bluuebunny/crossref_metadata_2025 huggingface dataset:
Fifteen‐Count Breathlessness Score in adults with COPD
Authors: WILLIAMS Marie , DE PALMA Laura , CAFARELLA Paul , PETKOV John
Published: August 2006

Objective and background:  The Fifteen‐Count Breathlessness Score (15CBS) has been reported to quantify breathlessness. The aim of this study was to determine the reliability and validity of the 15CBS in adults with COPD.

Methods:  Using an observational correlation design, subjects with clinical signs and symptoms of COPD were videotaped performing the 15CBS at a self‐selected (task 1) and an 8‐s counting pace (task 2), on two occasions with 5‐min rest between attempts. Respiratory‐related quality of life questionnaires, self‐report shortness of breath measures and pulmonary function tests were completed by all subjects.

Results:  Thirty subjects completed the protocol. No significant differences and good linear relationships were calculated for the 15CBS within subjects (task 1 P = 0.32, r = 0.75 and task 2 P = 1.00, r = 0.86) and between assessors (task 1 P = 0.57, r = 0.99 and task 2 P = 0.21, r = 0.75). No significant relationships were evident between the 15CBS and shortness of breath or quality of life scores. Significant relationships existed between the 15CBS and FVC (litres and per cent predicted).

Conclusion:  Most subjects completed the 15CBS using one breath, limiting discrimination between subjects with differing degrees of breathlessness. Although data from this study confirmed that the 15CBS is a reliable procedure within people with COPD, further modification is required to increase the validity and discriminative ability of this instrument.
Microarray analysis of gene expression associated with extrapulmonary dissemination of tuberculosis
Authors: KIM Deog Kyeom , PARK Geun Min , HWANG Yong Il , KIM Hyun Ji , HAN Sung Koo , SHIM Young‐Soo , YIM Jae‐Joon
Published: August 2006

Objective:  Although extrapulmonary organs are involved in 20% of patients with tuberculosis, the host genetic factors associated with the extrapulmonary dissemination of tuberculosis are not yet known. The aim of this study was to identify the host genetic factors associated with the extrapulmonary dissemination of tuberculosis by comparing gene expression profiles of patients who had recovered from extrapulmonary tuberculosis and those who had recovered from pulmonary tuberculosis.

Methods:  Five patients from each group were enrolled. Total RNA was extracted from peripheral blood mononuclear cells that had been incubated for 48 h with whole lysate of Mycobacterium tuberculosis (H37Rv, 0.5 µg/mL). Gene expression profiles were acquired using the GeneChip® array and its applied systems. Gene expression profiles from five patients with previous extrapulmonary tuberculosis and one pooled control sample from five patients with previous pulmonary tuberculosis were analysed and compared. Genes that were expressed concordantly in more than 80% of arrays and that showed more than twofold changes in at least one array among samples from patients who had recovered from extrapulmonary tuberculosis were identified.

Results:  Compared with the control sample, the expression of 16 genes, including those for tumour necrosis factor (TNF)‐α and cathepsin W, was increased, and the expression of 45 genes including that for TNF‐receptor superfamily member 7 (TNFRSF7), was decreased in the extrapulmonary tuberculosis patients. The altered expression of the TNF‐α, cathepsin W and TNFRSF7 genes was confirmed by quantitative RT‐PCR.

Conclusions:  Altered expression of the genes for TNF‐α, cathepsin W and TNFRSF7 may be risk factors for the extrapulmonary dissemination of tuberculosis in humans.
Comparison of airway dimensions in different anatomic locations on chest CT in patients with COPD
Authors: OHARA Tadashi , HIRAI Toyohiro , SATO Susumu , SATO Atsuyasu , NISHIOKA Michiyoshi , MURO Shigeo , MISHIMA Michiaki
Published: August 2006

Objective:  It is not well known whether there is heterogeneity in the airway dimensions at different anatomic locations in individual patients with COPD. The first objective was to compare airway dimensions of the basal segment bronchus between COPD patients and healthy controls. The second and third objectives were to compare the airway dimensions in two anatomic locations, and to investigate the relationship between CT measurements and pulmonary function among COPD patients.

Methods:  Thirty males with COPD (aged 68.7 ± 8.1 years) and 18 healthy males (aged 64.9 ± 14.0 years) were enrolled in the study. COPD was diagnosed according to the criteria of the Global Initiative for Obstructive Lung Disease Workshop Report. Pulmonary function tests and CT scans were performed on all subjects. Airway dimensions and lung attenuation were automatically determined using methods that were validated with a phantom.

Results:  Age, smoking index and height did not significantly differ between the COPD patients and healthy controls. The COPD patients had a significantly thicker airway wall than healthy controls. Among the COPD patients, there were no significant differences in the airway dimensions of bronchi in different segments; however, the airway and lung attenuation measurements of the lower lung field were more strongly correlated with FEV1 than those of the upper lung field.

Conclusion:  Patients with COPD had no significant heterogeneity in airway dimensions at different anatomic locations. The airway and lung attenuation measurements of the lower lung field were more strongly correlated with airflow limitation than those of the upper lung field.
Significant bronchospasm during sickle cell painful crises is associated with a lower peripheral eosinophil count
Authors: HASSAN Hilali , MUGHAL Inam , DAR Javeed , AL MEKKI Taj E. , CHAPUNDUKA Zivani , HADDAD Ahmad , HASSAN Imad S. A.
Published: August 2006

Background:  Bronchial hyperresponsiveness and/or bronchospasm are recognized complications of sickle cell disease.

Objective:  The aim of this study was to investigate the presence of bronchospasm during painful crises, using simple spirometry in patients with sickle cell disease.

Methods:  A prospective, non‐randomized study was undertaken in patients with homozygous sickle cell disease, who presented with increasing pain. A painful crisis was defined as any increase in bodily pains necessitating hospital admission. A 15% increase in FEV1 following salbutamol nebulization was considered significant.

Results:  Thirty‐nine patients took part in the study. Significant bronchodilator responses were demonstrable in 48.7% of patients during painful crises. Patients with such a response had a significantly lower peripheral blood eosinophil count (mean count 0.17 × 109/L vs. 0.445 × 109/L, P = 0.02, confidence interval for difference between groups, 0.0, 0.39). Furthermore, the magnitudes of the bronchodilator responses were related to the degree of lowering of peripheral blood eosinophil counts (rs = −0.344, P = 0.037).

Conclusion:  Significant bronchospasm is demonstrable in a sizeable proportion of patients presenting with painful sickle cell crises. There seems to be a negative correlation between the magnitude of bronchospasm and the peripheral blood eosinophil count. We postulate a possible role for pulmonary sequestration of eosinophils in the pathophysiology of bronchospasm in sickle cell disease patients.
Written action plans in chronic obstructive pulmonary disease increase appropriate treatment for acute exacerbations
Authors: WOOD‐BAKER Richard , McGLONE Shauna , VENN Alison , WALTERS E. Haydn
Published: August 2006

Objective and background:  COPD is a progressive disorder characterized by periodic exacerbations. While comprehensive self‐management programmes decrease health‐care resource utilization, the essential components are unclear. We performed a study of written action plans in the management of COPD.

Methodology:  A randomized, controlled, prospective parallel‐group study compared written action plans to usual practice.

Subjects:  Recruited from general practices, received an educational intervention with or without an action plan, which usually emphasized prompt treatment with antibiotics and corticosteroids. Subjects were followed up 3‐monthly for a year.

Results:  One hundred and thirty‐nine participants, mean FEV1 45 ± 16% predicted, were recruited, 81% completing the study. Both groups had a decline in lung function and physical activity, but increase in quality of life over the study period. Exacerbations were common. The intervention group was significantly more likely to have treatment with antibiotics (χ2 = 3.86; d.f. = 1; P = 0.05) or short course oral corticosteroids (χ2 = 14.25; d.f. = 1; P < 0.001). No differences were found between the number of general practitioner consultations, attendances at emergency departments or hospitalizations.

Conclusions:  The use of a written action plan in COPD increased appropriate therapeutic interventions for exacerbations, but this effect was not associated with a decrease in the use of health‐care resources.
Outcome in patients with lung cancer invisible on chest roentgenograms but detected only by helical computed tomography
Authors: KASHIWABARA Kosuke , KOHSHI Shu‐ichi
Published: August 2006

Objectives:  The aim of this study was to evaluate the prognosis for patients with lung cancer detected by helical CT but not by CXR.

Patients and methods:  One hundred and thirty‐seven asymptomatic patients with lung cancer diagnosed by annual mass screening of the chest were enrolled over a 7‐year period. Five‐year survival rates in patients with lung cancer detected only by helical CT (n = 19: CT‐only detection group) and in patients with lung cancer visible by both CXR and helical CT (n = 118: control group) were evaluated, and clinical variables were examined as possible predictors of survival time using the Cox proportional‐hazards model.

Results:  There was a significant difference between the 5‐year survival rates in the CT‐only detection group and in the control group (80% vs. 39%, log rank: P = 0.0171). The risk of death decreased 77% in CT‐only detectable lung cancer (hazard ratio: 0.219, 95% confidence interval: 0.057–0.845, P = 0.0275). Lung cancer could not be seen by CXR because nodules were small or faint (n = 11) or overlapping a shadow of thoracic components (n = 8). The percentage of subsolid nodules (classified as either part‐solid or non‐solid nodules) was higher in the subgroup with small or faint nodules (82% vs. 25%, P = 0.0423).

Conclusion:  Helical CT has the ability to detect early lung cancer before the small or faint nodules increase to a size visible on CXR, and patients with lung cancer detected only by helical CT have a better prognosis.
Trastuzumab (Herceptin)‐associated lung injury
Authors: VAHID Bobbak , MEHROTRA Anita
Published: August 2006

Abstract:  We report a case of trastuzumab pneumonitis in a patient with metastatic breast cancer. Bronchoalveolar lavage showed marked neutrophilia. A CT scan of the chest showed diffuse ground‐glass opacities. The patient was treated with corticosteroids with a partial response. Trastuzumab‐associated pneumonitis is not well described, and data in the literature is sparse. We describe the clinical and radiographical findings of trastuzumab‐associated pneumonitis.
Endobronchial argon plasma coagulation for the management of post‐intubation tracheal stenosis
Authors: YASUO Masanori , TANABE Tsuyoshi , TSUSHIMA Kenji , NAKAMURA Masaru , KANDA Shintaro , KOMATSU Yoshimichi , YAMAZAKI Seiichi , ITO Michiko , FURUYA Shino , YOSHIKAWA Sumiko , KUBO Keishi , KAWAKAMI Satoshi , YAMAZAKI Yoshitaka
Published: August 2006

Abstract:  Post‐intubation tracheal stenosis is usually caused by pressure necrosis at the cuff. Despite the fact that this phenomenon is well known and both large volume and low pressure cuffs have been developed, this lesion nevertheless continues to occur. Although the best results for tracheal reconstruction are obtained by an experienced surgeon, not all patients are able to undergo this operation for either medical or personal reasons. Argon plasma coagulation (APC) using flexible bronchoscopy has been successfully employed in the treatment of post‐intubation tracheal stenosis in two of the surgery‐refused and inoperable patients. The patients immediately experienced a relief of symptoms after APC. APC was thus performed 3–4 times every 1–2 weeks for each patient. In addition, there were no complications related to this procedure. The number of published clinical reports describing APC in benign airway stenosis are increasing. APC has also been reported to have several advantages over other interventional endobronchial techniques in the management of tracheo‐bronchial stenosis. We report two patients, and to our knowledge this is the first description of APC being used in the treatment of endobronchial dilatation for post‐intubation tracheal stenosis.
Worldwide trends in lung cancer pathology
Authors: GABRIELSON Edward
Published: August 2006

Abstract:  Molecular profiling studies serve to remind us that lung cancer is a complex disease, with different phenotypes that are characterized by variation in morphology as well as molecular composition. Over recent decades, there appear to be worldwide shifts in the relative frequencies of various phenotypic patterns of lung cancer, which are even more striking than changes in the overall incidence of lung cancer. This review summarizes major worldwide trends in lung cancer pathology, which can be explained in part, but not entirely, by changes in cigarette design. Characterizing these trends will be important for recognizing contributions of carcinogens other than tobacco smoke to the worldwide problem of lung cancer.
Lymphoepithelioma‐like carcinoma of the lung
Authors: HO James C. , WONG Maria P. , LAM Wah K.
Published: August 2006

Abstract:  Lymphoepithelioma‐like carcinoma (LELC) of the lung was first reported in 1987. In the past two decades, there have been just more than 150 cases reported in the literature. This uncommon but distinct form of non‐small cell lung carcinoma has a predilection for young non‐smoking Asians, without gender distinction. Histologically, it is indistinguishable from undifferentiated nasopharyngeal carcinoma. The carcinogenic role of latent Epstein–Barr virus infection in causing LELC of the lung has been evident almost exclusively in Asians compared with Caucasians. Among the reported cases, more than half were in early resectable stages (I or II) and there was a tendency for peribronchovascular spread with vascular encasement in advanced diseases. In order to establish the diagnosis of LELC of the lung, both nasopharyngeal carcinoma and lymphoma have to be excluded by endoscopic biopsy (with or without magnetic resonance imaging of the nasopharynx) and immunohistochemical staining of the biopsy samples. The mainstay of treatment for early‐stage disease is curative surgical resection, whereas multimodality treatment (surgery, chemotherapy, radiotherapy) has been adopted in advanced or metastatic diseases. The overall survival is more favourable in LELC of the lung compared with non‐LELC type of non‐small cell lung carcinoma. Future collaborative studies especially on optimizing treatment for this uncommon malignancy are clearly warranted.
Preventing tobacco and drug use among Thai high school students through life skills training
Authors: Seal Nuananong
Published: August 2006

Abstract  Tobacco and drug use remain major public health concerns. The aim of this study was to evaluate the effectiveness of a school health intervention program using life skills training (LST) to reduce tobacco and drug use among Thai high school students. A randomized pretest and post‐test comparative design was used to evaluate the effectiveness of the LST program. A total of 170 Thai students in grades 7–12 were randomly selected. The students in the control group received the tobacco and drug education curriculum normally provided; the intervention group received a LST program that provided information and skills specifically related to drug and tobacco use. Students in the school health intervention program had statistically significant positive effects regarding knowledge level, attitudes, and the development of refusal, decision‐making, and problem‐solving skills. The results showed that a LST program was effective for preventing tobacco and drug use in Thai high school students.
Grassroots efforts of Japanese women to promote services for abused women
Authors: Hatashita Hiroyo , Hirao Kyoko , Brykczynski Karen A. , Anderson Elizabeth T.
Published: August 2006

Abstract The purpose of this study was to identify and describe the personal experiences of six Japanese female volunteers who formed a support group to provide services for abused women. The interpretation of the women’s stories also increased understanding about the process of forming and developing a grassroots organization to take needed action. The interpretive phenomenological approach guided the study. The findings illustrate that a group of community volunteers can identify and effectively address a significant social issue on their own initiative.
Characteristics of nausea and vomiting in pregnant Japanese women
Authors: Kugahara Tomoko , Ohashi Kazutomo
Published: August 2006

Abstract  Nausea and vomiting in pregnancy (NVP) is a common condition in early pregnancy. The purpose of this study was to clarify the characteristics of Japanese women’s NVP and to determine the relationship between NVP and quality of life. The NVP was measured using the Rhodes’ Index and quality of life was measured by the SF‐36. Nausea and retching at 4–7 and 12–15 weeks was significantly more severe than at 16–19 weeks, whereas there was no difference in vomiting. A decrease in physical well‐being was correlated with the severity of nausea and retching at 8–11 and 12–15 weeks, but not with that of vomiting at any gestational period. Although the symptom of vomiting tended to be noticed more frequently, nausea and retching was more important in the care and treatment of NVP in Japanese women than vomiting, suggesting that professionals should carefully measure NVP symptoms using reliable instruments.
Investigation of the relationships among workplace stressors, ways of coping, and the mental health of Chinese head nurses
Authors: Xianyu Yunyan , Lambert Vickie A.
Published: August 2006

Abstract  Limited information exists about which workplace events are stressful for nurses in charge of a hospital patient‐care unit (head nurse) in China and how these nurses cope with these events. Therefore, the purposes of this descriptive study were to examine workplace stressors, ways of coping, and the levels of mental health of Chinese head nurses, as well as to identify the relationships among the workplace stressors, ways of coping, and mental health of Chinese head nurses. To address these purposes, four self‐report questionnaires were administered to a convenience sample of 92 head nurses from two teaching hospitals located in one city in central China. The findings suggested that workload, death/dying, and conflict with physicians were the most predominant sources of workplace stress, while the most frequent coping strategies used were positive reappraisal, planful problem solving, and self‐control. The mental health scores were found to be lower than prior research has suggested for some nurses in Asia. A number of significant correlations were found among demographic characteristics, workplace stressors, ways of coping, and mental health.
REDEFINING THE ROLE OF SPLENECTOMY IN PATIENTS WITH IDIOPATHIC SPLENOMEGALY
Authors: Pottakkat Biju , Kashyap Rajesh , Kumar Ashok , Sikora Sadiq S. , Saxena Rajan , Kapoor Vinay K.
Published: August 2006

Background:  Despite extensive work‐up to establish the cause of splenomegaly, splenectomy may be required for diagnosis in certain situations. The aim of this study was to find out the role of diagnostic splenectomy in the current era.

Methods:  Between January 1989 and June 2004, 211 patients underwent splenectomy for indications other than trauma. In 41 (19%) patients, splenectomy was carried out for diagnostic purposes. Retrospective analysis of these patients was done for the purpose of the study.

Results:  All patients who underwent diagnostic splenectomy had a complete haemogram, biochemical tests for liver and renal function, bone marrow biopsy and abdominal ultrasonography before splenectomy. There were 28 (68%) men and 13 (32%) women with median age of 37 years (range, 6–62 years). The median duration of symptoms was 12 months (range, 1–180 months). Common presentations were fever (n = 27; 66%), malaise (n = 26; 63%), pallor (n = 33; 80%) and gross splenomegaly (n = 27; 66%). Thirty‐two (78%) patients had hypersplenism. Splenic lesions were shown in 14 (34%) patients on ultrasonogram and in 16 (39%) patients on contrast‐enhanced computed tomography scan of the abdomen. Open splenectomy was carried out in all patients. Seventeen (41%) patients had postoperative complications. Among these, three (7%) patients had postoperative bleeding. One patient died because of acute respiratory distress syndrome. Final histopathology of the spleen showed lymphoma in 15 (37%), tuberculosis in five (12%) and other lesions in five (12%) patients. Sixteen (39%) patients had only congestive splenomegaly.

Conclusion:  A high proportion of patients presenting with idiopathic splenomegaly will have underlying haematological malignancies even in tropical countries. The clinical presentation, laboratory profile and imaging findings were not helpful in differentiating between patients with haematological malignancies and non‐malignant conditions. Splenectomy still has an important role in establishing the pathology in patients presenting with idiopathic splenomegaly.
EFFICACY OF MULTI‐SLICE COMPUTED TOMOGRAPHY CHOLANGIOGRAPHY BEFORE LAPAROSCOPIC CHOLECYSTECTOMY
Authors: Hirano Yasumitsu , Tatsuzawa Yasuhiko , Shimizu Junzo , Kinoshita Seiichi , Kawaura Yukimitsu , Takahashi Shiro
Published: August 2006

Background:  Bile duct injury is one of the serious surgical complications of laparoscopic cholecystectomy (LC). Clear biliary tract imaging to detect the anomaly of the bile ducts before operation is thought to be useful to prevent this complication. The objective of this study was to investigate the preoperative feasibility of using multi‐slice computed tomography scanning after drip infusion cholangiography–computed tomography (DIC‐CT) for LC.

Methods:  Laparoscopic cholecystectomies were carried out in 33 patients and DIC‐CT and magnetic resonance cholangiography (MRC) were also carried out in all of these patients. We evaluated the recognition of the junction of the cystic duct and detection of anomalies of the extrahepatic bile ducts using the latter two methods.

Results:  In 33 patients, DIC‐CT showed the junction of the cystic duct in 31 (94%) and MRC in 25 (76%) patients, respectively. Anomalies of the extrahepatic bile ducts or the cystic duct were detected in four (12%) patients by DIC‐CT, but MRC could show only one of these lesions. There were no major adverse reactions in either examination.

Conclusion:  DIC‐CT is an efficacious preoperative technique as compared with MRC for the biliary tract imaging. DIC‐CT may be of benefit for both patients scheduled to undergo LC and their surgeons.
MALIGNANT PROGRESSION OF ANAL INTRA‐EPITHELIAL NEOPLASIA
Authors: Watson Angus J. M. , Smith Barnaby B. , Whitehead Martin R. , Sykes Peter H. , Frizelle Frank A.
Published: August 2006

Background:  Anal intra‐epithelial neoplasia (AIN) is believed to be a precursor to squamous cell carcinoma of the anus. The risk of developing anal cancer in patients with AIN, although known to occur, has been thought to be relatively low. This study reviews our experience with AIN, reviewing the incidence and risk factors for development of invasive malignancy and the outcome of present management strategies.

Methods:  This study examined a cohort of 72 patients identified from a prospective database with AIN from a single institution between January 1996 and December 2004. A single pathologist examined all pathological specimens.

Results:  There were 72 patients (52 women) and the median age was 49 years (range, 18–81 years). We identified progression of AIN to invasive malignancy in eight patients despite undergoing surveillance. Regression following treatment or biopsy was seen in 25 patients. Four patients required stomas for incontinence following treatment.

Conclusion:  This study has shown a high rate of progression to invasive malignancy (11%) with AIN despite surveillance. The patients at risk of developing squamous cell carcinoma were the immunocompromised and those with genital intra‐epithelial field change. Treatment of AIN has significant complications and despite treatment, invasive cancers do occur. Decisions made for treatment of AIN can affect treatment choices if invasive malignancy develops.
DIAGNOSTIC VALUE OF THORACOSCOPIC PLEURAL BIOPSY FOR PLEURISY UNDER LOCAL ANAESTHESIA
Authors: Sakuraba Motoki , Masuda Kimihiko , Hebisawa Akira , Sagara Yuzo , Komatsu Hikotaro
Published: August 2006

Background:  We find pleural effusion in clinical practice frequently. However, it is difficult to make a diagnosis definitively by thoracocentesis or closed pleural biopsy. We directly examine the thoracic cavity by thoracoscopy under local anaesthesia, carry out pleural biopsy and make a definitive pathological diagnosis in pleurisy.

Method:  A retrospective study of 138 patients who had been diagnosed by thoracoscopy in our hospital was carried out between January 1995 and January 2005.

Results:  The patients were 114 men and 24 women, ranging in age from 21 to 85 years, with a mean of 59 years. The right side was involved in 83 patients and the left side in 55. The operations took 11–145 min, with a mean of 46 min. Thoracoscopy directly without thoracocenteses was carried out in 28 of 138 patients. Lung cancer with pleural dissemination was diagnosed in 27, malignant pleural mesothelioma in 10, tuberculous pleurisy in 32, non‐specific pleurisy in 58, other tumour in 2 and pyothorax in 9 patients. The overall diagnostic efficacy was 97.1% (134/138). The diagnostic efficacy in the cases of carcinoma was 92.6% (25/27), in malignant pleural mesothelioma it was 100% (10/10) and in tuberculosis it was 93.8% (30/32). No major complications occurred during the examination.

Conclusion:  Pleural biopsy by thoracoscopy under local anaesthesia should be actively carried out in patients with pleurisy, because the technique has a high diagnostic rate and can be easily and safely carried out.
LYTIC BONE LESIONS IN AN AUSTRALIAN POPULATION: THE RESULTS OF 100 CONSECUTIVE BIOPSIES
Authors: Clayer Mark T.
Published: August 2006

Background:  The identification of a lytic bone lesion is often perceived as a harbinger of malignancy, especially in an older patient. This study reviews the results of 100 consecutive biopsies of patients who presented with either a solitary lesion or multiple lytic bone lesions in the absence of a history of malignancy.

Methods:  Following preoperative planning, including plain radiographs, bone scan and computed tomography scanning, an open biopsy was carried out.

Results:  The most common site affected was the pelvis (20 patients), followed by the femur (19) and tibia (15). The lesions were solitary in 88 patients and multiple in 12. The most common diagnosis was a secondary carcinoma presenting as a bone lesion, which was found in 25 patients. The carcinomas were a widely distributed group, but the most common among them were renal cell carcinoma (seven patients), breast carcinoma (five patients) and lung carcinoma (five patients). The most common primary bone tumour was a giant cell tumour (16) followed by myeloma (10). Multiple lesions were not universally an indication of a malignant process. In 14 patients the lesion was not a tumour.

Conclusion:  This study emphasizes the importance of obtaining a tissue diagnosis.
FROZEN SECTION FOR PAROTID SURGERY: SHOULD IT BECOME ROUTINE?
Authors: Arabi Mianroodi Ali A. , Sigston Elizabeth A. , Vallance Neil A.
Published: August 2006

Background:  The role of fine‐needle aspiration (FNA) in salivary gland lesions as a preoperative diagnosis has always been under scrutiny. Several studies have shown that frozen section (FS) is accurate for pathological diagnosis and decision‐making during the surgery. This study has been carried out to assess the accuracy of FNA and FS in parotid surgeries.

Methods:  All parotid lesions removed between July 1998 and June 2003 by the Department of Otolaryngology, Head and Neck unit at Monash Medical Centre were reviewed. FNA, FS and definitive pathology were collected and discrepancies were identified.

Results:  Eighty‐five parotid tumours had been removed. Thirty‐three were malignant in which squamous cell carcinoma was the most common. FS was able to differentiate benign tumours from malignant with 100% accuracy (30 cases). FS was able to alter the surgical decisions in six cases. FNA had been carried out in 62 cases, with sensitivity and specificity of 77.2 and 90%, respectively.

Conclusion:  Frozen section in parotid surgery is accurate, inexpensive and may add important information that alters management and improves the outcome. The use of FS routinely in parotid surgery is recommended.
DOES HYPERPARATHYROIDISM CAUSE PANCREATITIS? A SOUTH INDIAN EXPERIENCE AND A REVIEW OF PUBLISHED WORK
Authors: Jacob Jubbin J. , John Mathew , Thomas Nihal , Chacko Ashok , Cherian Rekha , Selvan Ben , Nair Aravindan , Seshadri Mandalam S.
Published: August 2006

Background:  The association between pancreatic disease and primary hyperparathyroidism (PHPT) is controversial. We attempt to suggest a causal correlation and characterize the nature of pancreatic disease in PHPT.

Methods:  This study is a retrospective review of the medical records of patients who were diagnosed with PHPT and presented with pancreatic disease between 1 May 2000 and 30 May 2005 at Christian Medical College, Vellore.

Results:  During the period of 5 years, there were 1284 patients with pancreatic disease and 101 patients with PHPT admitted to our hospital, accounting for 0.42 and 0.03%, respectively, of the total hospital inpatient admissions of 302 883. Of them, 13 patients had both pancreatic disease and PHPT accounting for 1% of all admissions for pancreatic disease and 12% of admissions for PHPT. Patients admitted with PHPT have a 28‐fold increased risk of developing pancreatitis compared with patients admitted without parathyroid disease. The ages of the patients ranged from 22 to 52 years with a median age of 37 years. There were 9 male and 4 female patients. The mean calcium values among patients with PHPT and pancreatic disease were significantly higher than patients with PHPT without pancreatic involvement.

Conclusion:  The data suggest a causal association between the pancreatic disease and PHPT. This may be correlated to the higher calcium values. Until more information is available, it would be prudent to check serum calcium in all patients presenting with unexplained pancreatic disease.
NATIONAL BREAST CANCER AUDIT: OVERVIEW OF INVASIVE BREAST CANCER MANAGEMENT
Authors: Cuncins‐Hearn Astrid V. , Boult Margaret , Babidge Wendy , Zorbas Helen , Villanueva Elmer , Evans Alison , Oliver David , Kollias James , Reeve Tom , Maddern Guy
Published: August 2006

Background:  The National Breast Cancer Audit is an initiative of the Breast Section of the Royal Australasian College of Surgeons collecting surgical information in early breast cancer. It is managed in conjunction with the Australian Safety and Efficacy Register of New Interventional Procedures – Surgical. An overview of results for invasive breast cancer from January 1999 until December 2004 is presented to provide preliminary data for participating surgeons.

Methods:  Invasive breast cancer cases were retrieved from the National Breast Cancer Audit database for the 274 participating breast surgeons in Australia and New Zealand. Data for a variety of clinical parameters were analysed to provide an overview of the diagnostic, histological, surgical and adjuvant therapy management issues.

Results:  There were 25 026 cases of invasive breast cancer. Annual percentages of mammographically detected cancers from 1999 to 2004 did not differ significantly. Breast‐conserving surgery rates also remained stable at 60%. Margins were involved in 5% of patients; an additional 9% had final margins of less than 1 mm. Radiotherapy followed breast‐conserving surgery in most cases (86%). Patients undergoing mastectomy with large tumours (>5 cm) underwent radiotherapy in 71% of cases. When at least four lymph nodes were positive, radiotherapy followed mastectomy in the majority (75%) of cases. The most frequently carried out axillary procedure was a level 2 dissection. Chemotherapy was received by 78% of oestrogen receptor negative, axillary node positive, postmenopausal patients. Tamoxifen was used in the majority (83%) of oestrogen receptor positive cases.

Conclusion:  Surgeons contributing their invasive breast cancer data show a high quality of treatment. Some further improvement may be possibly related to excision margins and tamoxifen prescription for oestrogen receptor negative cancers. Chemotherapy prescription might also warrant further investigation.
ADENOID CYSTIC CARCINOMA OF THE TRACHEA: A LONG‐TERM PROBLEM
Authors: Clough Anthony , Clarke Peter
Published: August 2006

Adenoid cystic carcinoma of the trachea, although rare, is the second most common primary tumour of the trachea.1 It is a slow‐growing tumour found in younger patients than the more common squamous cell carcinoma and is relatively resistant to treatment, but metastasizes late in the course of disease and even in unresectable cases can be palliated successfully for many years. We present a retrospective 20‐year series of this condition from a single institute encompassing 13 patients of whom 6 were resected and 7 treated by palliative methods. A review of hospital records was carried out over the period 1984–2003. Details collected included symptoms before diagnosis, length of time from onset of the first symptom to diagnosis, resection details, survival statistics and accessory procedures tried before and after consideration of resection. The overall 5‐year survival was 38.5%, but the mean survival in resected patients was 66 months as against 36 months for unresectable patients. Although most patients presented with dyspnoea, this was initially often attributed to other factors. The mean time of diagnosis from the onset of symptoms was 16 months. Although complete resection remains the management of choice if feasible, modern techniques of maintaining the airway in unresectable patients can give useful palliation for years.
A DIFFERENT APPLICATION METHOD OF TALC PLEURODESIS FOR THE TREATMENT OF PERSISTENT AIR LEAK
Authors: Kilic Dalokay , Findikcioglu Alper , Hatipoglu Ahmet
Published: August 2006

Persistent air leak is a serious problem that may cause empyema, hypoxia, respiratory insufficiency, and other life‐threatening complications. Chemical pleurodesis may be carried out for the treatment of persistent air leak if the lung is fully expanded. However, the standard method of chemical pleurodesis entails clamping the chest tube for a period of time after instillation of the agent. In patients with massive air leak, this would result in a tension pneumothorax. Therefore, standard chemical pleurodesis for persistent air leak is not an appropriate treatment for these patients. In this study, we carried out talc pleurodesis in six patients using an inverted U‐shaped chest tube elevated to 60 cm that did not result in tension pneumothorax and mediastinal shift. No recurrence was observed during a mean follow up of 16.2 months.
CLOSTRIDIUM PERFRINGENS INFECTION OF PANCREATIC NECROSIS: ABSOLUTE INDICATION FOR EARLY SURGICAL INTERVENTION
Authors: De Silva N. M. , Windsor J. A.
Published: August 2006

It is generally accepted that the surgical treatment of pancreatic necrosis should be delayed as long as possible and after there is laboratory confirmation of infection, determined by image guided fine‐needle aspiration. Two cases of severe necrotizing pancreatitis are presented where gas developed in the pancreatic bed, detected by CT scanning, within 2‐‐4 days of the onset of symptoms. Bacteriology studies showed clostridium perfringens and other gram negative flora. The presence of retroperitoneal gas in this context is an absolute indication for early surgical intervention.
Phaeochromocytoma in pregnancy
Authors: Grodski S. , Jung C. , Kertes P. , Davies M. , Banting S.
Published: August 2006

Hypertension during pregnancy is a common problem, causing significant maternal and fetal morbidity and mortality. Pre‐eclampsia is by far the most common cause, affecting 5–10% of primigravid women. Phaeochromocytoma is a rare endocrine tumour causing hypersecretion of noradrenaline, adrenaline and/or dopamine. It is extremely rare during pregnancy and may be misdiagnosed with potentially catastrophic consequences. Delayed diagnosis remains a significant source of maternal and fetal morbidity and mortality. Recognition is critical, as the majority of maternal deaths have occurred when the diagnosis has been overlooked. Diagnosis of phaeochromocytoma is achieved by detecting increased catecholamines and metabolites (metanephrine and normetanephrine) on 24‐h urine collection, as these levels are unaffected by pregnancy or pre‐eclampsia. Definitive treatment of phaeochromocytoma is surgical and the laparoscopic approach has been shown to be safe and is preferred for most phaeochromocytomas. Medical preparation and treatment of hypertension is essential for safe surgery. Timing of adrenalectomy is either during the second trimester or as a staged procedure after Caesarean section delivery.
Controlled trial of multidisciplinary care teams for acutely ill medical inpatients: enhanced multidisciplinary care
Authors: Mudge A. , Laracy S. , Richter K. , Denaro C.
Published: August 2006

Background: Acute hospital general medicine services care for ageing complex patients, using the skills of a range of health‐care providers. Evidence suggests that comprehensive early assessment and discharge planning may improve efficiency and outcomes of care in older medical patients.

Aim: To enhance assessment, communication, care and discharge planning by restructuring consistent, patient‐centred multidisciplinary teams in a general medicine service.

Methods: Prospective controlled trial enrolling 1538 consecutive medical inpatients. Intervention units with additional allied health staff formed consistent multidisciplinary teams aligned with inpatient admitting units rather than wards; implemented improved communication processes for early information collection and sharing between disciplines; and specified shared explicit discharge goals. Control units continued traditional, referral‐based multidisciplinary models with existing staffing levels.

Results: Access to allied health services was significantly enhanced. There was a trend to reduced index length of stay in the intervention units (7.3 days vs 7.8 days in control units, P = 0.18), with no change in 6‐month readmissions. In‐hospital mortality was reduced from 6.4 to 3.9% (P = 0.03); less patients experienced functional decline in hospital (P = 0.04) and patients’ ratings of health status improved (P = 0.02). Additional staffing costs were balanced by potential bed‐day savings.

Conclusion: This model of enhanced multidisciplinary inpatient care has provided sustainable efficiency gains for the hospital and improved patient outcomes.
Cautionary tales in the interpretation of systematic reviews of therapy trials
Authors: Scott I. , Greenberg P. , Poole P. , Campbell D.
Published: August 2006

This is the second in a series of articles emphasizing the cautions in the interpretation of health‐care studies. Systematic reviews are presented as comprehensive, unbiased summaries of evidence and are often referred to by clinicians, guideline developers and health policy‐makers. Their strengths and limitations, and how their results can be subject to bias and misinterpretation, are discussed.
Management of paediatric thyroid carcinoma: recent experience with recombinant human thyroid stimulating hormone in preparation for radioiodine therapy
Authors: Lau W. F. E. , Zacharin M. R. , Waters K. , Wheeler G. , Johnston V. , Hicks R. J.
Published: August 2006

Background: Thyroid carcinoma in children is rare and raises unique management issues. Although metastatic disease is more common in this age group, prognosis remains good with appropriate treatment. The aim of the study was to report recent experience in the management of differentiated thyroid carcinoma in children, especially in the use of radioiodine after recombinant human thyroid stimulating hormone (rhTSH) stimulation.

Methods: Eight patients, aged 5–17  years (five were boys) presented following total thyroidectomy for thyroid carcinoma between May 2003 and June 2005. Seven had papillary carcinoma and one had follicular carcinoma. Five had known lymph node metastases and one had pulmonary metastases at presentation. Four patients had previously received therapeutic irradiation for malignancy. All eight underwent diagnostic iodine scans, seven with rhTSH stimulation. Seven went on to receive radioiodine treatment as hospital inpatients, comanaged by the paediatric and nuclear medicine units. The dosage of 131I ranged from 1.5 to 3.7 × 109 Bq. All except one were prepared by rhTSH stimulation.

Results: Seven of eight patients had significant uptake in the neck on diagnostic scan and two had pulmonary abnormalities. Six of seven evaluable patients achieved complete thyroid ablation. Both patients with pulmonary abnormalities had scan resolution, although one of them only after a second radioiodine treatment. All patients had thyroxine replacement in doses to suppress TSH and all remain alive and well at time of carrying out this study.

Conclusion: Optimal management of paediatric thyroid carcinoma necessitates a multidisciplinary approach. Radioiodine therapy under rhTSH is an effective and safe adjuvant treatment in this special subgroup.
Zoledronic acid prevents bone loss after allogeneic haemopoietic stem cell transplantation
Authors: D’Souza A. B. , Grigg A. P. , Szer J. , Ebeling P. R.
Published: August 2006

Allogeneic haemopoietic stem cell transplant (alloHSCT) patients are at increased risk of osteoporosis. Zoledronic acid (ZA) is a potent i.v. bisphosphonate; however, there are few data on ZA use after alloHSCT. The aim of this study is to examine the effect of a single 4 mg ZA infusion in alloHSCT patients with either osteoporosis (T‐score < −2.5) or rapid bone loss post‐alloHSCT. An uncontrolled, prospective study of 12 consecutive patients receiving ZA, predominantly within the first year post‐HSCT. Bone mineral density (BMD) was measured by dual‐energy X‐ray absorptiometry at the spine and proximal femur pretransplant, pre‐ZA and post‐ZA. The median annualized percentage change in total hip BMD between the pretransplant scan and the scan immediately before ZA was −13% (range, −51 to +3.6%). After ZA treatment, the total hip BMD increased by a median of +3.3% (range, −20.4 to +14.8%) in 75% of patients. The median annualized percentage change in femoral neck BMD between the pretransplant scan and the scan immediately before ZA was −13.2% (range, −40 to +1.0%). Post‐ZA, femoral neck BMD increased by a median of +1.4% (range, −22.2 to +33.6%). Only one patient continued to lose bone from the femoral neck post‐ZA infusion. The median annualized percentage change in spinal BMD pretransplant was −12.5% (range, −38 to +6.9%). Post‐ZA, spinal BMD decreased by a median of −2.8% (range, −27.6 to +24.4%). Four patients continued to lose bone from the spine post‐ZA. ZA reduces bone loss in most patients after alloHSCT. Our data require confirmation in a larger prospective, randomized study.
Screening for colorectal cancer by faecal occult blood test: why people choose to refuse
Authors: Worthley D. L. , Cole S. R. , Esterman A. , Mehaffey S. , Roosa N. M. , Smith A. , Turnbull D. , Young G. P.
Published: August 2006

To better understand the personal barriers that limit participation in faecal occult blood test (FOBT) screening for colorectal cancer, non‐participants from a recent screening initiative were sent detailed questionnaires, defining their reasons for not participating, as well as how to make screening more attractive. The important barrier was procrastination. The type of FOBT kit offered influenced the reasons for not participating. Convenient FOBT and greater general practitioner involvement may be important for optimizing community acceptance of FOBT‐based screening.
Study of bacterial communities in Antarctic coastal waters by a combination of 16S rRNA and 16S rDNA sequencing
Authors: Gentile Gabriella , Giuliano Laura , D’Auria Giuseppe , Smedile Francesco , Azzaro Maurizio , De Domenico Maria , Yakimov Michail M.
Published: August 2006

An ecological study on distribution of Antarctic bacterial communities was determined by 16S‐based phylogenetic analyses of clone libraries derived from RNA and DNA extracted from two different marine areas and compared between each other. Superficial seawater samples were collected from four stations in Ross Sea, three of them located in Rod Bay and one in Evans Cove; for each station two clone libraries (16S rDNA and 16S rRNA) were prepared and evident divergences between DNA and RNA libraries of each site were obtained. Of all phylotypes 93.6% were found in RNA libraries; in contrast, only 31 phylotypes (70.5%) were retrieved from total microbial community (DNA libraries). DNA and RNA sequences related to γ‐Proteobacteria and Bacteroidetes groups, typical for Antarctic sea‐ice bacterial communities, were detected in analysed sites. 16S rDNA and rRNA libraries derived from the two different areas were enriched by picophytoplanktonic 16S sequences of plastid and mitochondrion origins, reflecting that the algal blooms occurred during sampling (Antarctic summer 2003). The finding in Rod Bay libraries of high percentage of DNA clones apparently affiliated with β‐Proteobacteria typical for activated sludges and well water could be explained by the presence of a sewage depuration system at this site. Obtained results clearly demonstrate that combination of 16S rDNA and 16S rRNA gene sequencing is preferred approach to have a more reliable vision on the composition of microbial communities.
The in situ physiology of Skermania piniformis in foams in Australian activated sludge plants
Authors: Eales Kathryn L. , Nielsen Jeppe L. , Seviour Elizabeth M. , Nielsen Per H. , Seviour Robert J.
Published: August 2006

The in situ physiology of the filamentous bacterium Skermania piniformis frequently seen in activated sludge foams in Australia was investigated. An oligonucleotide probe, Spin1449, targeting the 16S rRNA of S. piniformis was designed for its identification by fluorescence in situ hybridization (FISH), validated with pure cultures and applied successfully to foam samples from two geographically distant Australian plants. While filaments of this bacterium appeared to be comparatively hydrophobic, the organism had no clear preference for hydrophobic or hydrophilic substrates. In both foams examined using microautoradiography (MAR), filaments selectively took up substrates under aerobic and anoxic (NO3–) but not anaerobic or anoxic (NO2–) conditions. Skermania piniformis assimilated oleic acid, palmitic acid, glycerol and glycine. Ectoenzyme activities detected suggest that S. piniformis has an ability to assimilate a greater range of substrates than might be concluded from the MAR data obtained here. Based on the substrate uptake data presented here, an anaerobic selector may work for controlling S. piniformis in activated sludge systems.