bluuebunny/crossref_metadata_2025 huggingface dataset:
Caring of ST‐elevation myocardial infarction patients in rural community hospital settings: Determinants of in‐hospital mortality
Authors: Okuyan Ertugrul , Uslu Ahmet , Levent Mustafa O. , Sahin Irfan , Dinckal Mustafa H.
Published: August 2010

Objective:  Cardiovascular disease contributes more than three quarters of all cardiovascular deaths worldwide. Adherence to myocardial infarction (MI) guidelines might not be possible in many rural hospitals. We aim to share our three‐year experience in rural settings regarding to ST‐elevation MI (STEMI) patients particularly by focusing on determinants of in‐hospital mortality.

Methods:  We retrospectively analysed our data for 559 acute STEMI patients admitted to our coronary care unit in Kastamonu city, Turkey between August 2004 and August 2007. Key demographic and clinical characteristics and data regarding symptom duration, prehospital transfer settings and insurance status were collected. Killip classes and in‐hospital therapy of all patients were recorded.

Results:  A total of 54 patients (9.66%) died within the hospitalisation period. Multivariate analysis revealed that advanced age > 65 years, late admission, hypotension at presentation, killip class > 2, anterior location, posterior location, lack of fibrinolysis and cardiogenic shock were independent predictors of in‐hospital mortality.

Conclusions:  In rural hospital settings, clinical resources and transfer facilities are limited. Therefore, improvement of early transfer and prehospital fibrinolysis capabilities should decrease mortality.
Pandemic influenza vaccination: Will the health care system take its own medicine?
Authors: Ferguson Craig D. , Ferguson Teagen E. , Golledge Jonathan , McBride William J. H.
Published: August 2010

Objective:  To identify factors associated with acceptance of the pandemic Influenza A H1N1 California 7/09 vaccine (pH1N1 vaccine) in rural hospital staff.

Design:  Cross‐sectional group administered survey.

Setting:  A 58‐bed rural Queensland hospital, over a 10‐day period starting five days after commencement of the pH1N1 vaccination program.

Participants:  Hospital staff and students.

Main outcome measures:  Intention to receive pandemic influenza vaccination, seasonal influenza vaccination.

Results:  The survey was completed by 252 staff and students (full response rate 76.1%, cooperation rate 98.4%). The majority of respondents had already decided whether or not to receive the pH1N1 vaccine: 111 (44.0%) intended to be vaccinated, 63 (25.0%) intended not to be vaccinated and 78 (31.0%) were undecided. Of 125 staff who had received the seasonal influenza vaccine, 86 (68.8%) intended to receive the pandemic vaccine. Respondents were less likely to state acceptance of the pH1N1 vaccine if they identified concern about vaccine adverse reactions (odds ratio (OR) 0.29; 95% confidence interval (CI), 0.11–0.78), vaccine safety (OR 0.20; 95% CI, 0.09–0.46), vaccine efficacy (OR 0.20; 95% CI, 0.04–0.87) or perceived limitations of vaccine trials (OR 0.08; 95% CI, 0.01–0.99) as primary reasons discouraging pandemic influenza vaccination.

Conclusions:  There is considerable concern among rural hospital staff regarding pH1N1 vaccine adverse reactions, safety, efficacy and the adequacy of clinical trials on its use. Education specifically addressing these concerns might increase pandemic vaccine acceptability.
Magnetic resonance appearance of tuberculosis of the knee joint with ruptured Baker's cyst
Authors: Kulshrestha A , Misra RN , Agarwal P , Gupta D
Published: August 2010

After the spine, the knee joint is the most commonly affected joint in skeletal tuberculosis. Baker's cyst is a rather rare complication of knee joint tuberculosis. The plain radiographic appearance of the tuberculous knee joint has been amply described. We present the magnetic resonance appearance of a tuberculous knee joint associated with a ruptured popliteal cyst.
Emergency embolization of multiple splenic artery pseudoaneurysms associated with portal hypertension complicating cystic fibrosis†
Authors: Geoghegan T , McAuley G , Snow A , Torreggiani WC
Published: August 2010

Cystic fibrosis (CF) is the most common potentially lethal genetic disease in the white population. Improvements in life expectancy have led to an increasing recognition of hepatobiliary complications from CF. Splenic artery aneurysms are a rare complication of portal hypertension with a high mortality due to their significant potential for rupture, resulting in life‐threatening i.p. haemorrhage. The optimum treatment of ruptured splenic artery aneurysms is controversial. This case describes the successful emergency embolization of multiple splenic artery pseudoaneurysms associated with portal hypertension complicating cystic fibrosis.
Low grade central chondrosarcoma of the fifth costotransverse joint
Authors: Bartalena Tommaso , Rimondi E , Rossi G , Bianchi G , Alberghini M
Published: August 2010

Chondrosarcoma (CHS) is the third most frequent primary malignant tumour of bone exceeded only by myeloma and osteosarcoma. It usually occurs in the trunk bones (pelvic girdle, shoulder, ribs) followed by the femur and humerus and is very rare in the spine accounting for about 5% of all CHSs. The majority of patients affected are over 50 years old. We report a case of a 22‐year‐old woman with a 2‐month history of pain on the right side of the upper thoracic spine. Complete imaging work‐up with radiographs, CT, MRI and digital subtraction angiography showed an osteolytic lesion of the right transverse process of T5 with extension into the ipsilateral rib and enhancing extracompartmental tissue involving the paraspinal muscles. Both CT‐guided core needle biopsy and excisional biopsy were consistent with grade I central CHS with myxoid change and focal areas of Grade II CHS.
Renal vein thrombosis in transitional cell carcinoma
Authors: Cilliers G , Naidoo A , Ackermann C , Parsons JJ , Andronikou S
Published: August 2010

A rare case of renal transitional cell carcinoma (TCC) associated with bland thrombus of the renal vein extending into the inferior vena cava is described. Tumour thrombus in renal cell carcinoma is frequently encountered, but only very rarely occurs with TCC. Bland renal vein thrombosis occurring with renal TCC has not been described before. Contrast enhanced computed tomography assisted in distinguishing between bland and tumour thrombosis and aided in surgical management.
Calcific myonecrosis: case report and radiopathological correlation
Authors: Constantine Sarah , Brennan Catriona , Sebben Ruben
Published: August 2010

We present a patient with an enlarging calf mass 36 years after a tibia and fibula fracture. He developed a peroneal nerve palsy after the accident, which was probably due to a subclinical compartment syndrome. Imaging of the leg was consistent with calcific myonecrosis. The diagnosis was confirmed histologically. The radiopathological findings of calcific myonecrosis are discussed.
Percutaneous biliary internal decompression in a patient with simultaneous malignant biliary and duodenal obstruction and surgically modified anatomy
Authors: Gulati MS , Sabharwal T , Dourado R , Adam1 A
Published: August 2010

Simultaneous involvement and obstruction of the common bile duct and the duodenum presents a difficult and challenging problem to the surgeon, the endoscopist and the interventional radiologist. In the case report we present here, the patient had had duodenal and biliary obstruction secondary to hepatic flexure adenocarcinoma and presented with recurrent obstructive jaundice. As the surgically modified anatomy precluded all conventional endoscopic and percutaneous approaches, it was necessary to use an improvised method of achieving biliary decompression.
Foramen of Monro meningioma with atypical appearance: CT and conventional MR findings
Authors: Hakyemez B , Erdogan C , Oruc E , Aker S , Aksoy K , Parlak M
Published: August 2010

Intraventricular meningiomas have often been reported; however, literature reveals very few cases localized within foramen of Monro. Herein we report a 57‐year‐old woman admitted with obstructive hydrocephalus‐related symptoms. Strikingly, the lesion was completely calcified in CT and had no marked solid component on MRI. The lesion was completely removed by surgical resection with a transfrontal intraventricular approach. The resected mass was histopathologically diagnosed as meningioma. The patient’s symptoms resolved immediately after the operation.
Elastofibroma dorsi: Typical radiological features
Authors: Haykir R , Karakose S , Karabacakoglu A
Published: August 2010

Elastofibroma dorsi is a rare benign and slow‐growing fibro‐proliferative lesion. It has a characteristic location (periscapular region) and a specific imaging appearance (sonography, CT, MRI) allowing accurate prospective diagnosis. The recognition of this benign lesion avoids unnecessary biopsy and/or surgery. We report two cases of bilateral elastofibroma dorsi illustrating characteristic imaging features on ultrasound, CT and MRI.
Oesophageal and tracheal perforation in thyroid B‐cell lymphoma
Authors: Jaremko JL , Rawat B , Naik S
Published: August 2010

We report an unusual case of spontaneous oesophageal and tracheal perforation secondary to thyroid B‐cell lymphoma in a previously healthy 76‐year‐old woman. Findings on chest radiography, CT and oesophagram are correlated to endoscopy, surgery and pathology. Such perforation is a rare and serious complication that should be specifically considered when a patient with a neck neoplasm develops acute respiratory or gastrointestinal symptoms.
Adductor insertion avulsion syndrome with stress fracture of femoral shaft: MRI findings
Authors: Lawande MA , Sankhe S , Pungavkar SA , Patkar DP
Published: August 2010

Chronic vague hip pain may be caused by stress‐related injury in the proximal or mid‐femoral diaphysis. This has been described as an entity called adductor insertion avulsion syndrome, or thigh splints. In the appropriate clinical setting, the radiologist interpreting the magnetic resonance imaging must be aware of this condition as its imaging findings are subtle. The diagnosis will help the clinician plan the appropriate management. Magnetic resonance imaging can also depict the complications such as stress fracture.
Meat balls: a pathognomonic ultrasound and computed tomography finding in mature cystic teratoma
Authors: Mahomedy S , Bayat MR , Seedat M
Published: August 2010

One of the commonest germ cell tumours are mature cystic ovarian teratomas. Although the imaging features of teratomas are highly variable, the sonographic and CT identification of fatty and calcific components are fairly suggestive. The case presented, however, is of an unusual, yet pathognomonic CT and ultrasound imaging appearance of an ovarian teratoma that was due to floating balls.
The Ileocaecal Knot
Authors: Menon Tulsi , Martin Richard , Ramsay Duncan , Archer Stephen
Published: August 2010

Variations in intestinal knot syndromes have been described in the past, including ileoileal knots, ileosigmoid knots and appendico‐ileal knots. We report a new type of intestinal knot syndrome, an ileocaecal knot, which, to our knowledge, has not been reported before in the world literature. Features on CT that may raise suspicion of an ileal knot syndrome are described.
Giant arachnoid granulation: Differential diagnosis of acute headache
Authors: Peters SA , Frombach E , Heyer CM
Published: August 2010

We present a case of intense, rapidly evolving headache clinically mimicking meningitis, subarachnoid haemorrhage or venous sinus thrombosis. Clinical examination, standard blood work and central nervous system studies were non‐contributory and effectively ruled out these diagnoses. Cranial multidetector CT studies before and after application of intravenous contrast medium performed prior to lumbar tap disclosed a non‐enhancing ovoid mass filling the superior sagittal sinus. This lesion posed a differential to venous sinus thrombosis, but ultimately fulfilled the criteria of a giant arachnoid granulation. The imaging characteristics and differential diagnosis of giant arachnoid granulations are discussed.
Celiomesenteric trunk: Two variants of a rare anomaly
Authors: Petscavage JM , Maldjian P
Published: August 2010

The celiomesenteric trunk is a rare congenital vascular anomaly characterized by a common origin of the celiac axis and superior mesenteric artery. We report two variants: one in which the left gastric artery arises from a short common trunk and a second where the left gastric artery originates directly from the aorta above the common trunk. We discuss a possible embryologic mechanism for formation of these variants and the clinical implications. These cases also illustrate the ability of multidetector CT to provide quality images of such vascular anomalies.
Aberrant right hepatic duct presenting as empyema of the gall bladder
Authors: Pottakkat B , Sikora SS
Published: August 2010

A 38‐year‐old male presented with recurrent right hypochondrial pain with history of acute cholecystitis. Ultrasonography of the abdomen showed distended gall bladder with dilated right hepatic duct with intrahepatic biliary dilatation in the right lobe of the liver. Endoscopic retrograde cholangiography showed non‐visualization of the right ductal system and gall bladder with extrinsic compression of the common hepatic duct. Contrast‐enhanced CT scan revealed a distended gall bladder with isolated dilatation of the intrahepatic biliary dilatation in the right lobe of the liver. Magnetic resonance cholangiography confirmed the same findings. At laparotomy, the right hepatic duct was seen directly inserted into the gall bladder body after a short extrahepatic course. The cystic duct provided the only route for biliary drainage through the gall bladder, but it was blocked. A cholecystectomy with a Roux‐en‐Y hepaticojejunostomy to the right hepatic duct was carried out. This case presents an extremely rare aberration affecting the extrahepatic biliary tree in which the right hepatic duct was directly inserted into the gall bladder.
Dyke–Davidoff–Masson syndrome revisited: A didactic case with interesting imaging findings
Authors: Sarikaya B , Sarikaya S
Published: August 2010

We present an adult female patient with Dyke–Davidoff–Masson syndrome with distinct features, and discuss neuroimaging findings some of which are unique to this syndrome.
Positron emission tomography‐Computerized tomography findings in a urinary bladder paraganglioma
Authors: Thambugala GM , Fulham MJ , Mohamed A
Published: August 2010

We present the staging fluorodeoxyglucose (FDG) positron emission tomography (PET‐CT) findings in a patient with a functional urinary bladder paraganglioma. The PET‐CT scan showed markedly increased FDG uptake into bilateral pelvic nodes that was consistent with regional nodal involvement. These findings were confirmed on histopathology. At present, there are no reports of PET‐CT findings in urinary bladder paragangliomas.
Intramedullary neurenteric cyst without concurrent malformation
Authors: Nagi S , Ghorbel D , Drissi C , Maatallah Y , Hammami N , Hamouda MB
Published: August 2010

Neurenteric cysts (NECs) are dysraphic lesions. They are usually extramedullary, the intramedullary forms are very rare. To our knowledge, only 10 cases of isolated intramedullary NECs have been reported. We report a case of intramedullary NEC without any associated dysraphic lesion. The clinical findings were: cervical pain and left hemicorporal weakness which predominated at the upper limb. Neuroradiological evaluation was performed by means of MRI which revealed a cystic lesion at C3‐C4 level. A partial excision was performed and the diagnosis of NEC was established by histological study.
Ketotifen abrogates local and systemic consequences of rat intestinal ischemia–reperfusion injury
Authors: KALIA NEENA , BROWN NICOLA J , WOOD RICHARD F M , POCKLEY A GRAHAM
Published: August 2010

Background:  Mast cell‐derived vasoactive and pro‐inflammatory mediators, particularly histamine, might contribute to local tissue damage and multiorgan dysfunction induced by intestinal ischemia/reperfusion (I/R). The purpose of the present study was to evaluate the effects of the mast cell stabilizer, ketotifen, on leukocyte adhesion within, and tissue leakage from the mucosal villous microcirculation after intestinal I/R.

Methods:  Superior mesenteric arteries of untreated and ketotifen‐pretreated (1 mg/kg orally twice daily for 3 days, and 90 min prior to ischemia) Piebald–Viral–Glaxo (PVG) rats were clamped for 30 min (n = 12 per group; sham operated controls n = 12). Mucosal surfaces of exteriorized ileal segments were visualized, and leukocyte adherence in, and macromolecular leakage (MML) from individual villi were followed for 2 h after clamp removal using in vivo microscopy. Blood pressure and heart rate were monitored, and lung tissue damage was assessed by histology.

Results:  Ten untreated animals subjected to intestinal I/R failed to survive the reperfusion period, leukocyte adhesion (P < 0.001) and MML (P < 0.001) were increased at all time‐points and blood flow stasis eventually ensued. In contrast, all ketotifen‐pretreated I/R animals survived the duration of the study. Ketotifen abrogated I/R‐induced leukocyte adherence within the villus mucosal capillaries and supplying arterioles and largely prevented pulmonary injury, yet surprisingly had no effect on intestinal vascular leakage.

Conclusions:  This is the first study to demonstrate that ketotifen is a powerful inhibitor of I/R‐induced leukocyte adhesion and can prevent localized and reduce remote organ damage after intestinal I/R injury. However, its effects are manifested in the absence of any influence on intestinal I/R‐induced vascular leakage.

© 2005 Blackwell Publishing Asia Pty Ltd
Clinical review of tuberculous peritonitis in 39 patients in Diyarbakir, Turkey
Authors: TANRIKULU A CETIN , ALDEMIR MUSTAFA , GURKAN FUAT , SUNER ALI , DAGLI CANAN EREN , ECE AYDIN
Published: August 2010

Abstract  Abdominal tuberculosis (TB) is a rare manifestation, which can be overlooked on long‐lasting and non‐specific findings unless a high index of suspicion is maintained. The purpose of the present study was to investigate the diagnostic features of 39 patients hospitalized with tuberculous peritonitis (TBP) in Dicle University Hospital, Turkey between January 1994 and August 2003. Twenty‐two patients were male; patient age ranged between 1 and 59 years (mean: 16.2 ± 14.4 years). There were 21 patients (54%) under 15 years of age. Thirteen children had a history of familial TB and seven adults had prior history of TB. Six (29%) of 21 pediatric cases had bacille Calmette‐Guerin (BCG) scars and results of 5‐tuberculin units (TU) tuberculin test were positive in seven children (18%). Of all cases, the most common presenting findings were abdominal pain (95%), ascites (92%) and abdominal distention (82%). Five of the patients had accompanying pulmonary TB, and six patients (15%) had intestinal TB who were admitted to emergency service with acute abdomen, of whom three (8%) had perforation and three (8%) had ileus. Histopathologically 20 cases (51%) were proven on abdominal ultrasonography, and computed tomography revealed most commonly ascites and thickening of peritoneum. No microbiologic evidence was obtained except three positive culture results for Mycobacterium tuberculosis. As a result, TBP should be considered for diagnosis, in patients with non‐specific symptoms of abdominal pain, wasting, fever, loss of appetite, abdominal distension and even symptoms of acute abdomen, because early diagnosis and effective treatment will decrease morbidity and mortality.
Cytokeratin immunoreactivity patterns in short‐segment Barrett's esophagus in Japanese patients
Authors: YAGI KAZUYOSHI , NAKAMURA ATSUO , SEKINE ATSUO
Published: August 2010

Background:  The origin of intestinal metaplasia at the esophagogastric junction has clinical importance. However, it can be difficult to differentiate between intestinal metaplasia of short‐segment Barrett's esophagus and cardiac intestinal metaplasia due to Helicobacter pylori infection. Specific patterns of cytokeratin (CK)7 and CK20 have been detected in long‐segment Barrett's esophagus. The aim of the present study was to assess the immunostaining patterns associated with short‐segment Barrett's esophagus.

Aims:  Paraffin‐embedded biopsy specimens were prepared from 128 patients with intestinal metaplasia of long‐segment Barrett's esophagus (n = 3), short‐segment Barrett's esophagus without H. pylori infection (n = 22), short‐segment Barrett's esophagus with H. pylori infection (n = 22), and cardiac mucosa (n = 49) and gastric mucosa from antrum and fundus (n = 44) with H. pylori infection. Sections were prepared and immunostained for CK7 and CK20.

Result:  A Barrett's CK7/20 pattern was present in all three patients (100%) with long‐segment Barrett's esophagus, 21 of 22 patients (95%) with short‐segment Barrett's esophagus without H. pylori infection, and six of 22 patients (27%) with short‐segment Barrett's esophagus with H. pylori infection (P < 0.05).

Conclusion:  Intestinal metaplasia of short‐segment Barrett's esophagus in patients without H. pylori infection is thought to be similar to that seen in long‐segment Barrett's esophagus.
Duodenal ulcer in South Africa: Home‐pounded versus milled maize
Authors: TOVEY FRANK I , HOBSLEY MICHAEL , SEGAL ISIDOR , JAYARAJ A PAUL
Published: August 2010

Background:  In South Africa there is suggestive evidence that home‐pounded maize protects against duodenal ulceration. Therefore the purpose of the present paper was to test, in an animal model, whether oil from home‐pounded maize gives protection against ulceration and whether this effect is present in commercially prepared maize oil.

Methods:  Gastric ulceration was induced in rats with topical ethanol 1 h after giving oil prepared either from fresh‐pounded or from commercially treated maize. The lengths of the linear ulcers produced were measured with a planimeter and summed in each rat. Control observations were made using arachis oil (which is known not to be ulceroprotective) and horse gram lipid (which is known to be strongly ulceroprotective). Statistical comparisons were performed mainly with the Mann–Whitney U‐test, but also with reference to the normal distribution. Thin‐layer chromatography (TLC) was performed on the oil from fresh maize, and the fractions similarly investigated for ulceroprotective activity.

Results:  Fresh maize oil was strongly ulceroprotective (P = 0.0039), commercial maize oil was not (P = 0.2864). The active ingredient in the fresh maize oil was located in the fraction near the solvent front.

Conclusion:  These findings support the hypothesis that home‐pounded maize protects against duodenal ulceration.
Sulfasalazine inhibits activation of nuclear factor‐κB in patients with ulcerative colitis
Authors: GAN HUA‐TIAN , CHEN YOU‐QIN , OUYANG QIN
Published: August 2010

Background:  Although sulfasalazine is widely used to treat inflammatory bowel disease, its mechanisms of action remain unclear. Activation of transcription factor nuclear factor (NF)‐κB, which controls transcription of various pro‐inflammatory cytokine genes, has been shown to play a critical role in the pathogenesis of inflammatory bowel disease. The purpose of the present study was to determine whether sulfasalazine therapy affected NF‐κB activation and the expression of pro‐inflammatory cytokines in patients with ulcerative colitis.

Methods:  A total of 38 patients with moderate ulcerative colitis were investigated. Twenty‐one patients received sulfasalazine. Seventeen patients did not receive any medication. Biopsy specimens were obtained from inflamed mucosa and analyzed for NF‐κB DNA binding activity, NF‐κBp65/IκBα protein expression and the levels of pro‐inflammatory cytokine mRNA using electrophoretic mobility shift assay, western blot analysis, immunohistochemical staining and reverse transcription–polymerase chain reaction (RT‐PCR) analysis, respectively.

Results:  Increased activation of NF‐κB and high levels of the expression of interleukin (IL)‐1β mRNA and IL‐8 mRNA were detected in biopsy specimens from patients with ulcerative colitis. Therapeutic administration of sulfasalazine effectively downregulated the activation of NF‐κB and the expression of IL‐1β mRNA and IL‐8 mRNA while IκBα levels were stable.

Conclusion:  The therapeutic benefits for ulcerative colitis of sulfasalazine might at least in part be attributed to its ability to inhibit NF‐κB activation, resulting in the downregulation of pro‐inflammatory cytokine mRNA expression.
Outcome of colorectal carcinoma in patients under 40 years of age
Authors: LIN JEN‐TSUN , WANG WEI‐SHU , YEN CHUEH‐CHUAN , LIU JIN‐HWANG , YANG MU‐HUA , CHAO TA‐CHON , CHEN PO‐MIN , CHIOU TZEON‐JYE
Published: August 2010

Aims:  Colorectal carcinoma in patients under 40 years of age usually has a poor prognosis. Controversies still exist regarding the features and the prognosis of colorectal cancer in young patients.

Methods:  The records of 45 patients with histologically confirmed colorectal carcinoma treated between 1992 and 2002 at the Division of Oncology at Taipei Veterans General Hospital were reviewed. The relevance of sex, duration of symptoms, tumor site, histological type, lymph node involvement, Karnofsky performance status (KPS), carcinoembryonic antigen (CEA) and lactate dehydrogenase (LDH) levels at the diagnosis and tumor stage to overall survival (OS) were determined by univariate analysis, and their independent significance were tested by multivariate analysis.

Results:  Most patients presented with an advanced tumor stage (24% Dukes’ C and 66% Dukes’ D). Colon carcinoma constituted 76% of the colorectal tumors. Family history was present in two patients and did not affect the OS. Two patients were found to have colon carcinoma during pregnancy. The 5‐year survival rate in patients with Stage B, C, and D were 25, 16 and 0%, respectively. With aggressive treatment, patients with early stage carcinoma achieved longer survival. Eleven patients received resection of metastatic carcinoma of the liver, lung and ovary. Adjuvant chemotherapy with irinotecan/5‐fluoroucil‐based chemotherapy seemed to improve the OS in such patients, though the OS was still poorer than in patients with early stage tumors. In univariate analysis, KPS (P = 0.0001), lymph node involvement (P = 0.0024), CEA (P = 0.0423) and LDH levels (P = 0.0126) at the diagnosis and tumor stage (P = 0.0122) proved to be significant predictors of overall survival. Multivariate analyses revealed that KPS ≥70% (P = 0.007) and normal LDH levels at diagnosis (P = 0.004) were predictive of overall survival in this population.

Conclusions:  The present study shows that performance status and preoperative LDH levels were the major determinants for survival in patients with colorectal carcinoma under 40 years of age and the present series also suggests that surgical resection of metastatic colorectal carcinoma followed by adjuvant chemotherapy might be beneficial in certain patients. The data also suggests that current treatment modalities for young patients with advanced colorectal cancer might not be effective and more effective therapeutic regimens might be needed. Thus, it is important for surgeons to recognize the potential for colorectal cancer in young patients and to take an aggressive approach to the diagnosis and early treatment of the disease.
Pre‐cutting using a noseless papillotome with independent lumens for contrast material and guidewire
Authors: UCHIDA NAOHITO , TSUTSUI KUNIHIKO , KAMADA HIDEKI , OGAWA MUTSUMI , FUKUMA HIROKI , EZAKI TORU , ARITOMO YUICHI , KOBARA HIDEKI , ONO MASAHIRO , MORISHITA ASAHIRO , MASAKI TSUTOMU , WATANABE SEISHIRO , NAKATSU TOSHIAKI , KURIYAMA SHIGEKI
Published: August 2010

Background:  The technical success of therapeutic endoscopic retrograde cholangiopancreatography (ERCP) depends on selective cannulation into the bile duct. We have developed a new type of precut papillotome for selective cannulation.

Methods:  The newly developed precut papillotome has been equipped not only with a lumen for contrast materials but also with an independent lumen for the guidewire. The operation of the guidewire and the injection of contrast material can be carried out simultaneously. The precut papillotome has a 20‐mm‐long knife and no leading tip. Half the proximal side of the knife is coated for insulation.

Results:  Selective biliary cannulation failed in 26 of 293 patients (8.9%) in whom therapeutic ERCP was attempted. We applied the precut papillotome to these 26 patients and selective cannulation was successful in 24 of 26 patients (success rate: 92.3%). No major complications occurred, although mild bleeding, which did not require endoscopic hemostasis or blood transfusion, was observed only in one patient.

Conclusions:  Although further studies with a large number of patients are needed to evaluate the efficacy of the papillotome, this papillotome may contribute to increase the safety and the success rate of precutting.
Multiple hepatic nodules: Rare manifestation of clonorchiasis
Authors: Liao Wei‐Chih , Wang Hsiu‐Po , Chiu Han‐Mo , Chang Chi‐Yang , Lin Jaw‐Town
Published: August 2010

A 38‐year‐old man was admitted due to intermittent right upper quadrant pain for 1 month. Leukocytosis with marked eosionphilia and elevated serum alkaline phosphatase were noted. Stool examinations revealed no parasites or ova. Ultrasonography and computed tomography disclosed multiple hepatic tumors. Biopsy of the hepatic tumor was performed due to non‐conclusive imaging studies and revealed eosinophil infiltration in portal areas only. Endoscopic retrograde cholangiography showed mild dilatation with irregularity of bilateral intrahepatic ducts, compatible with chronic cholangitis. Bile was aspirated and biliary lavage with normal saline was performed during endoscopy‐guided biliary cannulation. Microscopic examination of the aspirate showed the characteristic ova of Clonorchis sinensis. The patient received Praziquantel therapy for 1 day. Abdominal pain reduced in intensity gradually. Eosinophilia and multiple hepatic lesions resolved after adequate treatment of Clonorchis sinensis. The rare manifestation of multiple hepatic tumors in Clonorchis sinensis should be differentiated from other primary or metastatic neoplasms, while biliary lavage for parasite ova is a valuable diagnostic tool when stool examination is negative.
Liver injury induced by a Japanese herbal medicine, sairei‐to (TJ‐114, Bupleurum and Hoelen Combination, Chai‐Ling‐Tang) R1
Authors: Aiba Tsuneo , Takahashi Toru , Suzuki Kenji , Okoshi Shogo , Nomoto Minoru , Uno Katsuji , Aoyagi Yutaka
Published: August 2010

The case is reported of a man who showed acute hepatitis with jaundice after he was given a Japanese herbal medicine, sairei‐to (TJ‐114, Bupleurum and Hoelen Combination, Chai‐Ling‐Tang). Unusually, the component thought to be responsible for the observed drug‐induced liver injury was able to be identified. Lymphocyte migration inhibition testing indicated that the tuber of the perennial herbage Pinellia ternate was the causative agent.
Representations of people with dementia – subaltern, person, citizen
Authors: Gilmour Jean A. , Brannelly Tula
Published: August 2010

GILMOUR JA and BRANNELLY T. Nursing Inquiry 2010; 17: 240–247 Representations of people with dementia–subaltern, person, citizen

This study traces shifts in health professional representations of people with dementia. The concepts of subaltern, personhood and citizenship are used to draw attention to issues around visibility, voice and inclusion. Professional discourses and practices draw upon, and are shaped by historical and contemporary representations. Until recently, people with dementia were subaltern in nursing and medical discourses; marginalised and silenced. The incorporation of contemporary representations foregrounding personhood and citizenship into health professional accounts provide space for transformative styles of care. Privileging personhood centralises the person with dementia in social networks, focusing on their experiences and relationships. Respecting citizenship involves challenging discrimination and stigma: nursing from a rights‐based approach necessitates listening and being responsive to the needs of the person with dementia. Incorporating contemporary representations in health professional practice requires the discarding of the historically dominant elite and authoritarian accounts of dementia still apparent in some nursing texts along with, perhaps, the historically burdened term of dementia itself.
Ambivalence and the experience of China‐educated nurses working in Australia
Authors: Zhou Yunxian , Windsor Carol , Coyer Fiona , Theobald Karen
Published: August 2010

ZHOU Y, WINDSOR C, COYER F and THEOBALD K. Nursing Inquiry 2010; 17: 186–196 Ambivalence and the experience of China‐educated nurses working in Australia

The last decade has seen an increase in research on the experience of immigrant nurses. There are two prevailing approaches in this body of work. One is a focus on the positive or negative aspects of the experience, and the other, a depiction of the experience as a linear movement from struggle to a comfortable state. Based on our study findings on the experience of China‐educated nurses working in Australia, this study proposes that the concept of ambivalence is more appropriate in portraying the experience of immigrant nurses. Several sources of ambivalence experienced by the participants are represented: a disparity between expectation and reality, conflicting social and cultural norms, the dual reference points of comparison, divergent interests within families, and a sense that although it is unsatisfactory, it is hard to go back. We argue that immigration generates various forms of ambivalence and immigrant nurses must live with more or less ambivalence. The notion of ambivalence can explain a range of behaviours and situations beyond the scope of rational‐choice explanations. To date, ambivalence as a theoretical concept in understanding the experience of immigrant nurses has been either ignored or insufficiently addressed in the literature.
Continuing nursing education policy in China and its impact on health equity
Authors: Xiao Lily Dongxia
Published: August 2010

XIAO LD. Nursing Inquiry 2010; 17: 208–220 Continuing nursing education policy in China and its impact on health equity

The aim of this study was to evaluate the mandatory continuing nursing education (MCNE) policy in China and to examine whether or not the policy addresses health equity. MCNE was instituted in 1996 in China to support healthcare reform was to include producing greater equity in health‐care. However, the literature increasingly reports inequity in participation in MCNE, which is likely to have had a detrimental effect on the pre‐existing discrepancies of education in the nursing workforce, and thereby failing to really address health equity. Despite a growing appeal for change, there is lack of critical reflection on the issues of MCNE policy. Critical ethnography underpinned by Habermas’ Communicative Action Theory and Giddens’ Structuration Theory were used to guide this study. Findings are presented in four themes: (i) inaccessibility of learning programs for nurses; (ii) undervaluation of workplace‐based learning; (iii) inequality of the allocation of resources; and (iv) demands for additional support in MCNE from non‐tertiary hospitals. The findings strongly suggest the need for an MCNE policy review based on rational consensus with stakeholders while reflecting the principles of health equity.
Endoscopic lung volume reduction effectively treats acute respiratory failure secondary to bullous emphysema
Authors: SEXTON Paul , GARRETT Jeffrey E. , RANKIN Nigel , ANDERSON Graeme
Published: August 2010

Emphysema often affects the lungs in a heterogeneous fashion, and collapse or removal of severely hyperinflated portions of lung can improve overall lung function and symptoms. The role of lung volume reduction (LVR) surgery in selected patients is well established, but that of non‐surgical LVR is still being defined. In particular, use of endobronchial LVR is still under development. This case report describes a 48‐year‐old non‐smoker with severe bullous emphysema complicated by acute hypercapnic respiratory failure, who was successfully treated by endobronchial valve placement while intubated in an intensive care unit.
Correlated geographic variation in predation risk and antipredator behaviour within a wide‐ranging snake species (Notechis scutatus, Elapidae)
Authors: AUBRET FABIEN , MICHNIEWICZ RADIKA J. , SHINE RICHARD
Published: August 2010

Geographic variation in antipredator behaviour within wide‐ranging species may be driven by both genetic and environmental influences. We quantified antipredator responses in neonatal (laboratory born,n = 555) and adult (field caught,n = 346) tiger snakes (Notechis scutatus) from 11 mainland and island sites in southern Australia. We used these data to test predictions from Bonnetet al.'s hypothesis that the vigour of antipredator responses in this species reflects behavioural plasticity (in turn, driven by an individual snake's exposure to predators during its lifetime) rather than by genetic variation in this trait. We used the number of predator taxa in each area as an index of predator risk. As predicted, adult snakes from predator‐rich areas had more vigorous defensive responses when handled, whereas neonatal behaviour (although also variable among populations) was unrelated to predator species richness. Adult males bit more readily than adult females (as expected from the greater predation exposure of males during mate searching) but no such sex difference was evident in neonates. Although alternative models remain possible, our data are most consistent with the hypothesis that geographic divergence in antipredator tactics within this species primarily reflects developmentally plastic responses to local predation risk.
A BRIEF REVIEW OF THE CONCEPTS RELATED TO CERTAIN MODERN ANALYTICAL METHODS AND THEIR USE IN MEDICAL SCIENCE
Authors: Burnett W. , Kennard C. H. L.
Published: August 2010

A number of sophisticated analytical methods are available in Australia and are in current use in medical research. Some basic knowledge is required to understand the concepts behind their use, and expertise is necessary for interpretation of the results. In this brief review, the principles behind a number of modern analytical methods such as emission spectroscopy, electron microprobe, mass spectroscopy, infra‐red spectroscopy^ and X‐ray diffraction, have been described in simple terms. These techniques may be used in the analysis of biological specimens. A number of illustrations of their use in medical research have been given.
ELECTROSURGERY: A SHORT HISTORY1
Authors: Hall John C.
Published: August 2010

The use of electricity for therapeutic purposes is discussed from a historical aspect.
ROLE OF THE INTENSIVE CARE AMBULANCE IN THE TRANSPORT OF ACCIDENT VICTIMS
Authors: Compton Jeffrey , Little Miles
Published: August 2010

The performance of intensive care ambulance officers (paramedics) has been assessed by an analysis of interventions and outcomes in 75 patients transported by ambulance services to the Westmead Centre following accidents. An injury severity score has been used to compare anticipated with actual results. It appeared that some 20% of patients benefited from paramedical interventions, that some 10% reached hospital alive because of the interventions, and that about 3% survived in the long term because of the interventions. Ambulance officers showed themselves to be accurate in assessing the severity of trauma.
HYPOSPADIAS REPAIR UNDER THE AGE OF 1 YEAR
Authors: Mackay Athol
Published: August 2010

Hypospadias repair is a complex and challenging problem. Psychological, physiological, technical, and logistic problems all play a part. A retrospective survey of 108 infants, aged between 6 and 12 months, operated upon at the two Brisbane children's hospitals between 1977 and 1982, by a one stage total repair procedure, produced results comparable technically, functionally and aesthetically with other reported series. There were minimal psychological effects on the infant, and coincidentally reduced financial cost of the repair and hospitalization to the parents and society.
PROGESTERONE AND OESTROGEN RECEPTORS IN MENINGIOMAS: BIOCHEMICAL AND CLINICOPATHOLOGICAL CONSIDERATIONS*
Authors: Whinle Ian R. , Foo M. S. , Besser Michael , Vanderfield Geoffrey K.
Published: August 2010

Specific progesterone and oestrogen receptor proteins were evaluated by a dextran coated charcoal assay and Scatchard plot analysis in 20 intracranial meningiomas. Eleven tumours (55%) were progesterone receptor (PR) positive (mean 108 fmol/mg cytosol protein), whilst all were oestrogen receptor (ER) negative (ER < 10 fmol/mg cytosol protein). There were no trends to suggest a relationship between epidemiological data (patient age, sex and reproductive status in females) or meningioma location and size and the receptor status of the tumour. However, of the seven meningiomas that were histologically atypical, invasive or clinically recurred within 18 months, six were PR negative (PR < 10 fmol/mg cytosol protein). These results confirm that a large proportion of intracranial meningiomas contain significant amounts of specific PR protein and suggest that PR negative meningiomas are biologically more aggressive than PR positive meningiomas. They are also consistent with the hypotheses that PR proteins are not modulated by oestrogens acting through oestrogen receptors and that there are cytokinetic differences between sex hormone receptor proteins in meningioma and breast carcinoma. The full biochemical, cytological and clinical implication of these preliminary findings will, however, require further evaluation because of the unpredictable long‐term behaviour of intracranial meningiomas.
DOPPLER TESTING AS AN IMPORTANT CONSERVATION MEASURE IN THE TREATMENT OF VARICOSE VEINS
Authors: Large John
Published: August 2010

While it is rational to ligate incompetent proximal saphenous valves, when treating varicose veins, it is hard to justify ligation if they are competent. Accurate diagnosis of competence by clinical tests have proved less than satisfactory. Doppler testing, with a simple blood flow indicator, is suggested as a sound basis on which to make decisions regarding ‘selective ligations’ of incompetent proximal valves.
A METHOD OF USING THE TYMPANOMASTOID FISSURE TO FIND THE FACIAL NERVE AT PAROTIDECTOMY
Authors: Robertson M. S. , Blake P.
Published: August 2010

The methods of finding the facial nerve at parotidectomy are reviewed. The surgical anatomy of the tympanomastoid fissure and relevant segment of the facial nerve is described in detail. The authors' technique for finding the nerve using the tympanomastoid fissure as a guide is described.
DEVELOPMENT OF AN OVINE MODEL OF MYOCARDIAL INFARCTION
Authors: Rabbani Shahram , Ahmadi Hossein , Fayazzadeh Ehsan , Sahebjam Mohammad , Boroumand Mohammad A. , Sotudeh Maryam , Nassiri Seyed Mahdi
Published: August 2010

Background:  We report experimental myocardial infarction by occluding coronary arteries in ovine models.

Methods:  Twelve ewes were included in the study. After the chest was opened by left lateral thoracotomy incision, the second diagonal branch of the left anterior descending coronary artery was ligated at a point approximately 40% distant from its base. Prophylactic anti‐arrhythmics were given. Animals were mechanically ventilated during surgery and stayed in intensive care unit for 24 h postoperation. Experiments were then evaluated by echocardiographic, electrocardiographic, haemodynamic, serological and morphological investigations. Echocardiographic measurements were repeated after 2 months and animals were then killed for post‐mortem cardiac examinations.

Results:  All animals survived the surgical procedure. Cyanotic discoloration and hypokinesia in the cardiac tissue in an area of (30 ± 2) × (4 ± 2) mm plus ST‐segment elevations was detected immediately after vessel ligation. Moreover, there were pathological Q‐waves 2 months later. Echocardiographic evaluations showed an average of 30% relative decrease in cardiac ejection fraction. Wall motion analysis showed anteroseptal hypokinesia and akinesia in all animals 1 day and 2 months after operation, respectively. Thin‐walled infarcted areas with tissue fibrosis were evident in pathological investigations 2 months after surgery.

Conclusion:  In conclusion, we developed a practical and safe method for producing myocardial infarction in large animal models.
RISK FACTORS FOR TYPE II ENDOLEAKS AFTER ENDOVASCULAR REPAIR OF ABDOMINAL AORTIC ANEURYSMS
Authors: Warrier Ranjana , Miller Robert , Bond Rick , Robertson Ian K. , Hewitt Peter , Scott Alan
Published: August 2010

Background:  Endovascular repair has been shown to be superior to open repair of abdominal aortic aneurysm in terms of aneurysm‐related survival. However, endovascular repair has its own unique complications such as endoleak. Type II endoleaks may be associated with aortic rupture. We attempt to identify patient variables associated with the development of endoleaks and hence facilitate their early identification.

Methods:  Endovascular repair was carried out for non‐ruptured, infrarenal abdominal aortic aneurysms. Patients underwent preoperative computed tomography and angiography and were followed up with computed tomography and/or ultrasound scan at 1, 3 and 6 months and yearly thereafter. Univariate and multivariate analysis was used to identify any patient factors associated with the risk for developing an endoleak.

Results:  One hundred and one patients were included in the study (12 female : 89 male). Age 59–93 years. Mean follow up was 20.2 months. Type II endoleaks developed in 26 (25.7%) patients. Fifteen cases resolved during follow up, three of which required secondary intervention. Nine cases persist. No aneurysms ruptured. The presence of patent inferior mesenteric artery (P < 0.001) and sac enlargement (P = 0.001) were associated with development of endoleak as was diabetes in a multivariate model (P = 0.005). History of smoking (P = 0.01) was a protective factor. The presence of four or more lumbar arteries (P = 0.55) was not associated with increased risk.

Conclusions:  It is possible to identify individual patient risk factors associated with risk for developing type II endoleaks and it may be possible to modify screening practice as a result. The association between patent inferior mesenteric artery preoperatively and endoleak is further confirmed. Spontaneous sealing of endoleaks is common and rupture is rare. Early intervention is not mandatory.
MYTHICAL ‘TAILS OF LOCKWOOD’
Authors: Nightingale Sophie S , Al Shareef Yasir R , Hutson John M
Published: August 2010

The cause of testicular ectopia has long been a mystery, and over the years, many hypotheses have been suggested to explain the condition. The most famous of these hypotheses is that of the ‘Tails of Lockwood’. This developed from a paper written in 1888 by Charles Barrett Lockwood. Although little evidence has ever been found to corroborate this hypothesis, it remains in many textbooks and journal articles to the present day. In the 21st century, this theory should no longer be given as the cause for ectopic testes. Current biological evidence supports a complex process of growth, by elongation and migration of the gubernaculum, rather than a simple mechanical process of testicular descent, as proposed in the 18th century.
UPDATE ON CONGENITAL VERSUS ACQUIRED UNDESCENDED TESTES: INCIDENCE, DIAGNOSIS AND MANAGEMENT
Authors: Bonney Tamara , Hutson John , Southwell Bridget , Newgreen Don
Published: August 2010

Congenital and acquired undescended testes are two distinct entities. Current management is surgery in the first 6–12 months of life for congenital undescended testes. Current management of acquired undescended testes is surgery at the time of diagnosis. Accurate diagnoses and expedient management are imperative in this condition to minimize the long‐term sequelae of infertility and testicular cancer.