bluuebunny/crossref_metadata_2025 huggingface dataset:
Market delusions: rethinking the trajectories of post‐socialist societies
Authors: Williams Colin C.
Published: June 2005

Purpose

Recently, the recurring narrative that capitalism is stretching its tentacles ever moe widely and deeply into every crevice of daily life across the globe has been challenged in the context of Western economies and the Third World by an emerging post‐development corpus of thought. The aim here is to extend this critique of market hegemony by investigating the so‐called “transition” economies of East‐Central Europe.

Design/methodology/approach

The paper analyses the extent to which market practices penetrated the “transition” economies of East‐Central Europe in the years following the collapse of the socialist bloc, first through a review of the post‐development literature and then by examining the nature of work and trajectories of the “transition” economies.

Findings

Analysis highlights not only the shallow permeation of market practices but also the multiplicity of development trajectories being pursued at both the household and societal levels.

Originality/value

The outcome is to provide additional evidence from the post‐socialist East‐Central European bloc to support the critique of market hegemony and open up the future to alternative possibilities beyond marketisation.
ARIA: impact of compliance
Authors: Van Cauwenberge P.
Published: June 2005

Epidemiological studies show that the prevalence of asthma and allergic rhinitis (AR) has increased progressively over the past two to three decades. Similarly, there is increasing evidence that asthma and rhinitis frequently co‐exist in the same patients and that rhinitis is a risk factor for asthma. Although several guidelines are currently available for the diagnosis and management of AR, the earlier guidelines and their successors were not evidence based, and were developed primarily on the basis of expert opinion, but of course based on the available literature. More recently, the Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines were published in co‐operation with the World Health Organization. These guidelines are evidence based and directed towards managing co‐morbid rhinitis and asthma as different manifestations of a single airway disease, rather than as two separate diseases of the nose and the lung. They recommend treatment of AR in a step‐wise manner (using a combination of allergen avoidance, pharmacotherapy and immunotherapy), based on the duration and severity of disease, rather than on the basis of type of exposure (i.e seasonal, perennial, occupational), as recommended by previous guidelines. The ARIA guidelines recognize that both the availability and the cost of a particular intervention are likely to determine patient compliance, and therefore recommends a flexible approach based on availability and cost of specific interventions in different countries. Despite the availability of treatment guidelines, there is evidence that the severity of disease is often diagnosed and treated inappropriately by general practitioners (GPs), who frequently do not use a guided treatment strategy, leading to low patient satisfaction and compliance. This suggests a clear need to implement the guidelines among GPs, especially since the vast majority of patients generally trust their GPs to provide appropriate information and optimal medication for the management of their disease.
Pharmacological interventions and outcome measurements in the unified airway
Authors: Lipworth B. J.
Published: June 2005

In view of the large body of evidence for the role of histamine and cysteinyl leukotrienes (CysLT1) in the pathogenesis of allergic rhinitis (AR) and asthma, there has been a surge in the development of histamine H1 and CysLT1 receptor antagonists (H1 antihistamines and leukotriene antagonists, respectively) for the treatment of these conditions. Current treatment guidelines recommend the use of oral H1 antihistamines as first‐choice treatment for intermittent or persistent AR and the leukotriene antagonists, either as alternative or add‐on therapy to inhaled corticosteroids, for mild‐to‐moderate persistent asthma. However, recent studies, using a variety of traditional and novel outcome measures, have suggested that the H1 antihistamines and leukotriene receptor antagonists (LTRAs) may be effective in both asthma and AR. However, these studies have provided conflicting evidence as to whether H1 antihistamines and the leukotriene antagonists have the potential for additivity of response, when used as combination therapy in AR. There are also preliminary data showing that H1 antihistamines, like LTRAs, may further reduce inflammation, when used as add‐on therapy to inhaled corticosteroids in patients with mild‐to‐moderate persistent asthma. The clinical relevance of these findings, however, is presently not clear and also, the observed effects of these agents are likely to be dependent on the type of outcome measures used in these studies. Further studies are therefore clearly required to evaluate the effects of combined histamine H1 and CysLT1 receptor antagonists in patients with more severe disease over the longer term, particularly to evaluate asthma exacerbations and airway remodelling. Furthermore, it will be important to assess the potential for treating the unified airway in patients with concomitant asthma and AR in terms of comparing combined mediator antagonism with topical corticosteroid therapy.
Assessment of quality of life: advantages and pitfalls
Authors: Gerth van Wijk R.
Published: June 2005

There is increasing evidence that allergic diseases such as allergic rhinitis (AR) and asthma impair the overall quality of life (QOL) of patients and place a great economic burden on both the individual and society as a whole. While conventional measures, such as a medical history and specific allergy tests, give an indication of the patient's disease and its burden, these may not reflect the disease status accurately or in its entirety. The development of disease‐specific instruments (questionnaires) for measuring health‐related quality of life (HRQOL) of adults and children with AR, asthma, or co‐morbid allergic disease, has led to the recognition that these instruments provide a more accurate estimate of the burden of disease, and additionally represent a formal and validated part of the history. Studies employing HRQOL instruments have indicated that these instruments are simple to administer and represent validated and quantifiable methods for taking a simple patient history. Despite some limitations, these instruments are thought to be particularly useful because they (i) provide additional information on various aspects of disease or treatment which are not readily identified by the clinician, (ii) give an insight into the burden and consequences of allergic disease and (iii) describe the relationship between the medical treatment and improvement in HRQOL, which appears to be the motive behind good compliance and patient satisfaction.
Metoprolol in the Prophylaxis of Migraine: Parallel‐Groups Comparison withPlacebo and Dose‐Ranging Follow‐Up
Authors: Steiner T.J. , Joseph Rajiv , Hedman C. , Rose F. Clifford
Published: June 2005

SYNOPSIS

88 patients in need of prophylactic treatment for classical, common or mixed migraine of at least 2years' duration were admitted to a double‐blind placebo‐controlled trial of the beta1‐selective adrenoceptorblocker, metoprolol. All patients initially took placebo for 1 month, during which 29 were excludedprincipally because of failure to reattend or placebo‐response making active treatment unnecessary. Theremaining 59 patients were randomised to continued placebo or metoprolol 50 mg b.i.d. for 2 months.Patients after this time subjectively categorizing their responses as less than optimal changed,double‐blindly, from placebo to metoprolol 50 mg b.i.d., or from metoprolol 50 mg b.i.d. to 100 mg b.i.d., fora further follow‐up period of up to 3 months.

Placebo response was 40% overall, and often occurred after the first month. In the first double‐blindcomparative period metoprolol reduced attack frequency significantly, and more than placebo. Severity ofattacks still occurring was not altered by either treatment. Other measures of illness were alteredconsistently with these principal findings. Consistent improvements also were seen in patients switchingfrom initial placebo therapy to metoprolol 50 mg b.i.d. for the further follow‐up period, and those changingto the higher dose of metoprolol showed statistically significant further improvements, and clinicallyimportant improvements overall. Side‐effects were minor and reversible.

This study gives supportive evidence of the value of metoprolol in preventing migraine attacks andsuggests that individual dosage titration can substantially enhance its efficacy. Side‐effects do notsignificantly impede its use and other evidence suggests that beta1‐selective blockers are to be preferredover non‐selective in migraine therapy.
Effect of dietary l‐carnitine supplementation on growth performance of piglets from control sows or sows treated with l‐carnitine during pregnancy and lactation
Authors: Birkenfeld C. , Ramanau A. , Kluge H. , Spilke J. , Eder K.
Published: June 2005

Previous studies showed that supplementation of sows’ diets with l‐carnitine increases body weights of their piglets at birth. This study was performed to investigate whether piglets of sows treated with l‐carnitine differ in their growth potential from that of piglets of untreated control sows after weaning. It was also investigated whether supplementation of piglets’ diets with l‐carnitine improves their growth after weaning. In two trials, piglets of the first litters of primiparous sows (trial 1) and the second litters of the same sows (trial 2) were divided into four groups: group 1, piglets of control sows, fed a control diet; group 2, piglets of control sows fed a diet supplemented with 30 mg l‐carnitine/kg; group 3, piglets of l‐carnitine‐treated sows, fed a control diet; group 4, piglets of l‐carnitine‐treated sows fed a diet supplemented with 30 mg l‐carnitine/kg. Mean initial body weights of the piglets of the four groups were identical. They were 8.5 kg in trial 1 and 12.5 kg in trial 2. Diets were fed ad libitum over a period of 35 days. Piglets from sows treated with l‐carnitine did not differ in body weight gains, feed intake and gain : feed ratio from those of control sows. In trial 1, piglets supplemented with l‐carnitine had higher body weight gains (p < 0.005) and showed a tendency towards a higher gain : feed ratio (p = 0.09) than piglets fed the control diets. In trial 2, no significant difference in these parameters emerged between piglets fed the diet supplemented with l‐carnitine and those fed the control diet. In conclusion, this study shows that dietary l‐carnitine treatment of sows does not improve the growth potential of their piglets after weaning under the conditions of equal initial body weights. The study also shows that l‐carnitine supplementation of their diets improves the growth performance in light piglets of primiparous sows.
Pancreatic and duodenal injuries: Keep it simple
Authors: Rickard Matthew J. F. X. , Brohi Karim , Bautz Peter C.
Published: June 2005

Background:  The management of pancreatic and duodenal trauma has moved away from complex reconstructive procedures to simpler methods in keeping with the trend towards organ‐specific, damage control surgery.

Method:  A retrospective case note review was undertaken over a 30‐month period to evaluate a simplified protocol for the management of these injuries.

Results:  Of 100 consecutive patients there were 51 with pancreatic injury, 30 with a duodenal injury and 19 with combined pancreaticoduodenal trauma. Overall mortality was 18.0%, with a late mortality (after 24 h) of 9.9%. This is comparable to previous studies. Morbidity from abscesses, fistulas and anastomotic breakdown was acceptably low.

Conclusion:  The concept of staged laparotomy can be successfully applied to wounds of the pancreas and duodenum. Debridement of devitalized tissue and drainage can be employed for most cases of pancreatic trauma. Most duodenal injuries can be managed with debridement and primary repair. Temporary exclusion and reoperation should be employed for unstable patients.
Evolution of trends in risk management
Authors: Aziz Farah , Khalil Alizan , Hall John C.
Published: June 2005

In the past, the detection and response to adverse clinical events were viewed as an inherent part of professionalism; and, if perceived problems were not sorted out at that level, the ultimate expression of dissatisfaction was litigation. There are now demands for the adoption of more transparent and effective processes for risk management. Reviews of surgical practice have highlighted the presence of unacceptable levels of avoidable adverse events. This is being resolved in two ways. First, attention is being directed to the extent that training and experience have on outcomes after surgery, and both appear to be important. Second, a greater appreciation of human factors engineering has promoted a greater involvement of surgeons in processes involving teamwork and non‐technical skills. The community wants surgeons who are competent and health‐care systems that minimize risk. In recent times attention has been focused on the turmoil associated with change; but, when events are viewed over a period of several decades, there has been considerable progress towards these ideals. Further advancement would be aided by removing the adversarial nature of malpractice systems that have failed to maintain standards.
Evaluation of fresh frozen plasma usage at a tertiary care hospital in North India
Authors: Chaudhary Rajendra , Singh Harprit , Verma Anupam , Ray Vijaylaxmi
Published: June 2005

Background:  Concerns regarding transfusion‐transmitted infections and non‐availability of blood components in developing nations, make it crucial to optimize fresh frozen plasma (FFP) transfusions and reduce wastage.

Methods:  A concurrent prospective study of FFP usage was carried out in a tertiary care hospital in north India.

Results:  A total of 595 units were issued to 112 patients during the study period, of which 53 units (8.9%) were returned to the blood centre unused, leading to wastage. Appropriate indications for FFP usage were as per accepted British Council for Standardization in Haematology (BCSH) criteria. Among 112 patients 33 (29.5%) had had appropriate FFP transfusions (205 units) for indications that primarily included chronic liver disease, disseminated intravascular coagulopathy and prolonged bleeding with abnormal coagulation profile. Out of 33 patients with appropriate indications, 24 had abnormal coagulation profile but only half of these patients (n = 12) received adequate dose of FFP. Fresh frozen plasma was used for inappropriate indications in 79 patients (70.5%), which mainly included bleeding following cardiac surgery with normal coagulation test results, hypovolaemia and hypoproteinaemia. Such misuse was higher in surgical units than medical services (78 vs 45%).

Conclusion:  Fresh frozen plasma is grossly misused even in resource‐deficient nations and immediate intervention is needed to stem the flow of this component. Physician education programmes and a monitoring system to ensure strict adherence to the established guidelines are required to reduce undue waste of this blood component.
Randomized prospective controlled trial of lateral internal sphincterotomy versus injection of botulinum toxin for the treatment of idiopathic fissure in ano
Authors: Iswariah Harish , Stephens Jacqueline , Rieger Nicholas , Rodda David , Hewett Peter
Published: June 2005

Background:  Chronic anal fissure is a significant cause of morbidity. Internal sphincterotomy has long been the operative treatment of choice. Concerns remain, however, on its effects on continence. Botulinum toxin has been used as an agent for chemical sphincterotomy, causing temporary alleviation of sphincter spasm and allowing the fissure to heal. The aim of the present study was to compare the results of sphincterotomy to botulinum toxin.

Methods:  The study was designed as a randomized controlled trial. All adult patients over the age of 18 with chronic idiopathic fissure in ano who had failed conservative treatment were included in the trial. Patients were randomized to receive either Botox or sphincterotomy. Pain, healing of fissure and continence scores were the outcomes assessed.

Results:  A total of 38 patients were studied. Seventeen patients were randomized to receive Botox and 21, sphincterotomy. Patients in the Botox group were found to have significantly higher 2‐week pain scores and reoperation rates, and poor healing. Continence scores were not significantly different in the two groups.

Conclusion:  Sphincterotomy gives better results than Botox in the treatment of fissure. Botox, however, is safe with no complications and no detriment to continence and could be used in certain situations.
Role of fenestration and resection for symptomatic solitary liver cysts
Authors: Tan Yu‐Meng , Chung Alexander , Mack Peter , Chow Pierce , Khin Lay‐Way , Ooi London L.
Published: June 2005

Background:  Symptomatic liver cysts can be managed surgically by fenestration or by hepatic resection. The present study was designed to investigate the current role of each surgical technique in the management of this benign condition.

Methods:  Forty consecutive patients with symptomatic liver cyst (non‐parasitic and non‐malignant) surgically treated by fenestration or resection were identified from a prospectively collected database. An analysis of primary outcome measures including operative parameters, morbidity and mortality rates, length of postoperative stay and recurrence rates in months was carried out.

Results:  The laparoscopic fenestration group had the best perioperative outcome. At median follow up of 20 months, there were no recurrences in the resection group but recurrence occurred in 6/27 (22%) in the fenestration group. Four of these recurrences were asymptomatic and were managed conservatively while two symptomatic recurrences required a resection.

Conclusion:  Laparoscopic fenestration is the best treatment for symptomatic liver cysts as the primary operation. It is associated with the lowest blood loss, lowest morbidity and shortest hospital stay. Liver resection is best reserved for recurrent symptomatic cysts and cystic lesions suspicious of tumours where it can be safely performed and associated with a zero recurrence rate.
Recovery of parathyroid function after total thyroidectomy: Long‐term follow‐up study
Authors: Kihara Minoru , Miyauchi Akira , Kontani Keiichi , Yamauchi Akira , Yokomise Hiroyasu
Published: June 2005

Background:  To prevent postoperative hypoparathyroidism following total thyroidectomy, the parathyroid glands are preserved in situ and/or resected or devascularized parathyroid glands are autotransplanted. A retrospective investigation was conducted utilizing biochemical and specific endocrine assessments to evaluate the difference in recovery of parathyroid function in the long term.

Methods:  A total of 103 patients underwent total thyroidectomy at Second Department of Surgery, School of Medicine, Kagawa University between 1990 and 1998. These patients were divided into a preservation group (n = 17), with only preserved glands in situ; a combination group (n = 72), consisting of patients with one or more parathyroid glands preserved in situ and one or more autotransplanted parathyroid glands; and an autotransplantation group (n = 14), with only transplanted glands.

Results:  The overall incidence of permanent hypoparathyroidism in the preservation group, the combination group, and the autotransplantation group was 0%, 1.4%, and 21.4%, respectively. The mean levels of intact parathyroid hormone in the preservation group, the combination group, and the autotransplantation group recovered to 102%, 107%, and 50% of the preoperative levels at 5‐year follow up.

Conclusion:  The results of the present study suggest that parathyroid glands should be preserved in situ whenever possible, to promote better recovery of postoperative function, and that only autotransplantation produces inadequate recovery of long‐term function.
Prioritization of cataract surgery: Visual analogue scale versus scoring system
Authors: Wong Victoria W. Y. , Lai Timothy Y. Y. , Lam Philip T. H. , Lam Dennis S. C.
Published: June 2005

Background:  The purpose of the present paper was to evaluate the variability of using a visual analogue scale (VAS) and to assess the feasibility of a priority‐setting scoring system for prioritizing elective cataract surgery.

Methods:  Consecutive cases listed for cataract surgery were prospectively recruited. Ophthalmologists listed patients to undergo early or normal surgery and were asked to rate the urgency of surgery using a VAS. Patients were then reassessed and a cataract surgery prioritization (CSP) score was calculated based on the New Zealand priority criteria for cataract surgery. Correlation coefficients between VAS and CSP scores were calculated to determine the variability among ophthalmologists in using the VAS in prioritizing surgery. Further analyses were performed to assess the potential impact of implementing the CSP system.

Results:  A total of 326 patients were recruited. There was a positive correlation between VAS and CSP scores (Spearman ρ= 0.407, P < 0.001). A high degree of variation among ophthalmologists in the use of VAS was found. Patients with poor binocular vision were not listed as early, whereas patients with poor vision in the eye listed for cataract surgery but good vision in the fellow eye were more likely to be prioritized to have early operation. These findings suggest that patients with severe impairment in binocular visual function were not adequately accounted for during cataract surgery listing.

Conclusions:  The use of a VAS for prioritizing cataract surgery may be suboptimal due to high subjectivity. Adoption of an objective criteria‐validated priority‐setting scoring system may allow better stratification of patients to ensure better service provision.
Mini‐laparoscopic cholecystectomy in children under 10 years of age with sickle cell disease
Authors: Seleem Mohamed I. , Al‐Hashemy Ahmed M. , Meshref Sahar S.
Published: June 2005

Background:  Cholelithiasis is very common in patients with sickle cell disease (SCD) and is responsible for recurrent attacks of abdominal pain. The ideal management, especially for children, remains controversial. The purpose of the present study was to evaluate the safety and outcome of mini‐laparoscopic cholecystectomy (MLC) in young children under age of 10 years with SCD.

Methods:  A prospective study was carried out of 75 children with SCD under 10 years of age with recurrent abdominal pains seen between August 2001 and March 2004 at Armed Forces Hospital, Khamis Mushayt, Saudi Arabia, who were screened for cholelithiasis. Twelve (16%) of the 75 children were found to have gallstones. The mean age was 7.8 years (range 4−9 years). All 12 children underwent MLC. Anaemia was corrected preoperatively in all the patients. Operative time, intraoperative complications, hospital stay, and postoperative recurrent abdominal pain were recorded.

Results:  The mean operating time was 46.5 min (range: 35−65 min). Intraoperative cholangiogram failed in two children due to narrow cystic ducts. The mean hospital stay was 2.1 days (range: 2−4 days). No patient required intra‐abdominal drain. The mean follow‐up period was 13.4 months (range: 4−24 months). The only postoperative complication was deep jaundice 1 month postoperatively due to cholestasis, and this responded to medical treatment. None of the children had recurrent abdominal pain after MLC.

Conclusion:  Mini‐laparoscopic cholecystectomy is a safe surgical procedure for the management of cholelithiasis in children with SCD and leads to improvement in the quality of life by decreasing the frequency of recurrent abdominal pain.
Reoperative pancreaticoduodenectomy for periampullary carcinoma
Authors: Shukla Parul J. , Qureshi Sajid S. , Shrikhande Shailesh V. , Jagannath Palepu , DeSouza Luis J.
Published: June 2005

Background:  Potentially resectable periampullary tumours may not be treated appropriately due to lack of local expertise in both assessment of resectability and resection in referring centres. Tata Memorial Hospital is a major referral centre for oncology and these patients are finally referred to this institution. In carefully selected patients, resection can be accomplished. The purpose of the present paper was to determine the perioperative morbidity and mortality for patients undergoing reoperative pancreaticoduodenectomy at a major comprehensive cancer centre.

Methods:  Between January 1991 and December 2001 15 patients, who had undergone previous non‐resectional surgery for operable periampullary carcinoma, underwent re‐exploration. The perioperative morbidity and mortality were analysed and compared with that of the group of patients undergoing primary pancreaticoduodenectomy (143 patients) in the same period.

Results:  All the 15 patients undergoing re‐exploration had a successful resection by pancreaticoduodenectomy. In the reoperative group eight patients (53%) underwent classic pancreaticoduodenectomy and seven patients (46%) had a pylorus‐preserving pancreaticoduodenectomy, as compared to 102 (71%) and 41 (29%) patients in the primary surgery group, respectively. Although the mean operative time and the estimated blood loss were higher in the reoperative group, the morbidity and mortality rates were similar in the two groups. The overall 30‐day mortality rate was 6.6% and 6.9% in the reoperative and the primary surgery group, respectively. Major morbidity occurred in two of the 15 patients (13.3%), and one patient (6.6%) died following surgery in the reoperative group.

Conclusion:  Reoperative pancreaticoduodenectomy can be performed safely in carefully selected patients with resectable, localized periampullary tumours with similar morbidity and mortality to patients undergoing primary surgery.
Validation of EuroSCORE model in an Australian patient population
Authors: Yap Cheng‐Hon , Mohajeri Morteza , Ihle Benno U. , Wilson Anthony C. , Goyal Shiromani , Yii Michael
Published: June 2005

Background:  The purpose of the present paper was to assess the performance of the European system for cardiac operative risk evaluation (EuroSCORE) model in an Australian adult cardiac surgical population.

Methods:  The additive and logistic EuroSCORE models were retrospectively applied to predict operative mortality in 2106 consecutive patients undergoing cardiac surgery at St Vincent's Hospital, Melbourne between June 2001 and August 2003, and at Geelong Hospital between June 2001 and April 2004. The entire cohort and a subset of patients undergoing isolated coronary artery bypass graft (CABG) surgery were analysed. Model discrimination and calibration was tested by determining the area under the receiver operating characteristic (ROC) curve and Hosmer−Lemeshow χ2, respectively.

Results:  There were significant differences in the prevalence of risk factors between the Australian and European cardiac surgical populations. There were 81 deaths (observed mortality 3.85%) in the entire cohort and 39 deaths in the isolated CABG group (observed mortality 2.60%). The EuroSCORE models overestimated mortality (entire cohort: additive predicted 5.75%, logistic predicted 9.93%; isolated CABG: additive predicted 4.87%, logistic predicted 7.71%). Discriminative power was very good for the entire cohort (area under ROC curve, 0.81 (additive) and 0.82 (logistic)). Calibration of both models was poor.

Conclusion:  The additive and logistic EuroSCORE model of risk prediction was not validated in the present population of cardiac surgical patients. The models may not accurately predict outcomes of patients undergoing cardiac surgery in Australia.
Total thyroidectomy replaces subtotal thyroidectomy as the preferred surgical treatment for Graves’ disease
Authors: Ku Chun‐Fan , Lo Chung‐Yau , Chan Wai‐Fan , Kung Annie W. C. , Lam Karen S. L.
Published: June 2005

Background:  Total thyroidectomy is increasingly being adopted for patients requiring surgical treatment for Graves’ disease based on a comparable surgical risk and the lack of recurrence, as well as the questionable ability of subtotal thyroidectomy to maintain euthyroidism. The purpose of the present paper was to evaluate its safety and efficiency.

Methods:  Total thyroidectomy was adopted as part of the routine surgical treatment for Graves’ disease from 2000. Patients who underwent subtotal thyroidectomy (STT) from 1995 to 1999 (n = 119) were compared with those who underwent total thyroidectomy (TT) from 2000 to 2003 (n = 98) with respect to immediate postoperative morbidity and long‐term outcome.

Results:  Fourteen (11.8%) and 22 patients (22.4%) required calcium supplement on discharge in the STT and TT groups, respectively (P < 0.05). One (0.8%) and three patients (3.1%) developed permanent hypocalcaemia, respectively. Transient recurrent laryngeal nerve palsy occurred in 9.2% (n = 11) and 5.1% (n = 5) of patients or 5.0% and 2.6% of nerves at risk after STT and TT, respectively. None of the patients had permanent nerve palsy. The estimated blood loss was less and hospital stay shorter after TT. During a mean follow up of 64 months, 86 patients (72.3%) in the STT group required thyroxine replacement and seven patients (5.9%) developed relapse.

Conclusion:  Subtotal thyroidectomy was associated with relapse as well as hypothyroidism in a significant proportion of patients during long‐term follow up. Total thyroidectomy can be performed as safely as STT and should be recommended as the procedure of choice for patients requiring surgical treatment for Graves’ disease.
Effect of amrinone on mucosal permeability in experimental intestinal ischaemia/reperfusion injury
Authors: Ekingen Gülsen , Sönmez Kaan , Özen Onur , Demirogullari Billur , Karabulut Ramazan , Türkyilmaz Zafer , Yenidünya Sibel , Ayayvaci Sevil , Basaklar A. Can , Kale Nuri
Published: June 2005

Background:  The preventive effect of amrinone on ischaemia/reperfusion (I/R) injury has been shown in the medical literature. The purpose of the present study was to investigate the preventive effect of amrinone on I/R injury of the small bowel of the rat.

Methods:  Thirty‐two Wistar albino rats (140−180 g) were divided into four groups (n = 8). In all groups except the sham group the superior mesenteric artery was clamped for 30 min. At the beginning of reperfusion, 1 mL of 2405 Bq/mL 51Cr‐ethylenediamine tetra‐acetic acid (EDTA) was administered into the prepared ileal segment. Following 30 min of reperfusion, 1 mL of blood was obtained from the portal vein. After the rats were killed, the small intestine was removed for histopathological studies. A total of 5 mg/kg amrinone was administered to the rats in group 1 before ischaemia and in group 2 before reperfusion, whereas only saline was administered to the rats in the control group. Statistical analysis was carrid out with Kruskal−Wallis and χ2 test, P < 0.01 was considered significant.

Results:  Both the blood 51Cr‐EDTA measurements (mean ± SD) and mucosal injury grades (MIG) were highest in the control group (3.95 ± 0.71 c.p.m.; MIG, 3−5) followed by group 2 (0.50 ± 0.35 c.p.m.; MIG, 1−3), group 1 (0.47 ± 0.34 c.p.m. MIG, 0−3), and sham group (0.12 ± 0.05 c.p.m.; MIG, 0). The difference between groups 1 and 2 and the control group were statistically significant (P < 0.01 for each comparison). The results of group 1 and 2 were similar statistically (P > 0.05).

Conclusions:  Amrinone was found to be effective in preventing intestinal I/R injury.
CLIMATE FORCINGS AND THEIR INFLUENCE ON ALPINE HISTORY AS RECONSTRUCTED THROUGH THE APPLICATION OF SYNCHROTRON‐BASED X‐RAY MICROFLUORESCENCE ON LAYERED STALAGMITES*
Authors: FRISIA S. , BORSATO A. , SUSINI J. , SOMOGYI A.
Published: June 2005

Solar variability and volcanic activity strongly interact with climate and the environment. Synchrotron radiation X‐ray microfluorescence (micro‐XRF) to an annually laminated Alpine stalagmite confirmed that annual laminae result from hydrological variability and changes in the duration of soil microbial degradation. The latter is modulated by solar variability. At the centennial timescale, growth rate and solar activity appear to be correlated with temperature change, with low temperatures at solar minima. By combining micro‐XRF and absorption spectroscopy techniques (XANES), we also found that speleothems are a new archive of aerosol sulphate related to volcanic activity. Peaks in S‐concentration from c. 5.2 to 5.0 ka bp in an Alpine stalagmite suggest that multiple volcanic sulphate aerosol emissions enhanced Mid‐Holocene summer cooling, thus favouring the preservation of the Alpine Iceman mummy in a persistent ice casket.
LITHIC RESOURCES IN THE EARLY PREHISTORY OF THE ALPS*
Authors: CASA PH. DELLA
Published: June 2005

Rocks, which are ubiquitous in archaeological sites as chipped or polished tools, were important factors in the prehistoric Alpine economic system. Archaeometric characterization and identification of source areas open the path to a more detailed understanding of the production and diffusion mechanisms behind Alpine lithic industries. An overview of the situation from the eastern to the western Alps in the Mesolithic, the Neolithic and the Copper Age illustrates current debates and issues.
COPPER AND COPPER ALLOYS IN THE SOUTHEASTERN ALPS: AN OVERVIEW*
Authors: GIUMLIA‐MAIR A.
Published: June 2005

In recent years, several groups of archaeological metal finds from the areas around the southeastern Alps, dated between Bronze Age and Roman times, have been scientifically analysed (by ICP, AAS and/or XRF) within the framework of different projects. The data now available give a fairly good general picture of the evolution and development of metallurgy in this area and seem to indicate that the region played an important role in the exchange of objects and raw materials over many centuries. The significance of some of the metal finds, which are particularly relevant for this research, is discussed.
THE ANCIENT MINE OF SERVETTE (SAINT‐MARCEL, VAL D’AOSTA, WESTERN ITALIAN ALPS): A MINERALOGICAL, METALLURGICAL AND CHARCOAL ANALYSIS OF FURNACE SLAGS*
Authors: TUMIATI S. , CASARTELLI P. , MAMBRETTI A. , MARTIN S. , FRIZZO P. , ROTTOLI M.
Published: June 2005

The Cu–Fe mining district of Servette is located in the valley of Saint‐Marcel (Val d’Aosta) at about 1800 m a.s.l. in the western Italian Alps. A large furnace slag deposit occurs near the Servette mine. Slags are mainly constituted by silicate and oxide in a glassy matrix, with disseminated sulphides and iron–copper alloys, and they record temperatures of 1380–1100°C. Radiocarbon dating of slag charcoals has shown that metallurgy in this site took place around ad 890–980. The charcoal analysis has shown that coniferous wood was mainly utilized, and intensive exploitation over the centuries led to a change in the composition of the local woods.
THE COMPOSITION AND MANUFACTURE OF EARLY MEDIEVAL COLOURED WINDOW GLASS FROM SION (VALAIS, SWITZERLAND)—A ROMAN GLASS‐MAKING TRADITION OR INNOVATIVE CRAFTSMANSHIP?*
Authors: WOLF S. , KESSLER C. M. , STERN W. B. , GERBER Y.
Published: June 2005

Archaeological excavations between 1984 and 2001 at the early Christian cemetery church in Sion, Sous‐le‐Scex (Rhône Valley, Switzerland), brought to light more than 400 pieces of coloured window glass dating from the fifth or sixth centuries ad. The aims of this paper are threefold: first, to characterize the shape, colour and chemical composition of the glass; secondly, to understand whether the production of the coloured window panes followed traditional Roman glazing techniques or was of a more innovative nature; and, thirdly, to provide some indications as to the overall design of these early ornamental glass windows. Forty samples of coloured glass have been analysed by wavelength‐dispersive X‐ray fluorescence. The results of the chemical and the technological studies showed that most of the glass was produced using recycled glass, particularly as a colouring agent. Some of the glass was made of essentially unmodified glass of the Levantine I type. The results taken together seem to confirm that raw glass from this region was widely traded and used between the fourth and seventh centuries ad. The artisans at Sion were apparently still making use of the highly developed techniques of Roman glass production. The colour spectrum, manufacture and design of the windows, however, suggest that they represent early examples of ornamental coloured glass windows.
THE EMIGRATION OF PREALPINE LAKE MASTERS: A STUDY OF A 17TH‐CENTURY MANTELPIECE ATTRIBUTED TO THE CARLONE FAMILY OF ROVIO (TICINO, SWITZERLAND)*
Authors: CAVALLO G. , DERIGHETTI L. , NAPOLI S.
Published: June 2005

This work illustrates the possible connections between the phenomenon of the seasonal emigration of lake masters and the production of artistic artefacts. Within the ambit of these dynamics, a stucco mantelpiece was taken into consideration. Nothing was known about the object: neither its origin, nor the artist who produced it, nor the period of execution. Historical, stylistic and formal analyses of the materials and of the technique with which the work was executed allow us to verify that the mantelpiece was produced using the stucco technique in the 17th century, in Rovio (southern Switzerland, Ticino), and that it comes from one of the exponents of the Carlone workshop, whose representatives were important in the tradition of itinerant artistic workers. Due to their good technical and professional specialization, the Carlone workshop served both public and private buyers. Tommaso Carlone is the principal representative artist of the Carlone workshop; it is certain that his workshop produced the stucco mantelpiece. The migrations of the artists were seasonal and they maintained a close bond with their country of origin. When they returned to the country of origin, they produced works of great artistic value, of which the mantelpiece represents a splendid example.

 Through the employment of conventional analytical techniques (optical and electron microscopy, infrared spectroscopy and porosity measurements), it has been possible to study the technique with which the work was executed, the materials used and the decay. The mantelpiece was produced using the stucco technique by means of a body layer (slaked lime and silicate and carbonate aggregates) and a marmorino finishing layer (slaked lime and pointed calcite crystals). Above this layer, whose thickness varies in relation to the executed result, there is a thin lime plaster whitewash, pigmented with the dispersion of yellow ochre particles; chromatic alterations are an oxalate patina caused by firm adhesion to the marmorino layer, due to the denaturation of the proteic substances employed. The final treatment was made with beeswax, which increased the marmoreal effect. Several additional layers of lime plaster whitewash have also been applied over the centuries. The figurative central square of the plastic decoration was made using red ochre.
From Election to Government: Principal Rules and Deviant Cases
Authors: Isaksson Guy-Erik
Published: June 2005

This study focuses on the principal rules of government formation as well as on the deviant cases. On a party level, over 1,000 cases and approximately 250 government formations in 17 West European countries during the second half of the twentieth-century are analysed. By means of regression analyses, the study explores the effects of the size of the parties, other party characteristics, as well as characteristics in the party system on the choice of premier party and coalition party respectively. The results show that the choice of premier party to a great extent is decided by the size of the party and the position as median party. The choice of coalition party, however, is a far more complex process. Favourable and unfavourable conditions are defined, and the deviant cases are identified, compared and analysed with respect to the choice of PM party and the choice of coalition party respectively. The study shows that the deviant cases are not disparate. On the contrary, the deviant cases form a set of rules of their own.
Political Representation in Leader Democracy
Authors: Körösényi András
Published: June 2005

The essay focuses on the neglected problem of democratic politics, i.e. on the role of leadership. Although in democracies public office holders are controlled to a certain extent, leaders still have wide room for political manoeuvre and decide without any ‘instruction’ of the citizens. Re-working Weber's and Schumpeter's theory, the author aims to build the model of leader democracy. He highlights the major traits of it in a comparison with the deliberative and the aggregative–utilitarian concepts of democratic theory. The theory of leader democracy is applied to the problem of representation, which, in contrast to mechanical mirroring, gains a new, dynamic and qualitative meaning.
‘Civil Society’ and the Limits of Democratic Assistance
Authors: Sardamov Ivelin
Published: June 2005

A correlation between the strength of civil society and democratization is often assumed to imply a causal relationship between the two variables. In fact, this correlation may be spurious, both phenomena being shaped by deeper social processes related to modernization and individualization. An excessive focus on ‘civil society assistance’ may paradoxically hamper the deeper changes necessary for the development of a vigorous associational life and of democratic representation. It would therefore be more prudent to focus democratic assistance on the establishment of stable and efficient social and political institutions, and on the maintenance of key social infrastructures crucial to political legitimacy.
Electoral Politics in Africa: The Experience of Zambia and Zimbabwe
Authors: Tordoff William , Young Ralph
Published: June 2005

The neighbouring African states of Zambia and Zimbabwe have seen major changes to their systems of power following a series of elections between February 2000 and March 2002. These elections produced dramatic shifts in the balance between ruling parties and opposition forces, and challenged the continuance of powerful executive presidencies and one-party dominant political systems. The article explores the setting in which these electoral shifts occurred and attempts to mark out the domestic and international factors that have conditioned their impact. It concludes that profound structural changes are needed if either state is to move towards liberal democracy.
Comparative Trial of Tenormin (Atenolol) and Inderal (Propranolol) in Migraine
Authors: Stensrud Per , Sjaastad Ottar
Published: June 2005

SYNOPSIS

Atenolol, 50 mg, b.i.d., and propranolol, 80 mg b.i.d., were given to 28 patients with a presumed diagnosis of migraine, in a placebo‐controlled double‐blind cross‐over study, where each period lasted 6 weeks. In the total material, atenolol was significantly better than placebo in reducing attacks, whereas propranolol showed no definite such effect. In seven patients, the number of headache days was remarkably high (average: 22 headache days in 42 days), which may indicate that they have been inappropriately included in the material or have recorded interparoxysmal headache in addition to attacks. If these patients are excluded, the attack‐reducing effects of both propranolol and atenolol are significant and of equal magnitude.
Evaluation of a 5‐day Non‐drug Training Program for Headache at the Menninger Foundation
Authors: Sargent Joseph D. , Solbach Patricia , Coyne Lolafaye
Published: June 2005

SYNOPSIS

In 1972 a non‐drug program to meet the requests of headache sufferers outside the local area was begun; the purpose was to give these individuals the basic skills in applying biofeedback to their headache problem. Over the next 412 years, 166 headache patients, mostly migraineurs, were seen in this program. During the 5‐day period the patient underwent a complete work‐up and 10 one‐hour biofeedback training sessions.

A 50 item follow‐up questionnaire was sent to the 166 participants; 79 were returned. An examination of 21 variables from the medical records showed no significant differences on crucial headache variables between Returnees and Non‐Returnees of the questionnaire.

Sixty‐seven percent of those who responded felt their headache condition had improved since the biofeedback training; success in controlling the headache was related to continued practice of the skills acquired in the 5‐day period. Other post treatment attempts at therapy dramatically decreased in comparison to the number of other therapies tried prior to the biofeedback training.
Exposure to Sun and Precipitation of Migraine
Authors: Vijayan Nazhiyath , Gould Susan , Watson Craig
Published: June 2005

SYNOPSIS

Incidence of exposure to sun as a precipitating factor in headaches was evaluated in 263 patients. In 30% exposure to sun was found to trigger attacks of migraine compared to 7% of patients with muscle contraction headaches. Exposure to sun, therefore, is a more frequent precipitating factor in migraine than diet and hormonal changes which are more often mentioned and discussed in the literature.
Psychogenic Headache
Authors: Weatherhead A. Dixon
Published: June 2005

SYNOPSIS

An attempt has been made to identify what is commonly referred to as “psychogenic headache” and to differentiate between the most frequently encountered psychiatric disorders where headache is the main symptom. These disorders include anxiety reactions, conversion reactions and depressive reactions. While it is recognized that psychogenic factors often play a major part in migraine headaches and vascular headaches8 and possibly cluster headaches, this topic has not been discussed here as the literature on these types of headache is already extensive.This article attempts to review the causes, types, location and duration of psychogenic headaches and the types of premorbid personality encountered in the sufferer. It suggests how the diagnosis of psychogenic headache may be made and notes that effective treatment will depend upon establishing the correct diagnosis and include not only treatment of the symptom, i.e., the headache, but treatment of the underlying psychiatric disorder also.
Hyperresponsiveness of Migraine Patients to the Hypotensive Action of Bromocriptine
Authors: Fanciullacci M. , Michelacci S. , Curradi C. , Sicuteri F.
Published: June 2005

SYNOPSIS

Migraine frequently induces hypotension, which has a large postural component. Since pain and other symptoms of the migraine syndrome have been suggested to be central in nature, an involvement of the dopaminergic pathways within the central nervous system that mediate hypotensive responses, might be postulated in migraine patients. In the study, a test dose (2.5 mg) of bromocriptine, a brain dopamine agonist, induced an intense hypotensive reaction in migraineurs, but not in controls. During bromocriptine‐induced hypotension, serum dopamine β‐hydroxylase activity did not change. The fall of blood pressure, due to bromocriptine, in migraine patients could be considered as an indirect expression of brain dopamine receptor supersensitivity caused by a deficiency of dopamine and or endogenous morphine‐like substances. This mechanism is compatible with the hypothesis which considers migraine as a clinical condition of chronic natural opioid abstinence.
Physiological, Clinical and Therapeutical Basis of a New Hypothesis for Headache
Authors: Lechin Fuad , van der Dijs Bertha
Published: June 2005

SYNOPSIS

In the light of therapeutic, biochemical, physiological, pharmacological and clinical evidences, we postulate that the headache syndrome is due to an autonomic nervous system (ANS) imbalance, triggered by many aetiological factors. Consequently, this syndrome is most often observed in those subjects whose ANS balance is precarious, i.e. neurotics and psychotics. Two main types of headache patients could be differentiated: (1) those showing predominance of the serotonergic (5HT) over the catecholaminergic (CA) system (depressive patients) and (2) those showing predominance of CA over 5HT system (manic or hypomanic patients).