bluuebunny/crossref_metadata_2025 huggingface dataset:
Predictors of alpha‐fetoprotein elevation in patients with chronic hepatitis C, but not hepatocellular carcinoma, and its normalization after pegylated interferon alfa 2a–ribavirin combination therapy
Authors: Chen Tsung‐Ming , Huang Pi‐Teh , Tsai Ming‐Hung , Lin Lien‐Fu , Liu Chung‐Cheng , Ho Ka‐Sic , Siauw Chuan‐Pau , Chao Po‐Liang , Tung Jai‐Nien
Published: August 2010

Background and Aim:  Elevated serum alpha‐fetoprotein (AFP) levels are noted in patients with chronic hepatitis C (CHC) without hepatocellular carcinoma (HCC). The change in AFP levels after treatment with pegylated interferon and ribavirin (Peg‐IFN/RBV) combination therapy is still unknown. The aim of this study was to investigate the predictors of elevated serum AFP in patients with CHC, and its change after Peg‐IFN/RBV therapy.

Methods:  A total of 123 patients, intended to receive pegylated interferon alfa‐2a plus ribavirin therapy, were enrolled. Eighty‐three patients had complete treatment and received follow up for and additional 24 weeks. The factors that may affect the elevation of pretreatment AFP and the normalization of post‐treatment AFP were determined.

Results:  The mean AFP level was 18.5 ± 63.0 ng/mL (range, 1.3–676.0 ng/mL); 41 (33.3%) of the 123 patients had elevated serum AFP (more than 10 ng/mL) at baseline. A multivariate logistic regression analysis disclosed that older age (odds ratio [OR], 1.093; 95% confidence interval [CI], 1.015–1.177; P = 0.018), more advanced METAVIR fibrosis stage (OR, 5.237; 95% CI, 1.244–22.037; P = 0.024), a higher aspartate aminotransferase (AST) level (IU/L) (OR, 1.020; 95% CI, 1.008–1.033; P = 0.001), and lower platelet count (×109/L, OR, 0.985; 95% CI, 0.968–0.994; P = 0.003) were independent determinants of pretreatment AFP elevation. After treatment, 72 of 83 (86.7%) cases were found to have normal post‐treatment AFP levels (<10 ng/mL) at the end of follow up (EOF). Post‐treatment negativity of the chronic hepatitis C virus (HCV)‐RNA (OR, 10.014; 95% CI, 1.000–100.329; P = 0.050) and the post‐treatment platelet count (×109/L) (OR, 1.025; 95% CI, 1.001–1.050; P = 0.040) were associated with normal AFP at EOF. AFP progressively decreased with significant differences starting from the 12th week after treatment to the end of treatment, and was lowest at the EOF date for the sustained viral response (SVR) group. On the contrary, the non‐SVR group did not have an AFP change during and after treatment.

Conclusion:  Older age, low platelet count, higher AST levels, and advanced fibrosis predisposed chronic hepatitis C patients without HCC to have elevated serum AFP levels. After Peg‐IFN/RBV combination therapy, a higher platelet count and HCV viral eradication were determinants of normal AFP at EOF. Serial AFP levels decreased after treatment, presenting in a time‐dependent manner, specifically for the SVR group.
Preservations of nephrin and synaptopodin by recombinant hepatocyte growth factor in podocytes for the attenuations of foot process injury and albuminuria in nephritic mice
Authors: KATO TAKASHI , MIZUNO SHINYA , NAKAMURA TOSHIKAZU
Published: August 2010

Aim:  Podocytes provide a slit diaphragm to inhibit proteinuria, and nephrin between podocytes functions as a barrier during glomerular filtration. Hepatocyte growth factor (HGF) can improve proteinuria in rodents with various renal injuries, but little is known about the role of HGF in podocyte‐based events during glomerulonephritis. In the present study, we examined whether and how nephrin expression is sustained by podocytes during the HGF‐mediated attenuation of albuminuria.

Methods:  Lipopolysaccharide (LPS)‐treated mice were used as an animal model of albuminuria. We evaluated the effect of HGF on slit proteins using immunohistochemistry, western blotting and real‐time polymerase chain reaction.

Results:  Albuminuria occurred 36 h after LPS treatment in mice. This albuminuria did not involve podocyte loss, but was associated with a decrease in nephrin and its key anchor, synaptopodin. In these processes, c‐Met tyrosine phosphorylation, which represented HGF signal activation, occurred in glomerular cells including podocytes. When recombinant HGF was administrated to nephritic mice, c‐Met tyrosine phosphorylation became evident in podocytes. The enhancement of the HGF‐c‐Met signal was associated with increases in nephrin and synaptopodin. An electron microscopic examination revealed that LPS induced the foot process effacement of podocytes, while HGF injections suppressed the foot process injury. Overall, albuminuria was attenuated in the LPS‐treated mice after HGF administration.

Conclusion:  HGF protects podocytes from a loss of nephrin, at least in part, through maintaining synaptopodin. As a result, HGF was shown to sustain foot process structure, and albuminuria was attenuated under inflammation.
A critical analysis of health promotion and ‘empowerment’ in the context of palliative family care‐giving
Authors: Stajduhar Kelli , Funk Laura , Jakobsson Eva , Öhlén Joakim
Published: August 2010

STAJDUHAR K, FUNK L, JAKOBSSON E and ÖHLÉN J. Nursing Inquiry 2010; 17: 221–230 A critical analysis of health promotion and ‘empowerment’ in the context of palliative family care‐giving

Traditionally viewed as in opposition to palliative care, newer ideas about ‘health‐promoting palliative care’ increasingly infuse the practices and philosophies of healthcare professionals, often invoking ideals of empowerment and participation in care and decision‐making. The general tendency is to assume that empowerment, participation, and self‐care are universally beneficial for and welcomed by all individuals. But does this assumption hold for everyone, and do we fully understand the implications of health‐promoting palliative care for family caregivers in particular? In this study, we draw on existing literature to highlight potential challenges arising from the application of ‘family empowerment’ strategies in palliative home‐care nursing practice. In particular, there is a risk that empowerment may be operationalized as transferring technical and medical‐care tasks to family caregivers at home. Yet, for some family caregivers, a sense of security and support, as well as trust in professionals, may be equally if not more important than empowerment. Relational and role concerns may also at times take precedence over a desire for empowerment. The potential implications of ‘family empowerment’ are explored in this regard. ‘Family empowerment’ approaches need to be accompanied by a strong understanding of how to best support individual palliative family caregivers.
Applying a realist(ic) framework to the evaluation of a new model of emergency department based mental health nursing practice
Authors: Wand Timothy , White Kathryn , Patching Joanna
Published: August 2010

WAND T, WHITE K and PATCHING J. Nursing Inquiry 2010; 17: 231–239 Applying a realist(ic) framework to the evaluation of a new model of emergency department based mental health nursing practice

Evaluation has become progressively popular within public health and healthcare programme research, with an emphasis on outcomes and a desire to improve practice and service delivery. Mixed methods approaches are consequently being employed to capture the multidimensional characteristics of programmes that aim to address problematic situations affecting targeted populations. This paper provides an overview of critical realism, a modern philosophical perspective that seeks contextualised causal understandings of social phenomena. Realistic evaluation, a research methodology adapted from critical realism, is highlighted as a means of obtaining a deeper appreciation of how complex programmes work, for whom they work, and under what circumstances. The evaluation of a mental health nurse practitioner outpatient service based in the emergency department of a large teaching hospital in Sydney Australia is used to illustrate the application of a realist perspective to research in nursing practice.
The meaning of middle‐aged female spouses’ lived experience of the relationship with a partner who has suffered a stroke, during the first year postdischarge
Authors: Bäckström Britt , Asplund Kenneth , Sundin Karin
Published: August 2010

BÄCKSTRÖM B, ASPLUND K and SUNDIN K .Nursing Inquiry2010;17: 257–268 The meaning of middle‐aged female spouses’ lived experience of the relationship with a partner who has suffered a stroke, during the first year postdischarge

Stroke consequences present a great long‐term challenge to the spouses of the stroke sufferer. A longitudinal study with a phenomenological hermeneutic approach was used to illuminate the meanings of middle‐aged female spouses’ lived experience of their relationship with a partner who has suffered a stroke, during the first year postdischarge. Four middle‐aged female spouses of stroke sufferers participated in the study. Narrative interviews were conducted 1, 6 and 12 month postdischarge (total of 12 interviews), audio‐taped and transcribed verbatim to a text and interpreted by a phenomenological hermeneutic method inspired by Ricoeur. The findings showed a process over time during which spouses come to know, recognize and acknowledge the residual changes in their partners’ cognitive and emotional conditions and the impact on their relationship. Spouses showed grief due to the loss of the marital relationship they once had and anxiety that they would not be able to continue in an undesired relationship in the future. Even if the partner is still alive, there is a loss to grieve and to be understood, an important meaning of the transition process in the relationship during the first year after the partner's discharge.
‘Health equity through action on the social determinants of health’: taking up the challenge in nursing
Authors: Reutter Linda , Kushner Kaysi Eastlick
Published: August 2010

REUTTER L and KUSHNER KE. Nursing Inquiry 2010; 17: 269–280 ‘Health equity through action on the social determinants of health’: taking up the challenge in nursing

Reducing health inequities is a priority issue in Canada and worldwide. In this paper, we argue that nursing has a clear mandate to ensure access to health and health‐care by providing sensitive empowering care to those experiencing inequities and working to change underlying social conditions that result in and perpetuate health inequities. We identify key dimensions of the concept of health (in)equities and identify recommendations to reduce inequities advanced in key global and Canadian documents. Using these documents as context, we advocate a ‘critical caring approach’ that will assist nurses to understand the social, political, economic and historical context of health inequities and to tackle these inequities through policy advocacy. Numerous societal barriers as well as constraints within the nursing profession must be acknowledged and addressed. We offer recommendations related to nursing practice, education and research to move forward the agenda of reducing health inequities through action on the social determinants of health.
Pseudomonas aeruginosa: Host defence in lung diseases
Authors: WILLIAMS Bryan J. , DEHNBOSTEL Joanne , BLACKWELL Timothy S.
Published: August 2010

Lung infections caused by the opportunistic pathogen Pseudomonas aeruginosa can present as a spectrum of clinical entities from a rapidly fatal pneumonia in a neutropenic patient to a multi‐decade bronchitis in patients with cystic fibrosis. P. aeruginosa is ubiquitous in our environment, and one of the most versatile pathogens studied, capable of infecting a number of diverse life forms and surviving harsh environmental factors. It is also able to quickly adapt to new environments, including the lung, where it orchestrates virulence factors to acquire necessary nutrients, and if necessary, turn them off to prevent immune recognition. Despite these capabilities, P. aeruginosa rarely infects healthy human lungs. This is secondary to a highly evolved host defence mechanism that efficiently removes inhaled or aspirated pseudomonads. Many arms of the respiratory host defence have been elucidated using P. aeruginosa as a model pathogen. Human infections with P. aeruginosa have demonstrated the importance of the mechanical barrier functions including mucus clearance, and the innate immune system, including the critical role of the neutrophilic response. As more models of persistent or biofilm P. aeruginosa infections are developed, the role of the adaptive immune response will likely become more evident. Understanding the pathogenesis of P. aeruginosa, and the respiratory host defence response to it has, and will continue to, lead to novel therapeutic strategies to help patients.
Targeted therapy: An evolving world of lung cancer
Authors: LAM Kwok‐Chi , MOK Tony S.
Published: August 2010

Lung cancer remains one of the most fatal illnesses. Recent development in cancer genomics and molecular targeted therapy leads to a paradigm shift in management of advanced‐stage non‐small cell lung cancer. Patients with activated mutation of epidermal growth factor receptor (EGFR) responded dramatically to EGFR tyrosine kinase inhibitor such as gefitinib or erlotinib. Multiple randomized studies have showed EGFR tyrosine kinase inhibitor to be superior to standard first‐line chemotherapy in this biomarker‐selected population. As the vasculature is considered to be the ‘Achillus heel’ of the tumour, anti‐angiogenic treatment is considered to be a suitable target. Inhibition of vascular endothelial growth factor may improve the efficacy of chemotherapy, although a practical biomarker has not been identified. We have entered an era of personalized therapy for lung cancer and this evolvement holds great promises for better treatment in future.
THE ROLE OF INTENSIVE CARE UNITS
Authors: Gilligan John E. , McCleave David J. , Worthley Lindsay , Price Lynne
Published: August 2010

The indications for intensive care are discussed. Selection of patients should be based upon the apparent reversibility of disease processes and the likelihood of producing worthwhile relief of suffering. Admission statistics for one n‐bed unit are also presented, and survival rates exceeding 90% of three “model” conditions–namely, fat embolism, tetanus and Guillain‐Barré syndrome–are reported. The hospital costs for treating critically ill patients are approximately three times those for treating the “average” patient.
PATIENT MONITORING
Authors: Morton Anthony
Published: August 2010

Optimum results are obtained in the care of the critically ill patient if efforts are directed to maintaining the internal environment in a state as near normal as possible. This cannot be done without the use of basic monitoring procedures. Complex investigations may have a legitimate and necessary role as research tools. There is, however, a real risk of complex procedures becoming an end in themselves in general intensive therapy units, where they are apt to distract overworked nurses and medical attendants f r o m the care of their patients. It is important, therefore, for clearcut indications f o r various monitoring procedures to be defined, and in this paper an attempt has been made to outline a logical approach to the monitoring of critical 131 ill general surgical patients admitted to intensive therapy units.
DISSEMINATED INTRAVASCULAR COAGULATION CADE
Authors: Cade J. F.
Published: August 2010

Disseminated intravascular coagulation (DIC) is a syndrome of deposition of platelet‐fibrin thrombi in the microcirculation, with consumption of platelets and clotting factors and possible clinical features of bleeding or thrombosis or both. It may be produced by activation of coagulation, platelet aggregation or endothelial damage. It is not a primary disease, but a common and important complication of many serious illnesses, especially sepsis, carcinoma and obstetrical accidents. Shock and acidosis are frequent precipitating factors, and vitamin K deficiency is a common complicating factor. DIC usually produces no clinical features, but it may give rise to bleeding, ischcemic organ damage or shock. Although its clinical contribution is often difficult to separate from that due to the underlying disease, DIC remains the commonest cause of a generalized bleeding tendency in acutely sick patients. Laboratory confirmation consists of the demonstration of thrombocytopenia, coagulation impairment, hypofibrinogenamia, raised levels of fibrin degradation products, and positive results of para‐coagulation tests. The most important therapeutic measure is control of the underlying disease, but replacement therapy and heparin may be required, especially if bleeding is significant and the process is not acute and self‐limited.
BILATERAL CARCINOMA OF THE BREAST
Authors: Buls J. G. , Bennett R. C. , Chan D. P. S.
Published: August 2010

A review of patients treated at the Peter MacCallum Clinic, Melbourne, between 1968 and 1973 inclusive, revealed 76 cases of primary carcinoma involving the opposite breast. Twenty‐one of these occurred synchronously, when they were usually associated with elderly patients, a strong family history and an increased delay in presentation. The behaviour of these tumours aw.v unremarkable, though the survival of the patients may have been less than those with single lesions, and in accord with the doubled risk of distant spread and local recurrence. Fifty‐five patients with metachronous lesions did not present initially with features which would help to identify them as being prone to this double pathology. About 50% of the second carcinomas occurred within five years, but the remainder developed at intervals which were in several cases longer than 20 years. The patients did not present earlier on the second occasion, and several had advanced lesions. There was no evidence that the behaviour of the second carcinoma was influenced by immunological factors or patient susceptibility. Implications with regard to management are outlined, and the importance of long‐term follow‐up with regular examination is emphasized.
THE OUTPATIENT DIAGNOSIS OF BREAST LUMPS
Authors: Magarey Christopher J. , Watson Warren J.
Published: August 2010

A plan of management, based on a personal experience of 421 cases, has been developed for the outpatient diagnosis of breast symptoms. In the majority of patients the presence or absence of malignancy can be established with a high degree of certainty before biopsy, and benign masses can be safely excised on an outpatient basis. Only those patients whose breast symptoms and findings suggest malignancy need be admitted to hospital and prepared for major breast surgery. This plan has been shown to be safe, while avoiding unnecessary hospital bed occupancy.
ADJUVANT SYSTEMIC THERAPY IN “EARLY” BREAST CANCER
Authors: Cant Elizabeth L. McK.
Published: August 2010

“Early” breast cancer is a systemic disease in the majority of cases. Progress has been and is being made toward the determination of those women at risk of recurrence. Attractive as it seems, the value of systemic adjuvant therapy, given at the time of minimal tumour load, i.e., after mastectomy, is not proven. Therefore, for the average case it is better to treat the cancer locally and to observe and leave further evaluation of systemic therapy to those centres which are able to conduct controlled, randomized trials.
PYOGENIC OSTEOMYELITIS OF THE SPINE
Authors: Hooper Jonathan , Griffin Philip
Published: August 2010

The records of 30 patients who had suffered from vertebral osteomyelitis were reviewed. They conformed to a constant pattern, though varying in terms of: (i) the severity of the disease, due to host‐organism interrelationship; and (ii) age distribution. Causative organisms could not always be identified, though all lesions settled with conservative measures of rest and antibiotics. A high proportion of the patients who were followed up for more than one year were back at work. The anatomical distribution of the lesions can be explained by our knowledge of the vascular supply to the vertebral bodies.
THE PERITONEAL COMPLICATIONS OF VENTRICULO‐PERITONEAL SHUNTS1
Authors: King Philip
Published: August 2010

One hundred and two patients with ventriculo‐peritoneal shunts were studied. The aim of the study was to record the complications caused by the peritoneal end of the catheter and the frequency with which they occurred. Some of the complications involving tube migration arc illustrated by case reports emphasising the possible morbidity and mortality that may be associated with this problem. Fifty‐one patients in the series had a complication; of these, 23 had only a mild temporary intestinal ileus following initial insertion of the shunt system. In the remaining 28 patients, the complications could have been significantly reduced by careful attention to operative detail and a closer follow‐up of the patients following the shunt insertion.
CERVICO‐MEDIASTINAL LYMPHANGIOMA
Authors: Rasaretnam Rudra , Chanmugam D. , Sabanathan K. , Paul A. T. S.
Published: August 2010

Two cases of cervico‐mediastinal lymphangioma presenting in adults are reported. In one the lesion originated in the mediastinum and only when advanced showed extension into the neck. The other was associated with a cervical cystic hygroma. Both were relieved by one‐stage excision. Although they are benign, the tendency of these lesions is to become progressively larger, and to infiltrate between the vital structures in the neck and mediastinum. These features, and the importance of early surgery, are illustrated by the two patients we now report.
URETEROCALYCOSTOMY IN THE MANAGEMENT OF RENAL AND URETERIC TRAUMA: REPORT OF A CASE
Authors: Ahmed Saeed
Published: August 2010

The operation of ureterocalycostomy, although rarely indicated, may occasionally be most useful, and constitute a desirable alternative to removal of an injured kidney. A case of renal transection with avulsion at the pelvi‐ureteric junction, managed successfully by carrying out this procedure, is now reported.
OPERATIVE PANCREATOGRAPHY
Authors: Ham J. M. , Yeo B. W.
Published: August 2010

The results of operative pancreatography in 32 patients with pancreatitis arc reported. The main pancreatic duct was successfully and adequately demonstrated in 30 patients: in 29 by cannulation of the major ampulla, and in one by direct needle puncture of the duct. No films were obtained in one patient, and in another only the accessory duct could be demonstrated. There was thus a high rate of technical success, but the frequency of gross abnormalities of the major pancreatic duct was low, except in those patients with traumatic pancreatitis. These results are relevant to the assessment of the value of endoscopic retrograde cholangiopancreatography in pancreatic disease.
CHRONIC PANCREATITIS: RESULTS OF A PROTOCOL OF MANAGEMENT
Authors: Little J. M.
Published: August 2010

Thirty‐five patients with chronic pancreatitis of varying cause have been treated according to a protocol first introduced in 1979. At the end of a mean follow up time of 2.1 years, only 54% of patients were found to have derived benefit defined by pain relief and improved quality of life. Patients with alcoholic pancreatitis did particularly poorly, and alcoholics who continued to drink almost never benefited. Patients with dilated pancreatic ducts were more likely to do well than those with small ducts, and pancreaticojejunostomy had a satisfactory record of pain relief. Patients with biliary pancreatitis generally did well with cholecystectomy and clearance of the common bile duct. The 40–80% pancreatectomy had a poor record for pain relief, and produced diabetes in the majority of patients in whom it was used. Nothing will reverse the established pathology of chronic pancreatitis, which remains an unsatisfactory condition to treat.
THE PREVENTION OF POSTAPPENDICECTOMY SEPSIS BY METRONIDAZOLE AND COTRIMOXAZOLE: A CONTROLLED DOUBLE BLIND TRIAL
Authors: Chiam H. L. , Chee C. P. , Cheah K. C. , Somasundaram K. , Puthucheary S. D.
Published: August 2010

A double‐blind, randomized controlled trial was carried out in University Hospital, Kuala Lumpur to study the effect of metronidazole and cotrimoxazole on the incidence of wound infection following appendicectomy from November 1978 to January 1980. Patients were allocated at random into one of four groups: cotrimoxazole injection and placebo suppository, metronidazole suppository and cotrimoxazole injection, metronidazole suppository and placebo injection or placebo suppository and placebo injection. Treatment was started 30 min before operation and continued for 72 h. All patients were followed up for 2 weeks and thereafter for one month. A total of 283 patients was finally accepted into the study. Sepsis rates were found to be 27% for the untreated group, 9% for the group receiving metronidazole only, 8% for the group receiving cotrimoxazole injection only and 2.7% for the group receiving both drugs. The study showed that a combination of metronidazole and cotrimoxazole is a regime highly effective for prophylaxis against wound infection following appendicectomy.
THE EFFECT OF BLOOD TRANSFUSION ON THE INCIDENCE OF DEEP VEIN THROMBOSIS
Authors: Gray D. H. , Mackie Cherie E. J.
Published: August 2010

The incidence of postoperative deep vein thrombosis in 120 patients undergoing elective total hip replacement was determined venographicaily. Significantly more blood was administered to those developing thrombosis, particularly in the subgroups given general anaesthesia (P < 0.05). There were no differences in the postoperative haemoglobin values in any of these groups. The distribution of other risk factors identified, namely previous thrombo‐embolism, malignancy and previous vein surgery or injections did not influence this finding. The use of TED stockings (R Kendall) was effective. It is suggested that greater emphasis should be placed on techniques that reduce blood loss such as regional anaesthesia and the posterior approach to the hip. Further research into the fluids used for blood volume maintenance will be beneficial.
MICROCOMPUTERS IN SURGERY: A DATA FILE AND ANALYSIS PROGRAM
Authors: Isbister William H.
Published: August 2010

A microcomputer based patient data file and analysis system is both feasible and useful. One such system is described in this paper. The advantages and disadvantages of the system are discussed. It may be used in many patient‐related specialties and will enable practitioners not only to file their data but more importantly to analyse it so that they can improve their performance and cost‐effectiveness. It is the author's belief that few realize the potential of the microcomputer in clinical practice and many are put off computing and computerized recording and data analysis because of the size and the difficulties that most experience with larger minicomputer‐based facilities.
THE CONTINENT ILEOSTOMY — AN 11 YEAR EXPERIENCE
Authors: Failes D. G.
Published: August 2010

An 11 year experience of the continent ileostomy is reported. Forty‐nine patients have undergone a continent ileostomy during this period. There were 30 females and 19 males. The mean age was 35 years, the youngest 19 and the oldest 58. Forty‐four patients were suffering from chronic ulcerative colitis, four from polyposis coli and one from carcinoma of the rectum and multiple colonic polyps. The majority (41) of operations were carried out as secondary procedures but eight were done as primary procedures. The follow‐up varies from 11 years to three months. There were no deaths. Seventeen patients (34%) required revisional surgery for complications relating to the valve reservoir or stoma. Eleven of these were related to the valve — slipping four, prolapse five, fistula and perforation one each. Three patients had a para‐ileostomy hernia and two a stricture at skin level. Four patients required excision of the reservoir with establishment of an orthodox ileostomy. Eighty‐six per cent of patients are continent and never wear an appliance. The average capacity of the reservoir is 400 ml (range 15CL900). Most patients catheterize three times daily (range 2–6). Eighteen per cent catheterize once at night. The average time for catheterization is 6 min. Provided the procedure is technically satisfactory the continent ileostomy is considered the operation of choice for patients requiring a permanent ileostomy.
PERCUTANEOUS TRANSLUMINAL EMBOLEATION OF VERTEBRAL ARTERY INJURY
Authors: Richardson A. , Soo M. , Fletcher J. P.
Published: August 2010

A patient with vertebral artery injury from penetrating neck trauma was treated by percutaneous transluminal embolization.
UROLOGICAL ANOMALIES IN THE CAUDAL REGRESSION SYNDROME
Authors: Sparnon A. L. , Ahmed S.
Published: August 2010

Two cases of unusual urological anomalies seen in association with the caudal regression syndrome are reported. One patient had bilateral single ectopic ureters with unilateral renal agenesis and the other a megalo‐ureter secondary to a ureteric valve.
RESECTOSCOPICTRANSANAL RESECTION OF EXTENSIVE RECTAL ADENOMAS
Authors: Irwin Robin J.
Published: August 2010

Treatment of many rectal adenomas has hitherto been technically difficult because of poor access and extensive lesion size. Four cases are presented where a large rectal adenoma has been successfully resected using a Standard 28Fr urological resectoscope. This is the first known report of this means of treatment. The speed and ease of the technique and the usually pain‐free and rapid recovery of the patients has been encouraging.
INTRACRANIAL MENINGEAL CHONDROSARCOMA—PROBABLE MESENCHYMALTYPE
Authors: Rodda R. A. , Franklin C. I. V.
Published: August 2010

A 12 year old girl with episodes of left hemiparesis for 9 months was found to have a large, partly calcified brain tumour which at craniotomy presented on the parasagittal and medial surfaces of the right frontal lobe. No dural or falx attachment could be found and naked eye removal of the tumour was achieved. At a second craniotomy 10 weeks later there was recurrent tumour attached to the falx and involving the sagittal sinus. She died 5 months later. Pathologically, almost all this malignant intracranial neoplasm comprised differentiated cartilaginous tumour. Although only a very small amount of undifferentiated mesenchymal tissue was found in the surgical material available for histological study, it is suggested the tumour can be regarded as a predominantly mature mesenchymal chondrosarcoma of the meninges.
CAECAL DIVERTICULITIS
Authors: Randle P. M. , Matz L. R.
Published: August 2010

Ten cases of caecal diverticulitis are reviewed. Caecal diverticulitis is frequently diagnosed as appendicitis pre‐operatively and is difficult to distinguish from carcinoma or inflammatory bowel disease intra‐operatively. The average age of presentation is younger than that of left‐sided colonic diverticulitis. Most of the diverticula are narrow‐neck false diverticula. When diagnosed intra‐operatively hemicolectomy can often be avoided.
ACUTE APPENDICITIS PRESENTING AS A SCROTAL ABSCESS
Authors: Read A. G. , Mcquillan T. C.
Published: August 2010

A 50 year old man presented with scrotal pain of 2 weeks' duration. The finding of acute appendicitis as a scrotal abscess due to perforated appendix in an inguinal hernia is rare, and literature on this finding is reviewed.
INTRAMURAL HAEMATOMA OF THE OESOPHAGUS COMPLICATED BY PERFORATION
Authors: Skillington PeterD. , Matar KevinS. , Gardner MichaelA. H. , Parkes RobertP. F. , Cole PeterH.
Published: August 2010

A case is presented where spontaneous bleeding into the wall of the oesophagus was exacerbated by anticoagulant therapy. Subsequently, iatrogenic, full‐thickness perforation of the oesophagus occurred during endoscopy and ultimately, oesophagcclomy was required. If this condition is suspected on clinical grounds, the most appropriate sequence of investigations would appear to be contrast radiography in the first instance with cautious use of oesophagoscopy.
PRIMARY MUCO‐EPIDERMOID CARCINOMA ARISING IN A PAROTID LYMPH NODE
Authors: Adkins G. F. , Hinckley D. M.
Published: August 2010

A case of well‐differentiated muco‐epidermoid carcinoma in a parotid lymph node is described. This tumour appareitly arose within and was confined to the lymph node. Salivary ductal and acinar inclusions are often found n parotid lymph nodes and these may occasionally give rise to salivary gland tumours, both benign and malignant. The finding of a malignant salivary gland tumour within such a site does not necessarily imply a metastasis from a primary neoplasm elsewhere in the parotid gland.
OPTIMIZATION OF PERIOPERATIVE CARE FOR COLONIC SURGERY: A REVIEW OF THE EVIDENCE
Authors: Zargar‐Shoshtari Kamran , Hill Andrew G.
Published: August 2010

Enhanced recovery after surgery (ERAS) care pathways are becoming increasingly common in colonic surgery. ERAS is a combination of individual strategies that have been shown to be effective in improving care. In this article, we review the evidence surrounding core components of enhanced recovery care pathways for patients undergoing open colonic surgery. We will also identify new elements that should be considered as part of ERAS strategy.
SIMPLIFIED RISK STRATIFICATION IN ELECTIVE COLORECTAL SURGERY
Authors: Bowles Thomas A. , Sanders Kerrie M. , Colson Mark , Watters David A.
Published: August 2010

Background:  Audit is a compulsory part of practice and all outcomes are now scrutinized. Raw results may be used to compare performance but these may not accurately reflect case and patient mix. Risk stratification tools, such as American Society of Anaesthesiologists (ASA) and Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity (POSSUM), have been shown to predict morbidity and mortality at the expense of extra data collection. The Special Cooperative Audit of Rural Surgeons reported that two comorbidities increased mortality from 4% to 16, but this finding has not been confirmed. Our aim was to compare risk stratification tools and confirm or refute if comorbidities are accurate predictors of morbidity and mortality.

Methods:  We made use of an existing colorectal audit, which includes ASA, POSSUM, comorbidities and surgical outcomes. Our anaesthetic department provided data from preoperative cardiopulmonary exercise tests. A poor surgical outcome was defined as death, anastomotic leak and a complication requiring significant intervention.

Results:  Data collection was complete for comorbidities, but only 79% cases had ASA scores, 72% completed POSSUM sets and 39% anaerobic threshold. POSSUM >30, ASA III and two comorbidities were all predictors of mortality and grade 3 complications. Anaerobic threshold <11 mL/min/kg did not predict poor surgical outcome. Anastomotic leak was not predicted by any of the scoring systems.

Conclusion:  ASA, POSSUM and the presence of two comorbidities were significant predictors of mortality and morbidity, excluding anastomotic leaks. Comorbidities are simple to collect and their correlation with outcome compares favourably with POSSUM. Comorbidities are a simple and quick method of risk stratification for colorectal surgery.
PATIENT RECALL AFTER DIAGNOSTIC LAPAROSCOPY FOR ABDOMINAL PAIN
Authors: Omundsen Mark S , Dennett Elizabeth , Walker Heidi C
Published: August 2010

Background:  The purpose of the study was to ascertain how well patients recall their discharge diagnosis and details of their surgical procedure after a diagnostic laparoscopy at our institution.

Methods:  Three hundred and forty‐five patients were identified as being eligible in the study. Patient characteristics and treatment details were recorded. They were then contacted by telephone and 258 patients participated (response rate 75%). They were asked the same seven questions by an investigator who was blinded to their treatment details and their responses recorded.

Results:  The sample consisted of 248 (96%) women and 10 (4%) men. Only seven persons (3%) were incorrect about the state of their appendix. However, 108 persons (42%) were incorrect about their discharge diagnosis. Seventy‐one patients (28%) were unhappy with the information they received while in hospital. Age, whether pathology was found, dissatisfaction or type of operation was not found to significantly influence patient recall of diagnosis.

Conclusion:  We found that patients having a diagnostic laparoscopy at our institution often leave the hospital dissatisfied and with a poor understanding of their discharge diagnosis. This has important implications for future assessments of acute abdominal pain in these patients and can lead to misinformation and unnecessary surgical procedures.
GASTRIN IS NOT REQUIRED FOR LIVER REGENERATION
Authors: Dizdarevic Amra , Harun Nadia , Malcontenti‐Wilson Cathy , Shulkes Arthur , Christophi Christopher , Baldwin Graham S.
Published: August 2010

Background:  Although several growth factors are known to be essential for liver regeneration, the role of gastrin remains controversial.

Methods:  Liver regeneration was examined in wild‐type (WT) and gastrin‐deficient (gastrin KO) mice at days 2 and 10 after partial (40%) hepatectomy by measurement of liver weight. Hepatocyte proliferation and circulating gastrin concentrations were measured at the same time points by immunohistochemistry and radioimmunoassay, respectively.

Results:  There was no significant difference in the rate of liver regeneration between gastrin KO and WT mice. Hepatocyte proliferation in both groups was increased at day 2 but had returned to baseline values by day 10. At day 2, hepatocyte proliferation in the gastrin KO mice was significantly higher than in WT animals, whereas at day 10, proliferation was significantly greater in the WT mice. The circulating gastrin concentration in the WT mice was significantly lower at day 10 than in unoperated WT animals.

Conclusion:  This study suggests that gastrin is not essential for liver regeneration after partial hepatectomy.
CRITICAL EVALUATION: SURGERY FOR UNCOMPLICATED DIVERTICULITIS
Authors: Platell Cameron
Published: August 2010

Aim:  To examine the influence of previous episodes of uncomplicated diverticulitis on the prognosis of patients who subsequently develop complicated diverticulitis.

Patients:  One hundred and fifty patients with previous episodes of diverticulitis who were admitted to the Mayo Clinic (Rochester, MN, USA) with complicated diverticulitis (perforation, abscess, obstruction, phlegmon, fistula, or bleeding).

Design:  The retrospective analysis was based on two groups of patients: group A had one or two prior episodes of diverticulitis (n = 118) and group B had more than two prior episodes of diverticulitis (n = 32).

Measurement of outcome:  The following criteria were used: phlegmon was a symptomatic inflammatory mass separate from and not associated with a purulent fluid collection; pericolic abscess was a collection of purulent material localized near the colon or in the pelvis; obstruction was characterized by obstructive symptoms and a stricture or stenosis diagnosed by radiographic studies or pathological evaluation; fistulas included colovaginal and colovesicular connections; perforation was either a collection of contained air outside the bowel wall or a large amount of free intra‐abdominal air; and patients who required a transfusion for a lower gastrointestinal haemorrhage associated with symptoms and signs of diverticulitis were placed in the bleeding category.

Results:  Perforated diverticulitis occurred more often in patients from group A; because of this, patients in group A underwent more surgical diversions. There were no appreciable differences in operative complications, morbidity or mortality rates.

Conclusion:  Patients with more than two episodes of uncomplicated diverticulitis are not at increased risk for poor outcomes if they develop complicated diverticulitis.
LABORATORY RISK INDICATOR FOR NECROTIZING FASCIITIS SCORE AND THE OUTCOMES
Authors: Su Yi‐Chun , Chen Hung‐Wen , Hong Yu‐Cheng , Chen Chih‐Tsung , Hsiao Cheng‐Ting , Chen I‐Chuan
Published: August 2010

Background:  Laboratory risk indicator for necrotizing fasciitis (LRINEC score) is a simple laboratory tool used to distinguish between necrotizing soft‐tissue infections (NSTI) and other soft‐tissue infections. A LRINEC score of ≥6 is considered as denoting a high risk of necrotizing fasciitis. A certain LRINEC score might also be associated with mortality and other outcomes of patients with NSTI.

Methods:  A review of the medical charts of patients was carried out. The study sites were one tertiary academic centre and one community, university‐affiliated hospital. All adult patients with necrotizing soft‐tissue infections from 2002 to 2005 were selected then LRINEC scores were calculated for each patient. We enrolled patients where there was sufficient information to determine that the LRINEC score was either <6 or ≥6.

Resultsv:  A total of two hundred and nine patients were enrolled and analysed. The overall mortality rate was 33 of 209 (15.8%) and amputation rate was 55 of 209 (26.3%). The amputation rates were defined as numbers of patients who received amputation divided by numbers of total patients. Enrolled patients were divided into two groups. Group I was those whose LRINEC score was <6 and group II was those whose LRINEC score was ≥6. Significant differences in mortality rate (P = 0.04) and amputation rate (P = 0.002) were noted between two groups.

Conclusion:  The LRINEC score is associated with the outcomes of patients with NSTI. Patients with a LRINEC score of ≥6 have a higher rate of both mortality and amputation.
PREOPERATIVE CORE BIOPSY OF SOFT TISSUE TUMOURS FACILITATES THEIR SURGICAL MANAGEMENT: A 10‐YEAR UPDATE
Authors: Woon Dixon T. S. , Serpell Jonathan W.
Published: August 2010

Background:  Soft tissue sarcomas (STS) are rare. More often than not, the possibility of STS is not considered preoperatively and the lesions are enucleated. Enucleation (excisional biopsy) is inappropriate for sarcomas as it compromises the planning of definitive surgery and radiotherapy. Incisional biopsy has been regarded as the biopsy of choice by some, but it has a high rate of wound complications. The aims of the study were (i) to assess the current accuracy of core biopsy in the diagnosis of STS; (ii) to assess whether preoperative core biopsy facilitates the surgical management of soft tissue tumours; and (iii) to evaluate whether there has been an increase in the use of core biopsy before referral.

Methods:  Patients with soft tissue tumours managed by a surgeon with a special interest in soft STS from 1994 to 2007 were reviewed from data collected in a database prospectively. The accuracy of core biopsy in the diagnosis of soft tissue tumours and planning of definitive surgery were assessed.

Results:  Ninety‐four patients with 98 lesions were reviewed. Sixty‐eight lesions had core biopsy. The overall sensitivity of core biopsy in diagnosing soft tissue tumours was 83.6%. It has a sensitivity of 91.3% and specificity of 100% for malignant STS.

For patients who had core biopsy, 95% had one‐stage surgery; those who had no core biopsy, only 45% had one‐stage surgery (P value <0.001).

Conclusions:  Core biopsy is accurate in the diagnosis of soft tissue tumours. It is safe and does not have the complications of open biopsy. It enables most patients to have one‐stage surgery.
LAPAROSCOPY IN SUSPECTED ABDOMINAL TUBERCULOSIS IS USEFUL AS AN EARLY DIAGNOSTIC METHOD*
Authors: Krishnan Prasad , Othiyil Vayoth Sudheer , Dhar Puneet , Surendran Sudhindran , Ponnambathayil Shaji
Published: August 2010

Background:  Establishing a histological diagnosis in abdominal tuberculosis can be difficult, frequently delaying treatment. The aim of the study was to evaluate the role of laparoscopy for ascertaining the diagnosis in suspected abdominal tuberculosis.

Methods:  A retrospective review was undertaken of patients who underwent diagnostic laparoscopy for suspected abdominal tuberculosis over a 6‐year period, analysing its usefulness in establishing a histological diagnosis.

Results:  From May 1999 to April 2005, 131 patients underwent diagnostic laparoscopies in our institution, of which 41 patients had unknown aetiologies for ascites or abdominal pain. This subset of patients had been investigated for suspected abdominal tuberculosis with biochemical tests of serum and ascitic fluid; ultrasound and computed tomography scanning, upper and lower gastrointestinal endoscopies and contrast series, before being considered for diagnostic laparoscopy. None had manifest extra‐abdominal tuberculosis. At laparoscopy, 39 of these patients (95%) had peritoneal nodules. Frozen‐section biopsy from the peritoneal nodules established the diagnosis of tuberculosis in 33 patients (80%) whereas metastatic adenocarcinoma was reported in 6 (14%). Permanent sections confirmed the diagnosis of tuberculosis in all 33 patients. Only 2 (5%) patients had no findings on laparoscopy; nevertheless, on continuing follow up, no sinister diagnoses were made for these patients.

Conclusion:  In patients suspected to have abdominal tuberculosis without evidence of extra‐abdominal disease, early laparoscopy may be useful to establish a histological diagnosis with acceptably low morbidity (8%). Frozen section is useful to assess adequacy of biopsy and sampling. An extensive work‐up may hence be averted by a timely laparoscopy and early treatment can be instituted.
RISK‐ADJUSTED GENERAL SURGICAL AUDIT IN OCTOGENARIANS
Authors: Nichols Kirstin G. , Prytherch David R. , Fancourt Micheal F. , Gilkison William T. C. , Kyle Stephen M. , Mosquera Damien A.
Published: August 2010

Background:  Surgical admissions in patients more than the age of 80 years are increasing. Age‐related comorbidities place this group at particular risk of complications and death. The aim of this study was to specifically document our current outcomes in patients more than 80 years old admitted to a surgical unit, in particular, to assess the risk‐adjusted scoring tool used to predict outcomes in this patient population for operative and non‐operative patients.

Methods:  A prospective audit of all patients older than 80 years admitted to the general surgical unit between the 1 January and 30 November 2006 was carried out. Morbidity and mortality data were collected on standardized pro forma.

Results:  There were 243 consecutive admissions in 223 surgical patients (readmission 8.2%, n = 20) comprising 70 emergency admissions (28.8%), 82 elective admissions (33.8%) and 91 non‐operative admissions (37.5%). Complications occurred in 47.1% of emergency admissions, 18.3% of elective admissions and 23.3% of non‐operative admissions. Thirty‐day mortality was 15.7% (n = 11) for emergency admissions, 0% for elective admissions and 17.4% (n = 16) for non‐operative admissions. Emergency laparotomy 30‐day mortality was 31.6% (n = 6). There was no evidence of lack of fit when using the risk‐adjusted scoring tool to compare observed with predicted deaths in all patient groups.

Conclusion:  In all patients more than the age of 80 years admitted to General Surgery, Taranaki Base Hospital, morbidity and mortality results were acceptable when compared with published work. Risk‐adjusted prediction of mortality compared favourably with observed outcomes, but more data are required to validate this tool in elective patients.