bluuebunny/crossref_metadata_2025 huggingface dataset:
Habitat evaluation for crested ibis: A GIS‐based approach
Authors: Li Xinhai , Li Dianmo , Li Yiming , Ma Zhijun , Zhai Tianqing
Published: March 2003

We evaluated habitat quality for crested ibis (Nipponia nippon) using a geographic information system (GIS). First, we digitized the topography map, vegetation map, river map, road map and villages/towns map by ArcInfo, and gave each map layer a suitability index based on our perceptions of the needs of crested ibis. Second, we overlayed these maps to obtain an integrated map of habitat quality. Finally, we compared the calculated habitat quality with the actual distribution of crested ibis. We found that the birds were almost always located at the site of high quality (habitat suitability index [HSI] > 0.6), which indicated that the factors we selected were important for crested ibis. We also found that crested ibis were never located at some sites of high quality, thus, we assume that other factors not considered in this study limit the distribution of crested ibis. Regression analysis indicated that crested ibis preferred lower elevation habitats and tolerated higher levels of human disturbance in recent years than previously reported. These results reflected a 20‐year protection program for this species.
Spatiotemporal patterns of shoots within an isolated Miscanthus sinensis patch in the warm‐temperate region of Japan
Authors: KOBAYASHI KATSUMI , YOKOI YOTA
Published: March 2003

The shoot configuration of each monoclonal patch of phalanx‐forming tallgrass, Miscanthus sinensis, is characterized by the formation of a ‘fairy ring’, which forms as the result of developing vacant inner areas. One large‐sized M. sinensis patch (patch L), observed over a 9‐year survey period, underwent lateral expansion in almost all directions as a result of peripheral shoot births. In the year after the shoots in each part of patch L reached a maximum density (Dmax), the number of shoots decreased by approximately 20% per year. However, the overall number of within‐patch shoots was stable during the survey because the patch area increased at the periphery. Twelve patches (>900 cm2 in area) with orthotropic shoots were selected to observe the distribution pattern of within‐patch shoots, and the patch areas were divided into three parts: the exterior, intermediate and interior areas. In 10 of these 12 patches, shoot densities were lowest in the interior areas and highest in the exterior areas, which led to ring formation. The shoot density of each subarea was inversely related to the age of the subarea. This raises the possibility that in any part of these patches, shoot densities decrease annually from Dmax in a similar way.
Role of self‐efficacy and behaviour change
Authors: RGN Aisha Holloway , RGN Hazel E Watson
Published: March 2003

Behaviour change is an important concept in relation to health promotion and disease prevention. Self‐efficacy has been identified as an important determinant of health behaviour, future health behaviour and health behaviour change. In order to effectively facilitate behaviour change, it is essential that interventions are research based, and emphasize the utility of theory in practice. The effective practice of health promotion and disease prevention requires a full understanding of the processes of patient behaviour. This article presents the role of the nurse in influencing health‐related behaviour change. Self‐efficacy and related but distinct theories that underpin behaviour change are discussed. The empirical evidence that supports the link between self‐efficacy and predictions of health behaviours is also examined.
The role of prophylactic anti‐emetic therapy in emergency department patients receiving intravenous morphine for musculoskeletal trauma
Authors: Lambie Bruce , Chambers John , Herbison Peter
Published: March 2003

Objective: To determine if there is benefit in routine administration of the anti‐emetic metoclopramide to patients receiving intravenous morphine for musculoskeletal trauma.

Method: A randomized double‐blind placebo controlled trial using 214 patients who presented to Dunedin Hospital Emergency Department with musculoskeletal trauma, requiring intravenous morphine for analgesia. Those recruited were randomized to two groups. Group one received placebo prior to morphine while those in group two received metoclopramide 10 mg intravenously, prior to morphine. Any vomiting or severe nausea within 2 h of receiving intravenous morphine was recorded.

Results: The two groups were evenly matched for age, sex and morphine dose. Overall, 3.7% of patients in the study vomited (1.9% in the group receiving placebo and 5.4% in the group receiving metoclopramide). This difference was not significant (P = 0.17). The mean age was 78.5 years in the group that did vomit compared with a mean age of 46.0 years in those not vomiting. This difference was highly significant (P = 0.0009).

Conclusion: The incidence of vomiting in patients receiving intravenous morphine for musculoskeletal trauma is low and the routine use of an anti‐emetic in these patients is not justified. Intravenous metoclopramide in these patients does not reduce the incidence of vomiting.
Emergency treatment of hypothermia
Authors: Giesbrecht Gordon G
Published: March 2003

This review considers several recent concepts regarding aetiology and treatment of accid‐ental hypothermia. The importance and effectiveness of shivering heat production in the attenuation and reversal of hypothermia is described. Immediately following removal from cold stress, the patient is in danger of a deteriorating condition that may be due to collapse of arterial pressure and/or continued decrease of core temperature. Several controversies are discussed. It is advised that, when possible, patients should be actively but gently warmed as soon as possible (especially if arrival at the emergency department will take greater than 45 min). Extra time should be taken to check for life signs before cardiopulmonary resus‐citation is initiated. Chest compressions should proceed at regular normothermic rates and care should be taken to not overventilate the patient. In the emergency department, several factors should be considered before deciding on a treatment regimen. These factors include level of consciousness, cardiovascular stability, core temperature and the direction of change of core temperature. It may be advantageous to transport the more severely hypothermic patient to a more advanced care facility even though transport time may be greater. See Commentary, page 5.
Knowledge of heart attack symptoms in a community survey of Victoria
Authors: Smith Karen L , Cameron Peter A , Meyer Alastair , McNeil John J
Published: March 2003

Objective: To ascertain the level of knowledge of heart attack symptoms in the Victorian public.

Methods: This was a cross sectional telephone survey conducted during 2000–01. The questionnaire contained sections regarding participant demographics and knowledge of heart attack symptoms.

Results: A total of 1489 people completed the questionnaire (79% of eligible participants). The mean number of correct heart attack symptoms was 2.5 (95% CI 2.45, 2.60) (median three out of 10). Only 4.2% of participants reported at least five correct symptoms and 4.1% could not report any symptoms. A total of 84.6% of respondents reported chest pain as a symptom of heart attack.

Conclusions: The Victorian public appears to lack the knowledge of the varied range of heart attack symptoms. Methods of disseminating information regarding symptoms and ways to reduce prehospital delay need to be devised, particularly methods which target the older ‘at risk’ population.
Failure of intramuscular antivenom in Red‐back spider envenoming
Authors: Isbister Geoffrey K
Published: March 2003

Four cases of Red‐back spider envenoming are reported in which there was minimal response to intramuscular antivenom. Intravenous antivenom was then administered in each case with almost complete resolution of symptoms. All cases were followed up to confirm the effect of treatment. This failure of intramuscular Red‐back antivenom raises the question of its efficacy. There has been no controlled trial to prove that intramuscular Red‐back antivenom is effective and animal work with other antivenoms has demonstrated the intramuscular formulation to have delayed and incomplete effects. Controlled studies should be undertaken to establish the effectiveness of intravenous and intramuscular Red‐back antivenom.
Amiodarone: An emergency medicine perspective
Authors: Taylor Simone E
Published: March 2003

Amiodarone is a highly efficacious antiarrhythmic agent for many cardiac arrhythmias, ranging from atrial fibrillation to malignant ventricular rhythm disturbances. Significant interest has developed in recent years with the publication of randomized controlled trials supporting the efficacy of amiodarone over placebo and lignocaine for improving survival to hospital in patients with shock‐resistant ventricular fibrillation. Amiodarone has complex pharmacological and pharmacokinetic properties. It has significant long‐term adverse effects, but short‐term administration of intravenous amiodarone is generally well tolerated. This article will explore issues related to the clinical use of amiodarone from an emergency medicine perspective.
Audit of paediatric day‐case surgery in a district general hospital
Authors: Chiu Yw , Au Yk
Published: March 2003

Day‐case surgery is a major component of the workload in our hospital (Our Lady of Maryknoll Hospital, Kowloon, Hong Kong). We choose to audit paediatric day‐case surgery because the patients’ parents are anxious and therefore likely to reflect the finest details of care. The study was prospective. In a one‐year period (1997), the 235 paediatric day‐case surgery cases scheduled in our hospital accounted for 90% of all paediatric operations. The patients’ attendance rate was 98.8%. Five patients (2.2%) were kept overnight for observation. Six patients (2.6%) were re‐admitted after operation. There were 50 (22%) telephone hotline enquiries. The overall minor complication rate, as defined, was 4.8% and there was no major morbidity. A multidisciplinary approach including anaesthetists and nurses was the key to sucess. Easy access to medical advice was also important in order to avoid unnecessary re‐admission and parental anxiety. The well‐organized day‐surgery service was safe, well‐accepted and cost effective.
Multimodality treatment strategy for squamous cell oesophageal cancer
Authors: Chan Angus Cw , Griffith James F , Leung Sing F , Chung Sydney
Published: March 2003

Cancer of the oesophagus is notorious for its grave prognosis of an overall 5‐year survival rate of 10–20%. Surgical resection with curative intent remains the most effective treatment for this disease. To improve survival, a multimodality treatment strategy was adopted for managing patients with oesophageal cancer. The use of pre‐operative adjuvant chemotherapy did not confer any survival benefit to patients with localized oesophageal cancer, as is proven by most randomized studies; however, the preliminary results of pre‐ operative chemotherapy with radiotherapy is encouraging but needs to be verified in a randomized trial. For patients with incurable diseases, endoscopic stenting offers effective palliation of dysphagia with minimal morbidity and mortality.
A PROSPECTIVE RANDOMIZED TRIAL TO COMPARE ONE DOSE PREOPERATIVE, THREE‐DOSE PERIOPERATIVE AND 5‐DAY FULL COURSE ANTIBIOTICS FOR NON‐PERFORATED ACUTE APPENDICITIS
Authors: Mui L.M. , Ng E.K.W. , Lee D.W.H. , Lam Y.H. , Fung T.M.K. , Wong S.K.H. , Law K.B. , Chung S.C.S.
Published: March 2003

Background: Although prophylatic antibiotics has been proven to be effective in reducing wound complications after appendectomy, the most efficacous dosage remains uncertain.

Aim:

To determine the optimal duration of antibiotics after appendectomy for non‐perforated acute appendicitis.

Methods: From July 1995 to December 2000, all patients aged between 15 and 70 years with appendectomy performed via a right lower abdominal incision were considered for the study. Exclusion criteria included pre‐admission antibiotics, diabetes mellitus, known drug allergy and ruptured appendicitis. Intravenous Cefuroxime, 1.5g, and Metronidazole, 500 mg were given at induction of anaesthesia. After appendectomy, patients were randomized to one of the three treatment protocols: (A) no further antibiotics, (B) 2 more doses of antibiotics, or (C) a 5‐day course of antibiotics. Outcomes of surgery were compared using 1‐way ANOVA or Chi‐square where appropriate.

Results: Of 275 patients recruited, 6 had normal appendix revealed by histology and were excluded. Treatment A, B and C were assigned to 92, 94 and 83 patients, respectively. The 3 groups were comparable in demographics and pre‐operative characteristics. The outcomes were as follows:

Conclusions: A single dose of preoperative antibiotics is adequate for prevention of wound infection in non‐perforated appendicitis. Prolonged use of antibiotics is cost‐ineffective and may lead to unnecessary complications.
Laparoscopic exploration of common bile duct: A solution to difficult choledocholithiasis
Authors: Tang Chung‐Ngai , Siu Wing‐Tai , Chau Chun‐Han , Li Michael Ka‐Wah
Published: March 2003

Objective: To evaluate the role of laparoscopic exploration of common bile duct (LECBD) in the management of common bile duct stone, particularly for patients with failed endoscopic extraction and patients younger than 60 years old.

Method: Prospective data of laparoscopic exploration of common bile duct during 1995–1999 were analysed.

Results: During 1995–1999, 27 laparoscopic exploration of common bile duct (LECBD) were performed in patients with concomitant gallstone and common bile duct stone, in which half of these LECBD were performed after unsuccessful endoscopic retrieval (13 patients). LECBD was also indicated in patients younger than 60 years old (14 patients) because there was a concern about the potential long‐term complications of papillotomy‐like papillary stenosis and ascending cholangitis. One transcystic duct exploration and 26 choledochotomies were performed. Mean operating time was 138.7 min (70–300 min) and additional procedures included 19 laparoscopic ultrasounds (LUS), three laparoscopic intraoperative cholangiograms (LIOC) and two laparoscopic choledochoduodenostomies. Stone clearance rate was 96% with only one exception. Complications were encountered in nine patients (33%) and one patient died of sepsis subsequent to major bile leak (3.7%). Complications included bile leak/stent migration/collection (4), wound infection (3), minor wound bleeding (1) and self‐limiting postoperative intestinal obstruction (1).

Conclusion: LECBD has a high success rate of ductal clearance in patients with ‘difficult common bile duct stones’ despite unsuccessful attempts at endoscopic extraction.
Photodynamic therapy in malignant brain tumour: Is intratumoral injection of photosensitizer superior to conventional intravenous administration?
Authors: Chan Yung , Ip Sin‐Ming , Poon Wai‐Sang , Wickham Nicholas
Published: March 2003

Objective: Selective uptake and retention of haematoporphyrin derivative (HpD) in tumour tissue, especially at brain adjacent to the tumour (BAT) region, is an important factor in determining the efficacy of photodynamic therapy (PDT). The uptake and distribution of HpD was studied in 10 patients with malignant glioma.

Method: Five cases were injected with HpD intravenously at a dose of 5 mg/kg bodyweight. Another five cases were injected with 10 mg (2 mL) HpD by ultrasound guidance into the tumour centre. After 24 h, the patients underwent craniotomy for tumour debulking. Biopsies of the tumour tissue and BAT region were sent for analysis.

Results: In the intravenous administration group, the mean HpD level in the tumour centre was 2.0 ± 0.7 μg/g, which was lower than the level of HpD in the BAT region (3.6 ± 2.3 μg/g; P > 0.05). However, in the intratumoral injection group, the level of HpD was much higher in the tumour centre than in the BAT (4.7 ± 3.2 μg/g vs 1.4 ± 0.4 μg/g; P < 0.05). Fluorescence microscopy observations showed that HpD was distributed unevenly at the periphery of the blood vessels and stroma in the intravenous group. Bright and patchy distribution of HpD was also seen in the tumour centre after direct intratumoral injection. Intracellular uptake of HpD could be observed in the BAT region of both groups. Further study with a confocal laser scanning microscope (CLSM) provided evidence that HpD was localized intracellularly.

Conclusion: The study showed that conventional intravenous administration of HpD can achieve a higher level in the BAT region, but the distribution of HpD varied and was unpredictable. Intratumoral injection can achieve a much higher HpD in the tumour centre; however, the distribution in the BAT region is unsatisfactory because of the irregular shape of the tumour mass. Taking into account this variable result, the HpD level may need to be tailored to meet each individual patient's requirement.

Chinese Abstract

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Per‐anal stapled resection of a stapled anastomotic stricture
Authors: Langenberg Arthur van
Published: March 2003

Anastomotic stricture in colorectal surgery is an established problem. The incidence and aetiology of these strictures are discussed as well as the treatment options. A simple method of resecting those strictures of the rectum that are not amenable to repeated dilatation is described.

Chinese Abstract

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Indocyanine green angiography in the presence of subretinal or intraretinal haemorrhages: clinical and experimental investigations
Authors: Schütt Florian , Fischer Jörg , Kopitz Jürgen , Holz Frank G
Published: March 2003

Purpose: The absorption and emission characteristics of indocyanine green are associated with better penetration through ocular pigments, including melanin and blood, in comparison with fluorescein. Therefore, it has been assumed that indocyanine green angiography (ICG‐A) allows better delineation of fluorescent structures including choroidal neovascularization in the presence of haemorrhages. The degree and frequency of blockage by haemorrhages during ICG‐A and fluorescein angiography (Fl‐A) were compared and absorption characteristics by blood were experimentally determined.

Methods: Simultaneous confocal scanning laser ophthalmo­scopy was performed in patients with intraretinal or sub­retinal haemorrhages associated with various retinal diseases including neovascular age‐related macular degeneration. Areas of blocked choroidal fluorescence were compared in Fl‐A and ICG‐A using a standardized classification system by two independent readers. Experimental absorption measurements were performed using blood‐filled quartz cuvettes and laser light with 488 and 790 nm, respectively.

Results: Sixty eyes of 59 patients were analysed. Twelve eyes
(20%) showed blockage in Fl‐A only corresponding with funduscopically
visible blood. In 35 eyes (58%) the extent of absorption
was greater in Fl‐A compared with ICG‐A. An identical area of blockage
in both Fl‐A and ICG‐A was noted in 13 eyes (22%). The
coefficient of absorption was 18.4 mm‐1 for
Fl‐A (488 nm) and 5.4 mm‐1 for ICG‐A (790 nm).

Conclusions: In contrast to previous assumptions, the findings indicate that clinically intraretinal or subretinal haemorrhages are frequently associated with blockage not only in Fl‐A but also in ICG‐A. This is in accordance with the experimentally determined coefficient of absorption. Apparently, haemorrhages occurring in association with retinal and choroidal diseases commonly have a thickness sufficient enough to induce relevant absorption during ICG‐A, and thus impair delineation of fluorescent structures in planes posterior to the haemorrhage. Therefore, the diagnostic value of ICG‐A in presence of subretinal or intra­retinal bleedings is limited.
Use of mitomycin C in the treatment of corneal conjunctival intraepithelial neoplasia
Authors: Daniell Mark , Maini Raj , Tole Derek
Published: March 2003

Abstract

Purpose: To evaluate the efficacy of topical mitomycin C as a treatment of corneal conjunctival intraepithelial neoplasia.

Methods: An open prospective analysis of 20 cases of corneal conjunctival intraepithelial neoplasia with recurrent disease (17 patients) or refusing surgery (three patients) were treated with topical mitomycin C. Treatment was with mitomycin C eye drops, either 0.02% or 0.04%, four times daily for 1 week followed by a week off the cycle then repeated for a second week. Patients were examined weekly until the lesions were eradicated.

Results: Clinical resolution of disease occurred in 18/20 cases. The mean time to resolution was 4.5 weeks, the mean number of cycles of treatment was two. Average follow up was 13 months with four cases of recurrent disease. These four cases were retreated with complete resolution in two cases. Epithelial toxicity occurred in 10/20 eyes and lid toxicity in two cases. There were no long‐term complications on discontinuing mitomycin C.

Conclusions: Mitomycin C is effective in inducing regression of corneal conjunctival intraepithelial neoplasia. Complications are common but self‐limiting. An optimal regimen is still to be established.
Horse riding in urban conservation areas: Reviewing scientific evidence to guide management
Authors: Landsberg Jill , Logan Bill , Shorthouse David
Published: March 2003

Summary We undertook a literature review of the impacts of horse riding in conservation areas, and used it to guide management of horse riding in Canberra Nature Park (CNP), a large, fragmented semi‐natural park in and around the city of Canberra in the Australian Capital Territory. The literature review established that, because of their relatively large weight and small area in contact with the ground, horses have a relatively high potential for doing environmental damage. Impacts tend to be generally lowest for hikers, followed by motorcycles, horses and four‐wheeled vehicles. One study showed horse traffic caused more damage on established trails than motorcycles, off‐road bicycles or hikers. Most published studies of horse‐riding impacts in Australia have been conducted in alpine and subalpine environments, and in temperate woodlands and forests on sandstone near Sydney. They have shown that impacts are generally highest in previously untracked areas. Impacts on established trails are generally most marked on sections of trail that are wet, boggy or steep, and on unplanned and unmaintained trails. Impacts are lowest on constructed and maintained trails. Trail proliferation, associated with avoidance of untrafficable sections and short‐cutting, can be a major problem. Horses also have potential to spread weeds, because pastures and dried stock feeds contain large numbers of weed seeds that retain high levels of viability in horse manure. The risk of weed establishment is highest when manure is deposited in disturbed, damp sites, particularly when riding off‐track. Much less weed establishment is apparent when horse riders remain on‐track. Horse riding is a popular activity, but one that is relatively expensive to provide for, and one that may reduce opportunities for lower‐impact recreational park users. For all these reasons it appears socially equitable that provision is made for lower numbers of horse riders compared to numbers of park users involved in lower impact, more passive, recreational activities. We conclude by describing how this information was used to develop principles to guide management of horse riding and assess risk at individual sites in Canberra Nature Park.
Relationships between seed germination requirements and ecophysiological characteristics aid the recovery of threatened native plant species in Western Australia
Authors: Cochrane Anne , Kelly Anne , Brown Kate , Cunneen Simone
Published: March 2003

Summary One of the foremost technical issues addressed in reintroduction and restoration projects is the feasibility of establishing living plants. To advance the recovery process, the germination requirements of 201 threatened Western Australian seed‐bearing taxa representing a range of life forms, families and ecophysiological characteristics were studied. Procedures used to stimulate germination in otherwise dormant seed involved pretreatment using thermal shock, scarification, seed coat removal, soaking in an aqueous smoke solution and/or additions of the growth hormone gibberellic acid (GA3). Sixty‐one taxa germinated under the basic trial conditions of light (12‐ h photoperiod), temperature (constant 15°C) and moisture, without additional pretreatments. These taxa were generally those with canopy‐stored seeds in the families Proteaceae and Casuarinaceae, and small‐seeded taxa in Myrtaceae. Taxa with soil‐stored seeds required single or multiple cues to stimulate germination. Seeds in the families Fabaceae and Mimosaceae were dependent on cracking of the seed coat, mechanically through nicking of the testa or through thermal shock, as were several non‐leguminous species of the Sterculiaceae and Liliaceae. Complete or partial removal of seed coats, in conjunction with GA3 enhanced germination percentage in some taxa of the Myoporaceae, Lamiaceae and Myrtaceae. Application of GA3 also enhanced germination percentage in members of the Epacridaceae. Several taxa previously stimulated by aqueous smoke solutions were equally responsive to additions of GA3 after complete seed coat removal. In general, species with seed weights greater than 10 mg germinated better under a range of conditions than those with lighter seeds. There was no difference in germinability between resprouter and seeder species, and no obvious relationship between seed weight and germination rate. In the light of previous studies these results indicate that the relationship between germination requirements and ecophysiological characteristics is similar for both threatened and common species. These data will enable better prediction of likely dormancy breaking cues for other related species and will greatly assist the process of recovery and restoration work for mining operations and community bushland regeneration as well as single species reintroductions.
Practical method of germination for a key jarrah forest species: Snottygobble (Persoonia longifolia)
Authors: Mullins R. Greg , Koch John M. , Ward Sam C.
Published: March 2003

Summary Snottygobble (Persoonia longifolia) is an ecologically and economically important species in the jarrah forest in Western Australia but is not well represented in jarrah forest restoration projects because it is difficult to germinate. In restored bauxite mines the establishment density of Snottygobble from the soil seed bank is variable and often inadequate. Alcoa considers it a priority to re‐establish such key species at adequate densities in its restored mine areas The aims of the present research were: (i) to determine if the species could be cued to germinate; and (ii) to develop a practical method to re‐establish the species in restored bauxite mines. We found that fresh Snottygobble seed has high viability (> 90%) but seed stored at 4°C rapidly loses viability over the first year after seed fall. We obtained up to 40% germination using fresh seed that had been treated with gibberellic acid (GA3) after having part of the endocarp chipped away, sown on the soil surface and watered twice daily in an ambient temperature glasshouse in winter/spring. We found that the key to successful germination was combining surface sowing, endocarp chipping and GA3 treatment. Germination involved the breakdown of mechanical and, probably, chemical dormancy. There also appears to be a cool temperature requirement for germination. Practical recommendations to germinate Snottygobble are made. This germination method will have application to land managers, restoration practitioners and the horticultural industry. Alcoa will continue work to translate this success into an adequate stocking of Snottygobble in restored bauxite mines.

Key words bauxite mine, dormancy, endocarp chipping, endogenous, germination, gibberellic acid, Persoonia longifolia, restoration, Snottygobble.
Non‐traumatic orbital haemorrhage
Authors: Sullivan Timothy J , Wright John E
Published: March 2003

Purpose: To establish the incidence of underlying orbital vascular anomalies, the presence of systemic associations and predisposing factors, the natural history and appropriate management of patients with non‐traumatic orbital haemorrhage presenting in an orbital clinic.

Methods: The records of 115 patients with a diagnosis of non‐traumatic orbital haemorrhage were reviewed with regard to clinical findings, investigations, management and outcome.

Results: Associated orbital vascular malformations were present in 104 patients (90%). Thirteen (11%) had additional or other predisposing factors (childbirth, prolonged headstands, hypertension or coagulopathies). Six patients (5%) had no predisposing factor. Acute onset painful proptosis, associated with lid swelling or a mass, was the most common presentation. Visual acuity was reduced in 37 patients (32%) at presentation. Excluding eight patients (7%) who underwent surgery for optic nerve compression, spontaneous resolution of the haemorrhage was complete in 62%, partial in 27%, while 4% had no resolution. Final visual acuity was reduced in 23 patients (20%).

Conclusion: The majority of bleeds are associated with some form of orbital vascular anomaly. Where no such anomaly can be demonstrated a search for an underlying systemic cause should be performed. Haemorrhages in the young were usually localized whereas those in older patients were diffuse. Orbital imaging, with a combination of computed tomography and magnetic resonance imaging, was helpful in the assessment of these lesions. Most bleeds are venous and self‐limiting. Surgical intervention was rarely necessary and should be confined to those with optic nerve compromise or a localized lesion which persists.
Superior limbic keratoconjunctivitis: multifactorial mechanical pathogenesis
Authors: Cher Ivan
Published: March 2003

Origins of superior limbic keratoconjunctivitis (SLK) are not well understood. Prompted by suggestions that pressure and friction may contribute to SLK, this paper, using evidence from the literature and from personal Kodachrome records, aims to assess, and if appropriate, enhance this understanding. The survey disclosed evidence confirming mechanical aetiology. Support is presented for the notion that SLK arises from soft tissue microtrauma: (i) between tarsal and bulbar surfaces; and (ii) between conjunctival stroma and sclera. In each pair the two apposed tissues are in repetitive motion relative to each other. It is concluded that SLK arises because non‐ standard combinations of multiple predisposing and/or trigger factors exceed the physiological tolerance of mechanical stresses upon the ocular surface and tissues. Through their effects on particular tissues, eight separate stressing forces were perceived. The many contributing factors in four categories are integrated into a new aetiologic concept.
Dissociable factors affect speed perception and discrimination
Authors: Clifford Cwg , Arnold Dh , Wenderoth P
Published: March 2003

Factors affecting our judgement of the speed of visual motion were investigated. Two types of judgement were made: perceived speed relative to a standard comparison stimulus, and discrimination between the speeds of similar stimuli. The factors affecting these two judgements were found to be doubly dissociable, suggesting that they may be constrained by processing at different levels of the visual hierarchy. The results are discussed in terms of the 3‐D interpretation of visual image motion, and related to possible neural substrates.
Effect of lens style on postoperative refractive astigmatism after small incision cataract surgery
Authors: Whitehouse Geoff
Published: March 2003

Purpose: To evaluate the astigmatic results of two popular foldable intraocular lenses when standard surgical approaches are used in rural private practice in Australia.

Methods: Four hundred consecutive cataract operations were followed in a prospective study. The refractive results of patients receiving the Alcon Acrysof MA30 lens were compared to those receiving the Allergan silicone SI40 lens. All patients were over 60 years of age and had no intercurrent ocular disease. Refractive and keratometric astigmatism was analysed both by vector analysis and as an absolute measure.

Results and conclusion: The Acrysof lens is associated with less postoperative astigmatism (P = 0.01), than the Silicone SI40 lenses.
Congenital porphyria with necrotizing scleritis in a 9‐year‐old child
Authors: Venkatesh Pradeep , Garg SP , Kumaran Elan , Tewari Hem K
Published: March 2003

Porphyria is a rare metabolic disorder that is characterized by the accumulation of photosensitive, toxic intermediates of the heme metabolic pathway in various organs of the body including the skin, eye and neural tissue. Porphyria as a potential cause for bilateral necrotizing scleritis in children is very infrequently emphasized in literature, probably due to the relatively rare occurrence and lack of well‐documented cases. A case of a 9‐year‐old child with congenital porphyria who had developed necrotizing scleral ulceration in both eyes in addition to severe cutaneous hypersensitivity and facial disfigurement is herein presented.
Royal Australian College of Ophthalmologists and Royal Australian College of General Practitioners National GP Eye Skills Workshops: Colleges and Divisions reskilling general practice
Authors: Jackson Claire , De Jong Inge , Glasson William
Published: March 2003

Purpose: Little formal eye skills training has historically been available to Australian general practitioners at undergraduate or postgraduate levels. The development of the National GP Eye Skills Workshop was a joint initiative of the Royal Australian Colleges of General Practice and Ophthalmology, to enhance the skills of Australian general practitioners in a range of important ocular examination and procedural areas.

Methods: Workshops were run in eight Queensland Divisions of General Practice in 1998. Between two and 10 local ophthalmologists in each divisional area were involved either in the workshop programme or in the recruitment of patients for the patient assessment module. Workshops were run on weekends and included modules on vision testing and disease screening in children and adults, ophthalmoscopy, assessment for glaucoma and diabetic retinopathy, incision of chalazions, removal of corneal foreign bodies, ocular first aid, implementing eye assessment in busy general practice, and a patient assessment clinic. A questionnaire was administered which was comprised of sections relating to the format of the workshop, new skills and concepts learnt, learning exceptions, and perception of future ability to treat/scan/assess for eye conditions in general practice. The questionnaire was completed by 91% of participants.

Results: Participants strongly supported the impact of the workshop on their ability to detect and treat eye problems in their practices, and refer where appropriate to an ophthalmologist. They also rated highly all individual aspects of the programme in terms of impact on their delivery of general practitioner eye care.

Conclusions: The results illustrate the comprehensive success of the workshop programme in format, content, relevance and delivery.
Indocyanine green anterior segment angiography for studying conjunctival vascular changes after trabeculectomy
Authors: Alsagoff Zainah , Chew Paul Tk , Chee Caroline Kl , Wong Jun‐Shyan , Aung Tin
Published: March 2003

Background: The aim of the study was to evaluate the use of indocyanine green (ICG) for angiography of the anterior segment to characterize conjunctival and episcleral vasculature changes after trabeculectomy.

Methods: This was a prospective evaluation of anterior segment ICG angiography in 10 eyes of 10 patients undergoing trabeculectomy for the first time. Trabeculectomy was performed with intraoperative sponge application of 5‐ fluorouracil (5 cases) or mitomycin C (5 cases). Anterior segment ICG angiography was performed prior to surgery, then at 2 weeks and 2 months after surgery.

Results: With ICG, the anterior segment vessels were well delineated, including deep episcleral veins, which have not been clearly shown in previous angiographic techniques. Late phases of the angiogram could also be studied. The vascular alterations after trabeculectomy noted included loss of vascularity over the bleb area and vascular anastomoses along the perimeter of the avascular bleb.

Conclusions: Angiography using ICG has potential as an investigative tool to study the conjunctival and episcleral vasculature changes after trabeculectomy.
Diplopia as a complication of laser in situ keratomileusis surgery
Authors: Yap Eng‐Yiat , Kowal Lionel
Published: March 2003

A case is presented of a patient with high myopia who developed vertical binocular diplopia after decentred laser in situ keratomileusis (LASIK) surgery with associated decompensation of pre‐existing exophoria into an exotropia. A 40‐year‐old man underwent LASIK surgery for high myopia in his right eye. Preoperatively, he was approximately –26.00/–2.00 × 35° with visual acuity of 6/12–2 in that eye. He also had an asymptomatic exophoria. After LASIK surgery, he achieved a refraction of –3.25/–0.50 × 80° with 6/21 best‐corrected visual acuity. He also developed binocular diplopia. The ablation zone had been decentred upwards and there was also an exo‐ and hypo‐deviation of his right eye. He was able to superimpose the two images in free space with vertical and horizontal prisms. A hard contact lens also resulted in superimposition of the two images. Vertical decentration of the ablation zone can induce a vertical prism effect after LASIK surgery and result in vertical diplopia. This together with abnormal optics also caused loss of best‐corrected vision and decompensation of his pre‐existing exophoria into an exotropia.
The presentation, aetiology, management and outcome of optic neuritis in an Asian population
Authors: Wang Jenn‐Chyuan , Tow Sharon , Aung Tin , Lim Su‐Ann , Cullen James F
Published: March 2003

Purpose: To analyse the presentation, aetiology, management and outcome of patients with optic neuritis (ON) in Singapore.

Methods: This was a retrospective study involving consecutive patients with ON presenting at the Singapore National Eye Centre between January 1997 and May 1999. The presenting features, investigations, treatment and visual outcome after 6 months were studied.

Results: A total of 31 patients (39 eyes) presented with ON during this period, 17 of whom had anterior ON. No aetiology was found in 26 patients (83.9%), two patients (6.5%) had multiple sclerosis, one had active syphilis, one had rheumatoid arthritis and another had pan‐sinusitis. Seventeen patients (54.8%) were treated with intravenous methyl‐prednisolone followed by oral prednisolone. Within the follow‐up period 26 of 31 eyes (83.9%) with idiopathic ON attained visual acuity of 6/12 or better, with 12 (38.7%) recovering to 6/6 or better and only one eye ending with less than 6/60 visual acuity. The one patient with syphilis recovered 6/6 visual acuity bilaterally. Both patients with multiple sclerosis also had good visual recovery at 6 months. The visual outcome in those cases of ON associated with rheumatoid arthritis and pan‐sinusitis was poor with visual acuity of less than 6/60 at 6 months follow up in each instance.

Conclusion: The majority of the cases of ON in this study were idiopathic. There was a low association with multiple sclerosis. Most patients had good visual recovery within 6 months.
Four‐year review of open eye injuries at the Royal Adelaide Hospital
Authors: Casson Robert J , Walker James C , Newland Henry S
Published: March 2003

Purpose: To review the epidemiology of penetrating eye injuries and ruptured globes presenting to the Royal Adelaide Hospital, South Australia.

Methods: A retrospective case review over a 4‐year period.

Results: There were 109 penetrated or ruptured globes in 105 patients. The average age was 41 years and 80.2% were men. Over half were from rural areas. The commonest cause of injury was hammering metal followed by motor vehicle accidents. Falls in the elderly were the commenest cause of globe ruptures. A final visual acuity of 6/12 or better was found in 40% of eyes and no perception of light in 27%.

Conclusions: At the Royal Adelaide Hospital, the predominant referral centre for serious ocular injury in South Australia, approximately 25 open globe injuries are encountered a year. Although the epidemiology of these injuries was found to be similar to those previously reported in Victoria and rural New South Wales, differences were thought to reflect to the ageing population of South Australia. Rupture of an old, healed large‐incision cataract extraction wound was the commonest cause of ruptured globe. An effective preventive strategy to reduce the incidence of severe ocular trauma has yet to be implemented. The concept of a national population‐based severe ocular trauma database is considered.
Intraepidermal carcinoma of the eyelid
Authors: Sullivan Timothy J , Boulton Jonathan E , Whitehead Kevin J
Published: March 2003

Purpose: To examine the clinical and pathological features and treatment outcomes of cutaneous squamous intra­epidermal carcinoma of the eyelid in order to determine its behaviour, its relationship to squamous cell carcinoma and appropriate management.

Methods: All patients from the practice of one of the authors with a histological diagnosis of squamous intra‐epidermal carcinoma were included. Retrospective chart review was performed, and pathology re‐examined. All patients were recalled for examination. Histological diagnosis of periocular intraepidermal carcinoma, lesion characteristics, outcome of surgical excision, local recurrence, and occurrence of metastasis were assessed as main outcome measures.

Results:  Thirty‐one white, usually fair‐haired patients had a total of 37 lesions. Most had a history of occupational or recreational sun exposure. Other predisposing factors included exposure to arsenic, petroleum by‐products and epidermodysplasia verruciformis. All except one had other solar keratoses and non‐melanoma skin cancers. All had surgical excision. Six cases (16%) had evidence of progression to squamous cell carcinoma. Seven cases (18%) had local recurrence successfully treated by further local excision. No patient had perineural spread or distant metastasis.

Conclusions:  This lesion, which serves as a marker for severe actinic damage, may masquerade as chronic blepharitis. Early diagnosis prior to dermal invasion is important. Complete excision is the recommended treatment. Adjunctive treatment with topical 5‐fluorouracil may be appropriate in some circumstances. Long‐term follow up is mandatory.
Central retinal vein occlusion in pseudoexfoliation of the lens capsule
Authors: Gillies William E , Brooks Anne MV
Published: March 2003

In surveying an extensive group of patients with unilateral pseudoexfoliation of the lens capsule certain interesting points emerged, particularly on the incidence of central retinal vein occlusion in this condition, and perhaps in glaucoma also. A total of 284 patients with unilateral pseudo­exfoliation of the lens capsule were examined clinically after an ophthalmic and general history were taken. Mean intraocular pressure (IOP) was 30.9 mmHg in the affected eye and 18.1 mmHg in the unaffected eye. Central retinal vein occlusion occurred in 10 affected eyes but no unaffected eyes and always in affected eyes with a rise in IOP. Average IOP in the affected eye with central retinal vein occlusion was 37.5 mmHg (range 26−54 mmHg); in the unaffected fellow eye it was 18.0 mmHg (range 11−28 mmHg). Although the process involved in producing pseudo­exfoliation of the lens capsule may contribute to the precipitation of central retinal vein occlusion, these findings suggest the rise in IOP is the more important cause. This may also be so in other forms of glaucoma.
Reliability of computer‐assisted retinal vessel measurement in a population
Authors: Sherry Lauren M , Wang Jie Jin , Rochtchina Elena , Wong Tien Y , Klein Ronald , Hubbard Larry D , Mitchell Paul
Published: March 2003

The purpose of the study was to assess the intergrader and intragrader reliability of computer‐assisted retinal vessel dia­meter measurement in a defined, community‐based population. Retinal photographs from participants in the Blue Mountains Eye Study were digitized using standard techniques. A grader identified all retinal vessels located 0.5−1.0 disc diameter from the optic disc margin, and a computer program measured the width of these vessels. Intergrader and intragrader reliability was assessed on a random sub­sample of 184 and 97 images, respectively, using quadratic weighted kappa (κ) and correlation analysis (R2). Intergrader reliability
was high for summary indices of retinal arteriolar (κ = 0.85, R2 = 0.88)
and venular (κ = 0.90, R2 = 0.90)
diameters, and their ratio, the arteriole‐to‐venule ratio (κ = 0.75, R2 = 0.79). Intragrader reliability was also high, with kappa values ranging from 0.80 to 0.93 and from 0.80 to 0.92 for graders 1 and 2, respectively. It is concluded that the retinal vessel diameters could be reliably measured using computer‐assisted software and may be used for population‐based research.
Familial amyloidotic polyneuropathy presenting with rubeotic glaucoma
Authors: Dunlop Anthony AS , Graham Stuart L
Published: March 2003

A 78‐year‐old man with familial amyloidotic polyneuropathy type I (Met30), presented with rubeotic glaucoma 9 months following an uncomplicated vitrectomy for vitreous amyloidosis. There was retinal neovascularization and extensive retinal vascular closure. In the preceding 9 months, episodes of ‘uveitis’ and high intraocular pressure are thought to be due to amyloid protein released into the aqueous leading to trabecular meshwork obstruction and high intraocular pressures, thus compounding the ocular ischaemia created by amyloid vascular closure. The patient underwent pan‐retinal photocoagulation and Molteno implant surgery. The rubeosis regressed and pressure control was gained but sight was lost.
Role of daunorubicin in inhibiting proliferative vitreoretinopathy after retinal detachment surgery
Authors: Kumar Atul , Nainiwal Sanjeev , Choudhary Indranil , Tewari Hem K , Verma Lalit K
Published: March 2003

Purpose: To study the role of daunorubicin in inhibiting pro­liferative vitreoretinopathy after retinal detachment surgery.

Method: Thirty eyes of 30 patients with a primary rhegmato­genous retinal detachment and proliferative vitreoretin­opathy of stage D1 or more advanced were included in the study. The eyes were randomly assigned to either the experimental or the control group. The eyes in the experimental group received an intravitreal injection of dauno­rubicin (5 µg) before conclusion of the vitrectomy. The main outcome measures evaluated were: retinal attachment, vitreous activity and visual acuity at 3 months after surgery.

Results: Complete retinal attachment was achieved in 13 eyes (86.6%) in the daunorubicin group and 10 eyes (66.6%) in the control group, at 3 months. Nine patients (60%) in the daunorubicin group and five patients (33.3%) in the control group had a best‐corrected visual acuity of ≥3/60 at 3 months of follow up. There was a statistically significant reduction in vitreous reaction at all times during the postoperative period in the daunorubicin group.

Conclusion: Daunorubicin may be a useful drug in inhibiting proliferative vitreoretinopathy after surgery for primary rhegmatogenous retinal detachment.