bluuebunny/crossref_metadata_2025 huggingface dataset:
Femur bone repair in ovariectomized rats under the local action of alendronate, hydroxyapatite and the association of alendronate and hydroxyapatite
Authors: Canettieri Antonio Carlos Victor , Colombo Carlos Eduardo Dias , Chin Chung Man , Faig‐Leite Horácio
Published: September 2009

An evaluation was made of the local action of alendronate sodium (A), hydroxyapatite (HA) and the association of both substances (A + HA), in different molar concentrations, on the femur bone repair of ovariectomized rats. Ninety‐eight animals were divided into seven groups: control (C), starch (S), alendronate 1 mol (A1), alendronate 2 mols (A2), hydroxyapatite 1 mol (HA1), hydroxyapatite 2 mols (HA2) and the association of alendronate + hydroxyapatite (A + HA). Rats weighing about 250 g were ovariectomized and 2.5‐mm diameter bone defects were made on the left femur 30 days later. Each experimental group had defects filled with appropriate material, except for group C (control). The animals were killed 7 and 21 days after surgery. Histological, histomorphometric and statistical analyses of bone neoformation in the bone defect site were performed. From the histological standpoint, the major differences occurred after 21 days. All specimens in groups C, S, HA1 and HA2 presented linear closure of the bone defect, and most animals in groups A1, A2 and A + HA showed no bone neoformation in the central area of the defect. No statistically significant difference was found among the experimental groups after 7 days; after 21 days, group HA2 presented the highest amount of neoformed bone. There was no significant difference among groups A1, A2 and A + HA in the two study periods. It was concluded that alendronate, either isolated or in association with hydroxyapatite, had an adverse effect on bone repair in this experimental model. Moreover, the hydroxyapatite used here proved to be biocompatible and osteoconductive, with group HA2 showing the best results.
Analysing the role of endogenous matrix molecules in the development of osteoarthritis
Authors: Sofat Nidhi
Published: September 2009

Osteoarthritis (OA) is the most common form of arthritis worldwide. In this condition, damage to the extracellular matrix (ECM) of cartilage occurs, resulting in joint destruction. Factors mediating cartilage damage include mechanical injury, cytokine and superoxide release on a background of genetic susceptibility and obesity. Studies of arthritic cartilage show increased production of ECM molecules including type II collagen, cartilage oligomeric matrix protein, fibronectin (FN) and fibromodulin. Recent reports suggest that ECM proteins may become endogenous catabolic factors during joint damage. Activation of pro‐inflammatory pathways by ECM proteins has led to their description as damage‐associated molecular patterns (DAMPs). The ECM proteins involved include fibromodulin, which activates the complement pathway and may promote the persistence of joint inflammation. Fragmentation of type II collagen, FN and hyaluronan reveals cryptic epitopes that stimulate proteolytic enzymes including matrix metalloproteinases and aggrecanases (ADAMTSs – a disintegrin and metalloproteinase with thrombospondin type 1 motifs). Proteolytic fragments also stimulate the release of nitric oxide, chemokines and cytokines and activation of the MAP kinases. Reports are emerging that the receptors for the fragments described involve interaction with integrins and toll‐like receptors. In this review the contribution of endogenous ECM molecules to joint destruction will be discussed. A deeper understanding of the pathways stimulated by endogenous ligands could offer potential avenues for novel therapies in the future.
Otitis media in a mouse model for Down syndrome
Authors: Han Fengchan , Yu Heping , Zhang Jiangping , Tian Cong , Schmidt Cecilia , Nava Casey , Davisson Muriel T. , Zheng Qing Y.
Published: September 2009

The Ts65Dn mouse shares many phenotypic characteristics of human Down syndrome. Here, we report that otitis media, characterized by effusion in the middle ear and hearing loss, was prevalent in Ts65Dn mice. Of the 53 Ts65Dn mice tested, 81.1% had high auditory‐evoked brainstem response (ABR) thresholds for at least one of the stimulus frequencies (click, 8 kHz, 16 kHz and 32 kHz), in at least one ear. The ABR thresholds were variable and showed no tendency toward increase with age, from 2 to 7 months of age. Observation of pathology in mice, aged 3–4 months, revealed middle ear effusion in 11 of 15 Ts65Dn mice examined, but only in two of 11 wild‐type mice. The effusion in each mouse varied substantially in volume and inflammatory cell content. The middle ear mucosae were generally thickened and goblet cells were distributed with higher density in the epithelium of the middle ear cavity of Ts65Dn mice as compared with those of wild‐type controls. Bacteria of pathogenic importance to humans also were identified in the Ts65Dn mice. This is the first report of otitis media in the Ts65Dn mouse as a model characteristic of human Down syndrome.
Common genetic changes in leiomyosarcoma and gastrointestinal stromal tumour: implication for ataxia telangiectasia mutated involvement
Authors: Ul‐Hassan Aliya , Sisley Karen , Hughes David , Hammond David W. , Robinson Martin H. , Reed Malcolm W.R.
Published: September 2009

Gastrointestinal stromal tumours (GISTs) are the most common mesenchymal tumours of the gastrointestinal tract. Formerly GISTs were commonly classified histologically as leiomyosarcomas; however, they are now known to arise from the interstitial cells of Cajal. Majority of GISTs overexpress KIT and have characteristic mutations within the gene, which are the targets of drug treatment with tyrosine kinase inhibitors. Leiomyosarcoma is a malignant tumour of smooth muscle differentiation and falls into a group of sarcomas that show complex karyotypic changes with no consistent recurrent genetic abnormality. We have used comparative genomic hybridization in combination with fluorescence in situ hybridization to determine genetic differences between the tumour types. We found leiomyosarcomas and GISTs share common regions of chromosomal 13q and 11q imbalance, in addition to more specific 1p and 8p losses in leiomyosarcoma and 15q and 22q losses in GISTs. More importantly, we have shown for the first time a deletion in the ataxia telangiectasia mutated (ATM) gene locus with decreased/absent expression of ATM protein, and amplification in the region 13q21–q32 in both tumour types, suggesting both regions may play a role in leiomyosarcoma and GIST biology.
Testing the Metabolic Scaling Theory of tree growth
Authors: Coomes David A. , Allen Robert B.
Published: September 2009

1.  Metabolic Scaling Theory (MST) predicts a ‘universal scaling law’ of tree growth. Proponents claim that MST has strong empirical support: the size‐dependent growth curves of 40 out of 45 species in a Costa Rican forest have scaling exponents indistinguishable from the MST prediction.

2.  Here, we show that the Costa Rican study has been misinterpreted. Using Standardized Major Axis (SMA) line‐fitting to estimate scaling exponents, we find that four out of five species represented by more than 100 stems have scaling exponents that deviate significantly from the MST prediction. On the other hand, sample sizes were too small to make strong inferences in the cases of 33 species represented by fewer than 50 stems.

3.
 Recently, it has been argued that MST is useful for predicting average scaling exponents, even if individual species do not conform to the theory. We find that the mean scaling exponent of the Costa Rican trees is greater than predicted (across‐species mean = 0.44), and hypothesize that scaling exponents in natural forests will generally be greater than predicted, because the theory fails to model asymmetric competition for light.

4.
 Synthesis. We highlight shortcomings in the interpretation of data used in support of a key MST prediction. We recommend that future research into biological scaling should compare the merits of alternative models rather than focusing attention on tests of a single theory.
Human influence lowers plant genetic diversity in communities with extinction debt
Authors: Helm Aveliina , Oja Tatjana , Saar Liina , Takkis Krista , Talve Tiina , Pärtel Meelis
Published: September 2009

1.  Loss of plant species induced by adverse human influence and habitat fragmentation might be delayed due to a slow response to changed environmental conditions. This phenomenon is known as extinction debt, which can lead to the underestimation of actual threats to biodiversity. To adequately estimate the condition of recently fragmented plant communities and avoid future loss of species, good indicators of forthcoming extinctions are needed.

2.
 We studied the behaviour of genetic diversity of a relatively common habitat specialist grass Briza media in fragmented calcareous grasslands in which the extinction debt has been previously documented. Species richness in this system is shown to be determined by historical landscape patterns and human population densities prevailing centuries ago. We hypothesize that genetic diversity in this grassland system is related to current landscape patterns and contemporary human impact since genetic diversity might react more quickly to environmental changes than species diversity.

3.  In contrast to species diversity, genetic diversity was indeed best described by current connectivity of grasslands. Additionally, genetic diversity was negatively related to current human population density, indicating an adverse effect of contemporary human settlements on studied species. The faster response of genetic diversity to changed environmental conditions compared to species richness was further supported by the absence of an expected correlation between species richness and genetic diversity.

4.  Human population density a century ago had a positive effect on genetic diversity. A similar effect has been demonstrated for species richness in these grasslands, indicating that traditional land use in the past has supported the development of both genetic and species diversity.

5.
 Synthesis. Genetic diversity of Briza media in fragmented communities is reacting quickly to changes in landscape structure and anthropogenic pressure. Our results confirm that plant species can be prone to genetic deterioration due to habitat fragmentation and negative anthropogenic impact even if the decline in species richness has been delayed by extinction debt. Thus, a decrease of population genetic diversity in fragmented communities can be taken as the first indication of future species losses.
Plant–soil feedback induces shifts in biomass allocation in the invasive plant Chromolaena odorata
Authors: Te Beest Mariska , Stevens Nicola , Olff Han , Van Der Putten Wim H.
Published: September 2009

1.  Soil communities and their interactions with plants may play a major role in determining the success of invasive species. However, rigorous investigations of this idea using cross‐continental comparisons, including native and invasive plant populations, are still scarce.

2.
 We investigated if interactions with the soil community affect the growth and biomass allocation of the (sub)tropical invasive shrub Chromolaena odorata. We performed a cross‐continental comparison with both native and non‐native‐range soil and native and non‐native‐range plant populations in two glasshouse experiments.

3.  Results are interpreted in the light of three prominent hypotheses that explain the dominance of invasive plants in the non‐native range: the enemy release hypothesis, the evolution of increased competitive ability hypothesis and the accumulation of local pathogens hypothesis.

4.
 Our results show that C. odorata performed significantly better when grown in soil pre‐cultured by a plant species other than C. odorata. Soil communities from the native and non‐native ranges did not differ in their effect on C. odorata performance. However, soil origin had a significant effect on plant allocation responses.

5.
 Non‐native C. odorata plants increased relative allocation to stem biomass and height growth when confronted with soil communities from the non‐native range. This is a plastic response that may allow species to be more successful when competing for light. This response differed between native and non‐native‐range populations, suggesting that selection may have taken place during the process of invasion. Whether this plastic response to soil organisms will indeed select for increased competitive ability needs further study.

6.
 The native grass Panicum maximum did not perform worse when grown in soil pre‐cultured by C. odorata. Therefore, our results did not support the accumulation of local pathogens hypothesis.

7.
 Synthesis. Non‐native C. odorata did not show release from soil‐borne enemies compared to its native range. However, non‐native plants responded to soil biota from the non‐native range by enhanced allocation in stem biomass and height growth. This response can affect the competitive balance between native and invasive species. The evolutionary potential of this soil biota‐induced change in plant biomass allocation needs further study.
Maternal genetic correlations in the seed rain: effects of frugivore activity in heterogeneous landscapes
Authors: García Cristina , Jordano Pedro , Arroyo Juan Miguel , Godoy José Antonio
Published: September 2009

1. A frugivore‐generated seed rain combines dispersed propagules from source trees located all over the landscape. By selecting deposition sites, frugivorous vertebrates set the maternal genetic correlations in the seed rain, i.e. how maternal progenies become distributed over the landscape relative to the source trees and other conspecifics. This aspect, however, remains virtually unexplored despite its central effect on the demographic and genetic structure in plant populations.

2. We examined three components of maternal genetic correlations in the seed rain: the number of distinct contributing maternal trees (maternal richness), the genetic relatedness among contributing trees (maternal relatedness) and the probability that two seeds drawn from the same seed trap come from the same maternal tree (correlated maternity).

3. We studied the maternal genetic correlations in a vertebrate‐generated seed rain of aPrunus mahalebpopulation located in a heterogeneous landscape (c.25 ha). Based on the multilocus genotypes provided by microsatellite markers, we identified the source tree of dispersed seeds sampled in seed traps and distributed among six microhabitat types.

4. Seed traps showed a spatial aggregation of maternally related seeds that varied among microhabitats in relation to the frugivore foraging preferences, resulting in variable maternal correlations across the landscape. We found: (i) seed traps with high maternal richness and low genetic relatedness in sites dominated by high shrubs, frequently visited by most frugivore species; (ii) seed traps with low maternal richness, high relatedness and increased correlated maternity values resulting from recurrent dispersal from few isolated source trees to sites dominated by non‐fleshy fruited species; and (iii) seed traps under pine trees with high maternal richness and relatedness (but low correlated maternity) due to long‐distance dispersal events from several source trees growing closely to each other.

5. Synthesis. Maternal progenies became distributed non‐randomly over the landscape, where trees with similar maternal neighbourhoods tended to disperse their progeny to similar microhabitats. This resulted in genetic limitation, i.e. the failure of maternal trees to reach all microhabitats, as well as the failure of the microhabitats to cast all maternal progenies. Both the genetic limitation and the spatial aggregation of maternal progenies, driven by frugivore activity, might pervasively determine recruitment and spatial genetic patterns in heterogeneous populations.
Destruction without extinction: long‐term impacts of an invasive tree species on Galápagos highland vegetation
Authors: Jäger Heinke , Kowarik Ingo , Tye Alan
Published: September 2009

1. A common belief in invasion ecology is that invasive species are a major threat to biodiversity, but there is little evidence yet that competition from an exotic plant species has led to the extinction of any native plant species at the landscape scale. However, effects of invasive species at community and ecosystem levels can severely compromise conservation goals.

2. Our model species, the red quinine tree (Cinchona pubescens), was introduced to the Galápagos Islands in the 1940s and today extends over at least 11 000 ha in the highlands of Santa Cruz Island. It is also invasive on other oceanic islands.

3. We adopted a long‐term approach, analysing permanent plots in the Fern‐Sedge vegetation zone over 7 years, to test for impacts of C. pubescens density on resident plant species composition and on microclimate variables. We also tested whether the C. pubescens invasion facilitated the invasion of other species.

4. The rapid pace of the C. pubescens invasion was indicated by a more than doubling of percentage cover, a 4.6‐fold increase in mean stand basal area and a 4‐fold increase in the number of stems ha−1 in 7 years.

5. Photosynthetically active radiation was reduced by 87% under the C. pubescens canopy while precipitation increased because of enhanced fog interception.

6. Cinchona pubescens significantly decreased species diversity and the cover of most species by at least 50%. Endemic herbaceous species were more adversely affected than non‐endemic native species. Stachys agraria, another invasive species, colonized bare ground that developed under the C. pubescens canopy.

7. The numbers of native, endemic and introduced species in the study area remained constant throughout the 7‐year period.

8. Synthesis. This study clearly established C. pubescens as a habitat transformer, although its average cover did not exceed 20%. Despite the fact that no plant species has been lost completely from the study area so far, the introduction of the novel tree life form to a formerly treeless environment led to significant changes in stand structure and environmental conditions and to decreases in species diversity and cover. Such changes clearly conflict with conservation goals as set by the Convention on Biological Diversity.
A unified measure of the number, volume and diversity of dead trees and the response of fungal communities
Authors: Hottola Jenni , Ovaskainen Otso , Hanski Ilkka
Published: September 2009

1.  Much of ecological research focuses on the responses of species and species communities to variation in the amount and quality of resources that are required for survival and reproduction. In such research, it is critical to measure the availability of resources in a manner that is relevant in relation to the ecological requirements of the species.

2.  We have developed a measure for resource availability that integrates the contributions of the number, volume and diversity of resource units to quantify the amount of habitat that is available for a species community. We apply this measure to data on the occurrence of 116 species of wood‐decaying polyporous fungi in 47 study plots of boreal forest within an area of 150 × 150 km.

3.  We show that species richness and pooled abundance of common species is explained well by the number of downed logs, whereas the occurrence of 41 red‐listed species is best explained by the total volume of logs and by the abundance of large logs in particular. The occurrence of common species is explained by the local availability of dead wood, whereas the occurrence of red‐listed species is additionally affected by the spatial connectivity of the focal forest stand to the surrounding larger expanses of old‐growth forest.

4.  Our results elicit the contrasting ecologies of common and red‐listed species in relation to how the number of logs, their size distribution and diversity, and forest connectivity affect species occurrences. The results suggest that the most cost‐effective means of preventing further declines of threatened species is to increase the amount of large downed logs through restoration and biodiversity‐oriented management in the vicinity of existing areas of natural‐like forests.

5.
 Synthesis. Our results illustrate that the most relevant way of measuring resource availability can differ greatly even within a taxonomically coherent community seemingly sharing the same resources. Our approach for modelling resource availability applies to the resources that occur as discrete objects with variation in the size and quality of individual resource units.
Distance between the medialis angles of the eyes as an anatomical parameter for tooth selection
Authors: LUCAS B. L. , BERNARDINO‐JÚNIOR R. , GONÇALVES L. C. , GOMES V. L.
Published: September 2009

Summary  During the construction of a removable prosthesis, the lack of pre‐extractions records turns the selection of artificial maxillary anterior teeth into a complex procedure. The aim of this study was to identify a mathematical relation between the anterior dental segment and the distance between the medialis angles of the eyes, for selecting the suitable width of the six maxillary anterior teeth. Standardized digital images of 80 dentate Brazilian subjects were used to measure both facial and oral structures when viewed from the frontal aspect through an image processing program. Accurate casts were made to measure on a curve the distance between the maxillary canines. Parametric statistics was performed to analyse the results (P < 0·05). The distance between the medialis angles of the eyes showed no significant difference according to gender (P < 0·108). The Pearson Product Moment Correlation Coefficient showed significant positive correlation between the distance between the medialis angles of the eyes and all variables compared. After the linear regression analysis, mathematical formulae and biometric ratios were concluded to estimate the combined width of the six maxillary anterior teeth from the measurement of the distance between the medialis angles of the eyes. The distance between the medialis angles of the eyes measured through photogrammetry can be a reliable guide for tooth selection.
Full length sequence of a novel HLA‐B*3818 allele differs from HLA‐B*380201 allele in exon 4 and intron 5
Authors: Cheng L.‐H. , Zhu W.‐G. , Lan Y.‐X. , Jin S.‐Z. , Zou H.‐Y.
Published: September 2009

The full length sequence of HLA‐B*3818 differs from HLA‐B*380201 at nt 660 in exon 4 (C→A) and genomic position 2133 in intron 5 (A→C).
Genomic full length sequence of HLA‐Cw*030301, identified by cloning and sequencing
Authors: Xu Y. , Deng Z. , Zeng J. , Gao S. , Yang B.
Published: September 2009

Genomic full length sequence of human leukocyte antigen (HLA)‐Cw*030301 that differs from Cw*030401 by two‐nucleotide exchange at nt 473 (G>A) in exon 2 and nt 3033 (G>C) in 3′UTR, was identified by cloning and sequencing from a male Chinese donor.
Genomic sequence of HLA‐Cw*1222 allele identified in a Chinese Han patient from Southern China
Authors: Jin S.‐Z. , Li Z. , Zou H.‐Y. , Lan Y.‐X , Zhu W.‐G. , Cheng L.‐H.
Published: September 2009

The genomic sequence of HLA‐Cw*1222 allele is identical to Cw*120202 except for a single‐nucleotide substitution at codon 87 (CAG→CGG) resulting in an amino acid change from Gln to Arg.
Evidence for autotetraploidy associated with reproductive isolation in Saccharomyces cerevisiae: towards a new domesticated species
Authors: ALBERTIN W. , MARULLO P. , AIGLE M. , BOURGAIS A. , BELY M. , DILLMANN C. , DE VIENNE D. , SICARD D.
Published: September 2009

Partial or whole‐genome duplications have played a major role in the evolution of new species. We have investigated the variation of ploidy level in a panel of domesticated strains of Saccharomyces cerevisiae coming from different geographical origins. Segregation studies and crosses with tester strains of different ploidy levels showed that part of the strains were well‐balanced autotetraploids displaying tetrasomic inheritance. The presence of up to four different alleles for various loci is consistent with a polyploidization mechanism relying on the fusion of two nonreduced meiospores coming from two S. cerevisiae strains. Autotetraploidy was also in accordance with karyotype and flow cytometry analyses. Interestingly, most bakery strains were tetraploids, suggesting a link between ploidy level and human use. The null or drastically reduced fertility of the hybrids between tetraploid and diploid strains indicated that domesticated S. cerevisiae strains are composed of two groups isolated by post‐zygotic reproductive barriers.
Characteristics of the Cryphonectria parasitica isolated from Quercus in Slovakia
Authors: Adamčíková K. , Kobza M. , Juhásová G.
Published: September 2009

The occurrence of chestnut blight (Cryphonectria parasitica) on oaks in mixed chestnut‐oak forests was studied in 2003–2008 in Slovakia. Infections on living Quercus trees were found at four of seven localities. The disease incidence on oaks ranged from 1.3% to 15.8%. The symptoms on infected oaks were similar to those on chestnut, but less conspicuous. Cankers of C. parasitica were found only on Quercus robur and Q. petraea. A total of 22 isolates of C. parasitica, all virulent, were isolated. Each site yielded only a single vc type (EU12 or EU13). Field inoculation experiments on chestnuts with seven strains of C. parasitica from oaks and an isolate from Castanea sativa showed no differences in virulence. On Quercus robur stems, the cankered area was significantly smaller than on C. sativa and the cankers developed very slowly.
AN AUDIT OF THE PRACTICE OF ROUTINE CT IMAGING FOR RIGHT ILIAC FOSSA PAIN
Authors: Lee S.C. , Li A.C.N. , Leong H.T.
Published: September 2009

Aim: To review the practice and implications of performing computed tomography (CT) for patients with right iliac fossa (RIF) pain.

Methods: Patients admitted for RIF pain between July 1998 to April 2000 were classified clinically as having appendicitis, equivocal appendicitis or other conditions. They would all undergo CT abdomen and then managed accordingly. The accuracy of clinical and CT diagnosis were compared, with histology of the resected appendix as gold standard.

Results: There were 348 patients with RIF pain and 201 of them underwent CT abdomen. Appendicitis was diagnosed clinically in 45 patients, the remaining patients were either equivocal or suspicious of other conditions. From CT abdomen 82 were diagnosed to be appendicitis and 119 were found to be normal or having other pathology. For those with radiological appendicitis, 74 were proven on histology (sensitivity = 85%, positive predictive value (PPV) = 90% (74/82)). Within the clinical appendicitis group, 37 were confirmed by histology (PPV of clinical diagnosis = 82% (37/45)). Among the equivocal group, 50 patients turned out to be appendicitis.

Conclusion: Although CT is useful in diagnosing appendicitis, we do not recommend routine CT abdomen for patients with RIF pain as no significant additional benefit is seen in the group of patients with clinical appendicitis. However, there may be a role for it in patients with equivocal clinical features but a randomized clinical trial is needed for further evaluation.
DAY CASE HAEMORRHOIDECTOMY USING THE HAEMORRHOID STAPLER — A PROSPECTIVE STUDY
Authors: Li A.C.N. , Leong H.T.
Published: September 2009

Aim: To evaluate prospectively use of the haemorrhoid circular stapler (HCS) in day case haemorrhoidectomy.

Methods: Patients with prolapsing piles needing haemorrhoidectomy who met the criteria for day surgery were recruited. In addition to the standard practice, a comprehensive explanation regarding the procedure was given at the preoperative assessment clinic. All patients received lactulose 2 consecutive days before surgery and a prophylactic dose of intravenous metronidazole on induction of anaesthesia. Haemorrhoidectomy was performed with the circular stapler (HCS33‐Ethicon Endosurgery) employing the Longo technique. A diclofenac suppository and absorbable anal dressing were administered at the end of the procedure. Postoperative pain was assessed using the visual analogue scale prior to discharge on the same day. Patients were discharged with a bulking agent plus lactulose, oral diclofenac, TNG ointment and a telephone number to call for queries. Patients were seen at 1, 4 and 12 weeks after surgery during which time they would report on symptoms, duration of rest and overall satisfaction.

Results: 20 patients underwent the procedure. Only 1 patient required hospital admission, due to side effects of general anaesthesia. The mean pain score on discharge was 3.8 (range: 0–8). All patients were able to take up normal activities within the first week and passed regular motions with relatively mild symptoms.

Conclusion: Day case haemorrhoidectomy is not only feasible using the HCS, good patient satisfaction can also be achieved.
MANAGEMENT OF VESICO‐VAGINAL FISTULAE: LOCAL EXPERIENCE IN TUEN MUN HOSPITAL
Authors: Mah I.S.F. , Yung Y.P. , Chan W.H. , Au W.H. , Man C.W.
Published: September 2009

Aim: latrogenic injury at the time of gynaecological surgery, in particular hysterectomy, is the commonest cause of vesico‐vaginal fistulae (VVF) in the developed world. This is a retrospective review to study the aetiology, treatment options and outcome of surgery in patients suffering from VVF in our hospital.

Patients and Methods: The records of patients diagnosed to have VVF during the period July 1997 to December 2000 were reviewed. During that period 10 patients were diagnosed to be suffering from VVF. Their age ranged from 38 to 73 years old. The follow up period ranged from 5 to 42 months.

Results: Hysterectomy was the commonest cause of VVF in our patients (6 cases). Two cases were due to pelvic irradiation for carcinoma of cervix. One was due to recurrent carcinoma of cervix whereas the other one was due to bladder stone which had eroded into the vagina. One fistula healed by conservative treatment whereas 9 required surgical intervention: transabdominal repair using omental interposition in 6 and ileal conduit in 2 patients. One patient refused surgical treatment and defaulted follow‐up afterwards. During follow‐up, one patient died from recurrent carcinoma of cervix whereas the rest of the patients were well and dry.

Conclusions: Gynaecological surgery is the commonest cause of VVF in our locality. However, most of these fistulae are amendable to surgical repair. With the use of omental interposition graft, successful repair can be achieved in most patients.
MANDIBULAR RECONSTRUCTION USING FREE FIBULAR OSTEO‐MYO‐CUTANEOUS FLAP — CRAFTSMANSHIP & COMPLICATIONS
Authors: Cheung W.Y. , Cheng M.S. , Wong W.M. , Ho C.M. , Yip A.W.C.
Published: September 2009

A consecutive series of 26 free fibular flaps in 25 patients performed by the Division of Plastic Surgery in Kwong Wah Hospital between 1995–2000 was presented. There were 15 male and 10 female patients. Age ranged from 11 to 84 years old (median 56). Pathology involving the mandible included 18 squamous cell carcinoma, five radiation‐induced sarcoma, one radionecrosis and one ameloblastoma. After surgical ablation, all these oromandibular defects were reconstructed using free fibular flaps with closing wedge osteotomies and double‐miniplates fixation. Concerning the fibular flaps, there were one straight osteal flap, 12 osteo‐cutaneous flaps, and 13 composite osteo‐myo‐cutaneous flaps. Among the composite osteo‐myo‐cutaneous flaps, there were eight stacked bone flaps, three double skin islands composite flaps and two double muscles composite flaps. Hospital mortality of these advanced cancer patients was 7.7%. Success rate of free fibular graft was 96.2%. There was one total loss (3.8%), two flaps skin necrosis (7.7%) and three re‐operations for major complications (11.5%). Minor complications that included wound infection and self‐limited salivary fistula was 23%.

The additional craftsmanship for the complex oromandibular reconstruction required careful three‐dimensional planning and meticulous protection of individual components of the osteomyo‐cutaneous flaps so as to restore the lower face with form and function.
A PROSPECTIVE RANDOMIZED STUDY TO COMPARE THE ANTI‐XA ACTIVITY AND BLEEDING COMPLICATIONS OF STANDARD AND REDUCED DOSAGE OF FRAXIPARINE FOR THE PROPHYLAXIS OF POSTOPERATIVE DEEP VEIN THROMBOSIS IN RECTAL CANCER SURGERY
Authors: Ng S.S.M. , Lee J.F.Y. , Lai P.B.S. , Lau W.Y.
Published: September 2009

Background & Objective: Patients undergoing elective rectal cancer surgery are usually given Fraxiparine based on recommended dosages from Caucasians’ studies (0.2 ml if body weight <50 kg and 0.3 ml if body weight >50 kg) as prophylaxis for deep vein thrombosis (DVT). In our Chinese population, however, a number of cases of severe bleeding complications were observed with this standard dosage regimen. A prospective randomized study was therefore conducted to compare the anti‐Xa activity and bleeding complications of this standard regimen and a reduced dosage regimen (0.1 ml if body weight < 50 kg and 0.2 ml if body weight > 50 kg).

Methods: 29 patients with rectal cancer (standard : reduced = 14 : 15) were included in this study. Fraxiparine was given 4 hours prior to surgery and blood was taken just before surgery for measurement of anti‐Xa activity. Postoperatively the patients were examined clinically for DVT. Perioperative blood loss, transfusion requirements and postoperative bleeding complications were also recorded and analyzed prospectively.

Results: The mean anti‐Xa activity was significantly higher in the standard dosage group (0.302 u/ml vs 0.219 u/ml, P = 0.029). There was no clinically overt DVT in the two groups. Total perioperative blood loss and transfusion requirements were not different in both groups. However, one patient in the standard dosage group has developed major intraoperative bleeding that necessitated packing and relaparotomy for haemostatsis. This patient finally died of disseminated intravascular coagulopathy. Gross haematuria was also observed in two patients in the standard dosage group. None of the patients in the reduced dosage group had developed any major or minor bleeding complications postoperatively.

Conclusion: Fraxiparine as DVT prophylaxis in the Chinese population should be administered at a reduced dosage because it is shown in this study to be as effective as the standard dosage regimen in preventing DVT and yet it is associated with fewer bleeding complications.
EXPERIENCE IN 44 ORBITAL FRACTURE, ITS TREATMENT AND PITFALLS
Authors: To E.W.H. , Pang P.C.W.
Published: September 2009

There were 143 patients operated for facial fracture in the Prince of Wales Hospital during the period from February 1997 to December 2000. Out of 143 patients, 44 were operated for orbital floor fracture. The average age of the patients was 35. The male to female ratio is 5:1. Road traffic accident and assault are the main cause of injury. Diplopia was presented in 16% of all the cases. The average time lag between admission and operation is 92 hours. The average operating time is 75 minutes. All of them underwent orbital floor exploration with 86% had the orbital floor reconstructed with either titanium mesh, silastic‐mesh or medpor. The mean hospital stay was 10.2 days. The timing of operation, indications of pre‐op CT scan, surgical access and outcome will be presented.
RANDOMIZED TRIAL ON IMPROVING INTER‐HOSPITAL NEUROSURGICAL CONSULTATION BY TELE‐RADIOLOGY
Authors: Wong H.T. , Poon W.S. , Leung C. , Lam J.M.K. , Kwok S. , Lau Fl , Wai S. , Ng S.
Published: September 2009

Neurosurgical service requires team work and highly specialized resources. Acute neurosurgical emergencies are traditionally referred from district general hospital (DGH) to the Neurosurgical Unit (NSU) by telephone consultation. Initial experience had proved that tele‐radiology could improve diagnostic accuracy and reduce unnecessary transfer but clinical outcome improvement was not demonstrated.(1)

We compare the traditional telephone consultation with tele‐radiology. Patients with acute neurosurgical conditions in a DGH need consultation to NSU were included. These patients were divided into Head Injury, Stroke and Miscellaneous groups. They were further randomized to telephone or tele‐radiology consultation mode in different groups. There were totally 375 patients recruited and randomized from the period between 1 October 1998 to 30 June 2000. The time requested for referral to decision made were 35 minutes and 60 minutes respectively, but similar in head injury subgroup. The total numbers of patient needed transfer to PWH were fewer in tele‐radiology group (telephone: 80 vs. tele‐radiology: 61). The diagnostic accuracy was also higher in tele‐radiology group due to the visual aids from the transferred image. The overall outcome assessed on 6 months and showed that patients in tele‐radiology group have better outcome score.

In summary, this is a first randomized control study to confirm clinical benefits of tele‐radiology on managing inter‐hospital neurosurgical patients.

(1) Does Teleradiology Improve Inter‐hospital Management of Head‐Injury. KYC Goh, KY Tsang and WS Poon, Can J Neurol Sci 1997; 24: 235–239.
MICROVASCULAR FREE FLAPS IN HEAD AND NECK RECONSTRUCTION
Authors: Wong A.W.M. , Ho C.M. , Cheung W.Y. , Cheng M.S. , Yip A.W.C.
Published: September 2009

Reconstructive procedures of the head and neck aim to repair soft tissue and bony defects while restoring optimal function and cosmesis. The development of microvascular surgery has offered the possibility of free tissue transfer from distant sites to head and neck area. This allows reconstruction of composite defect in one stage. We would like to review a group of patients with various head and neck defects which were reconstructed with microvascular free flap.

Between January 1995 and December 2000, seventy nine patients underwent 82 microvascular free flap reconstruction following major head and neck resection. There were 26 fibular, 25 radial forearm, 20 jejunal, 4 lateral arm, 4 rectus abdominus, 2 latissimus dorsi and 1 groin flaps. The majority (95%) of patients had advanced head and neck cancer. The common tumor sites were oral cavity (55%), hypopharynx (23%) and mandible (9%). Three patients (4%) died perioperatively. There were five total flap failure (6%). The overall major morbidity was 17%, including anastomotic leakage, orocutaneous fistula and major wound infection. The general medical complications rate was 17%. Donor site morbidity rate was 11% and the majority were in form of superficial wound infection.

Given the good results observed and versatility of free flaps, we concluded that microvascular grafts should be considered in reconstructing head and neck defects following major ablative surgery.
RESULTS OF VIDEO ASSISTED THORACOSCOPIC PLEURODESIS IN MANAGEMENT OF PNEUMOTHORACES
Authors: Lo C.K. , Chu S.H. , Chung S.S. , Ma C.C. , Ko K.M. , Ho K.K.
Published: September 2009

The objective of the study is to find out the efficiency of video assisted thoracoscopic (VATS) pleurodesis and predisposing factors of postoperative complications.

This is a retrospective study that those who had VATS pleurodesis from January 1994 to December 2000 were recruited. There were consecutive 306 VATS pleurodesis performed on 271 patients. These included 33 female and 238 male patients from 15 to 73 years old. 31 of them had bilateral procedures. 244 of them had primary spontaneous pneumothoraces and 27 of them had secondary pneumothoraces. Most of them had two or more episodes of pneumothoraces and persistent air leakage >14 days before operations. 15 patients had failed surgical or chemical pleurodesis before VATS.

There was no operative death. Usually they were discharged within five days after operations. There were 21 persistent air leakage >5 days (6.8%), 1 bleeding required surgical haemostasis (0.3%) and 4 infectious complications (1.3%). Follow up duration was up to 72 months. There was 12 recurrence (3.9%) after discharge.

Absence of blebs, presence of pleural adhesion, prolonged chest tube placement before VATS pleurodesis, and failed surgical or chemical pleurodesis before are the predisposing factors of complications.
CIRCUMCISION OR NO CIRCUMCISION: AN OLD CONTROVERSY INTO THE NEW MILLENNIUM
Authors: Fan N. , Leung S.K. , Wong C.K. , Tse S. , Sze Y.S. , Lui K.W. , Ng T.K. , Yuen K.S. , Kong C.K. , Ng W.T.
Published: September 2009

Controversies still exist as to the exact definition of phimosis, true indications for circumcision, and results of different treatment options. A prospective study in the two years straddling the Millennium was done to definite the exact role of circumcision in the management of the preputial problems amid continuing controversies and in the wake of a new medical treatment, i.e. steroid application emerging since 1993.

244 referrals resulted in 195 circumcisions in 1999. Detailed analysis revealed that the indication was doubtful and arguable in 13.5% and 16%, respectively. The overall complication rate (bleeding, infection and rephimosis) occurred in 12%. Starting from 2000, application of 0.02% Trimcinolone cream was instituted: successful retraction in 74 was achieved in 81/95 patients. No side effects were noted. The positive predicting factors were identified.

Circumcision has been advocated as a routine to decrease the incidence of UTI, STD or Cancer. However, circumcision is fraught with early and late problems. There have only been 9 reported on the use of steroid application, all using potent preparations. We pioneered the use of a much weaker steroid that was documented to have comparable efficacy. Our proposed algorithm for offers great advantages, including tremendous savings to the hospital, and lifetime benefits to the patients!
THE DIAGNOSIS AND MANAGEMENT OF ORBITAL FRACTURE, A MULTI‐DISCIPLINARY APPROACH
Authors: Hui K.C.W. , Yiu C.P. , Lam L.K. , Tsang N.C.K.
Published: September 2009

The orbit is made up of seven bones, of which, the inferior wall is most vulnerable to injury and the lateral wall, the least common. In assessing facial trauma, it is crucial to include a comprehensive examination and to manage the orbital fractures accordingly. Orbital floor fracture may present with enophthalmos, diplopia and inferior orbital neuropathy. The infra‐orbital rim may show a step‐off deformity. Full ophthalmologic evaluation is important to rule out optic nerve neuropathy, retinal bleed, and corneal abrasion. Fracture extending to the superior orbital fissure is known as the superior orbital fissure syndrome, often presented with third, fourth and sixth cranial nerves dysfunction. Orbital roof fracture may involve the frontal lobe and frontal sinus. Fracture involving the naso‐orbital ethmoid complex may present with CSF leak, diplopia, displaced medial canthus and nasal fracture. High‐resolution 1.5mm CT scans is most useful in the aid of diagnosis in addition to tomography. Displaced fractures should be corrected surgically before bony union. Two examples of complex orbital fractures will be presented, illustrating the importance of a multi‐surgical team approach to achieve the optimum results.
VACUUM‐ASSISTED BIOPSY: A SAFE AND ACCURATE ALTERNATIVE TO EXCISION
Authors: Chung C.K. , Kwong A. , Hung W.K. , Chan M.C.M. , Lau Y. , Yip A.W.C.
Published: September 2009

Introduction: Image‐detected breast lesion is becoming a concern in surgery. After triple assessment, a suspicious or indeterminate lesion will usually require excision to rule out malignancy. Vacuum‐assisted biopsy is newly introduced as a minimally invasive alternative to operation in obtaining tissue for histological assessment. The early experience of this procedure in the Breast Centre of Kwong Wah Hospital is reviewed.

Method: Vacuum‐assisted biopsy was performed for image‐detected breast lesions under local anaesthesia using the Mammotome. Lesions were either vaguely palpable or non‐palpable but well seen on ultrasound scan with fine needle aspirated indeterminate cytology or benign cytology in a high risk patient. Definitive surgery was performed if the biopsy result showed malignancy or upon patient’s request. Other patients were followed up six monthly with clinical examination and ultrasound scan. Excision was indicated if there was any increase in size. The pathology was assumed to be benign if there was no change in six months time.

Result: From September 1998 to May 2000, 49 female patients were included. One of them had 2 lesions making a total of 50 cases. The mean age of the patients was 45.5 (22–58). The mean size of the lesion was 10.8mm (4–19). The procedure took 5–55 min (mean 16.6). It was successful in 49 cases (98%). Four lesions were found to be malignant. Three patients had definitive operations with the pathology confirmed while one patient defaulted follow up. Amongst the 45 benign lesions, 3 were excised upon request. The pathology were all benign. For the remaining 42 patients. 23 were followed up for 12 months and 19 patients for 6 months. Three patients were found to have enlarging lesions and excisions were performed which revealed benign histology. The breast lumps of the remaining 39 patients either remained unchanged or diminished size. There were no major complications (wound haematoma, infection). The average linear pain score (minimum 1, maximum 5) was 2.0.

Conclusion: Vacuum‐assisted biopsy is an accurate diagnostic tool with the advantage of minimal morbidity.
Cataract in central Sri Lanka: cataract surgical coverage and self‐reported barriers to cataract surgery
Authors: Athanasiov Paul A , Edussuriya Kapila , Senaratne Tissa , Sennanayake Saman , Selva Dinesh , Casson Robert J
Published: September 2009

Abstract

Purpose:  To determine the cataract surgical coverage and investigate the barriers to cataract surgery in the Kandy District of central Sri Lanka.

Methods:  A population‐based, cross‐sectional ophthalmic survey of the inhabitants of rural villages in central Sri Lanka was conducted; there were 1721 eligible subjects and 1375 participated (79.9% participation rate). The recorded data included age, gender, education, district, corrected visual acuity, dilated slit‐lamp examination and stereoscopic fundus examination. Lens opacity was graded using the Lens Opacities Classification System III. Participants with cataract‐induced visual impairment (acuity <6/18 in the better eye) were also invited to respond to a verbal questionnaire about barriers to cataract surgery.

Results:  Cataract surgical coverage per individual for visual acuity cut‐offs of <6/18, <6/60 and <3/60 was 41.9%, 76.8% and 82.7%, respectively; and per eye was 34.0%, 60.3% and 65.2%, respectively. Cataract surgical coverage was higher for men than women, and two‐thirds refused referral for surgery, for the following reasons: no desire to improve vision, fear of surgery and lack of awareness were the most frequently reported barriers.

Summary:  Cataract surgical coverage in central Sri Lanka is higher than that in neighbouring developing regions. Surgical uptake may be improved through better community education.