were mailed to 2733 members of two major surgical societies.

Recent experience with cancer of the ampulla of Vater in a national hospital group.

A total of 64 resections, 24 operative bypasses and 35 nonoperative biliary intubations, were performed for ampullary carcinoma in U.S. Dept.

Rare anal canal cancers in the U.S. veteran: patterns of disease and results of treatment.

Nationwide treatment results among U.S. veterans with rare anal cancers (AC) have not been previously reported.

Truncated MHC class II cytoplasmic and transmembrane domains: effect on plasma membrane expression.

Plasma membrane (PM) expression of major histocompatibility complex (MHC) class II molecule is required for the interaction of antigen (Ag) presenting cells and T lymphocytes. Class II molecules composed of an alpha and a beta chain are highly polymorphic which facilitates their interaction with Ag and Ag-specific T cells. Recently, we have focused on the less polymorphic sequences of class II molecules, the transmembrane (TM) and cytoplasmic (Cy) domains, in an attempt to understand what their function might be.

The Whipple resection for cancer in U.S. Department of Veterans Affairs Hospitals.

Objective: The authors compiled the results after Whipple resection for cancer from a large U.S. national hospital system.

Sediment contamination and biological effects in a Chesapeake Bay marina.

Complementary measures of sediment toxicity, sediment chemistry and benthic community structure were evaluated at stations within and on the outside perimeter of an enclosed marina on the Bohemia River, a northeastern tributary to Chesapeake Bay. Sediment concentrations of polynuclear aromatic hydrocarbons, copper and tributyltin (TBT) were elevated at stations inside the marina basin. A 28 day partial life-cycle test with the amphipod Hyalella azteca indicated no significant lethal effects associated with test sediments.

Small bowel melanoma: extended survival with surgical management.

Small intestinal melanoma is rare, and primary vs metastatic origin is often unclear. A patient with the longest reported survival (21 years) after resection of a melanoma in the small intestine is presented, and the debate regarding primary small bowel melanoma is reviewed. Multiple resections of neck recurrence (or second primaries) in this patient with prolonged survival validates the aggressive pursuit and excision of localized melanoma when possible.

Pancreatic cancer treatment in the U.S. veteran from 1987 to 1991: effect of tumor stage on survival.

To assess the outcomes after pancreatic cancer treatment in a nationwide hospital system, patients treated in Department of Veterans Affairs (DVA) hospitals from 1987 to 1991 were studied by tumor stage, the most significant reported influence on survival. Tumor registrars from DVA hospitals provided information that allowed TNM staging in 598 patients, and duration of survival from treatment to death was known in 96+% of cases. Survival was 9 months longer after 64 resections for stage I-II (localized) pancreatic cancer than after 149 other treatments (P < 0.

Analysis of Gulf of Mexico bottlenose dolphins for organochlorine pesticides and PCBs.

Organochlorine concentrations were determined in blubber samples from 33 Tursiops truncatus stranded on the Texas and Florida coastlines. All tissues had measurable concentrations of 4,4'-DDE (0.18-70.

Comparative evaluation of educational methods in surgical resident education.

Objective: To determine the influence of study methods on American Board of Surgery (ABS) examination performance.

Design: Performance on ABS examinations by and faculty evaluations of 54 categorical surgical residents from 1976 to 1992 were correlated with the residents' use of commonly available educational methods (textbooks, Selected Readings in General Surgery, grand rounds, preceptor guidance, clinical surgery review courses, surgical science review courses, Surgical Education and Self-Assessment Program [SESAP], and continuing medical education lectures) in early, late, and after residency.

Setting: An average-sized midwestern US university surgical residency.

Evaluation of alternate messages on an electronic message strip to recruit subjects to a smoking-cessation program.

The authors previously published details of a method to evaluate the effectiveness of electronic message strips in recruiting subjects to a smoking-cessation program. They now report data suggesting that a shorter, more negative message yields better results than a longer, more positive message. The data also show that this approach increases the number of subjects who enroll in a smoking-cessation program and the number of subjects who actually quit smoking.

A reappraisal of total pancreatectomy for pancreatic cancer: results from U.S. Veterans Affairs hospitals, 1987-1991.

Background: After enthusiasm for total pancreatectomy for pancreatic adenocarcinoma peaked in the 1970s, a failure to improve outcomes in the 1980s led to fewer reports of this procedure.

Methods: We retrieved records from 252 Whipple and 47 total pancreatectomies for pancreatic cancer performed at U.S.

Periampullary cancer treatment in U.S. Department of Veterans Affairs hospitals: 1987-1991.

Background: Reported treatment outcomes for painless jaundice caused by ampullary, distal biliary, or duodenal (ABD) cancer are better than those caused by pancreatic cancer.

Methods: Outcomes after resection, bypass, or biliary intubation were compared in 432 patients with ABD cancer and 1753 with periampullary pancreatic cancer from U.S.

Recurrent squamous cell carcinoma of the anal canal. Predictors of initial treatment failure and results of salvage therapy.

Objective: The outcomes of patients with squamous cell carcinoma of the anal canal treated by either sphincter-preserving procedures or radical surgery were evaluated, with the goals of identifying factors predicting treatment failure and quantifying results of salvage therapy in patients with recurrent disease.

Basic Procedures: A population-based study on all patients in all 159 hospitals of the Department of Veterans Affairs (VA) from 1987 to 1991 was carried out. Data were compiled from several national computerized VA data sets.

Complications and outcomes in the treatment of pancreatic adenocarcinoma in the United States veteran.

Background: Treatments for carcinomma of the pancreas have wide variations in reported complications and results.

Study Design: A population-based retrospective analysis of invasive treatments for carcinoma of the pancreas in all United States Department of Veterans Affairs hospitals was conducted using computerized patients files from 1987 to 1991.

Results: One thousand nine hundred sixty-four patients (99 percent male) were classified by the most aggressive treatment: 327 patients had pancreatic resections, while 1,180 had operative biliary or gastric bypasses, and 457 had percutaneous or endoscopic biliary intubations.

Current follow-up strategies after resection of colon cancer. Results of a survey of members of the American Society of Colon and Rectal Surgeons.

Unlabelled: The follow-up of patients after potentially curative resection of colon cancer has important clinical and financial implications for patients and society, yet the ideal surveillance strategy is unknown.

Purpose: The aim of this study was to determine the current follow-up practice pattern of a large, diverse group of experts.

Methods: The 1,663 members of The American Society of Colon and Rectal Surgeons were asked, via a detailed questionnaire, how often they request nine discrete follow-up evaluations in their patients treated for cure with TNM Stage I, II, or III colon cancer over the first five posttreatment years.