Hospital experience and hospital mortality following partial pancreaticoduodenectomy in The Netherlands

OBJECTIVE: To analyse the effect of hospital experience on mortality after subtotal pancreaticoduodenectomy in the Netherlands. DESIGN: Retrospective evaluation. METHOD: Information on hospital mortality and pancreatic resection in 1994 and 1995 in the Netherlands was obtained from the National Medical Register. Subanalysis was carried out of surgical mortality by age and hospital experience. RESULTS: Approximately 50% of the pancreaticoduodenectomies in the Netherlands were performed in hospitals with limited experience (< 5 procedures per year). Hospital mortality was higher in small-volume hospitals than in hospitals with experience (> 25 procedures per year): in 1994 17.2 and 0% and in 1995 14.6 and 2.9%, respectively (p < 0.05). Mortality was higher in patients older than 70 years compared with patients younger than 55 (p < 0.05). CONCLUSION: There was a correlation between mortality after pancreaticoduodenectomy and hospital experience. Therefore these procedures should be performed in centres with experience.     

Temperature dependence of spontaneous otoacoustic emissions in the edible frog (Rana esculenta)

The change in frequency of individual emissions in the European edible frog (Rana esculenta) when the temperature of the frog is modified, is part of a complex pattern of interaction between spontaneous otoacoustic emissions. At high temperatures (above 24 degrees C) two emissions are always detected (e.g., one near 800 Hz and one near 1200 Hz). The higher-frequency emission is lower in level and has a wider bandwidth than the lower-frequency emission. It is also often asymmetric and sometimes breaks into two emissions when an external suppressor tone is applied. When the temperature is decreased, these emissions are reduced in frequency at a rate of 0.04 octave/degree C. The higher-frequency emission becomes narrower and taller, and the lower-frequency emissions becomes broader and less intense. At approximately 18 degrees C the lowest of these emissions (now between 600 and 700 Hz) disappears and is replaced by a new emission approximately 100 Hz lower in frequency. When the temperature is carefully controlled the two emissions can exist simultaneously. The lowest-frequency emission changes 0.015 degree C/octave suggesting that the mechanisms controlling the frequency of this emission may be different than those determining the frequencies of the other emissions. All but the lowest-frequency emissions are maximal in level and have minimal bandwidth when the frequency is close to 700 Hz, which is interpreted as evidence that these emissions are filtered by a temperature-independent process.     

Laboratory evaluation of tissue heart valves. A comparative assessment

Tissue of commercially prepared tissue heart valves were evaluated and compared with aluminium treated, fixed porcine valve tissue in vitro (tensile strength, scanning and transmission electron microscopy) and in vivo (calcification potential after subcutaneous implantation in the rat model). Valve leaflets (n = 40) were divided into four groups according to the method of treatment: Group I (fixed in 0.652% glutaraldehyde, control), Group II (fixed and treated with aluminium), Group III (fixed and treated with Toluidine blue) and Group IV (fixed and treated with watersoluble alkyl sulphate). Tensile strength was not influenced in Group II and III (p > 0.05). Group IV indicated a significant (p < 0.05) reduction in tensile strength. Scanning electron microscopy revealed damage and loss of surface endothelium in Group III and IV respectively. Transmission electron microscopy indicated damage to underlying matricial cells in Group III and IV. Calcification potential was significantly (p < 0.001) reduced in Group II to IV. We conclude that damage ultrastructure could contribute to the reduced tensile strength in Group IV and that reduced tensile strength might have an influence on the long-term durability of tissue heart valves. Antimineralization treatment of tissue heart valves does retard calcification but is yet unable to inhibit the process completely.     

Role of dopamine in d-amphetamine-induced euphoria in normal, healthy volunteers.

The present study evaluated the role of dopamine in the euphorigenic effects of d-amphetamine in normal volunteers. d-Amphetamine (20 mg) was administered alone and after pretreatment with pimozide (4 mg), fluphenazine (3 or 6 mg), or prazosin (1 or 2 mg) in 3 separate groups of participants. Subjective effects were measured at regular intervals. It was hypothesized that pimozide and fluphenazine, but not prazosin, would attenuate the euphorigenic effects of d-amphetamine. In all studies, d-amphetamine produced robust stimulant-like effects (e.g., increased scores on measures of arousal and euphoria). Although none of the antagonists significantly attenuated subjective responses to d-amphetamine, there were trends for both dopamine antagonists to reduce some responses. Both dopamine antagonists also produced modest effects when administered alone. These findings are inconsistent with those of studies with laboratory animals, perhaps because of differing experimental conditions. Alternatively, these findings raise the possibility that separate processes mediate drug reinforcement and euphoria. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparative effects of enteric-coated pancreatin microsphere therapy after conventional and pylorus-preserving pancreatoduodenectomy

BACKGROUND: A comparative study was performed between patients with exocrine pancreatic insufficiency after conventional pancreatoduodenectomy (Whipple's procedure) and pylorus-preserving pancreatoduodenectomy (PPPD). In these patients the pharmacodynamics of 2-mm enteric-coated pancreatin microspheres (ECPMs) and their gastric transit time in relation to that of a solid meal were investigated. The efficacy of ECPM preparations may differ after Whipple's procedure compared with PPPD, because the latter procedure does not include gastrectomy. METHODS: Gastric transit was assessed by double-isotope scintigraphy. A pancake meal was labelled with 99mTc. ECPMs were cold-labelled with 170Er and neutron activated shortly before ingestion to enable imaging with a gamma camera. Intraluminal pancreatic enzyme activity was assessed during a 6-h period with two indirect tests: the cholesteryl [14C]octanoate breath test and the N-benzoyl-L-tyrosyl-p-aminobenzoic acid-p-aminosalicylic acid (NBT-PABA-PAS) test. RESULTS: In patients who had Whipple's procedure, the gastric transit time of ECPMs and of the pancake meal was not significantly different. The outcome of the indirect pancreatic function tests during enzyme supplementation was comparable, and not significantly different, from that in healthy volunteers. In patients who had PPPD, however, the gastric transit time of microspheres was greatly delayed compared with that of the pancake meal (P < 0.05). Improvement in the outcome of the indirect pancreatic function tests during enzyme supplementation was much less and remained well below that of healthy volunteers (P < 0.05). CONCLUSION: In cases of exocrine pancreatic insufficiency after Whipple's procedure, 2-mm ECPM treatment adequately restores pancreatic enzyme activity. Following PPPD, however, ECPM treatment is often ineffective because the microspheres are retained in the stomach. In these patients, use of conventional powdered pancreatin enzyme preparations may improve the efficacy of treatment.     

Application of an elastic-plastic model to the use of small specimen strength ratio for measuring fracture toughness

Data reported by Server and Wullaert correlating specimen strength ratio with fracture toughness were analyzed with the D-BCS-HSW model. This model is based on the Dugdale model, elaborated by Bilby, Cottrell and Swinden, and extended by Heald, Spink and Worthington. The data included instrumented precracked Charpy results on HSST plate 02, as well as static, intermediate, and dynamic tests of 1 — T compact and bend specimens of SA533B-1 steel. The model relates the fracture toughness to the crack length, specimen shape and size, applied failure stress and effective flow strength. The only parameter not provided by the data is the constraint factor, M, the ratio of the effective flow strength to the yield strength. The model was fitted to the data by non-linear least squares methods by which M was determined to be approx. 2.5 for the Charpy data, and from 2.1 to 2.6 for the other specimen data. The fit is considered to be reasonably good throughout the range from linear-elastic fracture mechanics through to plastic collapse. The result for the Charpy data is considered to be as good as that for the other specimens. The determination of only one parameter is needed to establish the relationship between specimen strength ratio and fracture toughness. This relationship then applies to the entire range of fracture regimes.