Elective Approach Research Articles

Clinical Outcome at 10 Years After Laparoscopic Versus Open Nissen Fundoplication

Laparoscopic surgery has become the elective approach for the surgical treatment of gastroesophageal reflux disease (GERD) in the last decade. Outcome data beyond 10 years are available for open fundoplication, but few studies report long-term follow-up after laparoscopic fundoplication and comparison between laparoscopic and open approaches. In this study, we performed a retrospective study of all the patients undergoing Nissen fundoplication (open and laparoscopic) for antireflux surgery between 1996 and 1998 at our institution. In total, 166 patients were included: 88 underwent open Nissen fundoplication and 78 the laparoscopic approach. Complication rate was 5% for both groups. Conversion rate for the laparoscopic approach was was 4%. Median postoperative hospital stay was 9.5 days for open surgery and 3 days for laparoscopic 1 (P < 0.001). During the follow-up, 3 patients required reoperation, 1 after laparoscopic Nissen and 2 after open surgery, all of them due to dysphagia, though complementary tests showed normal features. After 10 years, 24% of the patients of the open surgery group (OS) remain symptomatic, and in the laparoscopic group (LS) 11% (P < 0.05). Overall, 16% of OS take dialy proton-pump inhibitors and 7% of LS (P < 0.05). Three patients have undergone an open Nissen fundoplication and 2 a laparoscopic referring mild dysphagia (NS). The satisfaction rate of the patients was 96% for OS and 97% for LS (NS). Laparoscopic Nissen fundoplication appears to be at least as safe and long term in effectiveness for GERD as the open approach, with the associated postoperative advantages of a minimally invasive access.

Port-access surgery as elective approach for mitral valve operation in re-do procedures

Re-do mitral valve procedures performed through median sternotomy carry substantial mortality and morbidity. To avoid complications of sternal re-entry and to provide adequate mitral valve exposure, antero-lateral thoracotomy has been suggested by some authors. From October 1997 to January 2007, 677 mitral valve operations have been performed in our centre using port-access video-assisted right mini-thoracotomy. Among these, 241 (35.6%) were performed on patients who had undergone one or more previous cardiac surgery procedures. Mean cardio-pulmonary bypass time and endo-clamp time were 117+/-46 min and 71+/-31 min, respectively. Arterial cannulation was performed either on the ascending aorta, with the endo-direct cannula (112 patients, 46.5%), or peripherally with a femoral artery approach (129 patients, 53.5%). Conversion to median sternotomy was necessary in only two patients (0.8%) due to aortic dissection (one case) and left ventricle free wall rupture (one case). Median intensive care unit stay was 24h, median mechanical ventilation time was 12h; median hospital stay was 8 days. Bleeding requiring surgical revision occurred in 12 patients (4.9%). Hospital mortality was 4.9% (12/241 patients). Port-access video-assisted right mini-thoracotomy allows good results in a difficult subset of patients; it allows minimal adhesion dissection, short ICU and hospital stay. In our practice, this technique has become the treatment of choice for mitral valve re-do surgery.

Balancing Competing Demands: Position-Taking and Election Proximity in the European Parliament

Parties value unity, yet, members of parliament face competing demands, giving them incentives to deviate from the party line. For members of the European Parliament (MEPs), these competing demands are national party and European party group pressures. Here, we look at how MEPs respond to those competing demands. We examine ideological shifts within a single parliamentary term to assess how European Parliament (EP) election proximity affects party group cohesion. Our formal model of legislative behavior with multiple principals suggests that when EP elections are proximate, national party delegations shift toward national party positions, thus weakening EP party group cohesion. For our empirical test, we analyze roll call data from the 5th EP (1999-2004) using Bayesian item-response models. We find significant movement among national party delegations as EP elections approach, which is consistent with our theoretical model, but surprising given the existing literature on EP elections as second-order contests.

Patients with Less Than Three Episodes of Diverticulitis May Benefit from Elective Laparoscopic Sigmoidectomy

This study was designed to asses the predictive factors of postoperative complications in patients who underwent a laparoscopic elective approach for recurrent diverticulitis and to determine the relationship between the number of acute episodes and surgical morbidity. A retrospective analysis was performed on patients with colonic diverticular disease treated by an elective laparoscopic approach between July 2000 and November 2007. The variables studied were age, sex, BMI, ASA, number of previous acute episodes, local severity, abdominal surgery history, comorbidity, and laparoscopic training of the surgeon. Logistic regression analysis was used to establish significant results. A total of 137 patients were analyzed; 87 (63.5%) were men with a mean age of 56.7 (range, 27-89) years. Intraoperative and postoperative complications occurred in 2.9% (n = 4) and 12.4% (n = 17) of the patients respectively. Conversion rate was 9.4% (n = 13). Local severity (odds ratio (OR), 16.34; 95% confidence interval (CI), 4.1-64.5, p = 0.00007), history of abdominal surgery (OR, 3.02; 95% CI, 0.8-11.5; p = 0.02), and the training of the operating surgeon (OR, 4.8; 95% CI, 1.02-22.7; p = 0.001) were significant risk factors related to surgery conversion. A history of three or more acute episodes was significantly associated with a high severity of local process and was a risk factor related to conversion (OR, 2.6; 95% CI, 0.5-12.3; p = 0.22). The severity of the local process seems to be a risk factor for perioperative complications. A significant association (chi2, 4.45; p = 0.03) between conversion and postoperative complications also was observed (OR: 3.79, 95% CI, 1.02-14.07; p = 0.04). A history of three or more acute episodes of diverticulitis with conservative treatment is associated with a high severity of the local process during laparoscopic sigmoidectomy and increases the rate of conversion and perioperative complications.

Campaign Effects on the Accessibility of Party Identification

This study uses response latency, the time required for a survey respondent to formulate an answer upon hearing a question, to examine the accessibility of partisan self identifications over the course of a political campaign season. Although the aggregate distribution of partisanship remains fairly stable during the campaign, party identifications become more accessible to individuals with weaker party identifications as the election approaches. Consistent with theoretical expectations, the authors find that partisan orientations are more useful in forming political judgments when those orientations are more accessible to the voter. The effect of partisanship on vote choice is a third greater for voters with highly accessible party identifications than for those with less accessible party identifications.

Out of the Sample and One Step Ahead: Forecasting Supreme Court Confirmation Votes

We propose and test a model to forecast confirmation votes for Supreme Court nominees. Overall, the confirmation-vote model is a substantial step in the forecasting of the level of formal opposition (nay votes) in the Senate. Nominee-based characteristics—qualifications and ideological extremism—are strong predictors of the percentage of nay votes a nominee can expect during the confirmation vote. As another presidential election approaches, we provide forecasts of the formal opposition of potential nominees to the nation's highest court.

Laparoscopic Rectosigmoid Resection for Acute Sigmoid Diverticulitis

Laparoscopic sigmoid colectomy has been widely accepted as elective approach but is, however, still discussed controversially for acute cases. Patients receiving a laparoscopic early single-stage procedure benefit from an early postoperative convalescence with a minimum of disability. As more surgeons gain expertise in minimally invasive surgery of the rectosigmoid, this video highlights the main steps of a rectosigmoid resection for acute complicated diverticulitis.

DESIGN OF NEW RELIABLE CFD-BASED ESTIMATION OF FLOW RATE IN HAEMODYNAMICS MEASURES

The correct knowledge of the blood flow rate Q is a major issue in clinical practice, and give important information about the cardiovascular state of a patient. The actual elective approach for blood flow analysis is based on the Doppler technique which enable highly accurate velocity measures at different position of a vessel highlighting its usability in many clinical applications, such as during catheterisation analisys. However, Doppler velocimetry analysis cannot measure directly the flow rate. The latter has to be indirectly estimated starting from the value of the maximum velocity (VM) and the value of the area of the vessel (A). In particular in current clinical practice, from [Doucette 1992] it is usually assumed: Q = A·VM/2 (1) This equation involves a parabolic spatial profile for the velocity and is valid if we assumes that blood flow is steady, laminar and Newtonian and is flowing in a rectilinear cylindrical vessel. Unfortunately in many real cases this assumption is far to be fulfilled. For this reason by means of about 200 Computational Fluid Dynamics (CFD) simulations we designed and calibrated a new formulation for the flow-rate estimate in usual Doppler velocimetry analysis using a dimensionless index named Womersley number (W) used for quantifying the pulsatility of the flow (see [Ponzini 2006]).

The political economy of IMF forecasts

We investigate the political economy of IMF forecasts with data for 157 countries (1999–2005). Generally, we find evidence of forecast bias in growth and inflation. Specifically, we find that countries voting with the United States in the UN General Assembly receive lower inflation forecasts as domestic elections approach. Countries with large loans outstanding from the IMF also receive lower inflation forecasts, suggesting that the IMF engages in “defensive forecasting.” Finally, countries with fixed exchange rate regimes receive lower inflation forecasts, suggesting the IMF desires to preserve stability as inflation can have detrimental effects under such an exchange rate regime.

A meta-analysis of 21 178 patients undergoing open or endovascular repair of abdominal aortic aneurysm

Several studies have compared outcomes after elective open and endovascular approaches to abdominal aortic aneurysm (AAA) surgery, with varying results. A random-effects meta-analysis was undertaken to compare operative outcomes, postoperative complications, 30-day mortality and long-term patient survival after surgery. Endpoints were compared using odds ratios (ORs), weighted mean differences (WMDs) or log hazard ratios (HRs) as appropriate. Forty-two studies comprising 21,178 patients (10,855 open; 10,323 endovascular) were included. In the elective setting (20,715 patients), the endovascular method was associated with a shorter stay in intensive care (WMD--36 h; P < 0.001) and a shorter total postoperative stay (WMD--5.4 days; P < 0.001). Cardiac (OR 1.76; P = 0.002) and respiratory (OR 4.01; P < 0.001) complications were more common after open surgery. In the endovascular group, 30-day mortality was lower (OR 0.46; P < 0.001). Endovascular surgery was also associated with an improved long-term aneurysm-related mortality (HR 0.39; P < 0.001). For ruptured AAA (463 patients), the less invasive operation was associated with a reduced stay in intensive care (WMD--100.4 h; P = 0.005) and a significantly lower 30-day mortality (OR 0.45; P = 0.005). The endovascular repair of AAA offers a clear benefit in terms of reduction in postoperative adverse events and 30-day mortality. In the longer term, it is also associated with a reduction in aneurysm-related mortality, but not in all-cause mortality.

Forecasting non-incumbent presidential elections: Lessons learned from the 2000 election

As the 2008 election approaches, we offer a reexamination of the 2000 election — its place in history, political science, and presidential forecasting models. This is especially relevant since 2008, like 2000, will be an election without a president seeking reelection. How should forecasting models deal with such elections? Looking carefully at 2000 we evaluate the utility of “weighting” candidates in non-incumbent elections. Using Bayesian Model Averaging, we find that weighting helps to better predict 2000, but also produces a poorer model fit over a wider set of elections. For other non-incumbent elections, weighting only improves predictions for the 1960 election. Moreover, we find that the 2000 election is anything but ordinary; attempts by forecasters to change the specification of models to better fit the 2000 election are ultimately harmful to the forecasting exercise. We conclude that presidential forecasts are best when they ignore whether or not an incumbent is running.

CAMPAIGN DONATIONS TAKE BIPARTISAN SHIFT

U.S. CHEMICAL MANUFACTURERS haven’t exactly abandoned the Republican Party. But like many other donors in the business community, the industry is giving a much larger share of its political campaign contributions to Democratic candidates as the 2008 national elections approach Since 1990, companies that make chemicals and related products such as plastics, paints, and explosives have given three-quarters of their total donations to Republican candidates for federal office, according to the Center for Responsive Politics. CRP is a nonpartisan group that analyzes campaign finance records filed with the Federal Election Commission (FEC). So far in the two-year 2008 election cycle, however, the chemical manufacturing sector has delivered 62% of its campaign cash to Republicans, a considerable drop-off from 75% in the 2006 midterm elections and 77% in 2004, the last presidential election year. The driving force behind the change is the Democratic takeover of Congress after 12 years of Republican rule. Business...

Presidential Politics and the Resurgence of Health Care Reform

Health care reform is back in vogue as the 2008 election approaches. Jonathan Oberlander writes that the issue is playing out very differently in the parties' presidential primaries. Jonathan Oberlander discusses the health care plans of the presidential candidates and the striking differences between the two parties' approaches to health care reform.

Gemcitabine, ifosfamide and paclitaxel in advanced/metastatic non-small cell lung cancer patients: a phase II study

Although platinum-based two-drug combinations represent the elective therapeutic approach for advanced/metastatic NSCLC, there is still interest in exploring the efficacy and tolerability of platinum-free combinations including third generation agents in selected NSCLC population. Based on the satisfying activity of gemcitabine (G), ifosfamide (I) and paclitaxel (T) as single agents in NSCLC, we have designed a phase II study to explore an alternative approach to platinum-containing regimens using a combination of these three drugs. To investigate the activity/toxicity of T 175 mg/m2 on day 1, I 3 g/m2 on day 1 (with Mesna uroprotection) and G 1,000 mg/m2 on day 1-8, every 3 weeks in the treatment of advanced/metastatic NSCLC, 46 patients (38 male, 8 female) with NSCLC were enrolled: mean age 58 (range 33-70); Stage IIIB/IV=15/31; ECOG PS 0-1/2=31/15; adenocarcinoma=20, squamous=14, large cell=3, NSCLC=8, adenosquamous=1. A total of 221 cycles have been administered (median number 4.8 for patients). In intent-to-treat analysis, partial response was achieved in 17 patients (36.95%), stable disease and progressive disease was detected in 16 (34.78%) and 10 (21.73%) patients, respectively. Time to progression was 30.9 weeks; median survival time was 42.7 weeks; the survival rates at 12 and 18 months were 34.79 and 15.21%, respectively. No toxic deaths occurred. No patients experienced grade 4 neutropenia and thrombocytopenia. Neutropenia grade 3 occurred in 10 patients (21.7%); Anemia grade 3 in 1 (2.1%); Thrombocytopenia grade 2 in two patients (4.3%) and grade 3 in one (2.1%). Peripheral neuropathy grade 1 occurred in ten (21.7%) and grade 2 in two patients (4.3%). Additional non-haematological toxicities were mild nausea, emesis and fatigue. GIT is well tolerated and active regimen in both advanced and metastatic NSCLC. These data suggest future investigations for GIT schedule as a possible alternative to platinum-based regimens in selected advanced/metastatic NSCLC patients where survival, tolerability and quality of life are the primary goals.

The Siloviki in Putin's Russia: Who They Are and What They Want

Little is known about the siloviki, commonly but misleadingly described as a group of current and former intelligence officers from Putin's hometown of St. Petersburg. Yet, its members, interests, relationships, and influence are helping shape Russia as its 2008 presidential elections approach.

As Voters Head to the Polls, Will They Perceive a “Culture of Corruption?”

by James A. McCann, Purdue University David P. Redlawsk, University of Iowa Depublican Congressman Duke Cunningham resigns after pleading guilty to bribery. House Majority Leader Tom DeLay is indicted and forced to relinquish his leadership position, and later resigns from Congress. House Demo crat William Jefferson is stripped of his posi tion on the Ways and Means Committee after an FBI raid of his congressional office and amid reports that he hid $90,000 in alleged bribes in a freezer at his home. Stories of wrongdoing in government surface almost daily as members of Congress come under a microscope for close ties to lobbyists. As the 2006 congressional elections approach, Demo crats have made a central theme in their campaigns, arguing that a series of scan dals adds up to a full-blown of corrup tion. In response, Republicans have rejected this characterization and attempted to point the finger back at Democrats, suggesting that peo ple who live in glass houses shouldn't throw stones. For the Democrats' charge of a culture of corruption to stick, two conditions must hold. First, voters must accept that is commonplace-even a way of life-for those in and around the fed eral government. Sec ond, citizens have to place the blame for this squarely, or at least largely, on the Republican Party. We consider these two themes below. Do citizens perceive in the many trans actions and decisions that take place every day in politics? And if so, can Democrats use these judgments to their advantage?

Toward a New Economic Constitution: Judicial Disciplines on Trade Politics

This article first observes that protectionism is an icon of trade politics and thus likely to gather fresh momentum as a domestic election approaches. The paper then problematizes protectionism beyond mere seasonal election politics by revealing its fatal pathologies both to the United States and to the rest of the world. Protectionism basically caters to the special interest at the expense of the larger public interest, which may be coined as a Madisonian constitutional failure. It also deviates from global trading norms, which the United States hypocritically continues to preach adherence to for the rest of the world. This double standard creates images of American Exceptionalism and undermines the effectiveness of the multilateral trading system. As a solution, the paper suggests certain judicial options to discipline protectionist trade politics, such as structural and substantive due process as well as internalization of free trade principles. It argues that measures suspected as protection should undergo strict scrutiny, and should fail absent compelling justifications for them. It also submits that certain essential global trading norms, such as the non-discrimination principle, may be internalized by the Court under constitutional doctrines, such as Charming Betsy.

Endothelin-1 regulates parathyroid hormone expression of human parathyroid cells

Parathyroid cells synthesize and release endothelin-1 (ET-1). ET-1 displays an in vitro inhibitory effect on basal parathyroid hormone (PTH) secretion and also counteracts PTH hypersecretion stimulated by low calcium. Such effects are further demonstrated in vivo, independent of the changes in calcitonin. We propose that ET-1 may regulate the pathogenesis of uremic hyperparathyroidism. However, this was not directly demonstrated in human parathyroid glands. Hyperplastic parathyroid glands are obtained from the surgical operation for uremic hyperparathyroidism. Cells are isolated by enzyme digestion and treated with ET-1, and are assessed for PTH mRNA expression. PTH in the plasma and the medium is measured by a newly developed method to detect the whole PTH (1-84). Uremic patients with severe secondary hyperparathyroidism and ultrasonography-proved hypertrophy of parathyroid glands received elective surgical approaches under general anesthesia. The resected glands were immediately taken to the laboratory for fresh isolation. Following ET-1 treatment, PTH mRNA expression is evaluated by RT-PCR method. ET-1 is detected with radioimmunoassay kit and PTH is measured by a new commercially available Duo PTH kit. ET-1 exhibited a dose-dependent inhibitory effect (from 10(-12) - 10(-7) M) on PTH mRNA expression of parathyroid cells, either in the basal or in the low-calcium-stimulated states. Release of PTH into the medium is also gradually inhibited by the increase in ET-1 concentrations. Our results demonstrate that ET-1 attenuates PTH mRNA expression in freshly isolated human parathyroid cells, and PTH release is also decreased. This result is consistent with our previously reported in vitro and in vivo experiments.

Reliving History and Renewing the Health Care Reform Debate

As the 2008 presidential elections approach, health care reform is once again easing its way into the consciousness of many Americans. At last count, 48 million of them—nearly one fifth of those younger than 65 years—lacked health insurance,[1][1] and signs abound that the cost of health

Who’s in Charge in the Kremlin?

his country away from internal liberalization and a foreign policy rooted in constructive international engagement. Debates rage in Russia and beyond over Putin's consolidation of presidential power and despite his consistent protestations to the contrary the possibility he may amend the Russian constitution to extend his presidency indefinitely. Is Vladimir Putin too powerful for Russia's good? Events of the last year suggest a quite different trend in Russia's political life. The question is no longer simply one of Putin's appetite for autocracy. Instead, the threat to Russia's political, economic, and social stability is that, increasingly, no single person is really firmly in charge in the Kremlin, and that uncertainty will only grow as the next presidential election approaches. There are plenty of troubling signs that Putin's inevitable loss of influence over the course of events in Russian politics is already well underway. Divisions within Russia's party of power are deepening. The rivalries those divisions have created now threaten the country's political development, investment climate, and economic growth, and the Russian president seems unable to do much about it. Putin is still in the driver's seat. But, to paraphrase former presidential speechwriter Richard Goodwin, he may already have discovered that the steering wheel is no longer connected to the engine. Putin's loss of control arouses real anxiety in those looking for clear policy direction in Russia, because there has been an enormous consolidation of power in the Kremlin since the 1998 financial crisis, in which chaos in the Russian government led to a default on international debt. The more powerful the vehicle, the more dangerous it is that no one person seems able to steer it. As elbows begin to fly heading toward Russia's 2008 presidential election, battle lines have been drawn inside the Kremlin