bluuebunny/crossref_metadata_2025 huggingface dataset:
Analysis of pedigree and conformation data to explain genetic variability of the horse breed Franches‐Montagnes
Authors: Poncet P.A. , Pfister W. , Muntwyler J. , Glowatzki‐Mullis M.L. , Gaillard C.
Published: March 2006

Franches‐Montagnes is the only native horse breed in Switzerland, therefore special efforts should be made for ensuring its survival. The objectives of this study were to characterize the structure of this population as well as genetic variability with pedigree data, conformation traits and molecular markers. Studies were focused to clarify if this population is composed of a heavy‐ and a light‐type subpopulation. Extended pedigree records of 3‐year‐old stallions (n = 68) and mares (n = 108) were available. Evaluations of body conformation traits as well as pedigree data and molecular markers did not support the two‐subpopulation hypothesis. The generation interval ranged from 7.8 to 9.3 years. The complete generation equivalent was high (>12). The number of effective ancestors varied between 18.9 and 20.1, whereof 50% of the genetic variability was attributed to seven of them. Genetic contribution of Warmblood horses ranged from 36% to 42% and that of Coldblood horses from 4% to 6%. The average inbreeding coefficient reached 6%. Inbreeding effective population size was 114.5 when the average increase of the inbreeding coefficient per year since 1910 was taken. Our results suggest that bottleneck situations occurred because of selection of a small number of sire lines. Promotion of planned matings between parents that are less related is recommended in order to avoid a reduction of the genetic diversity.
Single‐nucleotide polymorphism identification in the caprine myostatin gene
Authors: Li X.L. , Wu Zh.L. , Gong Y.F. , Liu Y.Q. , Liu Z.Z. , Wang X.J. , Xin T.R. , Ji Q.
Published: March 2006

Polymerase chain reaction (PCR) products of MSTN gene amplified from 35 goats representing 17 Chinese indigenous goat breeds and five imported goat breeds were sequenced to identify the single‐nucleotide polymorphisms (SNPs) of a 379‐bp fragment including part of intron 2 and exon 3 of MSTN gene. A total of eight SNPs (A1980G, G1981C, A1982G, G1984T, A2121G, T2124C, G2174A and A2246G) were identified among the sequenced goats. The SNPs found are all located in intron 2 except for A2246G, which was a synonymous mutation in exon 3. Four haplotypes were sorted from these eight SNPs, of which, haplotype I (AGAGATGA) and haplotype II (GCGTGTAA) are the two main haplotypes with the frequency of 77.8% and 14.8% respectively. The SNPs found at positions 1980, 1981, 1982, 1984 and 2121 might be linked to inheritance completely.
Mapping of quantitative trait loci for lactation persistency traits in German Holstein dairy cattle
Authors: Harder B. , Bennewitz J. , Reinsch N. , Thaller G. , Thomsen H. , Kühn C. , Schwerin M. , Erhardt G. , Förster M. , Reinhardt F. , Kalm E.
Published: March 2006

A whole genome scan to map quantitative trait loci (QTL) for persistency of milk yield (PMY), persistency of fat yield (PFY), persistency of protein yield (PPY) and persistency of milk energy yield (PEY) was performed in a granddaughter design in the German Holstein dairy cattle population. The analysis included 16 paternal half‐sib families with a total of 872 bulls. The analysis was carried out for the first lactation and for the first three lactations combined using univariate weighted multimarker regression. Controlling the false discovery rate across traits and data sets at a level of 0.15 and treating the four persistency traits as different traits revealed 27 significant QTL. A total of 12 chromosomes showed significant QTL effects on a chromosomewise basis. TheDGAT1effect was highly significant for PPY and protein yield. A haplotype analysis using results of previous studies of the same design revealed a co‐segregation of various persistency QTL and QTL affecting health traits like dystocia and stillbirth and functional traits like non‐return rate 90 and somatic cell score.
Properties of random regression models using linear splines
Authors: Misztal I.
Published: March 2006

Properties of random regression models using linear splines (RRMS) were evaluated with respect to scale of parameters, numerical properties, changes in variances and strategies to select the number and positions of knots. Parameters in RRMS are similar to those in multiple trait models with traits corresponding to points at knots. RRMS have good numerical properties because of generally superior numerical properties of splines compared with polynomials and sparser system of equations. These models also contain artefacts in terms of depression of variances and predictions in the middle of intervals between the knots, and inflation of predictions close to knots; the artefacts become smaller as correlations corresponding to adjacent knots increase. The artefacts can be greatly reduced by a simple modification to covariables. With the modification, the accuracy of RRMS increases only marginally if the correlations between the adjacent knots are ≥0.6. In practical analyses the knots for each effect in RRMS can be selected so that: (i) they cover the entire trajectory; (ii) changes in variances in intervals between the knots are approximately linear; and (iii) the correlations between the adjacent knots are at least 0.6. RRMS allow for simple and numerically stable implementations of genetic evaluations with artefacts present but transparent and easily controlled.
Uncovering the evidence of non‐expert nephrology nursing practice
Authors: Bonner Ann
Published: March 2006

Expertise in nursing has been widely studied although there have been no previous studies into what constitutes expertise in nephrology (renal) nursing. This paper, which is abstracted from a larger study into the acquisition and exercise of nephrology nursing expertise, provides evidence of the characteristics and practices of non‐expert nephrology nurses. Using the grounded theory method, the study took place in one renal unit in New South Wales, Australia, and involved six non‐expert and 11 expert nurses. Sampling was purposive then theoretical. Simultaneous data collection and analysis using participant observation, review of nursing documentation and semistructured interviews was undertaken. The study revealed a three‐stage skills‐acquisitive process that was identified as non‐expert, experienced non‐expert and expert stages. Non‐expert nurses showed superficial nephrology nursing knowledge and limited experience; they were acquiring basic nephrology nursing skills and possessed a narrow focus of practice.
Quantitative evaluation of regular morning meetings aimed at improving work practices associated with effective interdisciplinary communication
Authors: Aston Judy , Shi Edward , Bullôt Helen , Galway Robyn , Crisp Jackie
Published: March 2006

In 2000, an interdisciplinary surgical morning meeting (SMM) was introduced into the infants’ and toddlers’ ward of a major paediatric hospital to help overcome a number of communication and work process problems among the health professionals providing care to children/families. The objective of this study was to evaluate the impact of the SMM on a range of work practices. Comparative design including pre‐ and postintervention data collection was used. Data were collected on 100 patient records. Twenty children, from each of the five diagnostic‐related groups most commonly admitted to the ward, were included. Demographic, medical review, documentation, critical incidents and complaint variables were obtained from three sources: the hospital clinical information system, the children's medical records and the hospital reporting systems for complaints and critical incidents. Children in the postintervention group were significantly more likely to be reviewed regularly by medical staff, to be reviewed in the morning, to have plans for discharge documented regularly throughout their admission and to have admission summary sheets completed at the time of discharge. The findings of the quantitative evaluation add some weight to the arguments for the purposely structured introduction of interdisciplinary teams into acute‐care environments.
Source and content of health information for patients undergoing laparoscopic cholecystectomy
Authors: Blay Nicole , Donoghue Judith
Published: March 2006

This study, a component of a larger research project examining the effect of pre‐admission education on patients’ ability and confidence in domiciliary self‐care following laparoscopic cholecystectomy, identified the source(s) of specific health‐ and hospital‐related information for patients undergoing this operative procedure. One‐hundred laparoscopic cholecystectomy patients were surveyed at pre‐admission, following assessment by the pre‐admission nurse, anaesthetist and registered medical officer to determine what information had been provided by the pre‐admission nurse and/or alternative sources of information provision. The findings showed that laparoscopic cholecystectomy patients received information from multiple sources. Pre‐admission clinic nurses were more likely to provide information related to the surgical procedure and hospital length of stay than about postoperative expectations and self‐care. Overall, patients perceived that medical practitioners imparted the most information. Printed literature and informal channels of information provision featured strongly, indicating patients’ resourcefulness in obtaining information related to their surgery. Informal communication showed the importance of social networks and personal experience in aiding patients’ comprehension of the hospital and recovery experience.
Priorities for midwifery research in Perth, Western Australia: A Delphi study
Authors: Fenwick Jennifer , Butt Janice , Downie Jill , Monterosso Leanne , Wood Jennifer
Published: March 2006

This paper reports a two‐round Delphi study undertaken to identify the research priorities of midwives at five public maternity hospitals in Western Australia's metropolitan area of Perth. In round one, 117 midwives identified 64 different problems or issues for research. Using thematic content analysis, these problems were grouped together and then collapsed to develop 17 specific research topics within four major categories. In round two, 152 midwives were asked to rank how important each of the topic statements were to women, their families and midwives. Research focusing on ‘the postnatal experience’ was ranked by midwives as the most important to the care of women and their families. From a midwife's perspective, the highest ranked topic was ‘examining the professional issues that impact on midwives’ clinical practice’ (e.g. midwifery and medical collaboration, potential litigation and horizontal violence in the workplace). The results of the study show that Western Australian midwives, like their national and international colleagues, are concerned about the delivery and organization of maternity services, the invisibility of the postnatal experience and how to operationalize evidence‐based care in the clinical area.
Work‐related empowerment of the multidisciplinary team at the Rheumatism Foundation Hospital
Authors: Suominen Tarja , Savikko Niina , Kukkurainen MarjaLeena , Kuokkanen Liisa , Irvine Doran Diane
Published: March 2006

Carried out as part of a staff development project, this study describes the experiences of work‐related empowerment within a multidisciplinary team at the Rheumatism Foundation Hospital in Finland. The data were collected using a structured questionnaire consisting of background variables and questions concerning verbal, behavioural and outcome empowerment. The questionnaire was sent to all members of the multidisciplinary team at the Rheumatism Foundation Hospital, with the exception of physicians, departmental secretaries and administrative personnel. The response rate was 58%. The data were examined using statistical methods. The multidisciplinary team felt quite strong verbal and behavioural empowerment, but was less confident in terms of outcome empowerment. Several factors were found to be associated with the different fields of empowerment. In conclusion, the multidisciplinary team felt quite strong work‐related empowerment.
Ineffectiveness of the measurement of ‘routine’ vital signs for adult inpatients with community‐acquired pneumonia
Authors: Mariani Paul , Saeed Musab U , Potti Anil , Hebert Brian , Sholes Kaley , Lewis Mary Jo , Hanley James F
Published: March 2006

More frequent vital sign evaluation does not result in a statistically significant difference in survival or the number of transfers to the intensive care unit (for progression of disease) after adjusting for age, gender, duration of intravenous antibiotics and comorbid conditions.
Conservation through buyer‐diversity: A key role for not‐for‐profit land‐holding organizations in Australia
Authors: Cowell Stuart , Williams Chris
Published: March 2006

‘Not‐for‐profit’ nature conservation organizations in Australia are a relatively new and growing phenomenon. Key players discuss the progress of these groups in securing ‘in perpetuity’ conservation on private land.
Abandoned Antarctic waste disposal sites: Monitoring remediation outcomes and limitations at Casey Station
Authors: Stark Jonathan S. , Snape Ian , Riddle Martin J.
Published: March 2006

Abandoned work sites, disposal sites, hazardous waste and untreated fuel spills in Antarctica have recently begun to receive significant attention. A profile of the clean‐up at Casey waste disposal site demonstrates a suite of cultural, social, economic and scientific changes to the way Antarctica and its environmental management are viewed.
Effect of some selective herbicide oversprays on newly emerged eucalypt and hopbush seedlings in Central Western New South Wales
Authors: Semple Bill , Koen Terry
Published: March 2006

Summary  Unlike parts of Victoria and South Australia, direct seeding of woody plants has been unreliable in Central Western New South Wales where failures have been attributed to low rates of seedling emergence and competition from herbaceous weeds. We investigated the usefulness of overspraying newly emerged seedlings of eucalypt (Eucalyptus spp.) and Narrow‐leaf Hopbush (Dodonaea viscosa ssp. angustissima) in an existing or potentially weedy seedbed using a grass‐selective herbicide (Fusilade® or Sertin®) and/or a soil‐residual herbicide (Simazine®). These treatments were investigated at two sites over three sowing seasons in Central Western NSW. In most cases, the herbicides failed to enhance seedling survival because grasses were not the main component of the weed species present or because the herbicide damaged the seedlings. Hopbush was relatively tolerant to Simazine but eucalypt seedlings were not, particularly at the site with sandy soils. Grass‐selective herbicides did not appear to damage seedlings. Suggestions for increasing the reliability of direct seeding in this region are presented.
Planting designs in ecological restoration: Insights from the Button Wrinklewort
Authors: Morgan John W. , Scacco Paul J.
Published: March 2006

Summary  The re‐establishment of threatened (and common) plant species populations is an important conservation activity in the agricultural landscapes of Australia where habitat fragmentation has destroyed much of their former range. The initial design of restoration plantings, including the number of individuals planted and their spatial configuration, is likely to affect long‐term persistence of the re‐introduced populations because of its potential effects on pollination and gene flow, but this topic has received little attention in the restoration literature. This study examined how population size and population density of experimental arrays of the grassland daisy Button Wrinklewort affected percentage seed set, a measure of reproductive success. We found strong evidence that population density, but not population size, affected seed set in this species. Seed set increased by, on average, 275% when plants were placed at high‐density relative to low‐density populations. The low seed set observed may occur because pollinator visitation rates decline in sparse populations or, alternatively, because pollinators are less efficient at pollen transfer when individuals are at low density. Hence, planting designs appear to be an important facet of restoration works that deserve far greater theoretical and practical attention than they have previously received.
Phytophthora Root Rot: Assessing the potential threat to Australia's oldest national park
Authors: Walsh Jillian L. , Keith David A. , McDougall Keith L. , Summerell Brett A. , Whelan Robert J.
Published: March 2006

Summary  Royal National Park, Australia's oldest national park, is a significant reserve for conservation of the flora and fauna that are characteristic of the Hawkesbury Sandstone in New South Wales. Since at least 1974, Phytophthora Root Rot (caused by Phytophthora cinnamomi) has been known to occur in the Park, but there is no knowledge of the extent of infestation or the potential impacts of the disease within the Park. This study investigated the distribution of the pathogen within Royal National Park at two scales: a systematic survey by vegetation type, and a targeted survey of populations of Waratah and Spear Grass‐tree. These two species are known to be susceptible to Phytophthora Root Rot and are therefore potential indicators of the impact of the pathogen on vegetation in Royal National Park. Phytophthora cinnamomi was recovered from all vegetation types sampled but most commonly in heathland/open scrub vegetation. The pathogen was easily recovered from sites containing Spear Grass‐tree, but was not isolated from any sites containing Waratah. Because of the widespread distribution of P. cinnamomi, we conclude that hygiene measures will be of little use to prevent the spread of the pathogen within Royal National Park. Monitoring of the occurrence and spread of disease symptoms in plants and applying phosphite to protect susceptible rare or threatened flora may be the most appropriate management options.
MAMMARY DUCT FISTULAE: CLASSIFICATION AND MANAGEMENT
Authors: Almasad Jamal K.
Published: March 2006

Background:  The aim of the present study was to review the management of mammary duct fistulae and propose a classification that could be useful in planning the management of mammary duct fistulae.

Methods:  Sixteen women presented with a mammary duct fistula, two of whom had two fistulae. The data analysed included age, smoking habit, previous abscesses, nipple abnormalities, imaging, culture, operative technique and histopathological findings.

Results:  The average follow up was 28 months, the mean age was 36.5 years and two women were heavy smokers. Nipple abnormalities were found in five (32%) patients, the average number of abscesses before the presentation was 1.8 and Staphylococcus coagulase negative predominated the culture. Eleven (69%) patients underwent total excision of the ductal system and fistulous tract using a technique modified by the author. Five patients were offered conservative treatment; however, one of the patients refused surgical treatment, but was still followed up in the present study. Histopathological results revealed periductal mastitis in 10 patients, idiopathic granulomatous mastitis in five patients and tuberculous mastitis in one patient.

Conclusion:  Deep mammary duct fistulae are directly related to a diseased ductal system and should be differentiated from superficial fistulae, which result from the infection of the subepidermal mammary glands. Deep fistulae that result from periductal mastitis should be treated by total excision of the ductal system in conjunction with the fistulous tract under antibiotics to ensure the lowest rate of recurrence. The technique used in the present study resulted in negligible morbidity and good cosmetic appearance. A trial of conservative treatment should be recommended for fistulae resulting from idiopathic granulomatous mastitis; however, further studies are required to establish the best treatment.
SURGICAL MARGIN AND ITS INFLUENCE ON SURVIVAL IN SOFT TISSUE SARCOMA
Authors: Dickinson Ian C. , Whitwell Duncan J. , Battistuta Diane , Thompson Bridie , Strobel Nichola , Duggal Amit , Steadman Peter
Published: March 2006

Background:  The goal of surgeons treating soft tissue sarcoma is to gain local control, to avoid risk of local recurrence and to avoid compromise of the patient's potential survival. The aim of the investigation was to assess the significance of the extent of surgical margin on the chance of death, metastasis and local recurrence.

Methods:  Two hundred and seventy‐nine patients who presented with soft tissue sarcoma without metastatic disease were analysed.

Results:  The extent of the surgical margin was not clinically or statistically significant in the development of metastatic disease. The presence of a contaminated surgical margin led to a significantly higher rate of local recurrence (as did a narrow surgical margin less than 1 mm). A margin greater than 1 mm allowed a satisfactory outcome in terms of low local recurrence rates. In terms of overall survival, the failure to achieve a wide surgical margin (wide contaminated margin) led to an increased relative death rate. However, when the margin was not contaminated (even if the margin was very close, less than 1 mm), the overall survival rate was similar across all groups. Patients who had radical resections did poorly; they generally belonged to a group in which palliative surgery was carried out, and they showed very high relative metastasis and death rates.

Conclusion:  The present study provides statistically significant evidence that increasing the width of resection improves local control and overall survival.
SURGERY FOR ACUTE ABDOMINAL CONDITIONS IN INTELLECTUALLY‐DISABLED ADULTS
Authors: Khalid Kamran , Al‐Salamah Saleh M.
Published: March 2006

Background:  Intellectually‐disabled patients with acute abdominal conditions are susceptible to late diagnosis and adverse outcome due to impaired communication, altered behaviour, neurological impairment, associated congenital anomalies, variable reaction to pain and drugs and various difficulties in perioperative management. The present study aims to present the experience of surgery for acute abdominal conditions in intellectually‐disabled patients. Various difficulties encountered during the management are highlighted and measures to overcome these problems are discussed.

Methods:  A prospective descriptive population study was performed through the prospective collection of data on consecutive intellectually‐disabled adults operated for acute abdominal conditions over a 5‐year period. Study parameters included demographic details, clinical presentation, diagnostic modalities, operative findings and outcome in terms of morbidity and mortality.

Results:  Of 19 men and three women with a mean age of 28.3 years, anorexia, vomiting, and increasing abdominal distension were the most common presenting features. History of pica was available in 36.4% of patients. Intestinal obstruction, acute appendicitis, volvulus and pseudo‐obstruction of the colon were the most frequently encountered conditions. Postoperative morbidity and mortality were 33 and 23%, respectively.

Conclusion:  Intellectually‐disabled patients demand particular clinical expertise owing to various difficulties inherent to their mental and physical disabilities. Short history, anorexia, vomiting and abdominal distension should make the clinician aware of the possibility of an acute abdominal condition. History of pica should be considered a serious clinical correlate. A high index of clinical suspicion, intensive perioperative care and low threshold for an early operation are recommended to reduce the higher morbidity and mortality figures.
REQUIREMENTS FOR TRAINEE LOGBOOKS
Authors: Watters David A. K. , Green Anthony J. , Van Rij Andre
Published: March 2006

All trainees are required to keep a logbook as a record of the procedures they have carried out during their surgical training. However, the current logbook is only a record of work carried out and not of the outcome of the operations. It does not prepare the trainee for either a lifetime practice of surgical audit or for a lifetime of learning from the audit process. The logbook requirements of different training boards vary and consequently, trainees find the keeping of a logbook an inconsistent process with ill‐defined learning objectives. The Royal Australasian College of Surgeons should define what needs to be collected, how data should be verified and how experience and learning should be reported, and should approve electronic databases that meet logbook standards. The choice of database software and format can then be left to the trainee. Although there are good examples of electronic logbooks being developed, there is, at present, no perfect logbook available. We recommend that all trainees, from the commencement of basic surgical training, should keep a logbook that contains the minimum and expanded datasets in addition to specific trainee data on supervision and learning. In addition to the current reporting format focused on procedural casemix and supervision level, quality/outcome reports and a record of learning are recommended.
SURGICAL DEXTERITY AFTER A ‘NIGHT OUT ON THE TOWN’
Authors: Kocher HEMANT M. , Warwick JANE , Al‐Ghnaniem REYAD , Patel AMEET G.
Published: March 2006

Background:  This study examines the effect of alcohol intake on surgical dexterity immediately after and the morning after alcohol intake and minimal sleep deprivation by simulating a typical night out on the town.

Methods:  Five surgeons (all men, aged 31–40 years) were trained on a laparoscopic surgical simulator (minimally invasive surgical trainer‐virtual reality) to reach a desired standard of performance. Three experimental settings were used: (i) a control night with no alcohol and full night's sleep; (ii) a sham night out (sleep deprived) without alcohol; and (iii) a night out with alcohol ad libitum. The parameters recorded were the average time taken to carry out a task, error rate, average diathermy time and diathermy (damage) time to main object. Comparisons between baseline readings, those in the middle of the night and those of the following morning were made by applying ANOVA methods after logarithmic transformation of the data.

Results:  The candidates consumed, on average, 10.33 units (range, 6–15 units) of alcohol and had 0.86% (range, 0.71–1.1%) of breath alcohol levels and an average of 3.75 h (range, 3–5 h) of sleep after a typical night out. The morning‐after breath alcohol levels were 0%. There was significant deterioration in performance, as measured by all indicators, immediately after alcohol consumption. The adverse effects on time taken to complete the task and total diathermy time were still apparent the morning after. The sham night out appeared to affect only ‘time parameters’. No significant changes in performance were seen in the control setting.

Conclusion:  Both alcohol consumption and sleep deprivation adversely affect the ability to carry out surgical procedures. Our simulation study suggests that the adverse effects of alcohol intake persist the following morning.
BENEFITS OF EARLY AGGRESSIVE MANAGEMENT OF EMPYEMA THORACIS
Authors: Bilgin Mehmet , Akcali Yigit , Oguzkaya Fahri
Published: March 2006

Background:  The end‐target of the management of thoracic empyema is to obtain early rehabilitation by re‐expansion of the trapped lung resulting from intrapleural infected material. Our aim was to shorten the hospitalization time and to prevent a possible thoracotomy by using video‐assisted thoracoscopy initially.

Methods:  Seventy patients with parapneumonic empyema were prospectively studied between January 1997 and June 2004. The patients were randomly divided into two groups. In group I (n = 35 patients), a chest tube was inserted into the patients after pleural content was evacuated and fibrins were debrided using video‐assisted thoracoscopy. In group II (n = 35 patients), tube thoracostomy was carried out without using a video‐assisted thoracoscope. Both groups were compared in terms of hospitalization time, open surgery for decortication and complications.

Results:  There was no statistically significant difference between the groups from the point of view of age and sex (P > 0.05). In group I, 17.1% of the patients underwent open decortication, whereas in group II, 37.1% of the patients underwent the same procedure (P < 0.05). Whereas average hospital stay in group I was 8.3 days (range, 7–11 days), it was 12.8 days in group II (range, 10–18 days; P < 0.05). There was one bronchopleural fistula in group I, and there was one bronchopleural fistula and one death in group II.

Conclusion:  Video‐assisted thoracoscopic evacuation and chest tube insertion in situ is a new therapeutic approach for pleural empyema that shortens hospital stay and reduces the necessity of open decortication.
INCIDENTAL THYROID CARCINOMA IN A LARGE SERIES OF CONSECUTIVE PATIENTS OPERATED ON FOR BENIGN THYROID DISEASE
Authors: Miccoli Paolo , Minuto Michele N. , Galleri David , D’Agostino Jacopo , Basolo Fulvio , Antonangeli Lucia , Aghini‐Lombardi Fabrizio , Berti Piero
Published: March 2006

Background:  The diagnosis of incidental thyroid carcinoma (ITC) in patients operated on for a benign disease is frequent. This study aims to determine both its clinical effect and the possibility of identifying this class of patients preoperatively.

Methods:  A total of 998 consecutive patients (697 women and 301 men; mean age, 49.5 years) undergoing surgery for benign thyroid pathology in a single institution were studied. The mean time between first diagnosis of thyroid disease and operation was 9.0 years (range, 0–50 years). All patients underwent at least one ultrasonography before surgery, and 678 patients underwent fine‐needle aspiration cytology. Patients with undetermined cytology or follicular nodules were excluded from the study.

Results:  Histology revealed an ITC in 104 patients (10.4%): 99 had a papillary carcinoma. Mean and median diameters of ITC were 1.4 and 0.7 cm, respectively (range, 0.1–7.5 cm). In 43 patients, the tumour size was greater than 1 cm, whereas it exceeded 2 cm in 25 patients. Tumours were multicentric in 19.8% of the patients and occurred in 8.2% of patients with nodular toxic goiter, 8.7% of patients with toxic diffuse goiter and 13.8% of patients with multinodular goiter.

Discussion:  The results confirm the high frequency of ITC. ITC was more frequent in euthyroid patients than in thyrotoxic patients (P < 0.03). Sex, age, thyroid volume and interval between diagnosis and surgery did not significantly influence its incidence. The majority of ITC was represented by microcarcinomas, but in approximately 25% of patients, the tumour size was greater than 2 cm. The role played by FNAC in excluding malignancies proved to be fairly inconclusive.
PRIMARY PERITONITIS IN ADULTS: IS IT TIME TO LOOK FOR A BETTER DIAGNOSTIC CLASSIFICATION?
Authors: Jarvis John , Trivedi Sid , Sheda Susan , Frizelle Frank A.
Published: March 2006

Background:  The occurrence of primary peritonitis is rare. The experience of a single institution and the definition of this disease are reviewed.

Methods:  A retrospective audit of primary peritonitis at a single institution was undertaken. Age, sex, clinical presentation, initial diagnosis, imaging and blood tests, comorbidities, recent medical intervention, surgical treatment and operative findings, antibiosis, bacterial isolates, the course of hospital treatment and follow up, including later diagnoses, were reviewed.

Results:  The audit was carried out at Christchurch Hospital between January 1998 and March 2005. A total of 115 patients were identified with a diagnosis of non‐specific peritonitis, of which five patients were identified with a diagnosis of primary peritonitis. All were women aged 22–38 years. Three had undergone a caesarean section in the last 3 months. The details of these cases are presented in detail.

Conclusion:  Five cases of primary peritonitis are reported, and from a review of published work, a classification of primary peritonitis is suggested, which more clearly identifies the cause of the disease.
PREDICTING IATROGENIC GALL BLADDER PERFORATION DURING LAPAROSCOPIC CHOLECYSTECTOMY: A MULTIVARIATE LOGISTIC REGRESSION ANALYSIS OF RISK FACTORS
Authors: Mohiuddin Kamran , Nizami Saira , Fitzgibbons Robert J. , Watson Patricia , Memon Breda , Memon Muhammed A.
Published: March 2006

Background:  Seventeen independent risk factors were examined using multivariate logistic regression analysis to develop a profile of patients most likely at risk from iatrogenic gall bladder perforation (IGBP) during laparoscopic cholecystectomy.

Methods:  Since 1989, a prospectively maintained database on 856 (women, 659; men, 197) consecutive laparoscopic cholecystectomies by a single surgeon (R. J. F.) was analysed. The mean age was 48 years (range, 17–94 years). The mean operating time was 88 min (range, 25–375 min) and the mean postoperative stay was 1 day (range, 1–24 days). There were 311 (women, 214; men, 97) IGBP. Seventeen independent variables, which included sex, race, history of biliary colic, dyspepsia, history of acute cholecystitis, acute pancreatitis and jaundice, previous abdominal surgery, previous upper abdominal surgery, medical illness, use of intraoperative laser or electrodiathermy, performance of intraoperative cholangiogram, positive intraoperative cholangiogram, intraoperative common bile duct exploration, presence of a grossly inflamed gall bladder as seen by the surgeon intraoperatively and success of the operation, were analysed using multivariate logistic regression for predicting IGBP.

Results:  Multivariate logistic regression analysis against all 17 predictors was significant (χ2 = 94.5, d.f. = 17, P = 0.0001), and the variables male sex, history of acute cholecystitis, use of laser and presence of a grossly inflamed gall bladder as seen by the surgeon intraoperatively were individually significant (P < 0.05) by the Wald χ2‐test.

Conclusion:  Laparoscopic cholecystectomy, using laser, in a male patient with a history of acute cholecystitis or during an acute attack of cholecystitis is associated with a significantly higher incidence of IGBP.
MUCH ADO ABOUT FUNCTIONAL ENDOSCOPIC SINUS SURGERY
Authors: Fernandes Sylvester Valentine
Published: March 2006

Background:  Reported success rates in endoscopic sinus surgery vary from 74 to 97%. However, the methods of evaluation and the functional endoscopic sinus surgery (FESS) techniques are not standard in these series. In our practice, some patients failed to attend the 3‐monthly follow up claiming all was well. With this experience, the aim of this study is to document a standard minimal technique with minimal follow up, which may be applicable to selected patients.

Methods:  An open prospective clinical trial was conducted. A total of 102 selected patients were subjected to minimal FESS surgery and discharged after a 3‐month follow up with instructions to return if problems re‐ensued.

Results:  In a telephone follow up ranging from 28 to 40 months postoperatively, 12 patients could not be traced. All of the other patients expressed satisfaction with the results. There were no patients who were dissatisfied with the outcome. However, two patients have persisted with postoperative check‐up visits on their own accord.

Conclusion:  It is possible in selected patients to resort to minimal FESS surgery with expectation of a good clinical outcome. It is stressed that, ‘rigid selection criteria’ apply.
PROSPECTIVE RANDOMISED CONTROLLED TRIAL ON THE ROLE OF PATIENT INFORMATION LEAFLETS IN OBTAINING INFORMED CONSENT
Authors: Ashraff Seemab , Malawa Gideon , Dolan Trevor , Khanduja Vikas
Published: March 2006

Background:  The aim of this study was to determine whether patient information leaflets help to improve patient recall during the process of informed consent.

Methods:  A prospective randomized controlled trial that compared a group of patients who were posted a patient information leaflet with those given verbal consent only was carried out. The study was conducted at the orthopaedic unit of a district general hospital. A total of 110 patients were selected, of whom 57 were randomly allocated to receive patient information leaflets by post and 53 were given verbal consent only. The outcome measure was the recall of information given to the patient. This was tested on admission by using a questionnaire. Each patient was allocated a score out of 10.

Results:  There was a significant difference between the patients in the group that received patient information leaflets and those in the group that did not (P < 0.0001; confidence interval, 2.0–3.1).

Conclusion:  Patient information leaflets are a useful tool for the surgeon to improve the recall of the information given to the patient, in order to facilitate informed consent.
RELAXATION OF THE CRITERIA FOR DAY SURGERY LAPAROSCOPIC CHOLECYSTECTOMY
Authors: Metcalfe Matthew S. , Mullin Emma J. , Maddern Guy J.
Published: March 2006

Background:  For day case laparoscopic cholecystectomy programmes, studies suggest that overnight admission may be predicted by the following factors: gall bladder wall thickness, patient age over 55 years and previous sphincterotomy. This study investigated the effect of relaxing selection for a day surgery laparoscopic cholecystectomy programme, by removing these factors from the exclusion criteria.

Methods:  Between September 2002 and April 2003, patients for elective laparoscopic cholecystectomy were considered for day surgery subject to standard criteria. For the initial part of the programme, patients were additionally excluded according to the risk factors mentioned above.

Results:  Thirty‐three patients underwent intended day case procedures. The first 16 were selected according to the more rigorous criteria. The latter 17 were significantly older, with a significantly higher incidence of gall bladder wall thickening. There were seven admissions, three in the former part of the study and four in the latter.

Conclusion:  The exclusion criteria described are not necessary for a good same‐day discharge rate.
DELAY TO APPENDICECTOMY AND ASSOCIATED MORBIDITY: A RETROSPECTIVE REVIEW
Authors: Omundsen Mark , Dennett Elisabeth
Published: March 2006

Background:  This retrospective review was undertaken to determine if time between presentation and appendicectomy is a factor affecting morbidity and length of hospital stay for patients with proven appendicitis.

Methods:  The notes of patients who underwent an appendicectomy at Wellington Public Hospital, New Zealand between June 2002 and February 2004 were retrospectively reviewed. Delay from admission until surgery was noted. Other variables recorded were age, sex, operation type (laparoscopic or open), white cell count, pulse rate and temperature at admission, antibiotic usage, ancillary investigations (e.g. ultrasound), operative findings, length of admission and in‐hospital complications.

Results:  A total of 480 appendicectomies were carried out. Four hundred and fifty‐seven (95%) records were retrieved, and 436 (91%) included the required information and were analysed. Ninety‐one (21%) resected appendices were pathologically normal, 275 (63%) were nonperforated, 61 (14%) were perforated and 9 (2%) had appendicular abscesses. The mean waiting time from admission to operation was 14.5 h (range, 1.6–99 h). There were 36 complications in 31 (7%) patients. The mean hospital stay was 74.4 h (range, 9.2–372 h). Three hundred and forty‐five admitted patients had histologically proven appendicitis. Patients who waited 12–24 h for their surgery, when compared with those that waited less than 12 h, did not have a statistically significant difference in either perforation rates (P = 0.66) or abscess formation (P = 0.14). There was also no statistically significant difference in the postoperative length of hospital stay (P = 0.6) or complication rate (P = 0.92) in patients who waited >24 h for their surgery. Patients with appendicitis who waited for >24 h (n = 44) had more abscesses (P = 0.0001). There was also a statistically significant difference in the perforation rate (P = 0.0001), postoperative length of stay (P = 0.04) and overall complication rate (P = 0.01).

Conclusion:  Time to surgery of up to 24 h does not lead to an increase in complicated appendicitis or morbidity. When the time exceeds 24 h, there is an increased rate of complicated appendicitis and morbidity, including complications that are not directly related to the appendicitis.
CURRENT CONTROVERSIES IN THE MANAGEMENT OF PATIENTS WITH SEVERE TRAUMATIC BRAIN INJURY
Authors: Adamides Alexios A. , Winter Craig D. , Lewis Philip M. , Cooper D. James , Kossmann Thomas , Rosenfeld Jeffrey V.
Published: March 2006

Background:  Traumatic brain injury is a major cause of mortality and morbidity, particularly among young men. The efficacy and safety of most of the interventions used in the management of patients with traumatic brain injury remain unproven. Examples include the ‘cerebral perfusion pressure‐targeted’ and ‘volume‐targeted’ management strategies for optimizing cerebrovascular haemodynamics and specific interventions, such as hyperventilation, osmotherapy, cerebrospinal fluid drainage, barbiturates, decompressive craniectomy, therapeutic hypothermia, normobaric hyperoxia and hyperbaric oxygen therapy.

Methods:  A review of the literature was performed to examine the evidence base behind each intervention.

Results:  There is no class I evidence to support the routine use of any of the therapies examined.

Conclusion:  Well‐designed, large, randomized controlled trials are needed to determine therapies that are safe and effective from those that are ineffective or harmful.
PALLIATIVE AND SHARED CARE CONCEPTS IN PATIENTS WITH ADVANCED COLORECTAL CANCER
Authors: Aggarwal Ghauri , Glare Paul , Clarke Stephen , Chapuis Pierre H.
Published: March 2006

Approximately 50% of patients with colorectal cancer (CRC) will eventually die of metastatic disease. Effective palliative management can be used within a shared care model in CRC to provide optimum symptom control, psychological well‐being and maintenance of quality of life for patients, their families and carers, including bereavement support. Maintenance of realistic hope and early goal setting are equally important in end‐of‐life discussions with patients and families. Palliative care should be incorporated early in the course of the illness, concurrent with disease‐modifying therapies. Within shared care, the palliative medicine specialist, surgeon and other members of the multidisciplinary team can each bring their own expertise to provide a patient‐centred approach. A case is presented that incorporates some of these principles and exemplifies the benefits of contemporary palliative care for patients with advanced CRC.
UNUSUAL MASS IN THE PARAPHARYNGEAL SPACE: A WARTHIN's TUMOUR
Authors: Shaw C.‐K. Leslie , Sood Sanjai , Bradley Patrick J. , Krishnan Suren
Published: March 2006

Parapharyngeal space (PPS) tumours are uncommon and can be a diagnostic challenge as the presenting symptoms are often vague and non‐specific. Most of the PPS tumours are salivary tumours (pleomorphic adenoma being the most frequent diagnosis), and are thought to originate from minor salivary glands or the deep lobe of the parotid gland. Warthin's tumour, another benign salivary tumour involving the PPS has been rarely reported. A case of bilateral, metachronous Warthin's tumour involving the PPS is reported here. PPS Warthin's tumour is a very rare condition that if undiagnosed may result in considerable morbidity.
Accuracy of information on medicines in hospital discharge summaries
Authors: McMillan T. E. , Allan W. , Black P. N.
Published: March 2006

Background: At Auckland Hospital, patients have been given handwritten summaries on discharge from hospital with a copy posted to the general practitioner. A typed summary is often not completed so the list of medicines on the handwritten summary needs to be accurate and complete.

Methods: We selected 100 patient charts from the general medical service and 100 charts from the general surgical service and recorded the medicines on admission, on the inpatient medication chart and on the discharge summary. We noted errors in the recording of medicines on the discharge summary and rated the severity of errors.

Results: Surgical patients were discharged on 7.88 (95% confidence interval (CI) 7.40–8.64) medicines and medical patients on 8.58 (95% CI 7.87–9.29) medicines. During the admission there were 0.59 (95% CI 0.38–0.80) changes to the medicines for the surgical patients and 1.70 (95% CI 1.39–2.01) for the medical patients (P < 0.0001). There were 0.81 (95% CI 0.65–1.02) errors per surgical discharge summary and 1.42 (95% CI 1.20–1.67) errors per medical summary (P = 0.006). Four errors were graded as having the potential to cause readmission to hospital, 24 as potentially serious, 83 as potentially troublesome and 111 as minor.

Discussion: Error rates were high and although the majority were minor, a number of them had the potential to cause serious consequences. There were more medication changes in the medical patients and this may contribute to higher error rates in this group. There is a need to improve the accuracy of recording medicines on discharge summaries. Strategies to improve this problem are discussed.
‘Free’ surfactant in gastric aspirates and bronchoalveolar lavage in children with and without reflux oesophagitis
Authors: Chang A. B. , Hills Y. C. , Cox N. C. , Cleghorn G. J. , Valery P. C. , Lewindon P. J. , Ee L. C. , Withers G. D. , Beem C. , Hills B. A.
Published: March 2006

Aim: Dipalmitoylphosphatidycholine (DPPC) is the characteristic and main constituent of surfactant. Adsorption of surfactant to epithelial surfaces may be important in the masking of receptors. The aims of the study were to (i) compare the quantity of free DPPC in the airways and gastric aspirates of children with gastroesophageal reflux disease (GORD) to those without and (ii) describe the association between free DPPC levels with airway cellular profile and capsaicin cough sensitivity.

Methods: Children aged <14 years were defined as ‘coughers’ if a history of cough in association with their GORD symptoms was elicited before gastric aspirates and nonbronchoscopic bronchoalveolar lavage (BAL) were obtained during elective flexible upper gastrointestinal endoscopy. GORD was defined as histological presence of reflux oesophagitis. Spirometry and capsaicin cough‐sensitivity test was carried out in children aged >6 years before the endoscopy.

Results: Median age of the 68 children was 9 years (interquartile range (IQR) 7.2). Median DPPC level in BAL of children with cough (72.7 μg/mL) was similar to noncoughers (88.5). There was also no significant difference in DPPC levels in both BAL and gastric aspirates of children classified according to presence of GORD. There was no correlation between DPPC levels and cellular counts or capsaicin cough‐sensitivity outcome measures.

Conclusion: We conclude that free DPPC levels in the airways and gastric aspirate is not influenced by presence of cough or GORD defined by histological presence of reflux oesophagitis. Whether quantification of adsorbed surfactant differs in these groups remain unknown. Free DPPC is unlikely to have a role in masking of airway receptors.