bluuebunny/crossref_metadata_2025 huggingface dataset:
Recurrent morphoeic basal cell carcinoma at the lateral canthus with orbitocranial invasion
Authors: Selva Dinesh , Hale Lloyd , Bouskill Keith , Huilgol Shyamala C
Published: December 2004

We present a case of recurrent, nodulocystic and morphoeic basal cell carcinoma (BCC) at the lateral canthus, with clinically silent orbital and intracranial invasion which was treated with radiotherapy. Orbital invasion is a rare complication of periocular BCC and occurs primarily in high‐risk canthal lesions. Preoperative ophthalmological review and imaging should be considered in these cases.
Cutaneous Wegener's granulomatosis: A variant or atypical localized form?
Authors: Kuchel Johanna , Lee Stephen
Published: December 2004

A 74‐year‐old woman presented with an antineutrophil cytoplasmic antibody titre‐negative, treatment‐responsive Wegener's granulomatosis confined to the integument. She initially presented with a painful left postauricular nodulo‐ulcerative lesion with chronically discharging sinuses. This lesion was effectively treated with a short, 3‐month course of cyclophosphamide and 24 months of oral prednisone. After 5 months in remission, she developed further similar ulcers, in addition to painless nodules on her ankles and feet bilaterally. These lesions resolved with an extra 32 months of high‐dose oral prednisone therapy before complete remission. At most recent review, there was no evidence of disease recurrence 21 months after ceasing all active treatment. Histology demonstrated a granulomatous inflammation. No systemic disease progression to the upper respiratory tract, lung or kidney was detected. This case highlights the importance of being aware of atypical or partial presentations of Wegener's granulomatosis. This diagnosis needs to be considered with patients presenting with a culture‐negative chronic ulcer, where malignancy and trauma have been excluded. This will avoid unnecessary surgery and ensure early diagnosis and effective treatment of a disease that is disfiguring and usually fatal if inappropriately treated.
Multiple squamous cell carcinomas complicating linear porokeratosis
Authors: Curnow Paul , Foley Peter , Baker Christopher
Published: December 2004

Linear porokeratosis is a distinctive variant of porokeratosis with malignant transformation, a known but infrequently reported complication. We report a case of linear porokeratosis on the right leg of a 57‐year‐old man present since infancy that, over a 2‐year period, developed two squamous cell carcinomas within the lesion. Concurrent right inguinal lymphadenopathy was demonstrated on biopsy to be reactive in nature.
Pachydermodactyly: A forme fruste of knuckle pads?
Authors: Chamberlain Alexander J , Venning Vanessa A , Wojnarowska Fenella
Published: December 2004

A 16‐year‐old boy presented with painless swellings localized to the radial and ulnar aspects of his second through to the fifth fingers on the left hand, with more subtle changes affecting two fingers on the opposite hand. This had developed in the absence of mechanical trauma. Investigations for an arthropathy were negative, while a biopsy showed marked epidermal hyperplasia and an expanded dermis. These features are typical of pachydermodactyly, a benign dermatosis of uncertain aetiology. The interesting feature of this case is the presence of knuckle pads in the father of the patient, which raises the possibility that these two similar entities are related.
Pedigree of multiple benign adnexal tumours of Brooke–Spiegler type
Authors: Saunders Helen , Tucker Paul , Saurine Tricia , Watkins Frances
Published: December 2004

A pedigree of autosomal dominant expression of multiple benign adnexal tumours is presented. Seven cases spanning three generations are discussed. The clinical manifestations of these tumours are quite variable, including multiple papules concentrated on the face, scalp nodules and a large turban tumour. One member of the family had a linear papular eruption involving one half of his body. Histopathology of all lesions demonstrated benign adnexal characteristics, including well‐characterized eccrine spiradenomas, trichoepitheliomas and an eccrine cylindroma. The cutaneous tumours occurring in these patients have continued to develop during their lifetimes. The authors propose that this pedigree has phenotypic characteristics consistent with Brooke–Spiegler syndrome.
Pigmented fungiform papillae on the tongue in an Asian man
Authors: Scarff Catherine E , Marks Robin
Published: December 2004

Fungiform papillae of the tongue vary in their appearance. It is not rare for them to be pigmented in black subjects, but this is less common in Asians. We report a case of pigmented fungiform papillae in a 65‐year‐old Vietnamese man. The patient also had recurrent aphthous ulceration and hepatitis C. Pigmentation affected all fungiform papillae and was asymptomatic. Macrocytosis was noted on full blood examination, while liver function tests were normal. The pigmentation of the fungiform papillae remained stable.
Contact dermatitis to Shiitake mushroom
Authors: Curnow Paul , Tam Mei
Published: December 2004

A 44‐year‐old woman with occupational allergic contact dermatitis to Shiitake mushroom (Lentinus edodes), sawdust and thiuram. She presented with an 8‐month history of hand and face dermatitis that developed after working for 2.5 years in a mushroom farm. Within 3 months of ceasing work at the farm, her symptoms resolved completely.
Reactive angioendotheliomatosis in the setting of antiphospholipid syndrome
Authors: Thai Keng‐Ee , Barrett Wade , Kossard Steven
Published: December 2004

A 31‐year‐old man with systemic lupus erythematosus and antiphospholipid syndrome developed erythematous purpuric plaques distributed over the lower chest, abdomen and upper thighs. Biopsy of lesional skin revealed intravascular proliferation of endothelial cells with associated microthrombi formation. The histological pattern was consistent with reactive angioendotheliomatosis, a rare reactive pattern seen associated with disparate medical conditions. The pathogenesis of the reactive angioendotheliomatosis in our patient was suspected to be related to his procoagulant state; thrombi formed despite a therapeutic international normalized ratio while on warfarin. His lesions began to resolve with the cessation of warfarin and commencement of subcutaneous enoxaparin, oral clopidogrel and oral aspirin. The skin biopsy findings were pivotal in influencing the change of therapy in this patient and decreasing his immunosuppression.
An Examination of the Efficiency of the 12-Item SPHERE Questionnaire as a Screening Instrument for Common Mental Disorders in Primary Care
Authors: Clarke David M. , Mckenzie Dean P.
Published: December 2004

Objective: To further examine the screening capabilities (sensitivity, specificity, etc.) of the 12-item Somatic and Psychological Health Report (SPHERE) questionnaire.

Method: A more extensive examination was carried out on data presented in a recent report.

Results: The sensitivities of the questionnaire, scored in three different ways, ranged from 100% to 47%. Specificities ranged from 18% to 72%. As a global screen for mental disorder it had a very high false-positive rate, with, in one sample, 83% of patients screening positive while only 27% had a current psychiatric diagnosis, and in the other sample 55% screened positive with only 13% having a current psychiatric diagnosis. The PSYCH-6 scale used by itself had similar properties to the 30-item General Health Questionnaire from which it was derived. The addition of the scale measuring fatigue (SOMA-6) increased or decreased specificity depending on how it was combined with the PSYCH-6 scale.

Conclusion: The evidence is insufficient to recommend the 12-item SPHERE, in its current form, as a screening instrument for DSM-IV mental disorders in general practice, as the specificity is inadequate. Ways of raising the threshold for caseness need to be explored. The argument for adding a measure of fatigue to a general screening measure is not supported.
Ethically Sensitive Mental Health Care: Is there a Need for a Unique Ethics for Psychiatry?
Authors: Crowden Andrew
Published: December 2004

Objective: This article takes up the challenge to comment and extend on Jennifer Radden's claims for a ‘unique ethics for psychiatry’ articulated in ‘Notes towards a professional ethics for psychiatry’, Australian and New Zealand Journal of Psychiatry 2002; 36:52–59.

Method: The author is analytically trained in bioethics and employs the method of conceptual analysis.

Results: Psychiatry is a unique mental health care practice which calls for unique ethical responses. However, it doesn't necessarily follow that a unique ethics for psychiatry is required.

Conclusions: A more plausible explanation for how philosophical ethics informs the unique nature of psychiatric practice is better articulated within claims about the role-related nature of particular health care practices and the influence that the virtue of phronesis (practical wisdom) has on a clinician's decision-making and judgement.
Repetition Risk for Adolescent Self-Poisoning: A Multiple Event Survival Analysis
Authors: Martin Reith David , Whyte Ian , Carter Greg
Published: December 2004

Objectives: To examine risk factors associated with re-presentation (event rates) following an initial episode of hospital treated self-poisoning.

Method: A longitudinal cohort study using the Hunter Area Toxicology Service (HATS) database of all presentations to hospital of self-poisoned patients aged 10–19 in Newcastle and Lake Macquarie Regions of New South Wales from January 1991 to December 1995. The study factors were: age, gender, employment status, ‘substance abuse’ and psychiatric diagnosis at index (first documented episode during the study time-period) admission. The main outcome measure was re-presentations per unit time. Time-event analysis (multivariate) was used to compare re-presentation rates per person-year exposure to the study factors.

Results: There were 450 patients who presented on a total of 551 occasions. The median and modal age at initial presentation was 17. Three hundred and nine (69%) were female and 141 (31%) were male. The probability (95% CI) of a patient re-presenting within one year of an index admission with self poisoning was 0.09 (0.07–0.12) and within 5 years was 0.16 (0.12–0.21). The adjusted rate ratios for episodes of re-presentation were: any ‘substance abuse (ever)’ 3.87 (2.08–7.21), ‘alcohol abuse’ 2.32 (1.15–4.68),‘benzodiazepine abuse’ 4.89 (1.63–14.62), schizophrenia and other psychotic disorders (DSM-IV) 2.85 (1.2–6.79), and any personality disorder (DSM-IV) 2.68 (1.73–4.16).

Conclusions: Interventions to decrease recurrence rates for adolescent self poisoning should be directed towards substance (particularly alcohol or benzodiazepine) abuse, nonaffective psychoses and personality disorder.
Outcome Evaluation of a Statewide Child Inpatient Mental Health Unit
Authors: Gavidia-Payne Susana , Littlefield Lyn , Hallgren Mats , Jenkins Peter , Coventry Neil
Published: December 2004

Objective: To assess the impact of inpatient intervention, provided by a child mental health unit in Victoria, Australia, on a number of key child and family variables.

Method: Pre-post test design with a four-month follow up was applied to assess changes across time. Twenty-nine parents, 42 teachers, and 37 referrers provided reports on a series of child, parent, and family functioning measures.

Results: Significant improvements in child behaviour and functioning, parenting competency and efficacy, parenting practices, and reduced parental depression were observed over time. Changes in family functioning scores were not significant; however, univariate analysis indicated improvements in two individual subscales.

Conclusions: There is a lack of studies of the outcome of inpatient interventions of children in psychiatric settings. However, as shown in the present study, improvements in functioning can be detected and obtained with short-term interventions that focus on both children and families. Methodological shortcomings (i.e. absence of comparison groups) and lack of specificity in intervention variables, however, are difficulties yet to be overcome in evaluation research of inpatient treatment.
Incidence of Catatonia in Children and Adolescents in a Paediatric Psychiatric Clinic
Authors: Thakur Anupam , Jagadheesan K. , Dutta Siddartha , Sinha Vinod Kumar
Published: December 2004

Objective: To investigate the incidence and phenomenology of catatonia in a child and adolescent population.

Method: Children and adolescents who had attended a paediatric psychiatric outpatient clinic between April and July 2001 were examined for catatonic signs with a formal catatonia rating scale, and patients who had at least two catatonic signs were included.

Results: Eleven patients met the criteria (5.5% of the entire sample and 17.7% of the patients with affective and nonaffective psychotic disorder); of them eight had an affective disorder and three a nonaffective disorder. The mean catatonic scores were significantly high for males and patients with mental retardation.

Conclusion: This study shows that catatonia occurs in children and adolescents. Further studies are essential to clarify the distribution of catatonia across various diagnoses and the outcome of paediatric catatonia.
Predisposition to Depression: The Role of Attachment
Authors: Beatson Josephine , Taryan Suzanna
Published: December 2004

Objective: To examine the hypothesis that adverse early relational experiences causing activation of the hypophysial-pituitary-adrenal (HPA) axis during critical early stages of development can predispose to depression. Patients thus affected are likely to manifest insecure patterns of attachment in close relationships and are vulnerable to depression after adverse life events.

Method: The literature pertaining to sensitization of the HPA axis in early life and the neurobiology of attachment is examined.

Results: Adverse early relational experiences can result in activation of the HPA axis, causing sensitization of depression pathways in the brain. Secure attachment acts as a buffer against HPA activation in response to stress. Infants with insecure attachment lack this buffering effect and may be predisposed to depression and other psychiatric disorders in response to psychosocial stressors.

Conclusions: There is a patient group predisposed to depression on the basis of adverse early life experience. In these cases, the neurobiology of attachment offers a means of integrating findings concerning sensitization of the HPA axis in infancy, the effects of early life experience on brain development, and predisposition to depression and other psychiatric disorders. These findings have important implications for the development of interventions aimed at prevention and treatment for this patient group.
Relationship Between Mental Health Disorders and Unemployment Status in Australian Adults
Authors: Comino Elizabeth J. , Harris Elizabeth , Chey Tien , Manicavasagar Vijaya , Wall Jonine Penrose , Davies Gawaine Powell , Harris Mark F.
Published: December 2004

Objectives: To compare the prevalence of anxiety and affective disorders among employed and unemployed patients and to compare the type of treatment received between the two groups for these disorders.

Method: A secondary analysis of the 1997 National Survey of Mental Health and Wellbeing of Adults cross-sectional study was undertaken.

Results: Unemployed adults were more likely to have symptoms of anxiety (OR = 3.09, 95% CI = 2.80–3.41) or an affective disorder (OR = 2.11, 95% CI = 1.95–2.27) or anxiety and/or affective disorders (OR = 2.53, 95% CI = 2.37–2.69). Unemployed participants with symptoms were less likely to have seen a general practitioner for treatment but when they did they received similar care to employed participants.

Conclusions: These results confirm studies reported elsewhere that the prevalence of symptoms of anxiety and/or affective disorders is higher for unemployed people. The data provide further evidence that people with an anxiety and/or affective disorder who are unemployed are not seeking medical treatment. However, unlike previous research undertaken by our group, these results indicate that symptomatic adults who seek help receive comparable treatment in general practice irrespective of their employment status.
Perceptions of Outcome from Electroconvulsive Therapy by Depressed Patients and Psychiatrists
Authors: Brodaty Henry , Berle David , Hickie Ian , Mason Cathy
Published: December 2004

Objective: To determine (i) patients' expectations before and attitudes after a course of electroconvulsive therapy (ECT); (ii) the concordance between the perceptions of patients and their psychiatrists; and (iii) whether patients and psychiatrists are accurate in predicting a positive outcome with ECT.

Method: Eighty-one inpatients (mean 67.2 years, median 70 years) with major depression were assessed before and after receiving a course of ECT. On both occasions, patients were administered the Hamilton Rating Scale for Depression (HRSD) and the Global Assessment of Functioning Scale (GAF). Patients and two research psychiatrists rated their expectancy of treatment outcome before ECT and their impression of outcome after ECT was completed.

Results: Both HRSD and GAF scores improved with treatment. Before treatment, 39.7% of patients believed ECT would improve their condition. Following treatment, 68.8% of patients thought their condition had improved as a result of ECT. There was only slight agreement between patients' and psychiatrists' expectations before and ratings of efficacy after treatment. The psychiatrists', but not the patients', pretreatment expectations of ECT efficacy were significantly associated with improvement in depression as measured by the effect size change in HRSD score from pre- to post-ECT.

Conclusions: Patients were poor judges of ECT outcome and, in this sample, less positive than previous reports had suggested. Psychiatrists' expectations however, were generally accurate indicating good clinical selection.
Gender Differences in the Relationship Between Acute Stress Disorder and Posttraumatic Stress Disorder Following Motor Vehicle Accidents
Authors: Bryant Richard A. , Harvey Allison G.
Published: December 2004

Objective: Acute stress disorder (ASD) describes initial posttraumatic stress reactions that purportedly predict subsequent posttraumatic stress disorder (PTSD). This study aimed to index the influence of gender on the relationship between ASD and PTSD.

Method: Motor vehicle accident survivors were assessed for ASD within 1-month posttrauma (n = 171) and were subsequently assessed for PTSD 6-months later (n = 134).

Results: Acute stress disorder was diagnosed in 8% of males and 23% of females, and PTSD was diagnosed in 15% of males and 38% of females. In terms of patients followed up at 6 months, 57% and 92% of males and females, respectively, who met criteria for ASD were diagnosed with PTSD. Females displayed significantly more peritraumatic dissociation than males.

Conclusion: Peritraumatic dissociation and ASD is a more accurate predictor of PTSD in females than males. This gender difference may be explained in terms of response bias or biological differences in trauma response between males and females.
The Therapeutic Alliance: The Key to Effective Patient Outcome? A Descriptive Review of the Evidence in Community Mental Health Case Management
Authors: Howgego Irene M. , Yellowlees Peter , Owen Cathy , Meldrum Lenore , Dark Frances
Published: December 2004

Objective: The aim of this review was to examine the level of evidence supporting the assumed link between a positive therapeutic alliance among patients and case managers and effective outcome for patients with a mental illness who are managed in community mental health services.

Method: MedLine, PsychINFO and Social Sciences Index search of articles from 1986 to 2001 returned 84 articles and two texts. Inclusion criteria were the use of validated measures and relevance to psychiatry and community case management.

Results: A definite correlation exists in the psychotherapy literature between the therapeutic relationship and improved outcomes, with its potential as a prognostic indicator acknowledged. Attempts to apply the concept to patients outside the field of psychotherapy have been slow, although expansion of the concept to other forms of change-inducing therapy was a current trend. Issues of definition, quantification and measurement of the relationship caused rigorous debate in the literature. Case management research demonstrating the importance of the therapeutic relationship and ‘goodness-of-fit’ between patients and case managers was sparse with no published Australian studies.

Conclusions: The level of evidence supporting the link between the therapeutic alliance of patients with mental illness and improved outcomes although sparse is encouraging. It indicates the potential of the alliance as a predictor of outcome for patients engaged in case management services in community mental health. Research to determine the role and effectiveness of the alliance in the patient/case manager dyad is needed to define this potential. Effectiveness of clinical practice in the case management field could be enhanced if research findings confirmed the genesis and value of the alliance in case management. Focus on relationship strategies as a clinical tool gives the clinician and service provider a potential vehicle for promoting partnerships with the seriously mentally ill person in managing their illness and optimizing their strengths in the community.
Use of Antidepressants by General Practitioners and Psychiatrists in Australia
Authors: Mcmanus Peter , Mant Andrea , Mitchell Philip , Britt Helena , Dudley John
Published: December 2004

Objective: To examine the antidepressant prescribing patterns of psychiatrists and general practitioners (GPs) in Australia, focusing specifically on: the prescribed daily dose, the relative proportions (from subsidized dispensing data) of prescriptions written, and how these proportions change over time for a newly listed antidepressant drug (using paroxetine as an example).

Method: Retrospective analyses of subsidized claims data (comprising nearly 90% of the community supply of antidepressants) and prescriber surveys.

Results: General practitioners prescribe 86% of subsidized antidepressants in Australia. Almost three-quarters of the antidepressant prescriptions prescribed in primary care management are also initiated by a GP. Psychiatrists prescribed higher doses than general practitioners for all the antidepressants examined. For paroxetine, a higher than average proportion of scripts were written by psychiatrists when the drug was initially available and it only reached the GP/psychiatrist split seen with an established drug in the same therapeutic class (fluoxetine) four years after marketing. The most prominent type of depression that GPs believed they were treating was ‘chronic mild depression’, which contrasts with the subsidized indication for all newer antidepressant classes of ‘major depressive disorders’.

Conclusions: General practitioners are the major providers of treatment for depression in Australia. When writing prescriptions for tricyclic antidepressants GPs use doses lower than those recommended for major depression, however, most management in primary care is not for conditions regarded by the GP as major depression. A significant number of prescriptions for the newer antidepressants may not accord with the Pharmaceutical Benefits Scheme (PBS) restrictions for use.
The Future of Consultation–Liaison Psychiatry
Authors: Smith Graeme C.
Published: December 2004

Objective: To review the status of consultation–liaison psychiatry and the factors shaping it, and suggest strategies for its future development.

Method: In addition to searches of the main computerized psychiatric databases and review of relevant Commonwealth of Australia publications, the author drew on discussions with national and international colleagues in his role as convenor of the International Organization for Consultation–Liaison Psychiatry.

Results: Physical/psychiatric comorbidity and somatization, the conditions in which consultation–liaison psychiatry specializes, are the commonest forms of psychiatric presentation in the community. They are as disabling as psychotic disorders, and comorbid depression in particular is a predictor of increased morbidity and mortality. Acknowledging this, the Second Australian National Mental Health Plan called for consultation–liaison psychiatry to be allowed to participate fully in the mental health care system. It stated that failure to define the term ‘severe mental health problems and mental disorders’ in the First Plan had led to some public mental health systems erroneously equating severity with diagnosis rather than level of need and disability. The call has been largely unheeded. The implication for patient care is both direct and indirect; the context created for psychiatry training by such a restricted focus is helping to perpetuate the neglect of such patients. This is a worldwide problem.

Conclusions: Proactive involvement with consumers is required if the problem is to be redressed. At a service level, development of a seamless web of pre-admission/admission/post-discharge functions is required if patients with physical/psychiatric comorbidity and somatoform disorders are to receive effective care, and consultation–liaison psychiatry services are to be able to demonstrate efficacy. Focus on comorbidity in the Australian Third National Mental Health Plan may force resolution of the current problems.
Schizophrenic Patients in Different Treatment Settings During the Era of Deinstitutionalization: Three-Year Follow-Up of Three Discharge Cohorts in Finland
Authors: Honkonen Teija , Karlsson Hasse , Koivisto Anna-Maija , Stengård Eija , Salokangas Raimo K.R.
Published: December 2004

Objective: We investigated differences in psychosocial and clinical characteristics, as well as the use of services, of schizophrenic patients in different treatment settings three years after their discharge from a psychiatric hospital. Furthermore, we examined secular changes in these phenomena during the era of rapid deinstitutionalization in Finland.

Method: Three nationally representative samples comprised 3257 schizophrenic patients who had been discharged in 1986, 1990 and 1994. The patients were interviewed three years after discharge by each district's psychiatric professionals using a structured interview schedule specifically designed for the purposes of the present study. Psychosocial functioning was assessed on the Global Assessment Scale and on a modified version of the Medical Research Council Practices Profile.

Results: In the 1990s, more patients with a poor clinical and psychosocial state were transferred from hospital to alternative outpatient facilities, such as sheltered workshops or supported residences. In successive cohorts, the proportion of patients who had dropped out of treatment decreased and the psychiatric and somatic state of the drop-outs improved.

Conclusion: In general, the psychiatric treatment system has worked well for most deinstitutionalized patients. In the future, however, it is important that the quality of care and adequate resources in the alternative outpatient facilities are ensured.
Dual Action Antidepressants and Some Important Considerations
Authors: Gupta Ramesh K. , Tiller John W. , Burrows Graham D.
Published: December 2004

Objective: To review controlled studies of long-term treatment and their side-effects with newer dual action antidepressants following an acute episode of major depression.

Method: A literature review ( MedLine) was undertaken and references were selected for their relevance and methodology in describing their contribution to the examination of our objective.

Result and Conclusion: Three dual action antidepressants are identified: venlafaxine, mirtazapine and milnacipran. These are more effective and better tolerated than the older tricyclic antidepressants in the treatment of an acute episode of depression and in the prevention of relapse. They also offer advantages in that they lack autonomic side-effects of the tricyclics. However, sedation, nausea and sexual side-effects may occur with venlafaxine, and weight gain with mirtazapine.
Thirty years’ studies on surgery and related basic research of hepatocellular carcinoma
Authors: Tang Zhao‐You
Published: December 2004

To emphasize the role of clinical innovation and basic research on the advances of hepatocellular carcinoma (HCC) surgery, related papers published by the author's institution in the last three decades and recent data were analysed. In the 1970s−1980s, diagnosis using alpha fetoprotein assay and innovation of limited resection instead of lobectomy have resulted in early diagnosis and resection of small HCC. These have led to a marked increase of long‐term survivors of HCC. In the 1980s−1990s, research works including establishment of human HCC nude mice model, experimental multimodality therapy and studies on targeting therapy have been conducted. These have made resection possible in some patients after downstaging of initially unresectable HCC. The 5‐year survival of unresectable HCC was improved. Since the early 1990s, research works have been carried out on metastatic recurrence of HCC, including the establishment of metastatic human HCC model, the molecular basis of HCC metastasis, angiogenesis and experimental intervention. These provide clues for prediction and prevention of metastatic recurrence of HCC. Translation from bench to bedside has resulted in improved disease free survival after curative HCC resection in a randomized control trial using interferon alpha. It is concluded, clinical innovation and basic research are essential for progress of HCC surgery.
Systematic review and meta‐analysis of clinical trials comparing endoscopic totally extraperitoneal inguinal hernioplasty with open repair of inguinal hernia
Authors: Lau Hung , Patil Nivritti G. , Lee Francis Chan‐Wing
Published: December 2004

Objective:  Endoscopic totally extraperitoneal inguinal hernioplasty (TEP) has been gaining in popularity in recent years. However, there has been little data to support the superiority of TEP over open repair. The objective of the present systematic review was to compare the effectiveness of open and endoscopic totally extraperitoneal approaches for the repair of inguinal hernias.

Data sources:  A search of electronic databases, including MEDLINE, EMBASE and the Cochrane Library, was conducted to identify appropriate articles published between January 1990 and March 2002. In addition, a manual search for other studies was undertaken by reviewing the bibliographic reference list of the retrieved articles, contents of surgical journals and proceedings of conferences.

Review methods:  Only those studies that reported randomized trials comparing the outcomes between TEP and open repair of inguinal hernias were included. The quality of recruited trials was assessed critically by using a scoring system modified by Evans and Pollock. The effect size of outcome parameters was estimated by odds ratio or weighted mean difference where appropriate.

Results:  Ten randomized trials, which included 3212 patients, were recruited in the present systematic review. Meta‐analysis reviewed a significantly lower wound complication rate after TEP (odds ratio (OR) = 0.50, 95% confidence interval (CI) = 0.37–0.69, P < 0.001). In all trials, patients who underwent TEP reported less postoperative pain than those who underwent open repair. The pooled effect of four trials with usable data of pain score also favoured TEP (weighted mean difference (WMD) = −0.26, 95% CI = −0.36 to −0.16, P < 0.001). Patients returned to normal activities significantly earlier after TEP than those who underwent open repair (WMD = −0.23, 95% CI = −0.31 to −0.15, P < 0.001). However, the mean operative duration of TEP was significantly longer than that of open repair (WMD = 0.54, 95% CI = 0.23–0.85, P < 0.001). With regard to the recurrence rate, the overall meta‐analysis favoured TEP. However, when open repair was categorized into either suture herniorrhaphy or mesh hernioplasty, the recurrence rate after TEP remained superior to sutured herniorrhaphy (OR = 0.54, 95% CI = 0.31–0.96, P = 0.03) but was comparable to that following open mesh hernioplasty (OR = 1.76, 95% CI = 0.60–5.22, P = 0.09).

Conclusions:  Meta‐analyses proved that TEP conferred significant early postoperative benefits, including a lower wound morbidity rate, faster return to normal activity and reduced postoperative pain at 1 week. With regard to the recurrence rate, TEP was superior to sutured herniorrhaphy, but showed a similar efficacy to open mesh hernioplasty. Future meta‐analyses of randomized controlled trials are required to evaluate the long‐term outcomes of TEP and open mesh hernioplasty.
Outcome analysis of 40 cases of vestibular schwannoma: A comparison of sitting and Park bench surgical position
Authors: Chan Yung , N. Datta Narendra , Chan Kwong‐Yau , Ur Rehman Safi , Poon Christopher Yee‐Fat , Kwok John Ching‐Kwong
Published: December 2004

The present study retrospectively reviews our experience in 40 cases of vestibular schwannoma, operated between the years 1995 and 2002. All the patients underwent tumour resection either in sitting or in the Park bench position via the suboccipital retromastoid route. The position of the patient was selected arbitrarily. Precordial Doppler echocardiography was used to monitor air embolism. Operative results, including the size of the tumour, completeness of resection, anatomical and functional preservation of the facial nerve, operative complications and mortality were analysed and compared in these two operative positions. There was no statistically significant difference in terms of surgical results between these two groups.
Local and regional spatial distribution of an eruptive and a latent herbivore insect species
Authors: Ribeiro Katia T. , Codeço Cláudia T. , Fernandes G. Wilson
Published: December 2004

Abstract  In this work, we investigated the spatial distribution of two sessile insect herbivores over the entire range of their host plant, Coccoloba cereifera, a sclerophyllous shrub endemic to Serra do Cipó, Brazil. The two insects have very distinct life histories and dispersal behaviours and we hypothesized that their classification into behavioural syndromes could be used to predict their spatial distribution patterns. Abgrallaspis cyanophylli (Homoptera) is an armoured scale insect that fits well into the eruptive syndrome. Stenapion aff. contrarium (Coleoptera) is a petiole borer with wide search capabilities, which fits into the latent syndrome. We expected that Abgrallaspis would follow the host plant aggregation pattern whereas Stenapion would be distributed more uniformly through the region and be less affected by host aggregation. We counted the number of attacked and non‐attacked ramets within two perpendicular belt transects as well as within a 20 m × 20 m quadrat placed over a dense shrub aggregation. Local quadrat covariance methods were used to estimate the spatial pattern of each insect. At fine scales, we found Stenapion evenly distributed over the host plant and Abgrallaspis with a significantly aggregated pattern. This finding is in accordance with our hypothesis. At larger scales, however, this pattern was lost and the results were largely variable. We conclude that the classification of insects into behavioural syndromes may be useful to predict distribution patterns at fine scales. At larger scales, however, history and chance events may be more important.
Spatial model for predicting the presence of cinnamon fungus (Phytophthora cinnamomi) in sclerophyll vegetation communities in south‐eastern Australia
Authors: Wilson B. A. , Lewis A. , Aberton J.
Published: December 2004

Abstract  The pathogen Phytophthora cinnamomi causes extensive ‘dieback’ of Australian native vegetation. This study investigated the distribution of infection in an area of significant sclerophyll vegetation in Australia. It aimed to determine the relationship of infection to site variables and to develop a predictive model of infection. Site variables recorded at 50 study sites included aspect, slope, altitude, proximity to road and road characteristics, soil profile characteristics and vegetation attributes. Soil and plant tissues were assayed for the presence of the pathogen. A geographical information systyem (GIS) was employed to provide accurate estimations of spatial variables and develop a predictive model for the distribution of P. cinnamomi. The pathogen was isolated from 76% of the study sites. Of the 17 site variables initially investigated during the study a logistic regression model identified only two, elevation and sun‐index, as significant in determining the probability of infection. The presence of P. cinnamomi infection was negatively associated with elevation and positively associated with sun‐index. The model predicted that up to 74% of the study area (11 875 ha) had a high probability of being affected by P. cinnamomi. However, the present areas of infection were small, providing an opportunity for management to minimize spread into highly susceptible uninvaded areas.
Boat harbour design can exacerbate hull fouling
Authors: Floerl Oliver , Inglis Graeme J.
Published: December 2004

Abstract  Hull fouling is a major cost for owners of small vessels and an important pathway for the spread of non‐indigenous aquatic species. The extent of fouling depends on a hull's susceptibility to recruitment by aquatic organisms and the local availability of competent planktonic propagules (‘propagule pressure’). Management strategies have typically been concerned with increasing resistance of the hull to recruitment through the use of toxic paints. Here we tested the hypothesis that fouling is influenced by the design of the harbour in which the boat is moored. We compared recruitment of sessile invertebrates to available surfaces in two types of recreational boat harbours: marinas that were partially enclosed by a permanent breakwall, and marinas that lacked breakwalls. Recruitment in the marinas was compared to coastal reference sites that were not used for mooring. At each location, recruitment tiles were deployed for 4 weeks on four separate occasions over a period of 2 years. Measurements of current velocities and spatial patterns of water flow at each location showed that permanent breakwalls created complex patterns of circulation that retained water within the marina basin for up to 12 h d−1. Despite large regional and temporal variability in fouling over time, most organisms recruited in greatest numbers to surfaces in partially enclosed marinas, and were often several orders of magnitude more abundant in the enclosed marinas than in unenclosed marinas or coastal reference locations. Harbour design has an important influence on the rate at which fouling organisms recruit to available surfaces within marinas. Entrainment of water in enclosed marinas may limit the dispersal of planktonic propagules by advective currents but effectively increases propagule pressure to available surfaces, including resident boat hulls. This is likely to accelerate the development of hull‐fouling assemblages and increase the chances of transport of non‐indigenous species that establish populations in the harbour basin.
Fire and flood: Soil‐stored seed bank and germination ecology in the endangered Carrington Falls Grevillea (Grevillea rivularis, Proteaceae)
Authors: Pickup Melinda , McDougall Keith L. , Whelan Robert J.
Published: December 2004

Abstract  Seed germination is dependent on the interaction between the dormancy state of a seed and the presence of favourable environmental conditions. Thus, the spectacular pulse of seedling recruitment in many Australian vegetation communities following disturbances such as fire can be attributed to changes in microsite conditions and/or the dormancy‐breaking effect of the disturbance on accumulated seed banks. Grevillea rivularis is a threatened species endemic to the area immediately above Carrington Falls in the NSW Southern Highlands. Most of the population is confined to the riparian vegetation zone in woodland and heath, and is therefore subject to periodic disturbance from fire and flood. For this species, a pulse of seedling recruitment has been recorded after fire, flood and mechanical soil disturbance. The aims of this study were to examine the density and vertical distribution of the soil‐stored seed bank and to investigate the role of heat and scarification as cues for germination of fresh and soil‐stored seed. There was a large seed bank under the canopies of established individuals (194 ± 73 seeds m−2) and most seeds were found in the 0–2 cm and leaf‐litter layers of the soil profile. The germination response of soil‐stored and fresh seed was examined using a hierarchical series of laboratory experiments. Seeds of G. rivularis showed marked dormancy polymorphism. Thirty‐six percent of soil‐stored seed germinated without treatment, whereas no untreated fresh seeds germinated. Scarification or heating caused significant germination of dormant soil‐stored seed, but only scarification resulted in germination of dormant fresh seeds. These results highlight important differences in the dormancy state of soil‐stored and fresh seed. Thus, being a riparian species in a fire‐prone environment, the dormancy mechanisms in seeds of G. rivularis suit this species to disturbance by both fire and flood.
Experimental determination of seed emergence and carry‐over in the soil seed bank of the herbaceous perennial, Trachymene incisa (Apiaceae)
Authors: Wardle Glenda M.
Published: December 2004

Abstract  Many populations of herbaceous perennial plants contain seeds stored in a soil seed bank. The contribution of seeds to population persistence is an important parameter in population models but germination rates of known‐age seeds are difficult to obtain because individual seeds cannot easily be followed. Although Trachymene incisa Rudge plants produce copious seeds that are dispersed into the soil, the existence of a seed bank has not been confirmed. To quantify the potential for a seed bank fresh seeds of T. incisa were sown into experimental seed banks in the eucalypt‐dominated Agnes Banks Woodland in western Sydney, NSW. A recent fire provided the opportunity to compare germination in the burnt and unburnt vegetation. Density of seed sowing and time of maturation/dispersal of seeds were manipulated in 75 seed cages. Emergence of seeds after 5 months was significantly higher for the earliest planting date but after 1 year, germination of seeds planted in the later weeks increased, and the final germination for all weeks was 28%. Density of sowing and the recent fire did not affect emergence. A second experiment planted over a broader time span (9 weeks instead of 3 weeks) confirmed the effect of planting date but also found significant spatial variation on a scale of tens of metres. Laboratory germination rates of over 70% confirmed that the seeds were viable and non‐dormant when sown in the field cages. The carry‐over of non‐germinated seed in the soil seed bank is estimated to be about 70% after 2 years, implying that a cohort of seeds would not be depleted through germination alone for up to 40 years. The potential for a long‐lived seed bank in this species is interesting because the plants are also capable of resprouting from their rootstock after fire, giving them characteristics of both resprouters and seeders.
Response of vertebrates to fenceline contrasts in grazing intensity in semi‐arid woodlands of eastern Australia
Authors: James Craig D.
Published: December 2004

Abstract  Changes in the abundance, species richness and assemblage composition of vertebrates due to grazing by domestic stock were investigated in the semi‐arid woodlands of eastern Australia. Analyses were based on the differences found at 10 fenceline contrast sites. Two species of amphibians, 22 species of reptiles and two species of small mammal were captured in pit traps during the surveys. Kangaroos (red and eastern grey), sheep, goats and 66 species of birds were recorded along line transects. Analyses revealed that abundance of diurnal reptiles and species richness of diurnal reptiles and birds were significantly lower on heavily grazed sites than they were on lightly grazed sites. At a local scale, the gecko, Gehyra variegata, was more abundant where grazing was heavier, while Diplodactylus conspicillatus, Diplodactylus steindachneri and Rhynchoedura ornata responded to variables indirectly related to grazing intensity (kangaroo density, sheep and goat dung mass and sheep density, respectively). Birds more commonly sighted on lightly grazed areas than heavily grazed areas were the apostlebird, brown treecreeper, crested bellbird, grey butcherbird, hooded robin, jacky winter, little woodswallow, Australian magpie‐lark, mulga parrot, splendid wren, white‐browed treecreeper and yellow‐rumped thornbill. Birds more commonly sighted on heavily grazed areas than on lightly grazed areas were the Australian raven and chestnut‐crowned babbler. Most variation in species composition between sites was due to spatial separation and no regional‐level indicator species of grazing were evident. A combination of direct grazing‐related changes (e.g. loss of ground cover) and indirect effects of the pastoral industry (e.g. introduction of artificial sources of water) lead to changes in fauna at different scales of analysis across regions.
Woody overstorey effects on soil carbon and nitrogen pools in South African savanna
Authors: Hudak A. T. , Wessman C. A. , Seastedt T. R.
Published: December 2004

Abstract  Woody plant encroachment in savannas may alter carbon (C) and nitrogen (N) pools over the long‐term, which could have regional or global biogeochemical implications given the widespread encroachment observed in the vast savanna biome. Soil and litter %C and %N were surveyed across four soil types in two encroached, semi‐arid savanna landscapes in northern South Africa. Litter at sampling points with a woody component had a higher %N and lower C : N ratio than litter at solely herbaceous points. Severely encroached areas had lower C : N ratios throughout the soil profile than less encroached areas. Soil %C and %N were highly influenced by soil texture but were also influenced by the presence of a woody overstorey, which increased surface soil %C on three soil types but decreased it on the most heavily encroached soil type. Soil C sequestration may initially increase with bush encroachment but then decline if bush densities become so high as to inhibit understorey grass growth.
Immediate impacts of invasion by Wasmannia auropunctata (Hymenoptera: Formicidae) on native litter ant fauna in a New Caledonian rainforest
Authors: Le Breton J. , Chazeau J. , Jourdan H.
Published: December 2004

Abstract  For the last 30 years, Wasmannia auropunctata (the little fire ant) has spread throughout the Pacific and represents a severe threat to fragile island habitats. This invader has often been described as a disturbance specialist. Here we present data on its spread in a dense native rainforest in New Caledonia. We monitored by pitfall trapping the litter ant fauna along an invasive gradient from the edge to the inner forest in July 1999 and March 2000. When W. auropunctata was present, the abundance and richness of native ants drops dramatically. In invaded plots, W. auropunctata represented more than 92% of all trapped ant fauna. Among the 23 native species described, only four cryptic species survived. Wasmannia auropunctata appears to be a highly competitive ant that dominates the litter by eliminating native ants. Mechanisms involved in this invasive success may include predation as well as competitive interactions (exploitation and interference). The invasive success of W. auropunctata is similar to that of other tramp ants and reinforces the idea of common evolutionary traits leading to higher competitiveness in a new environment.