bluuebunny/crossref_metadata_2025 huggingface dataset:
Improvement of 2D‐PAGE Resolution of Human, Porcine and Equine Follicular Fluid by Means of Hexapeptide Ligand Library
Authors: Fahiminiya S , Labas V , Dacheux JL , Gérard N
Published: August 2010

Contents

The major challenge of follicular fluid proteomic analysis is the presence of high‐abundance proteins that originate from plasma. These proteins can prevent the detection of lower abundant ones, produced locally by follicle cells and that may have important roles in follicular activity. In this study, the novel technology called hexapeptide ligand library was evaluated to enrich the low‐abundance proteins in follicular fluid of human (HFF), porcine (PFF) and equine (EFF) prior 2D‐PAGE. Our results showed that the new strategy enabled detection of many new protein spots, increased resolution and highly improved the intensity of low‐abundance proteins by 2D‐PAGE.
Short‐stay rural and remote placements in dental education, an effective model for rural exposure: A review of eight‐year experience in Western Australia
Authors: Kruger Estie , Tennant Marc
Published: August 2010

Objectives:  The increase in demand for dental care over the next 10 years is expected to outstrip the supply of dental visits in Australia, resulting in an ongoing shortage of dental practitioners. As trends in medicine have shown, the greatest effect will be felt in rural and remote regions, where an undersupply of dentists already exists. It is clearly evident that it is important to provide strategies that will increase the recruitment and retention of practitioners in rural and remote areas. Previous research suggested an increased likelihood for health graduates to choose rural practice if they have a rural background, or were exposed to rural practice during their education. Short‐stay (three to four weeks) placements for final‐year dental students has been part of dental education in Western Australia for near on a decade.

Methods:  This paper reflects on the experiences gained from managing this placement program.

Conclusions:  Short‐stay placements are a quality learning initiative but need a high level of planning and a clear vision to be effective.

Implications:  The key factors in ensuring sustainable, student centred learning is driven through a small core group of staff who have strong direct links with rural and remote communities, students and support providers. The integration of service, education and research goals have played a critical role in sustaining placements. The philosophy underpinning the rural placements needs to be clearly articulated and applied effectively in each step of their implementation and a highly focused customer‐service driven implementation is required to make short‐stay rural and remote placements effective.
Hepatic natural killer and natural killer T cells markedly decreased in two cases of drug‐induced fulminant hepatic failure rescued by living donor liver transplantation
Authors: MIYAKAWA RYOKO , ICHIDA TAKAFUMI , YAMAGIWA SATOSHI , MIYAJI CHIKAKO , WATANABE HISAMI , SATO YOSHINOBU , YOKOYAMA HISASHI , TSUKADA CHIKA , ISHIMOTO YUIKO , SUGAHARA SATOSHI , YANG XIU HUA , ABO TORU , ASAKURA HITOSHI
Published: August 2010

Abstract  The human liver contains significant numbers of innate immune cells, such as natural killer (NK) cells and natural killer T (NKT) cells, which express both T‐cell receptors and NK‐cell receptors simultaneously. It has been suggested that the innate immune system plays a crucial role in the liver. In this report, the distribution of NK and NKT cells in the liver and peripheral blood of two patients with drug‐induced fulminant hepatic failure (FHF) who had undergone living donor liver transplantation was examined. In both the liver and peripheral blood, the proportions of NK and NKT cells markedly decreased compared with those in healthy donors. It was also revealed that, unlike murine NKT cells, human CD56+ T cells and CD57+ T cells did not constitutively express CD28, which is one of the important costimulatory molecules on T cells. Additionally, the residual CD56+ T cells and CD57+ T cells in the patients expressed more CD28 than in controls. This result suggests that NKT cells might be more activated in FHF. Although the accumulation of further cases is required, it is suggested that both NK and NKT cells might be involved in hepatic injury in FHF.
Pancreatic tumor associated with pancreas divisum
Authors: KAMISAWA TERUMI , YOSHIIKE MASAMI , EGAWA NAOTO , TSURUTA KOUJI , OKAMOTO ATSUTAKE , FUNATA NOBUAKI
Published: August 2010

Background:

Although there has been considerable controversy regarding pancreas divisum and pancreatitis, little discussion of this has taken place. The purpose of the present paper was to investigate the relationship between these two conditions.

Methods:

A retrospective investigation was undertaken of pancreatic tumors associated with pancreas divisum, in 650 cases of pancreatic carcinoma, 80 cases of intraductal papillary mucinous tumor of the pancreas and 32 cases of pancreas divisum.

Results:

Of these 32 cases, four (12.5%) were associated with pancreatic tumor: pancreatic carcinoma (n = 3) and intraductal papillary mucinous tumor (n = 1). All tumors developed from the dorsal pancreas of pancreas divisum. Periductal and interlobular fibrosis detected in the non‐carcinomatous pancreas of the margin of distal pancreatectomy implied that chronic dorsal pancreatitis associated with pancreas divisum preceded carcinoma.

Conclusions:

Pancreatic tumors were detected in 12.5% of cases of pancreas divisum. In pancreas divisum, longstanding pancreatic duct obstruction caused by relative stenosis of the minor duodenal papilla might be a factor promoting oncogenesis.

© 2005 Blackwell Publishing Asia Pty Ltd
Human immunodeficiency virus and endoscopy: Experience of a general hospital in Singapore
Authors: CHONG VUI HENG , LIM CHEE CHIAN
Published: August 2010

Introduction:  As the human immunodeficiency virus (HIV) pandemic continues, demand on the endoscopic services will also increase. The aim of the present study was to characterize the characteristics and endoscopic findings of HIV‐infected Asian patients.

Methods:  Patients with HIV/AIDS who had endoscopy from January 1997 to September 2002 were identified and retrospectively reviewed.

Results:  There were 125 patients (male, 111; mean age: 43.2 ± 11 years; mean CD4 count 63 ± 85/mm3, range, 1–342/mm3) who underwent 181 procedures (upper gastrointestinal endoscopy [UGIE], n = 141; lower gastrointestinal endoscopy [LGIE], n = 40). The median time from diagnosis to endoscopy was 240 days (−660 to 4680 days). For UGIE the main findings were candidiasis, 23.1%; cytomegalovirus esophagitis/ulcers, 11.2%; duodenal ulcers, 8.4%; gastric ulcers, 7.0%; portal‐hypertensive‐related changes, 6.3%; idiopathic esophageal ulcers, 3.5%; herpes simplex esophagitis/ulcers, 3.5%; and tuberculosis, 2.1%. The CD4 counts were significantly lower in those with opportunistic infections (P = 0.004) but there was no difference between significant and non‐significant findings (P = 0.191). For LGIE 35% had endoscopic colitis, 80% of which were non‐specific. Significant findings were ileal tuberculosis, n = 3; colon cancer, n = 1; and colonic fistula, n = 1. Ten patients had undergone 16 procedures (UGIE, n = 13; LGIE, n = 3) prior to the diagnosis of HIV/AIDS. They were all male Chinese patients, with positive contact with commercial sex workers (CSW) and had lymphopenia at time of endoscopy. The median time from endoscopy to diagnosis was 180 days (range, 1–660 days). There were no significant differences in age (P = 0.512) and CD4 count at diagnosis (P = 0.066) between patients who had endoscopy before and after diagnosis of HIV/AIDS. Four procedures led to the suspicion of HIV.

Conclusions:  Endoscopic findings of symptomatic HIV Asian patients are comparable to those of the West. Universal precautions should always be exercised in all procedures to avoid transmission of disease.
Expression of cytochrome P450 enzymes in hepatic organoid reconstructed by rat small hepatocytes
Authors: MIYAMOTO SHIGEKI , HIRATA KOICHI , SUGIMOTO SHINICHI , HARADA KEISUKE , MITAKA TOSHIHIRO
Published: August 2010

Background and Aims: Small hepatocytes (SH), which are hepatic progenitor cells, were isolated from an adult rat liver. SH in a colony sometimes change their shape from small to large and from flat to rising/piled‐up. The morphological changes of SH may be correlated with hepatic maturation. Cytochrome P450s (CYP) are drug‐metabolizing enzymes and the expression is one of hepatic differentiated functions. However, it is well known that the re‐expression and maintenance of CYP activity are very difficult in cultured hepatocytes. We investigated the expression of CYP and the enzymatic activities in long‐term cultured SH.

Methods: SH were isolated from adult rat livers and SH colonies were collected, replated on new dishes, and then cultured. CYP1A1/2, CYP2B1, CYP3A2, CYP4A1, and CYP2E1 were induced by the addition of 3‐methylcholanthrene, phenobarbital, pregnenolone‐16α‐carbonitrile, clofibric acid, and ethanol, respectively. Immunocytochemistry, immunoblots, and enzyme activities were examined.

Results: SH could differentiate into mature hepatocytes by the addition of Matrigel and re‐express constitutive CYPs. The expression of CYP1A1/2, CYP2B1, CYP3A2, and CYP4A1 dose‐dependently increased and the amounts gradually increased with time in culture, especially in the cells treated with Matrigel. Activities of CYP1A, CYP2B, CYP3A and CYP2E in SH treated with Matrigel induced by each of the inducers were approximately 120‐fold, 2.8‐fold, 6.4‐fold and 0.8‐fold higher than in the control.

Conclusion: The matured SH could re‐express the constitutive CYP and recover inducibility, not only of protein expression but also of enzyme activities.
Effects of growth factors on the growth and differentiation of mouse fetal liver epithelial cells in primary cultures
Authors: KAWASAKI TAKAKO , TAMURA SHINJI , KISO SHINICHI , DOI YOSHINORI , YOSHIDA YUICHI , KAMADA YOSHIHIRO , SAEKI AYUKO , SAJI YUKIKO , MATSUZAWA YUJI
Published: August 2010

Background and Aims:  Growth factors (GF) are thought to affect the growth and differentiation of hepatocytes during liver development. However, in the midfetal liver, little is known concerning the role of GF.

Methods:  The DNA synthesis of fetal liver epithelial cells (FLEC) in monolayer culture and the liver‐specific gene expressions of FLEC in 3‐D culture were examined in medium supplemented with various GF.

Results:  DNA synthesis of FLEC was higher than that of adult hepatocytes without GF, and was increased by hepatocyte growth factor (HGF), heparin‐binding epidermal growth factor‐like growth factor (HB‐EGF), basic fibroblast growth factor (bFGF), epidermal growth factor (EGF) or transforming growth factor‐alpha (TGF‐α). However, FLEC responded less to GF in terms of DNA synthesis than adult hepatocytes. The liver‐specific gene expressions were increased in the presence of HGF, HB‐EGF, bFGF and EGF. In embryonic day (E) 13.5 FLEC, this increase was more apparent in the presence of HB‐EGF, whereas in E14.5 FLEC, it was more apparent in the presence of HGF.

Conclusions:  Hepatocyte growth factor, HB‐EGF, bFGF, EGF and TGF‐α increased DNA synthesis of FLEC. HGF, HB‐EGF, bFGF and EGF led to an increase in liver‐specific gene expressions; and their effects on differentiation differ as a function of gestation age.
Chronic hepatitis B virus infection in the Asia–Pacific region and Africa: Review of disease progression
Authors: LIN XIMIN , ROBINSON NOAH J , THURSZ MARK , ROSENBERG DANIEL M , WEILD ANDREW , PIMENTA JEANNE M , HALL ANDREW J
Published: August 2010

Abstract  Countries in the the Asia–Pacific region and Africa tend to have the highest prevalence of hepatitis B infection worldwide. Hepatitis B infection progresses from an asymptomatic persistently infected status to chronic hepatitis B, cirrhosis, decompensated liver disease and/or hepatocellular carcinoma. The aim of this review was to summarize rates and risk factors for progression between disease states in the Asia–Pacific region and Africa. A literature search was conducted employing MEDLINE and EMBASE (1975–2003) using the following key words: hepatitis B, natural history, disease progression, cirrhosis, hepatocellular carcinoma, mortality, Africa and the Asia–Pacific region. Bibliographies of articles reviewed were also searched. Ranges for annual progression rates were: (i) asymptomatic persistent infection to chronic hepatitis B, 0.84–2.7%; (ii) chronic hepatitis B to cirrhosis, 1.0–2.4%; and (iii) cirrhosis to hepatocellular carcinoma, 3.0–6.6%. Patients with asymptomatic persistent infection and chronic hepatitis B had relatively low 5‐year mortality rates (<4%); rates (>50%) were much higher in patients with decompensated liver disease and hepatocellular carcinoma. No data were found for progression rates in African populations. Hepatitis B e antigen was a risk factor for chronic hepatitis B, and bridging hepatic necrosis in chronic hepatitis B increased the risk of cirrhosis. Risk factors for hepatocellular carcinoma included cirrhosis, co‐infection with hepatitis C virus, and genetic and environmental factors. In this review, wide ranges of disease progression estimates are documented, emphasizing the need for further studies, particularly in Africa, where progression rates are largely not available. Summarizing information on factors associated with disease progression should assist in focusing efforts to arrest the disease process in those at most risk.
Precore stop codon mutation of hepatitis B virus is associated with low breakthrough rate following long‐term lamivudine therapy
Authors: SHIN JUNG WOO , CHUNG YOUNG‐HWA , CHOI MIN HEE , KIM JEONG A , RYU SOO HYUNG , JANG MYOUNG KUK , KIM IN SOOK , PARK NEUNG HWA , LEE HAN CHU , LEE YUNG SANG , SUH DONG JIN
Published: August 2010

Background:  Frequent viral breakthroughs limit the usefulness of lamivudine in the treatment of chronic hepatitis B (CHB). The purpose of the present study was to evaluate the effects of precore stop codon mutation (G to A mutation at nucleotide 1896; A1896) of hepatitis B virus (HBV) on the occurrence of viral breakthrough following lamivudine therapy.

Methods:  Among 260 consecutive CHB patients treated with lamivudine for >12 months, 231 patients whose pretreatment sera were available were tested for A1896 variant of HBV using direct sequencing.

Results:  Between patients with A1896 variant (n = 74) and those without it (n = 157), there was no difference in age, gender, serum alanine aminotransferase (ALT) level, the duration of therapy and prevalence of core promoter mutants. Serum hepatitis B e antigen (HBeAg) positivity and HBV‐DNA level were lower (P = 0.00 and P = 0.01) and liver cirrhosis was more commonly associated in patients with A1896 variant mutant compared with those without it. In univariate analysis, viral breakthrough was more frequent in HBeAg‐positive patients (P = 0.03) and in those with high serum HBV‐DNA level (P = 0.01) as well as in those without A1896 variant (P = 0.01). However, in multivariate analysis, the absence of A1896 variant (P = 0.02) and high serum HBV‐DNA level (P = 0.03) were independent factors for viral breakthrough following lamivudine therapy. The cumulative viral breakthrough rates at 1 and 2 years were much lower in patients with A1896 variant compared with those without it (P = 0.01).

Conclusion:  The stop codon mutation at the precore region of HBV in addition to low serum HBV‐DNA level may be associated with low breakthrough rate following lamivudine therapy.
Survival in hepatocellular carcinoma: Impact of screening and etiology of liver disease
Authors: KEMP WILLIAM , PIANKO STEPHEN , NGUYEN SHARA , BAILEY MICHAEL J , ROBERTS STUART K
Published: August 2010

Background and Aims:  As the merits of screening at‐risk populations for hepatocellular carcinoma (HCC) remain unclear, we compared the clinico‐pathologic features and survival of patients with cirrhosis and HCC detected by screening (Group A) to that in non‐screened cases (Group B).

Methods:  We studied cirrhotics who developed HCC between 1994 and 2002. During this period, cirrhotics managed by the Gastroenterology Unit were regularly screened at 6–12 monthly intervals while those managed by other hospital units were not. Demographic data, tumor details, treatment received and survival were recorded and compared according to screening status.

Results:  There were 96 cases identified; 41 by screening (group A) and 55 by non‐screening methods (Group B). HCC in Group A were smaller (P < 0.01), more likely unilobar (P < 0.01), at an early stage (P < 0.0005) and before vascular invasion (P < 0.005) than Group B cases. The frequency of hepatic surgery and/or local ablation was higher in Group A than Group B (P = 0.001). Overall median survival of Group A was 882 days versus 99 days in Group B (P < 0.0001). One‐ and 3‐year probabilities of survival in Group A were 89% and 38%, versus 33% and 19% in Group B (P < 0.001). Independent predictors of survival included screening, Child‐Pugh score, creatinine, tumor stage and absence of alcohol as the etiology.

Conclusions:  Screening for HCC in cirrhosis identifies tumors at an earlier stage, results in a higher chance of receiving curative treatment and possibly improves patient survival. The absence of alcoholic liver disease impacts favorably on survival.
Age‐related analysis of functional outcome and quality of life after restorative proctocolectomy and ileal pouch‐anal anastomosis for familial adenomatous polyposis1
Authors: Erkek Ayhan B , Church James M , Remzi Feza H
Published: August 2010

Background:  The aim of the present study was to evaluate the influence of a younger age at the time of ileal pouch‐anal anastomosis (IPAA) on functional outcome and quality of life in patients with familial adenomatous polyposis (FAP).

Method:  A total of 105 patients with FAP who had undergone IPAA were retrieved from a dedicated Institutional Review Board (IRB)‐approved IPAA database. Fifty‐three patients who had complete follow‐up data at 1, 3 and 5 years were included in the study. Patients were categorized into three groups according to their ages at the time of surgery. Group 1, patients ≤20 years of age (n = 9); group 2, patients >20 and ≤40 years of age (n = 23); and group 3, patients >40 years of age (n = 21). Perioperative characteristics, postoperative complications, quality of life scores and functional outcome at 1, 3 and 5 years of postoperative follow‐up were assessed.

Results:  At any time point, there were no significant differences among the groups in terms of perioperative characteristics, quality of life scores or level of satisfaction with the procedure. However, younger patients had significantly lower nocturnal bowel movements at the first and third years of follow‐up and tended to have less bowel movements per day at all stages of follow‐up.

Conclusion:  These findings indicate that younger patients with FAP are inclined to have better functional outcome after IPAA in the early postoperative period. This finding may be encouraging for colorectal surgeons who will operate on young patients with FAP.
Long‐term gastroesophageal reflux disease therapy improves reflux symptoms in elderly patients: Five‐year prospective study in community medicine
Authors: Miyamoto Masaki , Haruma Ken , Kuwabara Masao , Nagano Makoto , Okamoto Takeshi , Tanaka Mio
Published: August 2010

Background:  Gastroesophageal reflux disease (GERD) impairs the patient's quality of life (QOL), but the effect of long‐term maintenance therapy in elderly patients is unknown.

Methods:  We conducted a long‐term prospective study. Forty‐four GERD patients (11 males; mean age 74 years; QUEST score of at least 6 points) were enrolled in this study. Step‐down therapy was selected (proton‐pump inhibitor [PPI], histamine‐2 receptor antagonist and prokinetic agents for 1 month, respectively). Optimal medication for each patient was continued for 5 years. The efficacy, safety of treatment and reflux symptoms were analyzed. The profiles of the patients who had to continue PPI maintenance therapy were also analyzed.

Results:  Reflux symptoms were reduced by the PPI based step‐down therapy (baseline 13.8 times/month, after 3.2 times/month, P < 0.001). Reflux symptoms improved in 34 patients (77%). None of the 44 patients had to cease treatment because of side‐effects and none experienced any complications during the 5‐year period. The prevalence of Helicobacter pylori (Hp) infection in the PPI group (29%, 4/14) was significantly lower (P < 0.01) than in the other treatment group (72%, 21/29). The serum pepsinogen I/II ratio in the PPI treatment group (5.7 ± 0.5) was significantly higher (P < 0.01) than in the others (4.0 ± 0.3). The predictive factors for PPI maintenance therapy were Hp‐negative status and serum pepsinogen I/II ratio >6.0 (odds ratio 12.0, 95% confidence interval 2.7–54.2).

Conclusions:  Long‐term medication for GERD selected on the basis of the patient's profile (i.e. Hp status and gastric atrophy) improved reflux symptoms.
Clinical analysis of primary duodenal adenocarcinoma: An 11‐year experience
Authors: Hung Fu‐Chih , Kuo Chung‐Mou , Chuah Seng‐Kee , Kuo Chung‐Huang , Chen Yaw‐Sen , Lu Sheng‐Nan , Chang Chien Chi‐Sin
Published: August 2010

Background and Aim:  The impact of obstructive jaundice (OJ) complicated by primary duodenal adenocarcinoma (PDA) on survival, and its treatment options, has rarely been mentioned in literature. The aim of the present study was to review the clinical features of PDA patients in an attempt to determine the prognostic factors and the influence of OJ on survival.

Methods:  From May 1994 to February 2005, all duodenal malignancies treated at Kaohsiung Chang Gung Memorial Hospital were reviewed. Preliminary findings were made on a total of 116 duodenal adenocarcinoma (DA) cases. After excluding metastatic DA and the papilla of Vater cancer, 23 patients (19.8%), confirmed as having PDA, were enrolled.

Results:  Among the 23 predominantly male patients with a mean age of 68 years, abdominal pain was the most common symptom. Major tumor origin was the second portion, and the predominantly cytological feature was moderate differentiation. Tumor‐node‐metastasis (TNM) cancer stage IV accounted for 47.8% of the patients, and cancer‐directed surgeries (CDS) were performed on 11 patients. Seven patients experienced complications due to OJ, which could be a sign of grave prognosis predicting survival of less than 1 year. Four of the patients received internal or external biliary drainage before CDS or palliative surgeries. Cigarette smoking, cytology, TNM stage, aspartate aminotransferase (AST), OJ, and CDS were significant factors of overall survival in a univariate analysis. The independent predictors of long‐term survival were CDS, TNM stage, cytology, cigarette smoking, and AST using the Cox proportional hazard model.

Conclusion:  PDA patients who did not smoke and who were eligible for and received CDS had better prognostic outcomes.
Chronic obstructive pulmonary disease in the absence of chronic bronchitis in China
Authors: LU Ming , YAO Wanzhen , ZHONG Nanshan , ZHOU Yumin , WANG Chen , CHEN Ping , KANG Jian , HUANG Shaoguang , CHEN Baoyuan , WANG Changzheng , NI Diantao , WANG Xiaoping , WANG Dali , LIU Shengming , LU Jiachun , SHEN Ning , RAN Pixin
Published: August 2010

Background and objective:  COPD has a variable natural history and not all individuals follow the same course. The aim of this study was to assess the prevalence of COPD in the absence of chronic bronchitis (CB) based on a population survey in China, and to identify the determinants of CB in patients with COPD.

Methods:  A multi‐stage cluster sampling strategy was used to survey a population from seven different provinces/cities of China. All residents over 40 years of age were interviewed using a standardized questionnaire and spirometry was measured. A post‐bronchodilator FEV1/FVC < 70% was defined as the diagnostic criterion for COPD. All COPD patients who were screened were divided into two groups according to the presence or absence of CB.

Results:  Of the population of 20 245 that was surveyed, 70% of the 1668 patients who were diagnosed with COPD reported no history of CB. The ages, BMI and comorbidities of COPD patients with or without CB were similar. Male gender, residence in a rural area, having a lower level of education, exposure to tobacco smoke or biomass fuels, poor ventilation in the kitchen and a family history of respiratory disease were all associated with a higher risk of COPD with CB. Patients without CB had less difficulty in walking and higher FEV1/FVC values than patients with CB, but were more likely to be underdiagnosed. The strongest predictors of CB were male gender, current smoking and severity of dyspnoea.

Conclusions:  This survey confirmed that there is a high prevalence of COPD in the absence of CB in China. It appears that CB is not essential to the diagnosis of COPD.
Obstructive sleep apnoea is associated with risk factors comprising the metabolic syndrome
Authors: AKAHOSHI Toshiki , UEMATSU Akihito , AKASHIBA Tsuneto , NAGAOKA Kenichi , KIYOFUJI Kouji , KAWAHARA Seiji , HATTORI Tomohiro , KANEITA Yoshitaka , YOSHIZAWA Takayuki , TAKAHASHI Noriaki , UCHIYAMA Makoto , HASHIMOTO Shu
Published: August 2010

Background and objective:  Several features of OSA syndrome suggest that it is a manifestation of the metabolic syndrome (MS). In this study, we investigated the prevalence of the MS among male Japanese patients with OSA, as well as the relationship between OSA in non‐obese patients and components of the MS other than obesity (hypertension, dyslipidaemia and glucose intolerance).

Methods:  The study included 416 Japanese men who were diagnosed as having OSA by polysomnography. Among these, 101 non‐obese patients were selected and the severity of OSA, as well as the prevalence of hypertension, dyslipidaemia and glucose intolerance, was assessed.

Results:  The MS was associated with OSA in 218/416 patients (52.4%). A significant increase in the prevalence of the MS was associated with increased severity of OSA, as categorized according to AHI. In the non‐obese patients with OSA (mean age 57.6 years, BMI 22.7 kg/m2, AHI 34.3 events/h), hypertension, dyslipidaemia and glucose intolerance were identified in 70 (69.3%), 43 (42.6%) and 20 patients (19.8%), respectively. At least two of these factors were identified in 40 patients (39.6%). Non‐obese patients with severe OSA had a significantly higher prevalence of two or more of these factors (33/59 patients, 55.9%).

Conclusions:  Although Asians are generally less obese than Caucasians, the prevalence of the MS was high among Japanese patients with OSA, and even among non‐obese patients, OSA was associated with risk factors for the MS.
THE RATIONAL USE OF BLOOD1
Authors: Beal R. W.
Published: August 2010

A rational approach to the use of blood entails careful assessment of blood loss in the individual patient and a clear awareness of the advantages and disadvantages which may follow the use of whole blood. The use of red cell concentrates in preference to whole blood has therapeutic and immunological advantages for a majority of patients. Predictable changes which follow massive transfusion must be assessed and appropriate steps taken to minimize any undesirable results in the patient. A protocol for emergency transfusion is outlined.
INFECTION IN THE INTENSIVE CARE UNIT
Authors: Clarke Bernard
Published: August 2010

An epidemic of infection associated with Serratia marcescens and other Gram‐negative organisms resistant to aminoglycosides and other chemotherapeutic agents occurred in the Intensive Care Unit, and spread to other areas of the hospital. This paper describes the problems of sepsis in the critically ill patient, outlines the occurrence of organisms in the patients concerned in this epidemic, and discusses the policies adopted to control the incidence of life‐threatening infection caused by bacteria resistant to all other agents.
SELECTIVE SURGERY FOR CARCINOMA OF THE RECTUM
Authors: Mason A. York
Published: August 2010

The importance of selecting the best operation for each patient in the management of carcinoma of the rectum is emphasized. Selection must be based upon many factors, including the level of the lesion, and the mode and extent of spread. Using these important guidelines, the place of local excision, tube resection, and abdominal resection with anastomosis by the transsphincteric approach are discussed and the techniques described.
A FIFTEEN‐YEAR STUDY OF BREAST CANCER IN TASMANIA
Authors: Shugg D. , Shepherd J. J. , Sundstrup B. , Holden H. , Mltchell R. M.
Published: August 2010

Seven hundred and seventy‐nine patients presenting with breast cancer in Tasmania between 1960 and 1073 have been studied. No comparisons of different treatment have been made, but overall survival has been assessed. Median survival in the group was only 3‐3 years, but 30% of patients were still alive at ten years. Other factors assessed in relation to survival were axillary node involvement, site, size, age, parity, breast feeding and place of birth.
THE POSSIBLE RELATIONSHIP BETWEEN MAMMARY DYSPLASIA AND BREAST CANCER
Authors: Renwick1 Stuart B.
Published: August 2010

The literature concerning a possible association between benign mammary dysplasia and breast cancer is reviewed. Prospective studies confirm a higher increase in the incidence of breast cancer in patients with clinically and biopsy proven benign mammary dysplasia than in those in whom it has not shown to be present. A plea is made for active follow‐up of these patients.
THE EARLY DIAGNOSIS AND TREATMENT OF CONGENITAL DISLOCATION OF THE HIP
Authors: Paterson Dennis
Published: August 2010

In 1964, a screening programme was commenced in South Australia to diagnose and treat congenital dislocation of the hip in the neonatal period. The purpose of this paper is to present the findings of a statistical review of cases seen at the Queen Victoria Hospital during 1971 and 1972. Related factors, and the recommended method of treatment, are discussed, along with problems of early diagnosis and treatment of newborn children found to have unstable hips.
THE ANTERIOR APPROACH TO THE ADRENAL GLAND
Authors: Russell Ian S. , Corbet John
Published: August 2010

The traditional approach to the adrenal gland is via a loin incision. While this is frequently the ideal approach for unilateral disease if both adrenals are to be examined or removed the surgeon must choose between bilateral loin incisions and a transabdominal approach. A bilateral posterior approach may be made with the patient in a prone, semi‐jacknife position. This, however, is often unsuitable for sick patients, and of course does not permit the surgeon to perform a laparotomy or simultaneous oophorectomy if this is considered necessary. We feel, therefore, that an anterior approach merits serious consideration.
BREAST LOSS AND DELAY IN BREAST CANCER DIAGNOSIS: BEHAVIOURAL SCIENCE IN SURGICAL RESEARCH1
Authors: Magarey Christopher J. , Todd Peter B.
Published: August 2010

By the use of the methods of behavioural science, a study of women's attitudes to breast cancer and to breast surgery was carried out to provide firm data which might begin to settle the argument regarding conservative surgery for breast cancer. Conscious fears, including that of mastectomy, were found to have no significant influence on the time that a woman takes to report the presence of a breast lump to her doctor, or to commence the practice of breast self‐examination. The length of delay is determined by unconscious, non‐rational processes, and other factors beyond her control. Rational argument, therefore, such as that earlier diagnosis will permit more conservative surgery including partial mastectomy, zmll not influence women to present any earlier or to practise breast self‐examination.
THE USE OF DIRECTIONAL DOPPLER ULTRASOUND IN THE ASSESSMENT OF SAPHENOFEMORAL INCOMPETENCE
Authors: Chan A. , Chisholm I. , Royle J. P.
Published: August 2010

The prevalence of saphenofemoral incompetence in a series of 105 consecutive patients undergoing saph‐enofemoral ligation as part of an operation for primary varicose veins was determined using a directional continuous‐wave Doppler ultrasonic device. Saphenofemoral incompetence was correctly predicted in 97% of limbs. Using conventional clinical methods, incompetence was correctly predicted in 82% of limbs. This difference was highly significant (P < 0.01 McNemar). It is concluded that a directional Doppler ultrasonic assessment is a useful aid in the pre‐operative determination of saphenofemoral incompetence.
PALLIATIVE BYPASS SURGERY IN CARCINOMA OF THE HEAD OF THE PANCREAS
Authors: Gough Ian R. , Mumme Geoffrey
Published: August 2010

A review of 52 patients having palliative bypass surgery for carcinoma of the head of the pancreas revealed that 20% of patients required subsequent laparotomy for relief of gastric outlet obstruction and that biliary‐enteric anastomoses using the gall bladder were unsatisfactory in 25% of patients. It is recommended that gastroenterostomy be performed routinely during the intial laparotomy. The biliary anatomy should be demonstrated by preoperative or intra‐operative contrast X‐rays and the gall bladder should be used for biliary‐enteric anastomosis only when the surgeon is certain that the biliary system will be adequately drained.
LONG TERM FOLLOW‐UP OF SURGICAL ADRENALECTOMY FOR BREAST CANCER
Authors: Bennett Richard C.
Published: August 2010

A long term follow‐up of 300 patients treated by bilateral adrenalectomy for advanced breast cancer is presented. The notable features are the lengthy remissions and survival times which occurred in some patients. This is further evidence of at least two important biological subsets within the general population of breast cancers. Of the responders, 11% were still in remission at four years and 10% were alive at 10 years. Responders also enjoyed a good quality of life. These results are of considerable importance in assessing the relative merits of newer methods of treatment.
SPLENIC REGENERATION FOLLOWING SPLENECTOMY FOR TRAUMATIC RUPTURE
Authors: Kiroff G. K. , Mangos A. , Cohen R. , Chatterton B. E. , Jamieson G. G.
Published: August 2010

Thirty‐three patients previously splenectomized following traumatic rupture of the spleen were assessed using a radionuclide technique. Splenic tissue was detected by this means in 22 patients (67%). Peripheral venous blood was examined for the presence of erythrocyte surface vacuoles. Vacuolated red blood cells were detected more frequently than in the normal population. The incidence of vacuolated red blood cells was inversely related to the estimated volume of regenerated splenic tissue.
UROLOGICAL COMPLICATIONS FOLLOWING ABDOMINOPERINEAL EXCISION OF THE RECTUM FOR CARCINOMA
Authors: Waiters G. R. , Bokey E. L. , Chapuis P. H. , Maher P. W. , Pheils M. T.
Published: August 2010

A retrospective study was made of 122 patients who had an abdominoperineal excision (APE) of the rectum for carcinoma at Concord Hospital between 1971 and 1979. Fifty‐two percent of patients suffered one or more significant urological complications. These included urinary tract infection (32%), operative trauma to the urinary tract (8.5%) and temporary or permanent bladder dysfunction in 35% of patients. Acute urinary retention, when temporary, was managed by simple measures. Chronic retention, incontinence and some episodes of acute retention were due to a neurogenic bladder. These patients were difficult to treat. It is recommended that urodynamic studies be used to assess these patients who develop a neurogenic bladder before any treatment is instituted. This is relevant especially in those patients in whom a transurethral resection of either the bladder neck or prostate is contemplated.
A CLINICAL STUDY OF THE USE OF MUSCULOCUTANEOUS ISLAND FLAPS FOR RECONSTRUCTION IN HEAD AND NECK SURGERY
Authors: Englund Raymond , Sheridan Brian F. , Jensen Michael J.
Published: August 2010

Eleven cases of the musculocutaneous island flap (MCIF) and their use in major reconstructions for head and neck surgery are described. Methods used in investigating the blood supply of these flaps in cadaver specimens are discussed as well as the use of radionuclear scanning of the blood supply of the flaps in postoperative patients.
CONSIDERATIONS OF COST AND EFFECTIVENESS IN THE CHOICE OF MASTECTOMY
Authors: Black R. B.
Published: August 2010

Operable breast cancer may be managed equally well by a number of different regimens of mastectomy and/or radiotherapy. This paper examines the financial and morbidity costs, together with the node sampling efficacy, of three commonly employed techniques: simple mastectomy; total mastectomy with node biopsy or limited node excision; and modified radical mastectomy. Adjuvant radiotherapy (and/or chemotherapy) can only be applied rationally if node sampling is effective. Simple mastectomy cannot achieve this. Total mastectomy, providing that a node sample is obtained, is effective, and is probably the cheapest option. Total axillary clearance runs the risk of increased morbidity (and financial cost), while not necessarily guaranteeing more effective node sampling. Much of the cost and morbidity of mastectomy may be reduced by a limited but rational radiation policy.
A SUCTION CONE TO PREVENT SPILLAGE DURING HYDATID SURGERY
Authors: Aarons1 Barrie J. , Kune Gabriel A.
Published: August 2010

A safe and reliable suction cone is described which has an important place in the surgical treatment of hydatid cysts and has been successfully used in 42 cases. This device may also have a role in the surgical treatment of huge malignant ovarian cysts.
PROXIMAL AORTIC CROSS CLAMPING DURING NON‐AORTIC SURGERY
Authors: Harris J. P. , Stephen M. S. , O'Brien C.J. , Sheil A. G.R. , May J.
Published: August 2010

Temporary control of the aorta at the level of the diaphragm above the origins of the major visceral arteries is of proven value in the management of complex aortic disease including ruptured aneurysm,‘re‐do’aortic surgery and for aortic trauma. The value of the technique in elective non‐aortic surgery is less well known. Two patients, one with a massive leiomyosarcoma of the stomach and the other with blood loss complicating a distal splenorenal shunt, are described in which proximal aortic control was of use.
AN AMYLASE‐CONTAINING SUBDIAPHRAGMATIC BRONCHOPULMONARY SEQUESTRATION
Authors: Morris S.J.
Published: August 2010

A single case of a subdiaphragmatic bronchopulmonary sequestrated cyst removed at laparotomy is reported. Needle aspiration of the cyst prior to removal revealed a high amylase although the serum amylase was normal. A review of the literature failed to reveal a similar case. The ultrasound, computed tomography and histopathology of this case are described.
GUSTATORY SYNDROME FOLLOWING RADICAL NECK DISSECTION
Authors: Parkash Satya , Ramakrishnan K.
Published: August 2010

Gustatory syndrome in the temple region is common. This is a report of an unusual presentation in the submandibular region following a cervical block dissection.
DELAYED PRESENTATION OF POSTERIOR FRACTURE DISLOCATION OF THE HIP IN A CHILD
Authors: Garvan John D.
Published: August 2010

A case of delayed presentation of posterior fracture dislocation of the hip in a child is reported. Only four similar adult cases have been described in the English medical literature. This case is even more perplexing than those already reported in that AP and lateral X‐rays of the affected hip were performed on initial presentation and were normal. The mechanism of such a phenomenon, explanations for failure to detect such an injury and methods of avoiding this complication are presented.
CURRENT STATUS AND FUTURE PROSPECTS FOR ADJUVANT THERAPY OF MELANOMA
Authors: Herseys Peter , Balch Charles M.
Published: August 2010

Advances in the treatment of melanoma have resulted mainly from improved surgical management of the primary tumour assisted by a greater appreciation of major prognostic factors in the natural history of the disease. Further improvement in the treatment of melanoma will depend largely on introduction of methods to prevent recurrence of the disease. The present review discusses criteria for selection of patients with a high risk of recurrent disease and the adjuvant treatment that has been used in past studies to prevent recurrences. With few exceptions various regimens of chemotherapy, non‐specific immunotherapy with bacterial products or combinations of these treatments have not increased disease free or survival periods. Immunotherapy with various sources of melanoma antigens or with viral lysates of melanoma cells have produced encouraging results in uncontrolled studies and require further evaluation. Several advances appear to provide scope for new initiatives in immunotherapy. These include an appreciation of the role of suppressor cells in regulation of immune responses against tumour cells and possible methods to inhibit their activity. A second is the definition of various lymphokines involved in generation of immune responses (particularly interleukin 2) and development of in vitro methods for large scale production of these factors. Thirdly, methods are becoming available to define the heterogeneity of tumour cells in terms of cell surface antigens or their release of soluble factors which may help select treatments appropriate to each patient.
THE BILIARY PSEUDO‐TRINITY
Authors: Murley Sir Reginald
Published: August 2010

Attention is drawn to the biliary pseudo‐trinity, a too little recognized hazard of biliary surgery which explains many of the more serious examples of duct damage in the course of cholecystectomy. The subject is discussed in relation to four illustrative cases.
OESTROGEN RECEPTORS IN CYSTADENOCARCINOMA OFTHE PANCREAS
Authors: Kune Gabriel A. , Hunt Roland F.
Published: August 2010

The first case of cystadenocarcinoma of the pancreas in which oestrogen receptors have been detected is reported in a 41 year old woman. The biological and therapeutic implications of this finding are briefly discussed.
ATYPICAL MENINGIOMAS: CLINICAL PATHOLOGICAL CORRELATION
Authors: Wong George , Harper Clive
Published: August 2010

Four cases of atypical meningiomas with aggressive histological features have been reviewed. Atypical histological features may indicate higher probability and more rapidity of recurrence. The pertinent literature has been reviewed.
DIEULAFOY'S DISEASE—A DISTINCT CLINICAL ENTITY
Authors: Strong Russell W.
Published: August 2010

Dieulafoy's disease is a condition characterized by massive gastric haemorrhage from an abnormal submucosal artery in the upper third of the stomach. The site of rupture is marked by a small mucosal erosion over the point of rupture. Identification of the lesion is made by endoscopy, angiography or operation. However, the diagnosis is not always easy, especially as the bleeding is intermittent. Once diagnosed, treatment by operation is simple. The disease is possibly not rare, but rarely recognized.
A COMPARISON BETWEEN PRIMARY AND SECONDARY LIVER CANCER
Authors: Little J. M.
Published: August 2010

Two groups of patients have been compared, one with primary liver cancer, the other with liver secondaries. The groups did not demonstrate major differences in age, sex, ethnic background or treatment methods. Although patients with secondaries showed some survival advantage during the first 612 months, any difference had disappeared by 24 months. Patients with potentially ‘curable’ lesions having hepatic resection fared significantly better than all other patients, whether their tumours were primary or secondary in the liver. For practical purposes, the two groups can be considered as having problems of comparable biological significance.
IMPLEMENTATION OF A TRAUMA TEAM
Authors: Deane S. A. , Gaudry P. L. , Pearson I. , Ledwidge D. G. , Read C.
Published: August 2010

A team approach to the initial assessment, investigation and management of potentially seriously injured patients has been instituted. Team members are alerted through an emergency paging system which is activated when a patient fulfils one of a predetermined list of criteria relating to the injury incident, physiological status of the patients and anatomic injuries. Medical members of the team include surgical, intensive care, anaesthetic, and accident and emergency staff. The surgical representative acts as team coordinator.

Aspects of the function of the trauma team system were assessed over 4 months during which time 721 injured patients were admitted, 240 patients satisfied the trauma team criteria, and the team was called 152 times. The observed ‘false alarm’ rate was 38% but the true false alarm rate would have been 46%. Injuries sustained by some patients, who satisfied the criteria but who were not evaluated by the team, were of sufficient severity to justify a greater compliance with the system than was observed at this early stage after its implementation. Although a false alarm rate of 46% is higher than desirable, the number of calls per day would still only average 2 in a hospital with a high trauma patient load. The checklist criteria were highly sensitive (97%) in identifying those patients who should have been evaluated by the trauma team.

Although hospitals differ in workload and staffing, this trauma team model is recommended for more widespread use and for further evaluation and modification.
PERFORATED PEPTIC ULCER: A DELIBERATIVE APPROACH
Authors: Cocks J. R. , Kernutt R. H. , Sinclair G. W. G. , Dawson J. H. McL. , Hong B. H.
Published: August 2010

Between 1966 and 1987, 116 patients with 119 episodes of perforation were admitted to box hill hospital into one surgical unit, and 91 patients with 92 episodes were admitted into the other, with patients being admitted in alternate weeks.

In the former unit, in order to avoid surgery in those patients whose ulcers had sealed spontaneously, a deliberative approach was followed according to a strict protocol—involving a deliberate time delay in surgical decision‐making. In the latter unit, a more conventional approach was adopted, and patients in that unit are used as a retrospective comparison.

In the first unit, of 115 episodes which followed the protocol, six were unresuscitable, 15 needed immediate surgery and 94 followed a delayed approach. Of that 94, 12 needed surgery at 4–6h, and a further eight needed later surgery. Seventy‐four (68% of ‘operable’ patients) did not require corrective surgery at all, for their episode of perforation.

The operable mortality rate was lower (6% compared with 13%), the bedstay was shorter, the prolonged bedstay rate was lower, and the morbidity was no worse, than those patients treated more conventionally in the second unit.
LONG‐TERM RECURRENCE PATTERNS FOLLOWING PROXIMAL GASTRIC VAGOTOMY
Authors: Schache D. J. , Masters A. , Tovey F. I. , Heald R. J. , Rees M.
Published: August 2010

Two hundred and forty‐two consecutive patients were prospectively followed up following elective proximal gastric vagotomy (pgv) for duodenal, pyloric or prepyloric ulceralion. There was no operative mortality and no case of lesser curve necrosis. Five to 15 years follow‐up have been completed. One hundred and eighty‐three patients were assessable (80% of survivors) and 29 of 33 symptomatic patients attended for endoscopy. Fourteen recurrent ulcers had been diagnosed previously and six new recurrences were diagnosed, giving a total recurrence rate of 11%. Seven of these were transient/innocuous and 13 (7%) were chronic/malevolent recurrences. The majority (70%) of recurrences occurred in the first 5 years of follow‐up and only one recurrence occurred later than 10 years' follow‐up. More than half (56%) of the operations were performed utilizing burge intra‐operative testing and 44% without burge testing. No difference in recurrence rates was apparent between these two groups. In seven patients with pyloric or prepyloric ulceralion, three (43%) developed a chronic recurrence. PGV is a safe, surgical treatment for duodenal ulceration, offering acceptable recurrence rates and a very low mortality and low incidence of side‐effects. The majority of recurrences occur early in the follow‐up period. Burge intra‐operative testing provides no clear reduction in recurrence rates. PGV should not be used for pyloric or prepyloric ulceralion.