bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of Helicobacter pylori eradication on the anti‐secretory efficacy of lansoprazole in gastroesophageal reflux disease patients
Authors: GIRAL ADNAN , ÇELIKEL ÇIGDEM A , ÖZDOGAN OSMAN , TÖZÜN NURDAN , ULUSOY NEFISE B , KALAYCI CEM
Published: November 2005

Background:  Helicobacter pylori eradication was recommended for the prevention of atrophic gastritis in gastroesophageal reflux disease (GERD) patients on long‐term omeprazole treatment. It has been also shown that the treatment with proton pump inhibitors produces lower intragastric pH after H. pylori eradication in subjects with peptic ulcer and healthy individuals. The aim of the present study was to test the hypothesis of whether the efficacy of lansoprazole is reduced after the eradication of H. pylori in GERD patients with peptic esophagitis.

Methods:  Eight‐hour intragastric pH recordings were performed before and after an 8‐day course of lansoprazole (30 mg once daily) in 10 H. pylori‐positive male patients with reflux esophagitis and were repeated after the H. pylori eradication. Intragastric acidity was measured by using an antimony electrode placed 10 cm below the cardia.

Results:  Baseline median preprandial, post‐prandial, total intragastric pH and the percentage of time with pH < 3 were not different before and after H. pylori eradication without lansoprazole treatment. During lansoprazole treatment, median post‐prandial intragastric pH was lower (4 vs 2.7; P < 0.05) and the percentage of time with pH < 3 was longer (3.4%vs 41.8%; P < 0.05) after H. pylori eradication. Median total intragastric pH tended to be lower after eradication but no difference was found in preprandial median pH.

Conclusions:  In patients with reflux esophagitis treated with lansoprazole, intragastric pH increased significantly when H. pylori was present, especially in the post‐prandial period, whereas baseline pH remained unchanged after H. pylori eradication.

© 2005 Blackwell Publishing Asia Pty Ltd
Clinical application of Carlsson's questionnaire to predict erosive GERD among healthy Chinese
Authors: HUNG CHIH‐SHENG , LEE CHIA‐LONG , YANG JUI‐NENG , LIAO PEN‐TE , TU TIEN‐CHIEN , CHEN TZEN‐KWAN , WU CHI‐HWA
Published: November 2005

Background:  Gastroesophageal reflux disease (GERD) is a common gastrointestinal disease, yet there is no definitive gold standard to describe and diagnose it.

Aim:  We used endoscopic examination and Carlsson's questionnaire to evaluate the prevalence of erosive esophagitis during health examinations of individuals in Taiwan.

Methods:  From October 2001 to March 2002, 778 people underwent self‐paid health examinations including esophagogastroduodenoscopic examinations. All subjects completed Carlsson's questionnaire before endoscopy. We determined the positive predict rate, negative predict rate, sensitivity, and specificity of the Carlsson's score for predicting esophagitis and relationships of the score (score ≥4 vs score <4) and esophagitis based on sex, age, body mass index (BMI), smoking, peptic ulcer and drinking habits.

Results:  One hundred and thirty‐one people with scores ≥4 were highly suspected to have GERD. Of them, 21 were diagnosed as having reflux erosive esophagitis (16.0%) on endoscopic examination. Of 647 people whose scores were <4, 49 were diagnosed with having reflux erosive esophagitis (7.6%). Thus, 70 people were diagnosed as having erosive esophagitis for a prevalence of 9% (70 of 778). The difference between scores ≥4 and <4 to detect esophagitis differed significantly (P < 0.001). Total esophagitis differed significantly according to BMI, drinking habit and sex.

Conclusion:  The prevalence of reflux esophagitis is 9.00% at a single medical center in Taiwan. Esophagitis is positively related to higher BMI, alcohol consumption and being of male sex. Predicting the prevalence of esophagitis in a general population by using Carlsson's questionnaire was unsatisfactory.

© 2005 Blackwell Publishing Asia Pty Ltd
Ferroportin (Q248H) mutations in African families with dietary iron overload
Authors: MCNAMARA LYNNE , GORDEUK VICTOR R , MACPHAIL A PATRICK
Published: November 2005

Background:  Dietary iron overload found in sub‐Saharan Africa might be caused by an interaction between dietary iron and an iron‐loading gene. Caucasian people with ferroportin gene mutations have iron overload histologically similar to that found in African patients with iron overload. Ferroportin is also implicated in the hypoferremic response to inflammation. The prevalence of the ferroportin Q248H mutation, unique to African people, and its association with dietary iron overload, mean cell volume (MCV) and C‐reactive protein (CRP) were examined in 19 southern African families.

Methods:  Polymerase chain reaction (PCR) and restriction enzyme digestion were used to identify the Q248H mutation. Statistical analysis was carried out to correlate the presence of the mutation with markers of iron overload and inflammation.

Results:  We identified three (1.4%) Q248H homozygotes and 53 (24.1%) heterozygotes in the families examined in the present study. There was no increased prevalence of the mutation in index subjects or their families. Logistic regression showed significantly higher serum ferritin concentrations with the mutation. The mean cell volume (MCV) was significantly lower, and the serum CRP significantly higher in subjects who carried the mutation.

Conclusions:  The present study of 19 families with African iron overload failed to show evidence that the ferroportin (Q248H) mutation is responsible for the condition. Logistic regression, correcting for factors influencing iron status, did show increased ferritin levels in individuals with the mutation. The strong association with low MCV suggests the possibility that the ferroportin (Q248H) mutation might interfere with iron supply, whereas the elevated serum CRP might indicate that the ferroportin mutation influences the inflammatory response in African populations.

© 2005 Blackwell Publishing Asia Pty Ltd
Clinical predictors for delirium tremens in alcohol dependence
Authors: LEE JUN HO , JANG MYOUNG KUK , LEE JA YOUNG , KIM SEONG MAN , KIM KYUNG HO , PARK JOON YONG , LEE JIN HEON , KIM HAK YANG , YOO JAE YOUNG
Published: November 2005

Background and Aims:  This study was aimed to find clinical predictors for developing delirium tremens (DT) in alcohol dependence.

Methods:  This cohort study was retrospectively carried out among patients who were diagnosed as having alcohol dependence between January 2001 and July 2004. Fifteen parameters were compared between patients who developed DT and ones who did not. We identified clinical predictors for DT by using multivariate analysis.

Results:  A total of one hundred and seventy‐eight consecutive admission cases from 147 patients were analyzed. The mean age was 47.8 years, and 95.5% were male. Delirium tremens developed in 59 cases (33%) during hospitalization. On multiple logistic regression analysis, a previous history of DT (odds ratio (OR) 3.990; 95% CI 1.631, 9.759) and high pulse rate above 100 b.p.m. (OR 4.158; 95% CI 2.032, 8.511) were significant predictors for developing DT. When combined, DT developed in just 20.4% of cases without any predictors; however, if one predictor was present, DT developed in 45.6%, and if two predictors were present, DT developed in all cases (100%).

Conclusions:  A simple assessment using the past history of DT and the pulse rate, which may be easily evaluated in clinical settings, can allow physicians to readily identify the patients who are at a high risk of developing DT during an alcohol dependence period and reserve more intensive therapies for the selected cases.

© 2005 Blackwell Publishing Asia Pty Ltd
CpG island methylation as an early event during adenoma progression in carcinogenesis of sporadic colorectal cancer
Authors: KIM HEE CHEOL , ROH SUN AE , GA IN HWA , KIM JUNG‐SUN , YU CHANG SIK , KIM JIN CHEON
Published: November 2005

Background and Aims:  CpG island methylation is present in various tumors, including colorectal carcinomas, and is thought to be an important mechanism in carcinogenesis. We evaluated the methylation status of primary colorectal tumors to determine its role in the adenoma to carcinoma sequence.

Methods:  The methylation status of APC, THBS1, MGMT, hMLH1 and GSTP1, as determined by methylation specific PCR (MSP), and microsatellite instability (MSI) using three mononucleotide markers were assessed in 40 colorectal adenomas and 36 adenocarcinomas. The correlations of methylation status and MSI with the clinicopathologic parameters of the tumors were determined.

Results:  Of the 40 adenomas, 24 (60%) were methylated at one or more loci, and 12 (30%) at two or more loci (CpG island methylation phenotype‐high, CIMP‐H). Of 36 carcinomas, 27 (75%) were methylated at one or more loci and 11 (30.5%) at two or more loci (CIMP‐H). THBSI was the most frequently methylated locus in both adenomas (n = 19, 47.5%) and carcinomas (n = 16, 44.4%). Overall, methylation status of adenomas and carcinomas did not differ significantly (P = 0.53), nor did the methylation status of individual genes. For adenomas, size (P = 0.049) and histologic classification of the villous components (P = 0.018) were each associated with methylation status. For carcinomas, however, no clinicopathologic variable was related to methylation status. MSI was detected in three adenomas (7.5%) and five carcinomas (13.9%), and was closely correlated with hMLH1 methylation (P < 0.001).

Conclusions:  In colorectal tumors, CpG island methylation of tumor suppressor genes appears to be common and may be involved in the progression of adenomas.

© 2005 Blackwell Publishing Asia Pty Ltd
Factors related to post‐treatment relapse in chronic hepatitis B patients who lost HBeAg after lamivudine therapy
Authors: BYUN KWAN SOO , KWON OH SANG , KIM JU HYUN , YIM HYUNG JOON , CHANG YUN JUNG , KIM JIN YONG , YEON JONG EUN , PARK JONG JAE , KIM JAE SEON , BAK YOUNG TAE , LEE CHANG HONG
Published: November 2005

Background and Aim:  It is uncertain if a patient's lamivudine response after HBeAg loss is durable. In Korean chronic hepatitis B patients, the relapse rate is high after termination of lamivudine therapy for patients with HBeAg loss. We evaluated the factors related to relapse in chronic hepatitis B patients with HBeAg loss after lamivudine therapy.

Methods:  A total of 132 chronic hepatitis B patients, who initially had HBeAg and did not have decompensated features, were analyzed in this study. These patients lost the HBeAg after lamivudine therapy and then their therapy was stopped. Post‐treatment serum alanine aminotransferase (ALT), HBeAg, anti‐HBe and hepatitis B virus (HBV) DNA were monitored until relapse.

Results:  Seventy‐five patients relapsed (cumulative relapse rate: 56% at 6 months). Upon univariate analysis, the factors of age, serum total bilirubin, presence of anti‐HBe after HBeAg loss, and the duration of additional lamivudine therapy after HBeAg loss were associated with relapse. Upon multivariate analysis, older age, a higher serum total bilirubin and the shorter duration of additional lamivudine therapy were significant risk factors for relapse. Patterns of relapse were the re‐elevation of ALT, re‐emergence of HBV DNA (69 patients) and reappearance of HBeAg (55 patients).

Conclusions:  To prevent relapse in patients with chronic hepatitis B infection after lamivudine therapy, age and serum bilirubin level of patients as well as a prolonged duration of additional lamivudine therapy should be considered.
Liver support systems: Promise and reality
Authors: WIGG ALAN J , PADBURY ROBERT T
Published: November 2005

Effective liver support is needed for a variety of indications. A large number of both biological (containing hepatocytes) and non‐biological extracorporeal liver support systems have been described in the literature over the last 50 years. Despite this, there is a paucity of good quality randomized control data examining the effectiveness of these therapies in human liver failure. In this review article, we examine the available data, with particular emphasis on the current front runners, the MARS® and HepatAssist® systems. Other problems associated with the development of these liver support systems are also discussed. Although promising in animal studies, we conclude that the use of these technologies is not supported currently by a sufficient evidence base to recommend them for routine clinical use and that a lack of understanding about the critical functions required of a liver support system is retarding a more rational approach to the design of these systems.

© 2005 Blackwell Publishing Asia Pty Ltd
Effects of norepinephrine and acetylcholine on portal–systemic collaterals of common bile duct‐ligated cirrhotic rat
Authors: CHAN CHE‐CHANG , CHANG CHING‐CHIH , HUANG HUI‐CHUN , WANG SUN‐SANG , LEE FA‐YAUH , CHANG FULL‐YOUNG , LIN HAN‐CHIEH , TAI CHUN‐CHING , LEE SHOU‐DONG
Published: November 2005

Background:  Catecholamine exerts profound vascular effects on vascular smooth muscle, and serum norepinephrine (Nepi) and sympathetic nervous activity are increased in cirrhosis. The vascular response of Nepi and acetylcholine (Ach) in portal–systemic collaterals of cirrhotic rats is unknown. The purpose of the present study was to investigate the effects of Nepi and Ach on portal–systemic collaterals of common bile duct‐ligated (BDL) cirrhotic rats.

Methods:  Perfusion studies were performed 6 weeks after BDL when hepatic cirrhosis was induced. Three series of experiments were performed in BDL rats: (i) the Nepi (10−10 mol/L−10−5 mol/L) vasoconstrictory responses with (n = 6) and without (n = 5) α1‐ (phentolamine, 5 × 10−6 mol/L) or β‐  (propranolol,  10−5 mol/L)  receptor  antagonist  (n = 6  and  5,  respectively);  (ii)  the  Ach  (10−8 mol/L−10−5 mol/L) vasodilatory responses in Nepi‐ preconstricted portal–systemic collaterals in the absence (n = 7) or presence (n = 8) of Nϖ‐ l‐nitro‐arginine (NNA, 10−4 mol/L); and (iii) the effect of indomethacin (10−5 mol/L; n = 6) on Nepi responses. The collateral vascular responses were evaluated by the in situ collateral perfusion.

Results:  Norepinephrine significantly increased the perfusion pressure and was inhibited by phentolamine (P < 0.05). The constrictive responses of Nepi were not significantly modified in the presence of propranolol (P > 0.05). Acetylcholine produced >50% relaxation of the Nepi‐preconstricted collateral vessels and was inhibited by NNA (P < 0.05). In addition, indomethacin significantly enhanced the constrictive response of Nepi (P < 0.05).

Conclusion:  Norepinephrine has a vasoconstrictive effect on the portal–systemic collaterals of cirrhotic rats and this effect was mediated by α1‐receptor. Both nitric oxide and prostaglandin are endogenous modulators in the collateral circulation of cirrhotic rats.

© 2005 Blackwell Publishing Asia Pty Ltd
Clinical implications of the extent of invasion of T3 esophageal cancer by endoscopic ultrasound
Authors: YUSUF TONY E , HAREWOOD GAVIN C , CLAIN JONATHAN E , LEVY MICHAEL J , TOPAZIAN MARK D , RAJAN ELIZABETH
Published: November 2005

Background: Endoscopic ultrasound (EUS) is an accurate imaging modality for local staging of esophageal cancer. We aimed to determine if depth of tumor invasion beyond muscularis propria (MP), as determined by preoperative EUS, is predictive of tumor recurrence or survival (a positive change in mortality) in patients with T3 esophageal cancer.

Methods: Records and images of all patients with T3 N1 M0 esophageal cancer staged with EUS at our institution between January 1999 and October 2003 were reviewed. EUS images were independently reviewed by five blinded endosonographers and tumors were classified as minimally invasive (invasion < 3 mm beyond MP) or advanced (invasion ≥ 3 mm beyond MP) T3 disease.

Results: One hundred and sixty‐five patients with esophageal cancer underwent EUS for staging and 39 patients with T3 N1 esophageal cancer were identified; 17 patients had minimally invasive T3 disease and 22 had advanced disease. All patients underwent neoadjuvant chemoradiation therapy followed by esophagectomy. Median follow up was 13 months. Adjusting for age and sex, minimally invasive disease was not associated with a statistically significant improvement in recurrence‐free survival (hazard ratio, 1.45; 95% CI, 0.88–2.41,P = 0.14) or mortality (hazard ratio, 0.96; 95% CI: 0.49–1.78,P = 0.91).

Conclusions: The extent of invasion of T3 esophageal cancer beyond MP, as determined by EUS, is not a significant predictor of tumor recurrence or mortality.
Effect of topical esophageal acidification on salivary secretion: Identification of the mechanism of action
Authors: SHAFIK AHMED , EL‐SIBAI OLFAT , SHAFIK ALI A , MOSTAFA RANDA
Published: November 2005

Background:  In past studies, investigators have reported that the salivary glands respond to esophageal acidification by increased salivary secretion and termed this response the ‘esophago–salivary response’. The existence, however, of such a reflex was but a speculation because the verification of its mechanism could not be traced in the literature. In the current study, the hypothesis that the salivary glands’ response to esophageal acidification is a reflex was investigated.

Methods:  In 15 healthy volunteers (nine men, six women, age 32.3 ± 4.2 years) the saliva of the four salivary glands was collected by intubation after individual esophageal perfusion with normal saline and 100 mmol HCl. The test was repeated after each of the lower esophagus and the salivary glands had been separately anesthetized. The latency was calculated.

Results:  The mean basal volume of saliva was 62.7 ± 6.4 mL/60 min. This volume did not show a significant change (P > 0.05) on esophageal saline instillation, whereas acid perfusion effected a significant increase (P < 0.01). The mean latency was 12.4 ± 2.7 s. Esophageal acid perfusion after lower esophageal anesthetization did not produce a significant change in salivary volume; similar results were obtained on repetition of the test after anesthetization of salivary glands. When saline was used instead of lidocaine in the lower esophagus or salivary glands, the salivary glands’ response was similar to that without saline perfusion.

Conclusion:  Esophageal acidification effected an increase of secreted saliva which clears the esophagus of the refluxed acid. Increased salivation on esophageal acidification is suggested to be a reflex and is mediated through the ‘esophago–salivary’ reflex. This reflex might be of diagnostic significance in the investigation of reflux esophagitis, a point that requires further study.
Psychological impact and cosmetic outcome of surgical breast cancer strategies
Authors: Nano Maria Teresa , Gill Peter Grantley , Kollias James , Bochner Melissa Anne , Malycha Peter , Winefield Helen R.
Published: November 2005

Background:  Current surgical treatment modalities for breast cancer include breast conserving surgery, mastectomy alone and mastectomy with breast reconstruction. There are recognized benefits of breast conservation and breast reconstruction over mastectomy but there are few studies assessing this area in Australia. The aim of the present study was to compare the various surgical strategies for breast cancer treatment in terms of quality of life, cosmesis and patient satisfaction.

Methods:  A chart analysis was conducted of all patients who underwent Breast Cancer Reconstruction at the Royal Adelaide Hospital Breast Unit between 1990 and 2002. Patients were then traced and asked to take part in an interview. Mastectomy and breast conservation patients who attended outpatient clinic for follow up were also approached. All three groups were interviewed and self‐assessment quality of life questionnaires (Functional Assessment of Cancer Therapy−Breast, body image) were administered. The breast conservation and reconstruction groups also underwent assessment of satisfaction and cosmesis.

Results:  A total of 78 mastectomy, 109 breast conservation and 123 breast reconstruction patients were interviewed. Quality of life assessment was similar between the three groups but the breast conservation and reconstruction patients’ body image scores were superior to the mastectomy group. Patient satisfaction was higher in the reconstruction group than the breast conservation group of patients, while cosmesis was similar.

Conclusion:  While little difference was seen on quality of life assessment, body image is improved with the use of breast conservation and reconstruction. The high satisfaction and cosmesis scores in the breast reconstruction group are an indication of the superior results that can be achieved with breast reconstruction.
Surgical treatment of femoral artery infected false aneurysms in drug abusers
Authors: Georgiadis George S. , Lazarides Miltos K. , Polychronidis Alexandros , Simopoulos Constantinos
Published: November 2005

Background:  Post‐traumatic femoral artery infected false aneurysms (pfa‐IFA) in drug abusers are very common in modern societies, but their surgical management remains controversial.

Methods:  A review was undertaken of the English‐language literature between 1967 and 2004 for relevant articles describing at least four cases of pfa‐IFA in drug‐addict populations. The available surgical treatment options are discussed.

Results:  Recent surgical therapeutic reports favour aneurysm ligation and excision (Lig‐Exc) and local debridement (Ld) with observation‐selective (delayed) revascularization in cases where limb viability is threatened, or Lig‐Exc and Ld alone without vascular reconstruction. The former method carries the risk of delayed decision on attempted extremity salvage (12.1% amputation rate), accepting early (13.5%) and late (7.5%) claudication rate, and although the latter method has much lower early and late amputation rates (5.7 and 6.3%, respectively), it results in a high percentage of claudication and disability (early, 54.4%; late, 44.3%). Immediate (routine) revascularization using either in situ or extra‐anatomic bypass has also been associated with high complication rates. Even when it occurs through non‐infected tissue planes, the risk of graft infection (early, 21.1%; late, 32.4%) is of great concern, and the possibility of sepsis (together with anastomotic dehiscence (14%) and even amputation) is high (early, 9.8%; late, 11.3%). Reversing the order of revascularization produces zero early complication rates, but long‐term follow up reveals that 5.5% of patients have graft infection and 5.5% have had amputation. The follow up rates reported in the literature are poor (only 31.7% completed), and are also sometimes inaccurate.

Conclusions:  No surgical treatment for pfa‐IFA has been proved to be safe in terms of the overall surgical complications. Longer follow‐up periods are needed to provide accurate results.
Outcome of surgery for parotid tumours: 5‐year experience of a general surgical unit in a teaching hospital
Authors: Al Salamah Saleh M. , Khalid Kamran , Khan Iftikhar A. R. , Gul Rahman
Published: November 2005

Background:  Most of the recent reports on the surgical management of parotid gland disorders come from specialist divisions of otolaryngology, head and neck, or faciomaxillary surgery. The aim of the present study was to evaluate the outcome of surgery for parotid tumours in a general surgical unit of a teaching hospital.

Method:  A prospective clinicopathological study was undertaken over a 5‐year period for consecutive patients operated on for parotid gland tumours in the King Saud University Unit of Riyadh Medical Complex. Parameters analyzed were demographic details, clinical presentation, diagnostic work‐up, type of surgery, and outcome in terms of early and late morbidity.

Results:  Thirty seven parotid operations were performed on 36 consecutive patients. All patients presented with parotid gland swelling. Mean age was 51.6 years with a male preponderance. Fine‐needle aspiration diagnosed the pathology in 33 out of 37 lesions. Pleomorphic adenoma was the commonest pathology observed in 24 patients (64.9%). Warthin's tumour was more common among male patients and was the only pathology with bilateral involvement. Malignant tumour was found in five patients (13.5%). Superficial conservative parotidectomy was the most frequently performed operation (84%). Overall postoperative morbidity was 13.5%. Transient facial nerve palsy was observed in seven cases (19%). There was no recurrence identified in patients with benign diseases during the mean follow up of 38.5 months.

Conclusion:  Parotid gland surgery can still be performed in a general surgery unit with comparable outcome. However, the operation should be performed in units with special interest and experience in surgery for parotid gland disorders.
Clinical variables associated with positive angiographic localization of lower gastrointestinal bleeding
Authors: Abbas Saleh M. , Bissett Ian P. , Holden Andrew , Woodfield J. C. , Parry Bryan R. , Duncan David
Published: November 2005

Background:  Localizing the source of severe lower gastrointestinal (GI) bleeding is often difficult but is important to plan the extent of colonic resection. The purpose of the present paper was to audit the Auckland Hospital experience of selective angiography, in localizing lower GI bleeding.

Methods:  Patients admitted to Auckland Hospital with rectal bleeding and who subsequently had angiography were evaluated by reviewing their clinical notes and radiological results during a 7‐year period (1997−2003). Data collected included demographic details, haemodynamic parameters, change in haemoglobin level, requirement of blood transfusion within 24 h before the procedure, site of the bleeding and pathology.

Results:  The notes of 88 patients (male, n = 51; median age 69 years, range 8−99 years) were available for review and analysis. The site of bleeding was localized in 38 (51%); 30 of them had bleeding in the right colon or small bowel and eight in the left colon. Positive localization correlated with: haemodynamic instability P < 0.0001; drop in haemoglobin level of ≥50 from previous admission (P = 0.02); transfusion requirement of ≥5 units of blood within 24 h (P < 0.0001). Logistic regression analysis showed transfusion requirement of ≥5 units to achieve haemodynamic stability to be the most powerful predictor of accurate localization (odds ratio, 40).

Conclusion:  Catheter angiography for acute lower GI bleeding will successfully localize a point of bleeding in approximately 50% of patients. The most useful clinical indicator for positive angiography was haemodynamic instability particularly in those who require transfusion of ≥5 units of blood to achieve haemodynamic stability.
Rates for mastectomy are lower in women attending a breast‐screening programme
Authors: Samnakay Naeem , Tinning Jill , Ives Angela , Willsher Peter , Archer Steve , Wylie Elizabeth , Saunders Christobel
Published: November 2005

Background:  Mammographic screening for breast cancer facilitates earlier recognition of lesions, thus potentially allowing for breast‐conserving surgery. Few studies have compared the final surgical outcomes of women presenting through breast screening programmes with those presenting via other sources. Are breast cancer patients presenting through BreastScreen more likely to undergo breast‐conserving surgery than those presenting from other sources?

Methods:  Using the Royal Perth Hospital (RPH) Multidisciplinary Breast Service Database, the final surgical outcomes were reviewed for 723 women treated for breast cancer at RPH between January 2000 and August 2002. During this period, 397 patients were referred to the RPH Multidisciplinary Breast Clinic from BreastScreen WA, and 326 were referred from other sources.

Results:  Of all patients undergoing surgery for breast cancer, 58% in the screen group and 36% in the non‐screen group had breast‐conserving surgery (P < 0.0001). When surgical outcomes for women in the BreastScreen target age range of 50−69 years were analysed, 59.5% in the screen group and 42.3% in the non‐screen group had breast‐conserving surgery (P < 0.001). Patient choice was second only to disease extent as a factor determining the outcome of mastectomy. In both cohorts, more than 40% of patients who underwent re‐excisional surgery for positive margins, after initial breast‐conserving surgery, had residual invasive or in situ disease present.

Conclusions:  At RPH, BreastScreen patients were more likely to undergo breast‐conserving surgery than those who presented from other sources. A significant proportion of women with positive margins after initial breast‐conserving surgery had residual in situ or invasive disease. Re‐excision for positive margins was thus warranted.
Complete resection of non‐small‐cell lung cancer and oligo‐metastatic brain disease
Authors: Daniels Marissa , Wright Gavin M.
Published: November 2005

Background:  Non‐small‐cell lung cancer is a leading cause of cancer morbidity and mortality in Australia. Brain metastases are common, and rapidly fatal if untreated. Optimal management consists of resection and whole brain irradiation. However, there is a paucity of local data documenting survival after such treatment.

Methods:  Medical records for all patients who underwent complete resection of non‐small‐cell lung cancer at one institution between January 1999 and December 2003 were reviewed in order to determine survival after initial surgery. The survival of all patients was compared with patients who underwent resection of synchronous or metachronous brain metastases and whole brain irradiation as part of their lung cancer management.

Results:  Between 1 January 1999 and 31 December 2003, 170 patients underwent complete resection of non‐small‐cell lung cancer by a thoracic surgeon. Resection of synchronous or metachronous brain metastases followed by whole brain irradiation was also carried out on 15 of these patients. Complete cerebral resection was achieved in 12 cases. The overall 5‐year survival after attempted curative resection of brain metastases and successful complete resection was 60% and 70%, respectively. The survival of patients with both cerebral metastasectomy and lung cancer resection approximated that of the cohort of patients that only required complete resection of their lung cancer.

Conclusions:  Control of local disease at each site and long‐term survival after lung resection and resection of either synchronous or metachronous brain metastasis and whole brain irradiation is readily achievable. We believe this should continue as the standard of care for this presentation.
Repair of mandible defect with tissue engineering bone in rabbits
Authors: Li Zhi , Li Zu‐Bing
Published: November 2005

Background:  The aim of the present study was to investigate the effect of tissue engineering bone composed of bone marrow‐derived osteoblasts and demineralized bone in repairing mandible defect.

Methods:  Bone marrow‐derived osteoblasts of 20 rabbits were cultured and seeded into scaffold of allogeneic demineralized bone to construct tissue engineering bone graft in vitro, which was used to repair the 10 × 5‐mm bone defect made in the same rabbit mandible edge. Implant of demineralized bone alone was as the control. Rabbits were killed according to the schedule: five after 2 weeks, five after 4 weeks, five after 8 weeks, five after 12 weeks, and the implants were harvested for gross, radiographic, and histological observation.

Results:  New bone formation at the margin region of defect and osteogenesis at the centre were observed in the implant of tissue engineering bone, and the bone formation pattern included osteogenesis, osteoconduction, and osteoinduction. In the implant of demineralized bone alone, the major bone formation pattern was ‘creeping substitute’.

Conclusions:  The tissue engineering bone graft constructed by autogenous bone marrow‐derived osteoblasts and allogeneic demineralized bone was better than demineralized bone alone in bone formation capability, which might be an ideal graft for bone defect repair.
Rare localizations of echinococcosis: personal experience
Authors: Versaci Antonino , Scuderi Giuseppe , Rosato Alessio , Angiò Luigi Giuseppe , Oliva Grazia , Sfuncia Giuseppe , Saladino Edoardo , Macrì Antonio
Published: November 2005

Background:  The rare localizations of hydatidosis represent an interesting topic, especially with reference to epidemiological and diagnostic problems. Hydatid disease, common in Mediterranean countries, still remains endemic in some regions of Italy.

Methods:  In the period April 1983−October 2003 73 patients with hydatid disease were observed.

Results:  Seven patients (9.5%) presented a primary rare localization (thyroid, kidney, sacrospinal muscle, peritoneum and spleen). The main peculiarity of primary rare hydatidosis localizations concerns diffusion of the infecting embryo; the most reliable hypothesis is that liver and lung can be bypassed through precapillary anastomosis between pre‐ and post‐parenchymal circulation. The new imaging techniques allow a correct topographic evaluation and so a radical surgical treatment. The chemotherapy, complementary to surgery, produced degenerative modifications of parasite in 75.8% of the present cases and reduction of recurrence from 23.3% to 6.7%. At follow up of 1−5 years no patients had recurrence.

Conclusion:  It is important to be aware, especially in countries where echinococcosis is endemic, that it is possible to find an echinococcosis cyst in a rare localization.
Infra‐inguinal revascularization surgical site infections: Australasian benchmark
Authors: Hassen Tiffany A. , Fitridge Robert A.
Published: November 2005

Background:  Infra‐inguinal revascularization surgery remains one of the most commonly performed major vascular procedures in contemporary practice. Surgical site infections (SSI) are a common cause of morbidity in this patient cohort and generate high rates of limb loss and mortality when vascular graft involvement occurs. An overall reduction in North American SSI has been attributed to the establishment of national benchmarks. A comparable Australasian benchmark does not exist. The purpose of the present study was to assess the methods used by Australasian vascular units to determine SSI rates and to instigate the development of an acceptable benchmark.

Methods:  A structured questionnaire pertaining to SSI after infra‐inguinal revascularization surgery was sent to 26 Australasian vascular units. Data requested included the number and type of lower extremity revascularization procedures performed. Units were also asked to report the methods employed for defining and detecting wound infections and to document their SSI rate. The incidence of SSI causation by methicillin‐resistant Staphylococcus aureus (MRSA) was also sought.

Results:  The total number of revascularizations performed annually varied from 28 to 179 between units. The SSI rates ranged from 0 to 38%. The incidence of MRSA involvement varied from <1% to 56%. The SSI surveillance methodology varied considerably between units.

Conclusions:  The present study confirms the significant incidence of SSI after infra‐inguinal revascularization surgery in contemporary vascular practice. Standardized definitions and surveillance protocols are required to facilitate inter‐ and intrahospital comparisons. A possible benchmark infection rate may be 10−20%.
Small bowel tumours in emergency surgery: specificity of clinical presentation
Authors: Catena Fausto , Ansaloni Luca , Gazzotti Filippo , Gagliardi Stefano , Di Saverio Salomone , De Cataldis Angelo , Taffurelli Mario
Published: November 2005

Background:  Despite advances in diagnostic modalities, small bowel tumours are notoriously difficult to diagnose and are often advanced at the time of definitive treatment. These malignancies can cause insidious abdominal pain and weight loss, or create surgical emergencies including haemorrhage, obstruction or perforation. The aim of the present study was to describe the clinical presentation, diagnostic work‐up, surgical therapy and short‐term outcome of 34 patients with primary and secondary small bowel tumours submitted for surgical procedures in an emergency setting and to look for a correlation between clinical presentation and the type of tumours.

Methods:  From 1995 to 2005, 34 consecutive surgical cases of small bowel tumours were treated at the Department of Emergency Surgery of St Orsola‐Malpighi University Hospital, Bologna, Italy. Clinical and radiological charts of these patients were reviewed retrospectively from the department database.

Results:  All patients presented as surgical emergencies: intestinal obstruction was the most common clinical presentation (15 cases), followed by perforation (11 cases) and gastrointestinal bleeding (eight cases). Lymphoma was the most frequent histologic type (nine patients), followed by stromal tumours (eight patients), carcinoids (seven patients), adenocarcinoma (seven patients) and metastasis (three patients). Of the nine patients with lymphoma, eight were perforated, all patients with stromal tumours had bleeding, and all carcinoids patients had bowel obstruction. There were two patients with melanoma metastasis, both had bowel intussusception. Resection of the neoplasm was carried out in 32 patients and two patients were deemed unresectable and received a palliative procedure.

Conclusions:  The present study shows that there is a correlation between small bowel tumours and clinical emergency presentation: gastrointestinal stromal tumours (GIST) mostly bleed; carcinoids make an obstruction; lymphomas cause a perforation; and melanoma metastasis causes intussusception.
Methods of surgical therapy in pulmonary hydatid disease: is capitonnage advantageous?
Authors: Erdogan Abdullah , Ayten Arife , Demircan Abid
Published: November 2005

Background:  Hydatid disease of the lungs is still a serious health problem for some Mediterranean countries. The best surgical therapy for the treatment of this disease is still unclear. In this clinical retrospective study, we aimed to investigate whether capitonnage is an effective therapy method for a pulmonary hydatid cyst or not.

Methods:  Between 1990 and 2004, 89 patients (49 male and 40 female) each with a pulmonary hydatid cyst were treated surgically. The patients were divided into two groups based on whether capitonnage was carried out (group 1, n = 44) or not (group 2, n = 45). Cystotomy and the closure of the bronchial openings were carried out in both groups. The results were assessed in two groups during a 1 year follow‐up period. The groups were comparable with regards to their clinical, operative and demographic characteristics.

Results:  There was no mortality, and no significant difference in hospitalisation time between the two groups. It was 8.2 ± 3.2 days for group 1 and 8 ± 3.1 days for group 2 (P = 0.89). The most serious complications were restricted bronchopleural fistula (only one patient in group 2), empyema (only one patient in group 1 and two patients in group 2), and prolonged air leak (five patients in group 1 and six patients in group 2). These results were not valuable statistically (P = 1.00, P = 1.00 and P = 0.78, respectively).

Conclusions:  We conclude that it is not an advantage to carry out capitonnage when treating pulmonary hydatid cysts.
Aggressive surgical resection for hilar cholangiocarcinoma
Authors: Lai Eric C. H. , Lau Wan Yee
Published: November 2005

Background:  Surgical treatment of hilar cholangiocarcinoma remains a great challenge to surgeons because of its low resectability, poor survival, and high operative mortality and morbidity.

Methods:  The medical and pathological records of 36 patients with a preoperative diagnosis of ‘resectable’ hilar cholangiocarcinoma operated on by us between January 1998 and December 2002 were studied. The clinical presentations, operative records, and pathology results were retrospectively reviewed.

Results:  Twenty‐six patients (72%) underwent resection with curative intent. Apart from resection of the extrahepatic biliary tree and porta hepatis lymph node dissection, 85% received concomitant en‐bloc liver resection and 4% received ex situ liver resection and auto‐transplantation. The margin of resection was negative (R0 resection) in 73% of patients, and microscopically positive (R1 resection) in the remaining 27%. The 30‐day hospital mortality was 7.6%. Of the patients, 42% had major postoperative complications. The median survival was 20 months, with the longest survival 75 months. The 1‐, 3‐ and 5‐year actuarial overall survival rate after resection with curative intent was 77%, 31%, and 12%, respectively. The 1‐, 3‐, and 5‐year actuarial overall survival after R0 resection was 84%, 42%, and 16%, respectively. Tumour recurrence occurred in 58% of patients.

Conclusions:  Aggressive surgery increases the resectability of hilar cholangiocarcinoma. R0 resection provides the only chance of long‐term survival of these patients.
Aspirin induces apoptosis in oesophageal cancer cells by inhibiting the pathway of NF‐kappaB downstream regulation of cyclooxygenase‐2
Authors: Liu Jun‐Feng , Jamieson Glyn G. , Drew Paul A. , Zhu Gui‐Jun , Zhang Shao‐Wei , Zhu Tie‐Nian , Shan Bao‐En , Wang Qi‐Zhang
Published: November 2005

Background:  Aspirin has potential in the prevention or treatment of oesophageal cancer, the seventh most common cancer in the world, but its mechanism of action is still not certain.

Methods:  The oesophageal squamous cell carcinoma cell line TE‐13 was cultured with aspirin at different concentrations or for different times. Proliferation and apoptosis were measured by MTT reduction and flow cytometry. Expression of COX‐2 mRNA was measured by RT‐PCR and COX‐2 protein levels with Western blot analysis. Nuclear NF‐kappaB and cytoplasmic IkappaB protein levels were determined by electrophoretic mobility shift assay and Western blot, respectively.

Results:  Aspirin significantly inhibited cell proliferation and induced apoptosis at concentrations of 1, 4, 8 mmol/L. Aspirin dose‐dependently decreased the levels of COX‐2 mRNA, COX‐2 protein and nuclear NF‐kappaB protein and increased the cytoplasmic IkappaB protein.

Conclusion:  We conclude that aspirin inhibits the proliferation of, and induced apoptosis in, the cultured TE‐13 SCC cell line. These changes correlate with a reduction in COX‐2 mRNA and protein expression, prostaglandin synthesis, an inhibition of NF‐kappaB nuclear translocation, and an increase in cytoplasmic IkappaB. These results support the further investigation of the cyclooxygenase pathway in investigating the potential of aspirin and similar drugs in cancer prevention and therapy.
Once bitten, twice shy: an unusual case report of a mycotic aortic aneurysm
Authors: Chu Peter , Howden Benjamin P. , Jones Stephanie , Fell Gary , Roberts Andrew K.
Published: November 2005

Primary mycotic aneurysms of the aorta are a rare, but potentially lethal condition comprising less than 1% of all aortic aneurysms. All age groups are affected but patients younger than 50 years are most susceptible. Organisms commonly implicated in aortitis and mycotic aortic aneurysms include Salmonella species and Staphylococcus aureus1. We present the first case report of a primary aortic mycotic aneurysm caused by Capnocytophaga canimorsus, a commensal organism found in the mouth of dogs and cats and occasionally associated with serious human infections.
Constraint Respecters, Constraint Challengers, and Crisis Decision Making in Democracies: A Case Study Analysis of Kennedy versus Reagan
Authors: Keller Jonathan W.
Published: November 2005

Models linking domestic political constraints (audience costs, pressures for the diversionary use of force, democratic norms and institutions) to foreign policy behavior generally assume that leaders simply recognize and submit to constraints in their domestic environments—a strong structural argument. In contrast, research on political leadership and decision making suggests that leaders vary systematically in their orientations toward constraints: “constraint respecters” tend to internalize potential constraints, while “constraint challengers” are more likely to view them as obstacles to be overcome. This article develops an integrative theoretical framework that explicitly incorporates these insights and applies them to the domain of crisis decision making. After identifying leaders’ expected orientations toward constraints via at‐a‐distance methods, the plausibility of hypotheses derived from this framework is examined through case studies that explore the decision‐making processes employed by President Kennedy (a “constraint respecter”) and President Reagan (a “constraint challenger”) during international crises. The results suggest that there is important variation in how leaders perceive and respond to domestic constraints, and that leadership style is one—though not the only—important source of this variation.
Affect and Cognition in Party Identification
Authors: Burden Barry C. , Klofstad Casey A.
Published: November 2005

Despite the centrality of party identification in understandings of political behavior in the United States, there is an unacknowledged disparity between our theories and measurement of the phenomenon. The traditional method of measuring party identification relies on supplying cognitive cues by explicitly asking respondents to “think” about their partisanship. The Michigan theory of party identification, in contrast, assumes that partisanship is primarily affective. Using a survey experiment, we explore the effects of asking respondents to feel rather than think about their party identification. The new questions reveal that the electorate is more Republican than previously thought. Response timers show that respondents take longer to answer the new items, suggesting that they are surveying a wider and deeper array of considerations. These results serve to revive many of our traditional conceptions of how party identity works while also opening the door for new research questions.
Fighting and Flying: Archival Analysis of Threat, Authoritarianism, and the North American Comic Book
Authors: Peterson Bill E. , Gerstein Emily D.
Published: November 2005

In this archival study, themes of authoritarianism (Adorno, Frenkel‐Brunswik, Levinson, & Sanford, 1950) were content coded in American comic books. Comic books produced during years of relatively high social and economic threat (1978–82 and 1991–92) contained more aggressive imagery, more conventional themes, less intraception, and fewer spoken lines by women characters relative to comic books produced during years of relatively low threat (1983–90). Unexpectedly, speaking roles for characters of color did not differ due to the influence of threat. Discussion focused on the theoretical relationship between threat and manifestations of authoritarianism at the societal and individual levels.
Values, Framing, and Citizens’ Thoughts about Policy Issues: Effects on Content and Quantity
Authors: Brewer Paul R. , Gross Kimberly
Published: November 2005

This study examines how frames invoking a core value shape the content and quantity of citizens’ thoughts about a policy issue. An experimental study showed that exposure to a pro‐school voucher equality frame increased the probability that participants would invoke equality in their open‐ended survey responses. Exposure to an anti‐school voucher equality frame produced the same effect, as did exposure to both frames. At the same time, participants who received either frame or both frames provided fewer open‐ended responses. Thus, the frames appeared to focus participants’ thoughts on one value while reducing the overall extent to which they thought about the issue. In broader terms, value framing may have implications for the nature and quality of public deliberation about policy issues—a point that scholars should keep in mind when considering how to define and study framing effects.