bluuebunny/crossref_metadata_2025 huggingface dataset:
Hepatic venous pressure gradient measurement: is it mandatory in the management of portal hypertension?
Authors: POMIER‐LAYRARGUES GILLES
Published: December 2004

Abstract  Portal hypertension can be evaluated by hepatic vein catheterization and measurement of wedged and free hepatic vein pressures. The hepatic venous pressure gradient (HVPG) is the difference between both pressures and its normal value is lower than 5 mmHg. The technique is safe and reliable provided several requirements are fulfilled to get accurate results. HVPG measurement is useful to determine the site of increased resistance either presinusoidal, sinusoidal or postsinusoidal. If HVPG is normal in the presence of clinical signs of portal hypertension, evaluation of the portal venous system and direct measurement of portal vein pressure is required. HVPG measurement may also be used as a prognostic marker to evaluate the risks of developing complications such as ascites or variceal bleeding; in addition, it has been suggested that it could provide prognostic information for variceal rebleeding or survival. Primary and secondary prophylaxis of variceal bleeding can be achieved with a pharmacological treatment using beta blockers and/or nitrates. Repeated HVPG measurements are probably useful to monitor the treatment; it has been suggested that decreasing HVPG by 20% or below 12 mmHg is a reasonable target to define a good hemodynamic response and hopefully a low risk of bleeding; endoscopic therapy can be used in non‐responders. Repeated hemodynamic evaluation, however, is invasive and must be performed in specialized liver units; therefore, future clinical trials must demonstrate unequivocally the clinical usefulness of this approach prior to recommending repeated HVPG measurement on a routine basis.
HVPG measurement: is it mandatory for the management of portal hypertension?—Con
Authors: BOYER THOMAS D
Published: December 2004

Abstract  Complications of portal hypertension are common in the cirrhotic, and bleeding varices are a significant cause of morbidity and mortality in this population. We currently can identify the patients at greatest risk for bleeding by the endoscopic appearance of the varices and we know that once a patient bleeds, rebleeding is almost inevitable. Thus, both groups of patients are targets for preventative therapy. Currently, non‐selective beta‐blockers are used to reduce the risk of bleeding in both types of patients but many patients fail this form of therapy and bleed or rebleed. Recent studies have shown that patients who fail to have a hemodynamic response to beta blocker therapy are most likely to fail therapy and it has been suggested that measurement of the hepatic vein pressure gradient (HVPG) be used in the routine management of this group of patients. Unfortunately, there are many unresolved issues as to the utility of the hemodynamic response in the management of cirrhotics. Outside of academic medical centers, the ability to measure pressures accurately is limited and thus significant training would be required before the test can have widespread acceptance. More importantly, it has not been shown in prospective randomized trials that using the hemodynamic response to define the therapeutic approach is any better than the current approach of giving everyone beta‐blockers and using variceal band ligation in those who bleed or rebleed. Pending the completion and publishing of these types of controlled trials, measurement of the HVPG will remain of academic interest only.
Diagnosis and management of ectopic varices
Authors: VAN STIEGMANN GREG
Published: December 2004

Abstract  Ectopic varices are dilated portosystemic venous collateral vessels that may occur anywhere in the gastrointestinal tract. Ectopic varices account for approximately 5% of all hemorrhages from varices. Ectopic varices may occur as a result of portal hypertension from any cause but are more common (particularly duodenal and biliary varices) in patients with extrahepatic portal vein thrombosis. Ectopic varices may also develop following successful endoscopic obliteration of gastroesophageal varices. With the exception of isolated gastric fundal varices, ectopic varices have relatively low risk for bleeding. Diagnosis is often made by endoscopy; however, computed tomography, magnetic resonance imaging and portal venography may be needed in some cases. Endoscopic treatment is successful in many cases and is the safest option provided bleeding is definitively controlled. Surgical options are now reserved for treatment of life‐threatening bleeding or for shunt insertion in patients who are not candidates for transjugular intrahepatic portosystemic shunt (TIPS) as a result of portal vein thrombosis. Portal decompression using TIPS, in spite of the risk for encephalopathy, is the treatment of choice for bleeding from ectopic varices that cannot be successfully managed endoscopically.
Variceal bleed: secondary prophylaxis‐ drugs versus endoscopy
Authors: LO GIN‐HO
Published: December 2004

Abstract  Variceal rebleeding is frequently encountered in cirrhotic patients surviving an episode of acute esophageal variceal hemorrhage. Endoscopic therapy has evolved from injection sclerotherapy to banding ligation. Medical therapy evolves from propranolol to combination of nadolol and isosorbide‐5‐mononitrate. Either endoscopic therapy or medical therapy could be helpful for the majority of patients. The combination of endoscopic therapy and medical therapy is a logical approach to prevent variceal rebleeding. For failure cases, rescue therapy with transjugular intrahepatic porto‐systemic stent shunt or surgery ay be required.
Management of Budd–Chiari syndrome: what is the best approach?
Authors: WANG ZHONG GAO , ZHANG FENG JI , LI XIAO QIANG , MENG QIAN YI
Published: December 2004

Objective:  Exploring the proper management of a formerly rare and life‐threatening entity, hepatocaval syndrome or the Budd–Chiari syndrome (BCS).

Methods:  From four hospitals, 2677 patients with BCS were collected since 1981, among them, 2546 cases underwent surgery or intervention including 170 membranotomies, 560 shunts, 232 radical resections, 1289 PTA or stents, and 295 miscellaneous procedures.

Results:  Ninety‐five patients in this series were caused by lesions in the inferior vena cava (IVC). Patients treated in the first decade had an effective rate of 77.7%, patency for various approaches was approximately 60–90% at 7 years. In our early experience, 55.7% patients underwent shunts, 26.1% had membranotomy and only 0.8% the interventional modality. Recently this has shifted to 16.2%, 5.2%, and 55.6%, respectively (P < 0.01). In the early phase, 11.6% of patients were classified as stage I (less clinical severity), and 28.6% patients in stage IV (most severe). In contrast, recent patients, they were 56.1% and 4.8% (P < 0.01).

Conclusion:  Therapy has evolved from the relatively simple to the more complex (such as variety of shunts and radical correction) procedures, and finally, the interventional approaches chronologically. Regarding the best approach however, it depends on various factors. For those with Type I lesion (localized disorder in the suprahepatic IVC), interventional method is the means of choice, radical corrective surgery follows. For those with type II (long segment stenosis or occlusion of the IVC), major procedures, such as the mesocavoatrial shunt, maintain an essential role. For those with type III (the hepatic venous lesions), porto‐systemetic shunt remains the procedure of choice. The increased use of interventional method is a reflection of greater awareness and more frequent detection of much earlier cases. In contrast, the number of advanced cases declines, signaling a remarkable breakthrough in the management of the BCS.
Biomarkers as non‐invasive assessment of hepatic fibrosis in chronic hepatitis C
Authors: POYNARD THIERRY , IMBERT‐BISMUT FRANÇOISE , MUNTEANU MONA , MESSOUS DJAMILA , THABUT DOMINIQUE , RATZIU VLAD , BENHAMOU YVES
Published: December 2004

Abstract  Liver biopsy has been considered as the gold standard for assessing the stage and the grade of chronic liver diseases. Biopsy has a high sampling error (33% for fibrosis staging and 24% for necrosis staging), and intra‐ and interpathologist variability greater than 10%. Biochemical markers, particularly recent panels of markers (FibroTest‐ActiTest) have good predictive values with a better benefit risk ratio and lower cost than liver biopsy. Discordances between biopsy and serological markers results can be either due to serological markers or to biopsy. Because of the improvement of biochemical markers, the limits and the risk of biopsy, liver biopsy should not be mandatory any longer in the management of patients with chronic liver hepatitis C.
Recent concepts in iron metabolism and HFE mutations
Authors: POWELL LAWRIE W
Published: December 2004

Abstract  Our understanding of the mechanisms by which the body regulates iron absorption and iron homeostasis has improved greatly in recent years with the identification of key molecules such as HFE, ferroportin, transferrin receptor 2, hepcidin and hemojuvelin. Hereditary hemochromatosis, a primary inherited disorder of iron metabolism leading to progressive iron loading of parenchymal cells of the liver and other organs, can result from mutations in any of these genes. However, HFE‐associated hereditary hemochromatosis accounts for over 90% of cases in Caucasian populations. Penetrance is incomplete with variable clinical expression. The majority of cases demonstrate biochemical expression but a lower proportion develops advanced disease. Clinical disease, especially hepatic fibrosis, is related to the level of body iron stores which is reflected primarily in the liver. The available evidence indicates that adequate screening and diagnostic strategies can ensure that early case detection and treatment occur prior to the development of irreversible end‐organ damage. The most cost‐effective methods of early case detection are family (cascade) screening and evaluation of potential cases by primary care physicians with a high index of clinical suspicion.
Autoimmune serology in liver disease: methodology and interpretation
Authors: VERGANI DIEGO , MIELI‐VERGANI GIORGINA
Published: December 2004

Abstract  Accurate measurement of levels of autoantibodies in serum is critical for the diagnosis of autoimmune hepatitis. The major reactivities include anti‐nuclear antibody (ANA), smooth muscle antibody (SMA), antibody to liver kidney microsomes type‐1 (anti‐LKM1); other relevant reactivities include antibodies to liver cytosol 1 (anti‐LC1), soluble liver antigen (anti‐SLA), and neutrophil cytoplasmic antigens (ANCA). In addition to the classical indirect immunofluorescence technique, automatic assays based on recombinant antigens are now available, which allow detection of antibodies not visible on immunofluorescence, like anti‐SLA, and assist in the interpretation of at times problematic immunofluorescence patterns, like anti‐LKM1 or anti‐LC1.
Immunopathogenesis of primary sclerosing cholangitis: possible role of a shared colonic and biliary epithelial antigen
Authors: DAS KIRON M
Published: December 2004

Abstract  Primary sclerosing cholangitis (PSC) is a chronic fibrosing disease of both extrahepatic as well as intrahepatic bile ducts that is strongly associated with inflammatory bowel disease, particularly ulcerative colitis. It is characterized by progressive destruction of the bile ducts leading to widespread biliary obstructions and biliary cirrhosis. PSC is currently one of the more common indications for liver transplantation. It is an immune mediated disorder associated with autoantibodies against both colon epithelium as well as biliary epithelium, infiltration of the portal tract with functional T cells, abnormal expression of HLA molecules on biliary epithelial cells and a restricted T‐cell receptor repertoire. Activation of the complement system, following the deposition of antigen‐specific autoantibody with biliary epithelial cells, may also contribute to the pathogenesis of PSC. Four different HLA haplotypes have been associated with PSC: three with increased risk of disease and one with reduced risk. Bacterial products entering the biliary epithelium from colon may be a triggering factor strongly associated with ulcerative colitis; however, a further immune mediated chronic inflammation may be associated with cellular antigen(s) which is shown to be shared by human colon and biliary epithelium by molecular mimicry.
Comparison of gene therapy strategies for treatment of liver diseases
Authors: ROY‐CHOWDHURY NAMITA , LU YANG , JIANG JINLAN , LEE SUNG W , GUHA CHANDAN , ROY‐CHOWDHURY JAYANTA
Published: December 2004

Abstract  Liver‐directed gene therapy can be aimed at replacing a missing gene product, overexpressing or ectopically expressing a gene product in the liver, generating proteins that are normally not produced in the liver (e.g. hormones, vaccines), down‐regulating specific gene expression and targeted repair of genetic mutations. A common critical requirement for achieving these goals is the availability of efficient methods for transferring DNA and RNA into target organ in vivo. Both recombinant viruses and non‐viral vectors are being explored for transferring nucleic acids to cells in vitro and in vivo. This review compares the characteristics of these vectors in the context of their potential application in liver‐directed gene therapy for various inherited or acquired disorders.
Viral hepatitis: virus/host interaction
Authors: VERGANI DIEGO , MIELI‐VERGANI GIORGINA
Published: December 2004

Abstract  Hepatitis A virus is considered directly cytopathic to the liver cell. Severity of the liver damage is dictated by viral load. Acute infection is followed by sustained immunity to the virus. Hepatitis B (HBV) and C (HCV) viruses are noncytopathic, hepatotropic viruses that cause acute and chronic hepatitis and hepatoma. Cellular and humoral immune responses are responsible not only for viral clearance but also for hepatocyte damage. T‐cell response to HBV is vigorous, polyclonal, and multispecific in acutely infected patients who clear the virus while it is weak and narrowly focused in chronically infected patients. It is mainly executed by cytotoxic T lymphocytes (CTL), which destroy infected hepatocytes and secrete antiviral cytokines that interrupt the HBV life cycle. T‐cell response to HCV is strong and multispecific in both acutely and chronically infected patients. Whether HCV is susceptible to a cytokine‐mediated type of control is unknown. The ability of HCV to persist despite a strong CTL response suggests that HCV is either less visible to the CTL or less responsive to cytokine‐mediated antiviral signals than HBV. Both viruses, but especially HCV, have a high mutation rate, leading to the occurrence of variant viral genomes with growth advantage and the ability of escaping immune recognition.
Viral genomics and bioinformatics for hepatitis B virus
Authors: BARTHOLOMEUSZ ANGELINE
Published: December 2004

Abstract  Viral genomics and bioinformatics is the linkage of viral genomic information with the viral and clinical parameters of patients, including therapy details and host genomics for the development of individualized patient management. In addition to variation between HBV isolated from different patients due to genotypes, naturally occurring mutations and quasispecies, new mutations are selected due to antiviral drug pressure. As viremic patients with antiviral resistant viruses continue to be treated with the initial antiviral agent, they will select further compensatory mutations. These mutations may also affect treatment with a second or third antiviral agent. Thus, the emergence of mutations in intricate patterns provides further support for the need for interactive databases due to the evolving complexity of the HBV genome. Since drug‐selected HBV mutants can also act as vaccine escape viruses with the potential to infect the HBV vaccinated population, close monitoring of these mutants represents a high priority public health strategy.
Is cirrhosis reversible?
Authors: WANLESS IAN R
Published: December 2004

Abstract  Cirrhosis has traditionally been considered as an irreversible end‐stage of liver disease. In recent years clinical and histologic improvement has been documented in many patients if the primary disease can be controlled. Hepatic fibrosis can be resorbed from the liver through the action of proteinases. This causes fibrous septa to become delicate and in some instances to disappear. After septa are resorbed cirrhosis is not present according to the histologic definition. However, an early event in the formation of cirrhosis is obliteration of small portal and hepatic veins; regeneration of these veins is necessary to complete the process of reversal of cirrhosis. New systems of histologic analysis are necessary to define the cirrhotic state, such as the Laennec staging system.
Pathology of portal hypertension
Authors: DENK HELMUT
Published: December 2004

Abstract  Portal hypertension may be the result of intra‐ and extrahepatic impediment of portal venous blood flow. Portal vein thrombosis is the major cause of prehepatic portal hypertension, and hepatic vein occlusion, congestive heart failure and constrictive pericarditis lead to posthepatic portal hypertension. Cirrhosis is the most common intrahepatic lesion responsible for portal hypertension. Idiopathic non‐cirrhotic portal hypertension results from obliterative injuries more specifically directed to intrahepatic portal vascular structures (macro‐ and microvascular portal vein disease). Under these conditions, portal vascular dilatation, herniation into the periportal parenchyma and paraportal shunt vessels resemble collateral pathways. The liver parenchyma often shows nodular transformation which may even be the only clue to the presence of small portal vein obstruction in a small liver biopsy. Thus, the morphologic changes associated with idiopathic portal hypertension may be subtle and non‐specific. Their recognition, particularly in the liver biopsy, is a challenge to the pathologist.
Pathology and nomenclature of early hepatocellular neoplasia
Authors: WANLESS IAN R
Published: December 2004

Abstract  Hepatocellular neoplastic lesions are named according to the International Working Party classification. Hepatocellular carcinoma arises from atypical lesions called dysplastic nodules. Biopsy diagnosis of dysplastic nodules and well‐differentiated carcinoma is difficult because the histologic criteria are not well standardized and some criteria are seldom found in needle biopsies even when present in the resected lesion. To overcome these difficulties, a new system is being developed by the International Consensus Group for Hepatic Neoplasia and the Laennec Liver Pathology Society.
Pathogenesis of cirrhosis
Authors: WANLESS IAN R
Published: December 2004

Abstract  Cirrhosis develops by the accumulation of many focal lesions of parenchymal extinction. Parenchymal extinction is accompanied and presumably caused by obliteration of small portal and hepatic veins. Fibrosis occurs during the acute phase of injury but is rapidly removed leaving collapsed preformed stroma and obliterated small veins. Portal vein supply is replaced by arterial flow. Dominant arterial flow may prevent healing of extinction lesions and restoration of obliterated portal veins.
Liver transplantation in metabolic liver diseases
Authors: MIELI‐VERGANI GIORGINA , VERGANI DIEGO
Published: December 2004

Abstract  Two types of metabolic disorders are treated with transplantation: those associated with severe liver damage, like alpha‐1 antitrypsin deficiency, progressive familial cholestatic syndromes, tyrosinaemia, glycogen storage diseases, or cystic fibrosis; and those in which the liver is structurally normal, but is genetically unable to produce an essential protein, usually an enzyme, with consequent lethal systemic disease, like Crigler‐Najjar syndrome, familial hypercholesterolaemia, propionic acidaemia, or urea cycle defects. The first group of diseases, among which the most common is alpha‐1 antitrypsin deficiency, are treated by substitution of the whole liver with the donor liver, while the second group can be treated by auxiliary transplantation, to provide sufficient production of the deficient protein by the donor liver segment, while the native liver provides a safety net should the transplant fail and remains available for possible future gene therapy. In recent years, attempts have been made to treat these conditions by isolated human hepatocyte transplantation, with temporary success.
Micronutrients, probiotics and the liver
Authors: CHANDRA RANJIT KUMAR
Published: December 2004

Abstract  The liver is the main gateway to the passage of nutrients from the gut to systemic sites. The organ is affected by the deficiencies of many vitamins and trace elements and excess amounts of vitamin A, iron, copper and zinc. Recent work has documented the beneficial role of probiotic organisms for many parts of the body including the liver. This knowledge is finding clinical and public health significance in the prevention and management of many human diseases.
Reducing blood loss in liver surgery
Authors: FAN SHEUNG TAT
Published: December 2004

Abstract  Reducing blood loss during liver surgery is the major objective and duty of the surgeon because massive blood loss affects both short‐term and long‐term survival of patients having partial hepatectomy or liver transplantation. Bleeding occurs from the liver transection surface, inferior vena cava, hepatic vein, and sometimes iatrogenic rupture of hepatocellular carcinoma. The anterior approach right hepatectomy has been advocated to reduce bleeding resulting from mobilization of the right lobe of liver. Intermittent inflow occlusion has been shown to be beneficial in reducing bleeding during liver transection, but the accumulated ischemic time should not exceed 120 min. The ultrasonic dissector is the best instrument in reducing blood loss during liver transection. Hemostatic material application to the transection surface is usually not required after careful transection of liver with the ultrasonic dissector.
Resecting hepatocellular carcinoma in cirrhotic liver
Authors: FAN SHEUNG TAT
Published: December 2004

Abstract  Resecting hepatocellular carcinoma (HCC) in a cirrhotic patient is potentially dangerous and recurrence of HCC after operation is high. Our current strategy consists of careful preoperative assessment of liver functions by indocyanine green clearance test, intraoperative techniques to reduce blood loss, and postoperative surveillance and prompt treatment of recurrences. The 5‐year overall survival rate of HCC patients after resection is 34.3%, which is comparable with that in patients with normal liver (37.3%) or chronic hepatitis (45.3%).
Malignant mesothelioma of the tunica vaginalis testis: A case with a predominant sarcomatous component
Authors: Shimada Satoko , Ono Kenzo , Suzuki Yasuhiko , Mori Naoyoshi
Published: December 2004

We present a case of malignant mesothelioma (MM) of the tunica vaginalis testis. A 64‐year‐old man was referred for an operation on a right hydrocele that later proved to be a tumor during surgery. The tumor was malignant with a biphasic pattern of epithelial and sarcomatous components. The latter component was predominant. Cuboidal or columnar cells formed irregular tubular structures in the epithelial component. In contrast, spindle‐shaped or polygonal cells formed   intricate structures with   stromal  connective tissues in the sarcomatous component. Immunohistochemical staining revealed that the tumor was mesothelial in origin and positive for cytokeratin, vimentin, HBME‐1 antigen and calretinin. In general, MM occur in the pleura or peritoneum; those originating in the tunica vaginalis testis are very rare and represent less than 5% of all MM. In addition, MM in the tissues usually consist primarily of an epithelial component. According to previous reports tumors with a predominant sarcomatous component are extremely rare. In general, a sarcomatous component predicts poor prognosis and our case does, in fact, deteriorate over time. Our case suggests that despite its low incidence, MM must be considered when a case is diagnosed as hydrocele testicle.
Phosphoglyceride (PG) crystal deposition disease: A novel acquired disease in which PG crystals are deposited in injured soft tissue and bone with phospholipid metabolism disturbance
Authors: Miura Katsutoshi , Han Guiping , Kondo Shinichi , Ohhashi Hiroyuki , Tsutsui Yoshihiro
Published: December 2004

The clinical history and crystal characteristics of three published cases and three new cases of phosphoglyceride (PG) crystal deposition disease of soft tissues and bones were compared. All patients (age range, 51–64 years) were generally healthy without a genetic background of congenital immunodeficiency or lipidosis. Foreign body granulomas grew slowly, predominantly at postoperative or repeat injection lesions. In two cases, crystals were deposited in multiple locations, and in one case, lipophage accumulations were found in the bone marrow. The crystals characteristically dissolved in acetic acid with oxygen gas formation, easily dissolved in alkalis and showed positive staining for PG by the gold hydroxamic acid method. All crystals examined by infrared microscopy, mass spectrometry and X‐ray microanalysis showed similar results, supporting the theory that the crystals were PG. Phosphoglyceride deposition disease is a lipid metabolic disorder in which PG crystals are slowly deposited, predominantly in injured soft tissues, forming foreign body granulomas. The diagnosis can be based on histological characteristics. The prognosis is favorable, although some cases showed systemic depositions with repetitions. Lysosomal phosphoglyceride metabolism in macrophages might be affected.
Developing a conceptual understanding of rural health practice
Authors: Bourke Lisa , Sheridan Collette , Russell Ursula , Jones Graeme , DeWitt Dawn , Liaw Siaw‐Teng
Published: December 2004

Objective:  This study presents a set of concepts underpinning rural practice that could assist teaching health and medical students.

Outcome:  Five concepts, important in distinguishing rural health practice, are presented and discussed. These are rural–urban health differentials, access, confidentiality, cultural safety and team practice. Together these concepts impact the ways in which rural health professionals provide care, due to fewer services, greater distances, smaller populations, less choice of services and smaller workforce.

Conclusion:  These concepts introduce students to some of the positive and negative aspects of rural practice, as well as opportunities for rural practitioners to have a diverse practice, to become involved in all aspects of health and to initiate change. They provide an understanding of rurality from which health students can learn from their practical experiences during rural placements.

What this paper adds?:  The present study contributes to understanding rurality and its impact on rural health by the application of sociological concepts to rural health in Australia. The present study identifies five concepts important in understanding rural practice.

1. Health Differentials: The rural population is in some ways different and their health conditions can vary from the urban population.

2. Access: Rural residents have less access to services due to distance, cost, fewer services and smaller workforce.

3. Confidentiality: Confidentiality impacts on health consumers and practitioners because there is less anonymity and sometimes a faster flow of information in rural communities.

4. Cultural safety: Respecting the identity/ies and needs of everyone is important in rural health services because specialist services are fewer.

5. Team practice: Teamwork is vital in rural practice and can improve the management of health care.

Teaching these concepts should improve students’ understanding of rural health and expose them to some of the diversity, opportunities and challenges of rural practice.
Evaluation of hospitalisation for Indigenous children with malnutrition living in Central Australia
Authors: Russell Beth J. , White Andrew V. , Newbury Jonathan , Hattch Carmel , Thurley Jennie , Chang Anne B.
Published: December 2004

Objective:  To evaluate the effectiveness of hospital admissions for indigenous children with malnutrition in a rural/remote Australian centre.

Design:  Retrospective review of the medical records.

Setting:  Rural secondary hospital.

Subjects:  Remote and rural indigenous children aged less than four years managed for malnutrition in Alice Springs Hospital (ASH).

Main outcome measure:  The primary outcome measure was weight gain during hospitalisation and posthospitalisation. Secondary outcome measures were yield of investigations, diagnoses made, treatments given, social interventions, readmission rate and nosocomial infection.

Results:  Median age of the 55 children was 15.1 months. Median weight change was 1.5 g day

−1

prior to hospitalisation, 36.7 g day

−1

during and 9 g day

−1

two months following hospitalisation (P < 0.05). Investigations performed had high yields (80% of children had a treatable organic contributor to malnutrition). Nosocomial infection occurred in 21 (38%) children. Readmission occurred at an average of 1.9 times per child (range 0–5), 34 (37%) occurred within three months and 48 (52%) within six months.

Conclusion:  In rural Indigenous children with malnutrition, hospitalisation was effective in re‐establishing growth and defining organic contributors to malnutrition. However, the high readmission rate and nosocomial infection mandates that alternative models to nutritional rehabilitation, in addition to a broad psychosocial and public health approach to prevention and management of malnutrition, is required.

What this paper adds:  Malnutrition is very common among Indigenous children living in rural and remote communities. Hospitalisation in rural hospitals is often used to break the cycle of malnutrition and infection, but this intervention has never been evaluated.

Hospitalisation was effective in re‐establishing growth and defining organic contributors to malnutrition. This, however, occurred at the expense of the high readmission rate and nosocomial infection. The present study suggests that alternative models to nutritional rehabilitation in addition to a broad psychosocial and public health approach to prevention and management of malnutrition is required.
Developing support for remote nursing education through workplace culture that values learning
Authors: Gibb Heather , Anderson Judith , Forsyth Katreena
Published: December 2004

Objective:  The present study presents the cultural challenges of introducing workplace learning associated with a nursing educational pathway into small rural hospitals.

Design and Intervention:  Focus groups were conducted before and after an action research intervention to determine whether changes in understanding and values on learning had occurred.

Setting:  Eight multipurpose services or small rural hospitals across rural New South Wales were involved in the intervention.

Subject:  Nursing staff from eight rural health facilities participated voluntarily in the present study.

Outcomes:  Two outcomes were achieved:

• The development of mentoring, locally tailored to the needs and expectations of nursing participants;

• Values and understanding of learning were enhanced, with advanced levels of learning being identified and demonstrated by staff in the practice setting.

Conclusion:  Small rural hospitals can provide opportunities for advanced clinical learning. Forms of major mentoring are, however, critical to this process.

What is already known:  With nursing educational bases shifting to TAFE (technical and further education) and university campuses in regional and metropolitan cities, the culture of learning has been largely lost or replaced with that of service delivery in small rural hospitals. Students studying in isolation often receive little support in clinical learning from their workplace. Action research intervention aimed to change the culture to one that values and supports workplace learning.

What does this study add:  The present study demonstrated how small hospitals can develop values around their workplace being a site of advanced learning beyond skill acquisition. This suggests the critical importance of establishing particular forms of mentoring for all staff, to establish advanced learning as a core business of small rural hospitals.
Defining remote health
Authors: Wakerman John
Published: December 2004

Objective:  To develop a definition of the discipline of Remote Health.

Design:  A broad literature search using key words and an Internet search of industry‐recognised web sites were carried out.

Results:  Fifty‐five relevant citations and nine web sites were reviewed, covering Australia, Canada, New Zealand, the United Kingdom and United States. The papers offered a variety of definitions of geographical and practice‐based approaches to ‘remoteness’, and definitions of ‘remote and rural health’.

Conclusions:  None of the single current definitions in the literature adequately reflect all of the characteristics of Remote Health in Australia. A definition is offered: Remote Health is an emerging discipline with distinct sociological, historical and practice characteristics. Its practice in Australia is characterised by geographical, professional and, often, social isolation of practitioners; a strong multidisciplinary approach; overlapping and changing roles of team members; a relatively high degree of GP substitution; and practitioners requiring public health, emergency and extended clinical skills. These skills and remote health systems, need to be suited to working in a cross‐cultural context; serving small, dispersed and often highly mobile populations; serving populations with relatively high health needs; and a physical environment of climatic extremes.

What this paper adds?:  In Australia and internationally there are a variety of measures of rurality and remoteness, which have focused on geographical or medical practice‐based sociodemographic factors, often related to remuneration scales. With an increasing recognition of and interest in the distinction between ‘Rural Health’ and ‘Remote Health’, there needs to be a better understanding of the characteristics of the emerging discipline of Remote Health which distinguish it from Rural Health practice.

This paper searched the international literature for a meaningful definition of Remote Health in the Australian context. There was not one single, appropriate definition, but the information uncovered has contributed to the development of a definition that can inform the work of educators, researchers and policy‐makers, and give appropriate recognition to Remote Health practitioners.
The human transcript induced in spermatogenesis 50
Authors: SASAKI YOSHIHITO , MIYAMOTO TOSHINOBU , SENGOKU KAZUO , HAYASHI HIROAKI , TAKUMA NAOYUKI , ISHIKAWA MUTSUO
Published: December 2004

Background and Aims: Recently, a number of genes that are expressed specifically in the testis have been identified in rat and mouse. In 2002, 80 transcript induced in spermatogenesis (Tisp) genes with this specific expression were isolated in mice. In the human, however, the number of such genes isolated is much lower. The aim of this study therefore was the isolation of human genes specifically expressed in testis.

Methods: We searched for human genome region with homology to the mouse Tisp gene family at the amino acid level using GenBank. The primers were made in human homologous regions, and polymerase chain reaction analysis was performed with templates using cDNA libraries of a range of human tissues. The cDNA specifically expressed in testis were isolated and detailed expression analysis was performed.

Results: The 28 human TISP related genes were analyzed. Five of these genes were not expressed in testis and only three, TISP50, TISP15 and TISP43 related gene, were expressed specifically in testis. The cDNA of these three genes were isolated.

Conclusion: Expression analysis demonstrated that there is some discrepancy between human and mouse for the TISP gene family. From expression patterns and amino acid sequences, it is suggested that the human TISP50, TISP15 and TISP43 related genes play some critical roles in spermatogenesis. (Reprod Med Biol 2004; 3: 237 – 243)
Botulinum toxin for periocular lines: the single‐injection technique
Authors: Salti Giovanni
Published: December 2004

Background  Botulinum is a well established treatment for facial wrinkles and hyperfunctional lines, including those at the periocular area.

Objective  To illustrate a simple periocular injection technique. It differs from the usual one since it is a single injection, instead of several.

Methods  Thirty consecutive patients were treated with this technique on one side, and the standard multipuncture technique on the contralateral side. Each patient, being their own control, received 10–12 Botox units to each side. The orbicularis oculi muscle was injected using two different types of needles: a standard 30 g 13 mm needle for the multipunctured side and a 30 g 25 mm needle for the single puncture side. Follow up assessments were made on days 7, 15 and 120.

Results  Good results were achieved in all patients. No relevant cosmetic difference was noticeable between the two sides. The pharmacological effect lasted about 5 months, with no difference between the two techniques. Both techniques were safe and caused the same amount of bruising. The single injection was preferred by patients. The single‐injection technique, on the other hand, requires more skill and experience by the operator.

Conclusions  The single‐injection technique for periocular lines is a useful alternative to the standard multipuncture technique. It reduces patients’ discomfort.
Magnetic resonance imaging and spectroscopy of skin and subcutis
Authors: Querleux Bernard
Published: December 2004

Amongst in vivo skin imaging methods, magnetic resonance (MR) imaging and spectroscopy is of high interest not only for its ability to distinguish structures at a submillimetre scale but also for its ability to describe the physiology of the different skin layers through the measurement of their intrinsic MR parameters.

High spatial resolution MR imaging allows the differentiation of epidermis, dermis and hypodermis. Cutaneous appendages such as hair follicles are also clearly visible. By measuring proton relaxation times and proton density, it is possible to go a step further in the description of skin physiology in vivo through the analysis of water‐macromolecular interactions within the dermis as an example. Finally, quantification of water and lipid components in healthy and diseased adipose tissue by localized spectroscopy is also described.

Even if MR imaging is of little interest for dermatological diagnosis, some preliminary studies have shown interesting results for preoperative staging, postoperative follow‐up, and assessment of the efficacy of new dermatological products. In healthy skin, MR imaging and spectroscopy is a very promising method for the study of chronological and photoageing effects.
Benign summer light eruption and polymorphic light eruption: genetic and functional studies suggest that a revised nomenclature is required
Authors: Hawk John
Published: December 2004

New research indicates that polymorphic light eruption (PLE) is an autoimmune disease against an ultraviolet radiation‐induced cutaneous antigen. PLE may even confer some protection against skin cancer later in life. This new information demands a reassessment of the precise nature and nomenclature of PLE.

 Benign summer light eruption (BSLE) (lucite estivale bénigne) is the name used in continental Europe, and particularly France, to describe a clinically short‐lived, itchy, papular eruption particularly affecting young women after several hours of sunbathing at the beginning of summer or on sunny vacations. Clinically more prolonged forms of solar eruption, starting early in spring and persisting for long periods, have been known in France as polymorphic light eruption (PLE) (lucite polymorphe) (‘European PLE’).

 Investigative studies, however, now suggest that BSLE and some cases of ‘European PLE’ are part of the same spectrum. In the Anglo‐Saxon literature, they are lumped together as PLE (‘Anglo‐Saxon PLE’). The other cases of ‘European PLE’, which do not fall within the compass of ‘Anglo‐Saxon PLE’, are, in the Anglo‐Saxon literature, classified as either actinic prurigo (AP) (a genetically determined, prolonged, excoriated form of Anglo‐Saxon PLE), or chronic actinic dermatitis (CAD) (a sunlight‐induced eczema precisely resembling allergic contact dermatitis, apparently to an ultraviolet radiation‐induced antigen).

 It is therefore proposed that:

the European term BSLE be dropped and that these patients be reclassified within the spectrum of (Anglo‐Saxon) PLE,

the European use of the term PLE (‘European PLE’) be discontinued,

those previously diagnosed as having ‘European PLE’ be reclassified as (Anglo‐Saxon) PLE, AP or CAD, as appropriate.

 The benefits of such a change in nomenclature would be twofold, firstly a uniformity of terminology and secondly, and more importantly, terminology would then correlate better with our recently improved understanding of the pathogenesis of these disorders.
Lasers alleviate acne
Authors: Nouri Keyvan , Ballard Christopher J
Published: December 2004

Propionibacterium acnes (P. acnes) and sebaceous glands are involved in the pathogenesis of acne. Although often effective, traditional therapies can have drawbacks, such as photosensitivity, other toxicities, polypharmacy and frequent dosing. Lasers have been studied to seek a solution that may overcome these disadvantages.

 Lasers and other light therapies target the wavelengths of the porphyrins in P. acnes to induce thermal damage that causes the bacterium's destruction. Pulsed‐dye laser (PDL) or a system of light pulses and heat with wavelengths between 430 and 1100 nm are both efficacious. The 1450‐nm diode laser targets sebaceous glands and is also effective. Topical indocyanine green (ICG) photodynamic therapy (PDT), using the near‐infrared (NIR) laser, targets either P. acnes or sebaceous glands. ICG‐PDT has fewer adverse effects than aminolevulinic acid‐PDT.

 Lasers are still a relatively new therapy for acne and may be best used in an adjuvant role.
Nail beauty
Authors: Baran Robert , Schoon Douglas
Published: December 2004

Nail beauty depends firstly upon nail health. It is a truism to say that a beautiful nail is always a healthy nail. In addition, there are subjective and evolving aspects of nail beauty which are related to fashion.

 The texture of the nail affects its appearance and function. Soft or brittle nails are fragile. This results in unattractive longitudinal and horizontal splitting. Fragility is encouraged by wet work and excessive nail manicuring, especially by the removal of nail cosmetics. Critical to the aesthetic appeal of the nail is its shape. Most pleasing are nails are those that conform to the ‘magic’ ratio, in which the nail's length is approximately equal to its breadth, especially for the thumbs. The role of nail decoration and nail art in nail beauty is a subjective and evolving question of fashion.
Use of Community Health Workers in Research With Ethnic Minority Women
Authors: Andrews Jeannette O. , Felton Gwen , Wewers Mary Ellen , Heath Janie
Published: December 2004

Purpose

: To explore roles and effectiveness of community health workers in research with ethnic minority women in the United States (US).

Methods

: Medline (1966‐2002) and CINAHL (Cumulative Index to Nursing and Allied Health Literature; 1982‐2002) databases were used to locate published research studies on the use of community health workers with ethnic minority women in the US. Key words for searches were community health workers, community health aides, health promoters, and community workers.

Results

: An integrative analysis of 24 studies showed that, despite varying roles and functions, evidence indicates that community health workers are effective in increasing access to health services, increasing knowledge, and promoting behavior change among ethnic minority women. Other advantages of using community health workers are to provide social support and culturally competent, cost‐effective care. Recommendations for future directions of research with community health workers and ethnic minority women include improved conceptualization of the community health worker role, theoretical frameworks for research designs, enhanced methods for evaluating effectiveness, and increased community involvement.
Women, Nursing, and Baccalaureate Education in 20th Century America
Authors: D'Antonio Patricia
Published: December 2004

Purpose:

To analyze the social meaning of the American system of education for nursing practice.

Methods:

Historiographical analysis to compare and contrast the relative educational level of different self‐reported groups of American women with that of nurses in the later decades of the 20th century.

Findings:

Early 20th century social support for efforts to improve the overall educational level of some nurses planning careers in education, administration, or public health nursing lent credence to the belief in nursing as a vehicle for upward social mobility. This promise of mobility was particularly apparent in the educational backgrounds of African American, Hispanic, and Asian American nurses. However, the late 20th century decreased average educational level of U.S. nurses relative to that of all U.S. women jeopardizes the clinical and social roles of the profession.

Conclusions:

The language of class and community status is needed in addition to that of science, knowledge development, and clinical excellence to increase social and political support for educational initiatives.
The influence of contraction amplitude and firing history on spike‐triggered averaged trapezius motor unit potentials
Authors: Westad C. , Westgaard R. H.
Published: December 2004

The spike‐triggered averaged (STA) technique was used to examine trapezius motor unit potentials and their dependence on contraction amplitude and firing history. Individual motor unit firings were identified by a fine‐wire intramuscular electrode, while STA‐derived potentials were extracted from the simultaneously recorded surface electromyographic (SEMG) signal. Amplitude‐controlled contractions and contractions with typing tasks and mental stress were carried out. STA potentials were mostly derived from 20 s intervals of firing. Motor unit synchrony was estimated by peristimulus time histograms (PSTHs). An association between SEMG amplitude and STA‐derived motor unit potentials was found: motor unit area showed a four‐fold increase when SEMG amplitude increased from 1.5 to 10.5% of the root mean square‐detected SEMG signal at maximal voluntary contraction (%EMGmax). Low‐ and higher threshold motor unit potentials, all with recruitment thresholds <10% EMGmax, had similar area at the same contraction amplitude. A significant increase in the STA‐derived potentials was observed after 3 min of constant‐amplitude contractions; however, this difference was reduced after 10 min and no longer present after 30 min of contraction. Motor unit synchrony accounted for, on average, 2.8% additional firings within 2 ms of the triggering motor unit. We conclude that the increase in STA‐derived potentials with contraction amplitude is, to a major extent, due to motor unit synchrony, limiting the applicability of this method in postural muscles presenting wide motor unit potentials. The similar area of motor units at same SEMG amplitude may indicate that trapezius motor units recruited below 10% EMGmax are of similar size and thus not organized according to the Henneman size principle.